OBSERVATIONS ON KatLA-AzAR IN KAsSALA PROVINCE

BY

L. Bousrietp, M.A., M.D. (Cantas.), M.R.C.S., L.R.C.P. (Lonp.), R.A.M.C.

Bimbashi, Egyptian Medical Corps, 8.M.O., Kassala

Since August, 1907, eight cases of this disease have been definitely diagnosed in the province, and all have terminated fatally, while thirteen other cases, extremely suspicious, have come under my observation or to my knowledge, of whom nine are already dead.

It is almost impossible to give any trustworthy idea of the prevalence of the disease, as the towns and villages are far distant one from another, usually being visited but once

a year by a doctor, and then only for a day or two.

Thus cases positively diagnosed have only been found at Kassala (7) and Mafaza (1), and prolonged observations on cases have only been carried out at Kassala and Gedaref, namely, where doctors were present.

However, the positive diagnosis of eight cases presents a serious picture when one remembers the fact that for every native admitted there are five or more who do not seek medical assistance.

It is a matter of extreme difficulty to trace the history and movements of the patients. Indeed, in some cases it is almost hopeless, for many have no fixed abode, are often admitted

very ill, have no friends to speak for them, and, further, talk in various dialects. Thus

of all the cases it has only been possible to find out definite abodes and house contacts in

six out of a total of twenty-one, and even in these six cases sometimes the residence in a

tukl (hut) or hosh (compound) was only for a few weeks.

Of the co-inhabitants I have had an opportunity of examining, I have found none

suffering from the disease or presenting signs of ill-health suggestive of kala-azar, and. in

the few instances where I have been able to search the dwellings I have been unable to find bed-bugs.

However, I believe bed-bugs exist in every town and village of Kassala, and, personally, know of their existence in Kassala, Gedaref, Gallabat, Mafaza, Tomat, Sofi, and Turkelein.

Specimens from the first three towns were sent to Dr. Balfour for examination, and Mr. H. King has identified them as Cimex lectularius.

Dogs are very common everywhere, but, unfortunately, this possible source of infection was not studied, since the observations on the lability of dogs! transmitting the disease were not then known to me.

To study the disease properly in this province, one specially appointed is required, who

has all his time at his command for making lengthy observations and carrying out the

difficult but important work of tracing these cases to their source in the various places.

The disease is apparently new or but recently recognised, for following Dr. Neave’s case

in 1904, the next one observed was by Captain Cummins in May, 1907, and in this province, though a case was suspected early in June, 1907, it was not until the third splenic puncture

(August 30th) that Leishman-Donovan parasites were found, and since that date seven

other cases have been definitely diagnosed.

The very great importance of recognising the appearance of this disease in a new country is such that I append two tables, ‘‘A”’ of those cases definitely diagnosed by the discovery of the parasites, and ‘‘B”’ of those extremely supicious of kala-azar, but where

the parasites were not found.

* Nicolle, C., La Semaine Médicale, March 11th, 1908, and MM. Ch. Nicolle et Ch. Comte, La Semaine Médicale, April 22nd, 1908.

Number of cases

Bed-bugs in Kassala Province

Historical