L . ^- '^"' Ayv. ^^ ^ THIRD REPORT OF THE WELLCOME RESEARCH LABORATORIES o^oCL^/^ AT THE GORDON MEMORIAL COLLEGE KHARTOUM ANDREW BALFOUR, :\[.D., B.Sc, F.R.C.P. Edin., D.P.H. Camb. DIKECTOR Fellow of the Eoj'al Institute of Public Health, the Society of Tropical Medicine and Hygiene, and the Society for the Destruction of Vermin ; Member of the Incorporated Society of Medical Officers of Health, and the Association of Economic Biologists ; Corresponding Member Societe de Pathologic Exotique ; Medical Officer of Health, Khartoum ; etc. Published foe Department of Education, Sudan Government Khartoum BY BAILLIERE, TINDALL & COX, 8, Henrietta Street, Covenj' Gaudkx, London 1908 ICOPYKIGHT THE GORDON MEMORIAL COLLEGE AT KHARTOUM Patron : H.M. THE KING President : TiiK Right Hon. J^dun X'iscount Kitchener of Khartoum, G.C.B., G.C.M.G., CM., ETC. Hon. Treasurer : The Right Hon. Lord Hillingjjon Hon. Secretary: Baldwin S. Harvey, Esq., (iT, Lombard Street, Loudou, E.G. Committee and Trustees : The Right Hon. Lord Viscount Kitchener of Khartoum, G.G.B., G.G.M.G., O.M., ETC. Sir Eldon Gorst, K.C.B. (e.f oljUdo), His Britannic Majesty's Agent and ConsuJ-General in Egypt Sir F. Reginald Wingate, K.C.B. , K.C.M.G., etc [ex oijicio)^ Governor- General of tlie Sudan William Middleton Camrrell, Esq. [ea- offi,rio). Governor of tlie Bank of England The Right Hon. Earl of Cromer, G.C.B., G.C.M.G., CM., K.C.S.L, etc. The Right Hon. Lord Rothschild, (j.C.V.O., etc. The Right Hon. Lord Hillingdon The Right Hon. Lord Revelstoke The liKiiiT Hon. Sir Ernest Cassel, (jI.C.ALG., G.C.V.O., etc. Hugh Colin Smith, Esq. Sir Henrv Craik, K.C.B., M.R. Henry S. Wellcome, Esq. Sir William ]\Lvther Hon. Solicitor: Henry Turton Norton, Esq. Hon. Auditors : Messrs. Gerard Van de Linde & Son Director af I'^ducation. in flie Sudan, and Principal of tlie Colleuse Construction — Dwelling-Houses in the Tropics (McLean) — Conservancy — Sewage Collection and disposal — Waste Water Collection and Disposal — Refuse Collection and Dis]io.sal — Water Supply — Aerated Waters— Ice — Milk — Slaughter-house — Markets — Infectious Diseases— Disinfection -Vital Statistics— Infectious Diseases Statistics. SlKKPIN<: SiCK.\F,.SS and the liAHR-F^L-tillAZAL I'P.OVINCE. ( Extracts froill ('(tjil'lill lliilt'ri> lieitovt to the Siidmi S/rcjiiu;/ iSirkiiess! VoiiuiiisKioii A/iril, 190SJ ... ... !)3 The Tsetse Flies of the Bahr-El-Ghazal — The Exi.stence or otherwi.se of Sleeping Sickness in the i>ahi--El-Gha/.al- The ProbaViility or otherwise of Slee|iing Sickness becoming prevaleni in tlic l'iahr-El-( ihazal Province — Preventive Measures. Additional Notes. By !!. (!. Auchihalh. in:Ai.iNv L. ISoiisfield 107 Number of Cases — l!ed-liugs in Kassala Province — Historical Notes —Tables of Cases — Types of Parasites Observed— House Infection — Is Abyssinia to ISlaine ?— ilaji of Kassala Province— Analysis of Cases — Death Kates — Duration (^f Illness— Clinical Features— Diattnnsis— Differential Diagnosis — Treatment — Cases Detailed. IvKPOItT OF Tr.AVELLINc; I'ATIIOLoiilST AND PlIOTOZoOLOCilST. J!v C. M. WfNYON l:il Introducti(jn--The Floating Lal>oratory— f-'lan of \Voi-k— Details of Ex|iedition --.\ckno\\ Irdg- nients— Hniiiiiii Comlitions : Dysentery, Malaria, Dracontia.sis — Tryiiano.soMiiasis in Domestic Animals Treatment of Tryiianosonuasis— TIse of ' Soamin '--Try|iano.somes : Detailed De.sci'iptions of those found — Tryiianosonies of (iuiiiea Fowl, Lizards, Snakes, .Mice, Hats, Rats, F'ish and Toads— Flagellates in IJiting i'dies: Tit/i((ui(Iw, Mosip.iitoes, Tsetse Flies — Flasmodid, Plitxiitodiiiiii in a Lizard — lliftiinjiruteus in a Lizard — llnlteriilid in various B'nxh—II(-tinori/sfii/iiiiii in Spittiug-.snake.s — Bitlieda, Piroi)lasm of the Striped Mouse — H;einogregarines in Lizards, Snakes, Tortoise, Crocodile, Toads and F'resh-waler Fisli — Leurori/fo:o>7 .Methods of Pre.seivation— Treatment with Hot Alcohol— Rapid Method of Examination — Treniatoda— Method of Hardening Neiiiatoda— Identity of iStruii(ji//us and Schrostotiniiii — The Bur.sati Nematodes — Filaria, /•'. ivjanw, F. hiituiiix -I'lij/sdlojiteridtt : P. /iti/(liii--(.Ae.unr<, Cii/i'.r. — (Juli.r .■ia/im, n. sp. — Genus, Miiiietecukj: uov. gen. — Mimeteinde.r liiuijii, n. sp. -(4eiuis, Tihiiinrhi/m-htis — 7'ctHi.orhi/nchiis violnr.eun, 11. s]). — (ieuus, Mnnumijin —J/tmoiiii/i'i circiiintesttii'at — (Jeiuis, ['rniKifd'HKi — Iriniofri'in'i /iiif/iiloir/ihitla, n. s]).— UraHut(t'nix\ .Medical Superstitions Introduction- Sniierstitious Atniosphere— The liakiin — The Fiki — The Evil Eye — Evil Spirits — Written Charms — Other Varieties of Charms — Stones as Charms- Mode of Wearing Charms — iuintine Methods of Suiieniatural Cures — Prayer and Laying-on of hands — The ilystic Writing — The Sjiilting Cure — The Fire Cure — The Casting (Hit of Devils— Sand-gazing — Local Drugs — Drugs used in Fever, Exantheiiis, Chest Complaints, Leprosy, Gonorrh(ea, Syjihilis, Guinea Worm, [Mental Diseases — Fumigation-- Massage- Anointing —Midwifery — Signiticance of the Scalp- Lock— Surgical Instruments— Wounds and Oiierations — Trilnil Marking — Tattooing. Jveport upon the Physu'al Characters of Nilotic Neoroid Tisibes. By D. Waterston ;S25 Dr. Pirrie's \\'ork— Account of Dr. Pirrie's Journeys — Burun (■ouiitry — Physical characters — Fertits — Table of measurements of Fertit tribe— Furawis — Gebelawis— Measurements of Gebelawis— Nubas — Bongos or 1 )olir — Nyam-nyanis — Baris — Dinkas— Measurements of Dinka tribe— Nuers — Measurements of Niier tribe— Shilluks — Mea.surenieiits of Shilluks - Buruns — ileasurements of Burun tribe — Notes on Customs, etc., of Buruns and other tribes — Fur.s — Abyssinians — Summary of general physical characters — Average of measurements and indices — Sudanese tyjies. Notes on Ethnouraphic^u. Specimens collectei^ by Dr. A. .M.^cI'ier Pirrie. By D. J. Vallance 377 Kepre.sentative collection of Burun oltjects- Sliilluk lu'ad-dress- Coniiiarison with .Vnslralian natives — Dinka method of cuiiping. 10 CONTENTS I'AGE liEl'OKT OF THE CHKMK'AL SECTION. I'lY WiLLIAM l)EAM 385 List of Analyses and Exaniination.s — Siieeial Research on rJnni Aralnc-ClicniicMl ( 'oiii|iositii>n (jf Nile Waters — Examination of Water of Nile Tribntaries, including the Atliara River — Poisonous AVell Waters — Limestones and Limes — flyiisum Deposits, Red Sea ProviTice — Water from Deep Wells at Khartoum — The Deteetion of Well Pollution liy the use of Fluorescein — Salt frc.im Lugware Country — Chemical Compositions of some Sudan Grains, Great Alillet (dui'a), Indian Duras, Pigefin-jiea, Chick-jiea, Small Millet (telehun), Barley, Lentil, Lupine, I'ice, l>ulrush Millet (dukhn). Pea and small millet (tetf). Fenugreek, Wheat — .Analyses of IJeans, iLiize — Analyses of Oil-seeds, Earth-nuts, Safflower, Cotton Seeds, Castor-oil Seeds, Sesame, Sesame Cake — Some Sudan Fats and Oils — Heglig Fruit. Shea butter, Zawa oil, Ben oil — Sudan Gums — Ha.shab Gum — Visit to Kordofan Forests — Tapping Season — ilethod of Tapping — Conditions iuHuencing Exudation — Origin of Gum — Conditions affecting its Produi'tion— Soil — Analyses of Soils from Gum Districts— Moisture — Protection from Fire — Tajjping — Inoculation — Effect of Temjierature — Season of Collection — Tables of Analyses — Viscosity — Alterations on Storage— Sunnnary of Results — Commercial Grading of Sudan Gums— Talh (Juni — Gum of Anii-i'i unihir,! — Kuk Gum — Gum from Acurin xiniin —(\nn\ from Oiliiin f'nirficosn — Subakh (Jum — Taitar Gum — Wa Gum — Detei mination of Mscosity of Gum Solutions — Torsion Vi.scosimeter, Glass A'iscosimeter — Curve of Viscosities — Ostwalds Viscosimeter. Notes on the Chemistry of Sudan (Jums. By E. S. Edie 441 Pentoses in Gums — Changes in Viscosity — Sugar in Gums — Hashalj Gum— Calculation of the Gluco.ses — Pentoses and Hexoses — (Jjitical Activity of Gum.s — Table of Results— Specific Piotatiou for Hashab Gum — Inorganic Constituents of Hasliab Gum — Deternunation of Osmotic Pressure — ilolecular Change in Gums — Talh Gum, Rotation, Ash, Osmotic Pressure — Sunt Giuii l^^tation Asli — liai-ti'rial ( )iigin of Gum — Gum liacilli (inni and Beetles — Bacterium foun 1'late II. — IlerjietoiiioiMS Parasite.s ((.'n- thidia pulicis) in hind gnt of Flea ( LifmupujiUit rleopulro') Fivniii ;!2 Pl.vte III. — (1) Hieniogregarine of Rluitii- phiojjhis rii6roj>uiirf:. Kn- cy.sted and free forms (2) Hsemogregariue and try- panosome of the Khartoum toad (Bufo regular h) Fur inn 35 Plate IV. — Bo^dne Pirojilasinosi.s ... FmiiKj 37 Plate V.— Fowl Spirochajtosi.s ... Fwiwi 88 Plate VI. — Fowl Spirochaitosi.s, free and intra-corpuscular fonii.s ... Ftifiiiij 4U Fig. i.— Black Leghorn hen, acute S|iiiii- ch.BtosLs Fig. 5. — Sudanese cock in the "after ])ha.se" of Spirochietosis, .suffering from scaly leg Fig. 6. — Forms of Fowl Spirocluetes in the blood Fig. 7. — Temperature chart, spii-oi-h;etal fever Fig. 8.— Forms assumed by spirochetes ... Plate VII. — Malignant Malaria, aimeboid forms of ])arasite ... ... FariiKj i\2 Fig. 9.— Pools left by the falling Pdue Nile opposite Eastern section of Khartoum ... ... ... ... (i;') Fig. 10.— Pools left by the falling lilne Nile in sand-baidv, Khartoum Figs. 11-14. — Designs and plans for dwelling-houses in the Troiiics, 0!>, Fig. 15. — Sanitary pails, Khartoum ... 72 Fig. 16. — Map of Khartoum sanitary system 7.') Fig. 17. — Crowley cart, now abolished ... 77 Viii. IX. — Conservancy camel cart. Khartcmin .sanitary service ... ... ... 77 Fig. 10. — Conservancy mule ti-olley, Khartoum 77 Fig. 20. — Type of incinerator, modified after Aforris ... ... ... 711 Fig. 21. — Plans of public latrine, Khartoum HI (i.") 71 Fig Fig Fig Fig. 20 Fig. 22. — Alga causing " green water " in Blue Nile Fig. 23. — Maj) of lload from Tambura's Post U) Wau Fig. 24.— :Map of South West Ikdir-El-Cjihazal Plate A'III. -(1) Kala-azar. Film from spleen (2) Kala-azar. Scrai)ing from spleen ... ... ... Fdriii// Fig. 2."). — Map showing proved and suspected cases of Kala-azar in Kassala province 26. — Tyjies of i)arasites ... 27. — Temperature charts 28. — Route of Travelling Pathologist and Protozoologist in the Floating Laboratory 1907-1908 29. - Floating Laboratory and camp at Bor on the Jebel River Fig. 30. — Floating Laboratory on Soliat ... Fig. 31. — Floating Laboratory on Nile Kg. 32. — Bacteriological secticjii, Floating- Laboratory ... Figs. 33 and 34. — Interior view.s of Floating Laboratory, looking towards stern Fig. 35. — Cyst of Entnmitha roli ... F'ig. 36. — Leprosy. An;esthetic ])atches ... F"ig. 37. — Mycetoma of foot — early stage ... Fig. 38. — Mycetoma of foot — late stage ... Plate IX. — Anatomy of (iuinea Worm Embryo Fig. 39. — Three forms of 'ryii/iinioxoiiiii ttinium Pl.VTK X. — ISahesiit icu/'ir/x n. sp. Various types of try|ianosomes ... Fachi'i Fig. 4U. — Trypanosome and Haimogregarine of Ojihiort'jihiihtx o/isairux Plate XL — IlerjietomoiKix of 'J'li/xiims sociiiK. \'arious Forms of the //er/)Kf(iiiii;ii)is frdin Mi/ioini/ia Hill, ... ... ... ... Fiicinii 1'late .\1I. — Plnxiiiodiinii mU.s" Lslainl 172 Plate XVII.— (1) X ^'^''^''^ Plate XXX\'I.— Wiiig.s oi New CulivIJa^ 257 Plate XXXVIL— New Vnliah,' 259 nuiuntu^. {\\)('„u^n=n IX ... ... ... ... 17 Plate XXXIX. - Wiii.n scales of New Ciilichiif ... ... ... ... 2(;o Pl.vte .\IX. — (_'ii,ixu.-i reiiiiiijix pL.n'K .\.\. — (1) Atnirtiixjiix iiiirr Fig. 47. — Longitudinal seetion of ''/. ii^iiii/mii 19(1 Fig. 48. — Transver.se seetion of (•'. irmifuni 19(1 Pl.VTE XXI. — Ikdfourin uiiiiKiiinmit. l-'m-iiiii 19(i Plate XXII. - Anatomy of lliiljnurin /iiijuiii/ii/ii'i ... ... ... ... 198 Fig. 49.— Thre.shing dura 2(in Fig. 5(1— Biu-tas building lianilio.i huts ... 200 I'L.VTE .V.XIII. — Sniinhiiin iirisiirn/l U. Siiii- iilniiii (liiijiiKisiiiii ... ... Fiii-imi 20(1 Plate XXIV. - IFniiiitui,,,!,! :l.„xl„,i„ii. Jl(tiiinti tiniiiix. ... Fiiri'iii, 210 1'"*! Plate .\.L.— Wing .scales of New Ciillriila 265 \ Fig. 55. — Wing scales of /'/■kiiuIh nin jKiUiihii'i'jiItclii ... ... ... 2()() 183 Pig, 5(j. -liurun with skin affection, iiossifily k'lirous ... ... ... ... 268 Fig. .57.— Shilluk huts 272 Fig. .58.— Trial by Britisli magistrate ... 276 Fig. 59.— Trial for adultery 276 Fig. 60. -Native hut, Purta tribe, .lebel Keili 279 Plate .XLL— (_'harnis : Ketali, He,gab or Waraga, 28(J i'L.n-E XLIl.— Charms i'.s3 Fi.g. 61. — English translation of Ketab (Fig. (32) 285 Fig. 62.— Love Ketab 285 Figs. 63 and 64. — The seven charms a.gainst I'm El Sibian 287 Fig. 65. — Lohn (or writing boartl) cju which Koranic jihrase.s, mystic in.scri])tions, etc., are inscribed by Fikis 2.S7 Fig. 66. — Vessel of holy water 287 Plate XXV. — 'FhIhiuks liiiiiilf'tlns ... Faciini 212 Pig>>. (57-73. — The seven written charms Fig. 51.— Larva of I'undm Fly 215 Fig. .52.— Tumbu Fly, ('nnh/lnhi,, unlhn,- IKijilliniii ... ... ... ... 217 I'l.vte XXVL— Acarina Fur'niii 220 Plate XXVII.— )S'eS(n///(( nrtin,. (Iimilix iiivohilit. Eiiriiriiiif,t sa/>j,/,//rii,(,. /',„■/,- Fig. 98.— Wooden clamii '" ■^■''" 31.s iixjda mvii/ni/i. Stalwimns,,,,,,, Fig. 99.-(Jourd or ivory perfoi'ated disc ni'inrhe, etc /•;,-■/„,/ 1\)u mid na'thod of u.se 318 LIST OF ILLUSTRATIONS 13 Fig. 100. — Circumcision tlmnis in si/ it Fig. 101.— Xuba girl's lip iierfcrateil and distended Fig. 102. — Ceremonial dance... Fig. 103. — Dr. Pirrie's caravan Fig. 104.— Alexander MacTier Pirrie Fig. lOo. — lioute followed by Dr. Pirrie ... Fig. 106. — CJliief geograpliicid features of Burun country Fig. 107. — One of Dr. I'lirie's caniping places Fig. 108. — Piurun village Fig. 109. — Hunting party of natives on White Nile Fig. 110. — Group of children at P.oi' Fig. HI. — Native i)i]ie— Sliilluk tiilie . . Fig.s. 112 and 113. — P)Urun women ... Fig. 114.— Shilluk Fig. 115. — Greek trader at lior with elejihant tusks Fig. IIG. — View near Keili in the Gel)el country Fig. I17.-Shilluks Fig. lis.— Deformed Native at Wan Figs. 119 and 120. — Small ambatch canoe — Shilluk with spears Fig. 121. — Shilluks in dug-out on the Sobat Fig. 122.— .Vndiatch canoe on White Nile Fig. 123.— Shilluk family at Barboi Fig. 124.— Dinkas on White Nile Fig. 12.5. — Young Dinka beau Fig. 12G. — Dinka traders in Purnn cnuntry Fig. 127. — Dinka smelter Fig. 128.- Dinka from Bahr-El-Ghazal ... Fig. 129. — Characteristic nose and teeth of Dinka Shilluk Fig. 130.- Fig. 131. Fig. 132. Fig. 133. Fig. 134.- Fig. 13.i. Figs. 13(; Fig. 138. Fig. 139. Fig. 140. Fig. 141. Fig. 142.- Fig. 143.- Fig. 144.- Figs. 14.') — Jlnrun -Dinka — I'ni'un warriors —Natives near Bor... —Shilluks at Tautikia and 137. — Bilatend facial paralysis in Burun ... — No.strils of Dinka —Curvature of tibia in ISuruii ... —Burun — sitting posture — I'lurun woman anointing her husband with oil and red ochre prior to a journey — Burnns on the Valms lliver —Burun dance --Buriui villagt! and 1 Ki. -Buruns on the Vabus PAGE 319 321 323 323 324 327 328 329 329 331 331 333 333 333 33.5 335 335 336 337 337 337 339 339 341 343 343 345 345 347 347 347 347 349 349 351 351 3,51 353 355 355 357 357 3.59 Fig. 147. — Malformations and nnnsiial ron ditions of the .luiicle Inund in three Dinkas 360 Fig. 148. -View of Bor, Jeliel Itiver ... 361 Figs. 149 and 150.— Possibly a case of hyjx'rdactyli.sm among Buruns (left and right hands) 364 Fig. 151. — P)uruu wonian ... ... ... :i65 Fig. 152. — Young wcimen nf Bor — Diidca tribe 3G5 Fig. 153.— Omdas liut, .lebel Keili 366 Fig. 154. — Diluka (native dance) of the Burta Tribe 366 Figs. 15.5-174. — Sudanese tyjies (various tribe.s) ... ... ... 367-371 Figs. 17.5-182.— Sudanese ty]ies, Khartoum gaol 372, 373 Figs. 183-189. — Sudanese tyjics, Khartimm soldiers 374 Figs. 190-197.— Sudanese ty])es 375 Pl.^te ,\LIV. — Ethnograjihical siiecimens collected by ]_)r. A. MacTier Pirrie 376 Fig.s. 198 and 199. — Shilluk wearing circular head-dress of antelojje's mane ... 377 Fig. 200. — Native method of cu]iping ... 37.s Plate XLV.— Ethnograiihical specimens collected by ]_)r. A. MacTier Pirrie 379 Fig. 201.— View of Bor ;l.si) Plate XLVI. ] Ethnographical f :iM Plate XLVII. > s]iecimens collected by-i 382 Plate XL VIII. J Dr. .\. MacTier Pirrie [ 383 I ;a. n--El-Giia/.a Wan near Taiara, gum near pomt Fig. 202.— Fort Wan, Province Fig. 203.— Native huts in Fig. 204. — Gum gartlen Kor(h)fan ... Fig. 205. — Tapping tree Fig. 206.— E.xudation of of tainnng ... Fig. 207. — Native gum collector Fig. 208.- — ^CoUector with water-skin, sack and spear ... Fig. 209. — Collection of gum frnni upper branches Fig. 210. — Kordofan Sheik, owner of gum garden Fig. 211. — Gum dealer at Omdurman Fig. 212. — Loading gum on camel Fig. 213. — Loading gum on barge ... Fig. 214. — Gum picking. Omdurman Fig. 215. — Jjleachmg gum. Onidurnian ... Fig. 216. — Viscositie.s of cane sugar .solution Fig. 217.— Ostwald's vi.sco.simeter Fig. 218. — Bacterium isolated from giun- l)earing branch of Acirin rurc/,... 3.S4 3.S4 417 419 421 423 125 425 427 427 429 431 431 431 439 440 449 INTRODUCTION TN presenting the Tliirtl Report of these Laboratories it is necessary to correct the apparently prevalent and erroneous idea that the Laboratory Reports are issued annually. This is not the case. No fixed period is allowed to elapse between the appearance of the Reports. They are issued when convenient anooks and treatises. The fact that H. E. the Governor-Cxeneral kindly granted me a month's study-leave for special wurk on water liacteriology in the summer of 1907, enalded me to make good some deficiencies. The various references are given so that those who wish to go more fully into any special subject may be able to obtain the original book or paper, and it is hoped that the notes may also stimulate enquiry and indicate subjects requiring elucidation in the Sudan. As far as possible the references have been confined to sound, practical papers likely to be helpful, but the scientific aspect of certain questions has been considered for the reasons stated above. ■ Mr. Wellcome is org.inising an historical medical exhibition to lie held in London shortly. Those interested in .ancient and native medicine and surgery would do well to communicate with him.— A.B. - This Review is issued as a Supplement to the Report and is contained in a separate volume. INTKODUCTION 17 Thu tliii'il change is tlic introdiietiuii of a chapter nmler tlie licailiiig of "Sanitary ^a"''ar.v Notes," wliicli will lie fonihl to ileal chictly with sanitation as it concerns Jvhartouni. In my capacity as Medical OlKcer of Healtli of that city, I liave been much impressed by the useful lessons to be learned from a study of the problems in connection with the carrying-out of a sanitary policy for a new town in such a country as the Sudan. At every stej) the laboratory work is found to aid and supplement the hygienic measures. One cannot carry on sanitary work properly, especially in the Tropics, ludess one has access to Sanitary work chemical and bacteriological laboratories. Hence I consider that it is not out of place to i^^boratones direct attention to the broader aspects of water supply, milk supply, sewage collection and disposal, etc., in a lalmratory report. Indeed this line has already been followeil in connection with the mosquito reduction operations [cide First and Second Reports). Moreover, the ordinary M. 0. H. reports have, according to regulation, to be very short and concise, and in these brief articles one cannot carefully enter into th(! important questions which present themselves at every turn. These are of special interest, not onlv to Khartouin, but to other of the northern Sudan towns, and have a direct bearing on tropical sanitation in all hot, dry and dusty countries. Finally, it seems to me only fitting that the early sanitary history, of a city destined possibly to become a very important centre, should be recorded in some more permanent manner than lias hitherto been possible. As regards the general laboratory work one can again report very considerable progress in several directions. The chemical investigations have now become most important and The chemical extensive, and there is such a mass of routine work that Dr. Beam, even with Mr. (tooiIsou's skilled assistance, finds it dilHcult to obtain leisure for exploiting new fields, though, at the same time, some of this routine work is itself of the nature of research. The appointment of Dr. Beam to a seat on the Central Economic Board was imdoubtedly a step in the right direction, and both the Board and the Laboratories have benefited thereby, while assuredly the numerous chemical analyses have furnished most useful information which is beginning to bear fruit in several directions. With sanitary and medico-legal questions the chemical laboratory has also been concerned on many occasions. The winter of 1907 witnessed tlu! arrival of Jlr. E, S. Edie, the second CaTuegie Research Fellow to be attached to these laboratories (yiile infra). Mr. Edie was appointed to carry out special investigations on the chemistry and bacteriology of Sudan gum-arabic. It may be remembered that in the last Special report Dr. Beam contributed an important i)aper on this, the most valuable of Sudan "^^"^^"^ "" i 111' guni-arabic products, and his researclu^s soon showed that very little was really known concerning the composition of gum and the causes which lead to its formation. One had not iinudi liope of obtaining a worker in a field so little exploited and so ditficult, but happily Dr. McCoi-iiiick, the Secretary of the Carnegie Trust, was able to indicate Mr. E. S. Edie, who had been engaged in advanced research, under Professor Jloore, at the Bio-chemical Laboratory at Liverpool. Not only was Mr. Edie able and willing to occupy the post, the creation of wliich was due in large measure to Mr. Wellcoinc's generosity, but Professor Moore very kindly arranged that he should have some special instruction in the lines of his future work, and was also good enough to give us the loan of some useful apparatus. Mr. Edii' ariived at the end of October, 1907, and soon adapted himself to his new surroundings. As will be seen from his report he has taken up two lines of research : — L Chemical — dealing with the analysis of gums from different sources and of gums of different qualities from the same species of tree, his object being to dis(^ov(!r the relationship between the proportion of various constituents and the physical diaracters of the gum. 18 INTKODUCTION 2. Ijucteriulogical — emleavouriuy to isulute IVdiii "iini-beari)iLr bniiu-lies bacturiii wjiicli The entomological work Work on anthropology The Carnegie Trust and thi- Laboratories Dr. Pirrie's Expedition will prutluce gum when cultivHted in artificial iiUMlia,, ami working out the morphology and i-uhural characteristics of any liacteria isnlatcd, in onler to compare them with gum-producing bacteria already described. The inHueuce of bacterial action on the ipiality of gum lias also beeu cousideretl, as have other factors which may be operative in gum production, such as enzyme action and oxidation. A glance at the contents of this volume will show that Mr. King, our Entomolngist, has had pleutv to do. Indeed, althougli I knew that his services were urgently required, I had scarcely realised the hill scope ami variety of the work which awaited him. It is not too much to say that the native has come to look on Mr. King as a friend and adviser. His work has earned for him the name of the "Father of Flies," and it is interesting to see the Sudan field-workers crowding rouuil him and listening eagerly to his explanations and instructions. The pity of it is that these latter are so rarely followed. Their fatalism and a natural indolence and improvidence often [)reveut the natives, unless supervised, from taking those active measures so necessary in cases of insect infestation in crops. Doubtless, however, they will some day be snhiciently educated to profit fully from Mr. King's investigations, and, in any case, the latter is doing a vahiable and philanthropic work concerning which he gives full and interesting details, while the purely scientific side of economic eutomologv has certaiidy not been neglected. Mr. King's labours have also a direct bearing on Tropical Medicine, ;ts witness his researches on mosiinitoes and the bionomics of the Nile Tiilndiiild-. In this connection one has again to record valuable aid kindly rentlered by Mr. Theoiiald and jMr. Austen, to both of whom the laboratories are deeply indebted. The former once again furnishes a special papt'r on Sudanese CuJiviiliv, for which he has at length been able to draw up a synoptic table that is certain to aid greatly in their identification. Yet another subject which has received attention is Anthropt)h)gy. It may be remembered that in the Second Keport mention was made of the fact that, at the suggestion of the Director of Education, the Trustees of the Carnegie Kesearch Fund had been approached and had agreed to recognise these laboratories as a working place for their Research Fellows. One hail hoped ttj secure the services of a. chemist and bacteriologist, but, despite the kind help of Dr. McCormick, Dr. Dobbie of the Koyal Scottish Museum, Dr. Lauder of the East of Scotland Agricultural College, Professor Muir of Glasgow, and others, one has to acknowledge failure. The men were simply not to be had. I had then to ask myself if there was any other branch of science which could be usefully exploited. Ntiturally one thought of Anthropology, for the more that is known concerning the natives of the Sudan the more enlightened and correct is the administration of their affairs likely to be, and this applies very especially to the less civilised races in the south. Thanks largely to Sii' William Turner and Professor Curniingham, of Edinburgh, the laboratories were fortunate enough to secure the services of Dr. k. jMaeTier Pirrie, who held a special degree in Anthropology and was particularly well versed in physical work. Dr. Pirrie, though labouring under the disadvantage of not knowing the country, made wliat, umler the circumstances, was a sctmewhat remarkable journey into the almost unknown Rnrun country which lies between the White Nile and Abyssinia. Apart from anthropological investigations on the Buruns, Dr. Pirrie was able to furnish the (Tovernmeut with some useful intelligence, and to prepare nui]is and plans of eonsiihu-able value. Dr. Pirrie also carried on work in Khartoum, at Renk en the White Nile, at Melut, amongst the Nners at Barboi, amongst INTROnUCTION 19 Sliilliiks and Dinkas, ami traversed u great deal of wild eountry. The reader, liuwever, will look in vain tor any detailed report from Dr. Pirrie's pen. It is my very sad duty to record the faet that his expedition to the Sudan proved fatal to this young and enthusiastic observe!'. He returned to Seothmd early in Jtily, 1907, suftering from continued fever and other symptoms pointing to infection \\dth the parasite of Leishmaniosis (kala-azar). An illness of several months" iluration ensueil, iluring which, wdienc^ver his state of health permitted, Dr. I'ii-rie made efforts to work u[i his material and ^jrepare a paper for the Carnegie Trust and the Laboratories' lleport. At times he seemed to improve somewhat, but the fever always reasserted itself in a severe form. He became gradually weaker and died on November 16th, 1907. It was felt that au efibrt should be made fully to utilise his Death of notes and obsei'vatious, and Professor Cunningham, of Bdiuburgh, under whose direction Dr. Pirrie was to have worked out his results, kindly took charge of matters, aud it is due to his help aiul to the valuable assistance rendi'red by Dr. David Waterston, of his department, and bv ilr. D- J. Vallance, of the Koyal Scottish Museum, that we have been enabled to publish a record of the work performed. Of its value I must leave others to judge. Natimilly it has suffered greatly from the absence of Dr. Pirrie's guiding hand and brain, but it is fortunate that we are able to present some evidence of his skill iu, aud devotion to, the dihicult work he undertook. The (loveruor of the Upper Nile Province assured me that Dr. Pirrie's method of managing the natives surprised aud pleased him, and one can -Assistance in 111 1 • • 1 ^ • i 1 • ■ 1 ^- 1 • preparation only deeply regret that so promising a career was cut short in this untimely lashion. ^f y^^. pi„-[es Dr. Waterston has had a task of much difficulty, but has succeeded in working up Report Dr. Pirrie's statistics, aud contributes a paper embodying, as far as possible, the results of his observations. Mr. Vallauce deals with the archaeological and ethnological aspects of the research. To both these gentlemen the laboratories are greatly indebted. Mr. S. C. Dunn has kindly permitted us to reproduce some of his interesting photographs of the Burun country; while mention must be made of the kind help rendered Dr. Pirrie by Mr. K. T. Stouve, during his expedition. The Floating Laboratory became an accomplisheil fact in April, 1907, and started on a The Floating maiden trip up the White Nile in charge of Dr. C. M. Wenyon, Protozoologist to the London ^ o'^tory School of Tropical Medicine. We owe his appointment in part to the kind co-operation of the Conunittee of that School, in part to Mr. Wellcome, and in part to the Sudan Co-operation Government, and we owe the Floating Laboratory partly to the latter and partly to London .School Mr. Wellcome. Mr. Wellcome presented the excellent equipment chiefly intended for of Tropical ... , 1-1 1 11/1 1 1 ■ lit- Medicine protozoological and entomological work, ami the iToverumcnt housed it and placed it upon a special barge. The working room is of considerable dimensions, completely mosquito proof, supplied with water from a tank on the upper deck, siiecially ventilated and in every w^ay fitted for the purpose it is intended to fulti]. Mr. King, who spent some time in the laboratory on the White Nile; and Sol)at, informs me that " it is an ideal thing for working in up-river in the rauis but would, I think, be infinitely mori' serviceable if it was not dependent on the post-boats for towing or had a small launch attached." As a matter of tact arrangements had been made for the laboratories to take over the steamer of thi^ Slavery Department as soon as their new vessel was ready. Unfortunately the latter did not fulfil expectations and was not accepted, so that we were deprived, for the time being, of this useful auxiliary and had to do the best we could, assisted by the Steamers and Boats Department, wdii(di has aided us in every possible manner. Jjater on, liowever, we secureil this small steamer, whicdi. apart from otlier 20 INTMOUUCTION The cunsidurations, will form ii fonvenieiit liiibitatiou for workers in the laLuratury. The latter ^aioiaoiy ^_^^^^ aecommoilate six workers with ease, and I fullv expect will add yearly to our lunseuiii steamer ' • ^ •' *' valualik' and widl-preserved collections illustrative of every branch of tropical pathology. Indeed, I may perhaps be pardoned if I here state my conviction, already recorded A suggestion elsewhere, that in the teaching of Tropical Medicine in Great Britain what may be called a for the teaching m^^j.jjjy fiouting laboratory would be of the utmost service. Every year I am inundated by ot I ropical D . . . J Medicine appeals for material for teai.-hing [lurposes from England, Scotland, Ireland, the United States and various parts of the Continent. It is notewortliv that amongst the institutions which apply are the two great English Schools of Tropical Medicine at London anil Liverpool, and it is evident that even the latter school, despite its numerous aud valuable research expeditions, cannot obtain all it reipiires for the instruction of its students; hence I believe the difficulty might be solved by the iirovision of a well-eipiip[)ed laboratory on board a vessel of from 8UU to 1000 tons burthen. Such ;i ship would be able to visit any portion uf .\ nuirnie ^]^^ glolie, could asceud large navigable rivers and would be the means of bringing back floating . . , . laboratory a store of most valuable material both for museum and teaidiing purposes. It would be the duty of whoever was jjlaced in charge to conduct abroad the Ijest students in Tropical Medicine of any ye.tr. Participation in such an expedition wouhl be the prize of diligence and ability, aud in such a laboratory both tutorial and research work could be conducted ihuhig the voyage. Doubtless a certain number of graduates would welcome the opportunity for such a course of study, as opportunities woidd be afforded for visiting tropical hospitals and laboratories in different countries. If properly approachwl I believe those in charge of such institutions would be ghid to assist in every possible way, and they might be repaid by demonstrations of new techniipie and interesting specimens. These institutions tire often in cities on or near the sea, as tor example Calcutta, Bombay or Madras, Cairo, Alexandria or Leopoldville, Hong Kong, Rio de Janeiro, Manila, and so on. It is on the littorals of tropictil cornitries thtit dengue, yellow fever and other imjiorttiut diseases occur, and in the event of epidemics, the infected places might be speedily visited and pei'haps materially aided aud benefited, while at all times the collection of si)ecimeus bearing on Tropical Medicine would form ;i most important ibity. Specimens could be brought back in good condition, diseases studied on tlie spot and parasites, especiallv blood parasites, observed in a living state. It will be at once appanait that such a, laboratory ship could be utilised for the study of zoology, especially economic entomology, botany, geology and hygiene, all subjects more or less intimately couuected with Tropical Medicine. rheChaiienger 'Pile Challenger Expedition is still remembereil. This scheme would proviile for a kind of perpetual Challenger, and woidd, I think, challeuge comparison favourably with any existing method of giving instruction in diseases of the Tro})ics. It seems to me that it is largely ;i question of money, for difficulties as regards stability at sea, which ;ire important in connection with microscopic and other delicate work, might possibly be surmounted by the application of the principles of the gyroscope. I commend this ideti to the consideration of those responsible for the teaching of Tropical Medicine to students in temperate climates. Dr. Wenvon's report will be found full of interest. He has, I believe, had almost unrivalled opportunities, and he has known how to nudie the very best use of them. Indeed, it would almost seem as though the floating laboratory had a special attraction for objects associated with Tropical Medicine. On the initial trip the number of TahaiiUla: which boarded the barge was quite phenomenal. They swarmed into the laboratory and sunned themselves upon the wire-netting of the windows. Tahaiiics sucitis was specially in evidence, and in a Expeditif ion INTRODUCTION 21 very short time we were able to prove that this fly, whicli may very well he the carrier of camel trypanosomiasis in Kordofan, harboured a species of [{erpetomonas. I merely mention this fact here to show how speedily snbject-matter for researeh presented itself. Another The Floating noticeable featnre was the way in which the natives flocked to the barge. They had got the on the' White idea that it was a Floating Hospital and crowded on board eager to get medicine for their '^'■'^ manifold ailments. As Mr. Wellcome had provided a certain number of simple di-ngs, with directions as to use printed in Arabic, some eft'ort to ludp these unfortunates could be made, and in return they were, as a rule, tmly too glad to allow blood films to be taken and observations made concerning the illnesses from which they were suffering. It may, perhaps, be thought that it would have been a wiser policy to confine the work within certain limits — to concentrate energy on one ov two subjects. It was i'elt, however, that in a country like the Sudan it was better to obtain in the first instance a general idea of the field of work, and it is hoped at a later date to exploit more thoroughly those subjects wliich appear to have the more pressing claims to investigation. As regards the bacteriological laboratory, I regret to say that my time for research has been very limited. Every year the routine examinations become more numerous. Moreover, Res<\nrch work the general administrative work is heavier than before and the creation of sundry Boards, whose meetings have to be attended, and the control of the puldic health work in Khartoum all militate against efforts at special investigation. The necessity for a prolonged and careful bacteriological analysis of the proposed new water supply for the town also greatly interfered with research. Hence the output is somewhat meagre, but in one instance is of considerable interest. Spirochetosis of fowls was found to exist in Khartoum and became the subject of extended research owing to the discovery of what eventually proved to be an ''after phase'' of the infection, but which, for a long time, presented a puzzling problem for solution. The state of the blood in dengue fever has claimed attention and a few experiments have lieen made with Derris root as a larvicide in mosi[uito work. Many bloud examinations have been conducted and the empiiry into animal trypanosomiasis has beini carried a little further afield. The disease which attacks camels in Kordofan has been studied, a new trypanosome has been found in cattle from the Kassala district, and the therapeutic action of a new arsenical preparation, allied to, but less toxic than, atoxyl has been the subject of investigation. Piroplasmosis, as it occurs in the Sudan, has also received some attention. Still, one cannot preteml that the research work has been in all cases satisfoctory. Necessity for Investigations have had to be left unfinished and sometimes a promising field has liad ""-"^''^'^ <" P to be abandoned or passed by. Moreover a great deal of valuable pathological material is wasted in Khartoum. Medical Officers as a rule have not time to conduct post mortem examinations in the minute manner demanded by the careful study of morbid histology, nor have they much opportunity of seai'ching for the metazoan parasites which play so important a part in tropical pathology. Our knowledge of these worms as they occur in the Sudan is very limited ; but fortunately, we have been favoured with a valuable paper by Dr. R. T. Leiper, who kindly undertook to examine the helminthological material brought back by Dr. Wenyon. However, as research was one ot tlie main objects for which llie laboratories were founded and as, at times, ev(,'n the routine work was in danger of being neglected, I felt amply justified in applying for another oificial to act as Pathologist and Assistant Bacteriologist. I am glad to say that the post was created, and Colonels l-5ruce and Leishman, of the Royal Army Meilical Corps, very kindly found a man to fill it in tlie person of Mr. R. Gr. Archibald, who was not oidv a past prizeman in patiiology at the lioyal Army 22 INTRODUCTION Appointment of Assistant Bacteriologist and Pathologist Staff chanEfes The Museum Donors of specimens Lack of space The outlook Meilieal College, London, but had worked for a year in Colonel Leisliman's laboratory under that distinguished oljserver's personal supervision. Further, Mr. Archibald was just leaving for special service in Uganda, so that prior to his joining us in April, 1908, he had obtained practical e.Kperience in Sleeping Sickness and other important tropical disorders, many of which are identical with those prevtiiliug in the Southern Sudan. He at once settled down to work and, apart from rendering most useful general assistance, was able to aid me in the compilation of the Review, and to undertake an investigation into the value of the native zeer as a water hlter, besides instituting a comparison between his observations in Uganda and those of Captain Howard Ensor in the Bahr-El-Ghazal Province of the Sudan. Otherwise the staff remains as before. Mr. J. J. A. Vitalc became Head Clerk, and was furnished with an assistant. These changes were rendered absolutely necessary by the great increase in office and clerical work. The Museum has continued to expand, and, in addition to pathological and entomological material, exhibits of " Solaro " tropical clothing, tablets for water sterilisation, etc., have been obtained and are likely to be of use to officials. One is always glad to receive specimens dealing in any way with tropical sanitation. Colonel Hunter and Mr. and Mrs. Broun presented native drugs from Ktissala ami Kordofan respectively, while the principal donors on the pathological side have lieen Ca}>tains Anderson, Bousfield, Thomson, Ensor and Mackenzie, of the Egyptian Medical Service ; Drs. Crispin and Waterfield, of the Sudan Medical Department ; and Captains Olver and Williams, of tlie Veterinary Service. Captain P. E. Vaughan has once more sent many l)lood tilms, some of which proved of value ; Captain C. Percival presented tsetse flies, together with notes upon them, and there have been other presentations from divers sources. A few words as to the inadequacy of the space at our disposal. We have in all sis rooms, but could do with twice that number. Fortunately the Director of Education will ere long be able to aid us to some extent in this direction, but one cannot help feeling that sooner or later the time will arrive when the laboratories must be lioused in a special and separtite l)uil(ling. There is no ilesire to be dissociated from the Department of Education, for the laboratories have benefited greatly by this relationsliip, ami liappily there will be no need to go far away. Mr. Currie is willing to grant us the ground necessary, provided funds are forthcoming. The type of building one would like to see is that in which so much good work has been performed at Manila in the Philippine Islands. We look forward to the day when all the various branches of Science represented in tlie Sudan will be gatliered under one roof and when tlie usefulness of the laboratories will be eiihanceil by tlw establishment of a serum department. Scientific veterinary work is of tlie utmost vtilue and importance in such a country as this, and the laboratories should certainly be able to afford the Veterinary Officers every facility for the manufacture a.nd storage of curative and preventive sera as well as for the study of the numerous diseases which affect Sudanese stock. Sera, for use in medical eases and vaccine lymph, might also be manufactured, lor at present transport, especially in the summer, is apt to ruin lymph and serum, and in a hot country curative sera may rapidly lose their potency unless very carefully stored. Doubtless a long time must elapse before such an ideal is attained, but a first step would be the provision of new premises, which would be carefully planned to afford every facihty for working; a point even more important in the Tropics than within the temperate zone. We have been so fortunate in thi^ past in getting what was absolutely essential that one INTBOnTI(1TTON 23 is not witliout lu)p(> for tlie fntnvc Tims in 1907 vvc aguin receivoil a spc^cial and niucli needed grant of £ E 150 for books and pci'iodii-als. It is n.Miiarkalile how very little can be Grant to the got for sn(di a sniu when the back numbers of important journals are concerned, but still this '"'''™>' grant has aided us very considerably and the library is at last approaching respectable dimensions. We are again indebted to the Department of Agriculture, U.S.A., and to many Outside aid British, Colonial and Foreign schools and departments tor literature on the varied subjects with which we have to deal. One takes this o[)portunity of thanking all those who have been good enough to send us reprints of their work. In one dii-ection no real progress can be reported. The Therapeutic Garden mentioned Tiie in the First Eeport has not proved a success. This is partly due to the fact that it was Garder"'""" found very difficult to obtain the required seeds for planting, and that there has been no time to devote to what looked like a pi-omising scheme. True, we have a number of trees and shrubs which have grown at a phenomenal rate, but few of them are of interest, and I think it will lie found better to utilise the garden space in other directions, as indeed has already been done to some extent. It is doubtful if the indigenous medical plants of the Sudan are of sufficient value to justify the experiment. The attempt, however, has served to secure a useful plot of land and the cost has been trifling. In the Second Report one gave a list of some of the subjects whirh would rep;iy investigation. Amongst these were guinea worm infection and the therapeusis of Trypanosomiasis. So rapid is the march of progress that much which was obscure about The advance these two diseases has been cleared up, thanks in the one instance to the work of Leiper, Medidn^^' and in the other to the researches of Thomas and Breiul, Ehrlich and Browning, Laveran and Mesnil, Koch and many others. Mycetoma, which was also mentioned, has received attention from Brumpt, whose studies have yielded valuable information. The laboratories have been unable to deal with any of these subjects fully, but with the increase of the staff and with outside aid one may hope to extend investigations and help in work which is for the good of humanity. Attendance at the Sleeping Sickness Conference in London Necessity for impressed upon one the crying need for the rapid but careful study of the diseases which f'"""^'-"'' ^^'"■''^ tend to make parts of Africa uninhabitable alike ibr the black man and the white. There is much apathy amongst civilised nations, who will readily spend vast sums on all manner of objects but are too often blind and deaf to the claims of Science as a benefactor of mankind. Happily this cannot be said of the Government of the Sudan. One has received constant support from H. E. the Governor General, and it is again a pleasant duty to record the help and assistance rendered by many officials, and especially by the Head of the Department to which the laboratories belong. On the part Mr. Wellcome Acknowiedg- plays in the development of the work I need not dilate ; it must be evident from a perusal "'^"'^ of this introduction, which I would conclude by once more thanking the laboratories' staff for their loyal assistance, and at the same time expressing our indebtedness to all those wdio have kept our uccmIs in mind. 24 INTKODUCTION A tire at the Laboratories T^osses Timely aid Re-fittins Acknowledg nients NOTE Since the above was writteu a heavy cahimity has befallen the luburaturies. From some unknown cause a disastrous fire broke out in them early on the morning of May 11th. In a couple of lionrs the ilark room, the bacteriological room and the kitchen had been comiilctcly gutted. Not only was a large quantity of equipment destroyed, but all tlie trypanosomiasis strains were lost, together with records of two years' work on this subject. Many valualile microscopical specimens, collected since the foundation of the laboratories, were consumed, as was a considerable portion of the Review, newly-written, and of whi(di there was no duplicate. The office files for five years — books and sanitary records, being housed, for lack of space, in the bacteriological room — perished. Unfortunately, manv museum specimens, some of special interest, were in the kitchen awaiting preparation and remounting, and these wei'e all lost. So were ]\Ir. Edie's cultures of bacteria isolated from gum. It was chiefly due to the magnificent lielp rendered by (lolouel ('liapman commanding, and the officers and men of tlie 1st Battalion Royal Dublin Fusiliers, and by El-Kaiiiiakam Stockwell Bey commanding, and the ofticers and men of the ord Battalion Egyptian Army, who were assisted by the fire brigades of the Public Works Department, the Mudiria and the Gordon College, that the museum room itself and the Director's office, together witli the library, were saved. The chemical ami entomological rooms also escaped destruction, though considerable damage was done to the chemical equipment. The blow was a very severe one, and has prevented the completion of several of the research papers. Nearly all the paraffin blocks prepared during the past eighteen months, and containing the embedded organs of fowls, dead of spirochajtosis, were lost, and it has been impossible to collect fresh material. Work on the therapeutic treatment of trypanosomiasis had to be abandoned, and indeed in every direction we found ourselves crippled and hampered. At the same time sympathy and help were not lacking. Mr. Wellcome at once cabled his intention to refit the laboratories in the most up-to-date manner possible, anil promptly despatched a large quantity of the more necessary equipment. Drs, Stephens and Breiul, of the Liverpool Sidiool, kindly replenished our trypanosomiasis strains. Every aid was rendered us by the Director of Education and his staff, who undertook the reconstruction of the buihliug, and from many quarters offers of assistance reached us. Thus, Mr. Hewins, the Secretary of the Central Economic Boanl, aided us in having the Review re-typed when it had again been written, and similar help was proffered by Mr. Huxley, of the Public Works Department. It is not possible to mention all those who were good enough to offer or render assistance, but it can safely be said that this ready sympathy and help did much to lighten the weight of a misfortune which was none the easier to bear in that it happened as the hot weather began, during which it is at any time difficult to be energetic. Personally I would specially thank the members of the Staff for the manner in which they set to work to retrieve the damage and to help those concerned with the bacteriological work, who naturally suffered the greatest loss of time and material. One must also express one's appreciation of the kindness shown by H.R.H. the Duke of Connaught, who graciously wired his condolences to H.E. the (xovernor General from Malta, as soon as he received news of the fire. At a later date the authorities at the Royal Army Medical Col reading-room. lege, Londe very kindly permitted me the use of their library and INTKODUCTION 25 Needless to say onr grateful thanks are due tn all those who strove to qnem-li the flames and mitigate the loss. Theirs was a task of nnioh difficulty and considerable disconil'ort most ably performed, and they had the satisfaction of knowing that their efforts were not in vain, for, had the museum, the library and the Director's office perished, the loss would hav(; been irreparable. As it is, a great deal can be made good in time, and, so far as general Conclusions usefulness goes, the laboratories will only lie temporarily crippled. We hope to be in complete working order about the time this Report appears. Thanks to Mr. Wellcome, it was possible to undertake a certain amount of routine work by the beginning of June, the new equipment having reached us in record tiiiii\ Fig. 3.— Map of Anglo- Egyptian Sudan TRYPANOSOMIAStS IX THE AnG LO-Eg Y P T I A \ SunAX By the Director Nearly all the records of trypanosomiasis work, and especially the experimental work on therapeutics carried out by me alone and in coajunction with Mr. Archibald, were destroyed by fire, hence this Eeport has had to be much curtailed. Considering for a moment the work dealt with in the last Report, one may note that chrysoidin appeared to be quite as effectual in human trypanosomiasis given by the mouth as given hypodermically, but, as mentioned, the drug has the disadvantage of irritating the kidneys, and in any case failed to cure monkeys infected with T. (/(niihipimc. The case of human trypanosomiasis appeared to improve under its use, but unfortunately the patient sustained an injury to his leg, which resulted in a general septicaamia that proved fatal, despite careful surgical treatment in the Military Hospital, Khartoum. It is worth noting that at no time during his illness could trypanosomes be demonstrated in his peripheral blood. No other cases of human trypanosomiasis, or sleeping sickness, have been available, but, thanks to the kindness of Drs. Stephens and Breinl, of the Liverpool School of Tropical Medicine, we were put in possession of a strain of T. (jaiiiliiciife. It was found that gerbils {Gerhillus pygargus) could readily be inoculated and they were used in the subsequent work, the object of which was to test the value of one of the new organic arsenical salts of the aromatic series, namely ' Orsudan,' which is Sodium 3-methvl-4-acetylaminopheuyl- 'Orsudan'as ' . ■ a therapeutic arsenate, and has the chemical iornmla : — agent /OH (CH . CO) . NH— <:=>-As =0 I ^ONa CH, Arsenates have the general formula EAsO(OH)._,. 'Orsudan' is anhydrous and contains The arsenates 25-4 per cent, of arsenic. It is soluble in three times its weight of water, yielding a neutral solution. It is considerably less toxic than atoxyl, and is the least poisonous of the three allied salts recently placed on the market. The others are 'Soamin' (Sodium para-aminophenylarsonate) and 'Kharsin' (Sodium-3-methyl-4-aniiuophenylarsonate). (Sec Dr. Wenyon's Eeport.) ' Orsudan ' is only one-fifth or one-sixth as toxic as ' Soamin.' Having been successfully employed in syphilis, and as they resemble atoxyl, it was thought advisable to try them in trypanosomiasis. I selected ' Orsudan ' for experimental work, and proceeded to ascertain its lethal dose for gerbils, and to employ it in the case of animals infected with T. gamhiense (Liverpool strain) and the trypanosome of nude trypanosomiasis. At a later date, Mr. Archibald was associated with me in this work, and it is exceedingly unfortunate that all our papers were destroyed and that all the strains were lost. As a result, one cannot give the results obtained in detail while the work was cut short just when things looked somewhat promising. It was found that a healthy gerbil of average weight — about 40 granunes — could be given as a rule 1 c.c. of a 4 per cent, solution of ' Orsudan ' without a lethal effect being produced. In the case of infected animals, care was taken only to employ those which had been infected for some days, showed trypanosomes in their peripheral blood and had begun to lose weight. This is in accordance with the regulations followed by Breinl, Todd and Kinghorn. So far as can be told, there was a difference in their reaction to the drug between gerbils inoculated with T. gaiiihloise, and those inoculated with the mule trypanosome (so-called), Action on trviKinosoines Reco\frv 28 TRYPANOSOMIASIS IN THE ANGLO-EGYPTIAN SUDAN which, as we shall see. is probably T. peniiull (Laveran). The latter were found to resist the toxic effects of the drug better than tlie former. Thus 1 CO. of a 1 per cent, solution frequently proved fatal to the gamhiense gerbil, while the ppcamll (.'') gerbil withstood 3 c.c. with ease, as a general rule. It was found that in both eases the drug freed the peripheral circulation of parasites within a few hours of its subcutaneous injection. Before vanishing, the trypanosomes assumed curious spherical shapes, and were undoubtedly destroyed, if not by the direct action of the drug, then by its influence on trypanocidal agents in the blood and tissues. In one case of pecniidi {.'') infection a dose of 1 c.c. of a 3 per cent, solution abolished all trypanosomes from the peripheral blood within twenty-four hours, and produced a remarkable change in the animal, which had been fast going down-hill. After a sliort period of more acute illness it recovered, became lively and active, and continued so for ten days, its blood foliowwi by remaining free of parasites ; then it relapsed, the parasites reappeared and multiplied in its peripheral circulation, and it died within a few days (date uncertain, as records lost). Another gerbil relapsed in a similar maimer, and a further injection of 1 c.c. of a 1 per cent, solution failed to save it. In the case of a (jiuiihiiusi' gerbil, the trypanosomes disappeared for nine days after treatment, at the end of which time the animal died without a relapse having occurred. The cause of death could not be ascertained. The dose was only 1 c.c. of a 1 per cent, solution, so it is unlikely that the drug was to l)lame. ' Orsudan ' exercises no preventive action, and further work must lie carried out before its precise value can be ascertained. .^s regards animal trypanosomiasis in the Sudan, one has to record the discovery of trypanosomiasis in camels and of a trypanosome in cattle winch differs from any liitherto found in tlic Sudan. C A M E Ij T li y r a n o r o m I A s I s The camel disease was first investigated by Captain Olver, the Principal Veterinary Officer, and at a later date I found trypanosomes in the blood smears from sick camels sent In Koniofan nie from El Obeid, Kordofan. More recently an infected pariah dog was sent me by Captain Anderson, S.M.O., El Obeid, and from this strain it was found possible to inoculate gerbils, jerboas and guinea pigs (vide iiijr. Mdtr Trypanosomes of the Anglo-Egyptian Sudan 1. Trypanosome of mule trypanosomiasis, /'. dimorffho?! or /. fi^candi 2. Trypanosome of camel trypanosomiasis in Kordofan 3. Trypanosome of cattle on the White Xile, /■. natium. This closely reseinhles tlie short form found in mulL-s 4. Trypanosome of cattle in the Kassala Province, prohably /'. cazalfwja I.eishman Stain TliYl'ANOSOJIIASIS IN THE ANGLO-EG Vl'TIAN StTDAN 31 colour to a yrcou, viscid, somi-solid lic^uid. Sometiuies the small intostines aro I'ouiul intiamud, and in cases where there has been marked meltEna the rectum is found full cjf bl,)od.-' The condition of the spleen and liver is not mentioned, but in several i'es[)ects the symptoms and post mortem appearances resemble those seen in cattle ati'ected with V. iininiui. Of special interest is the gastric ulceration. I examined the smears, which showed ''a^"""-' ... ulceration moderate trypanosome infection. Tiie ti'ypanosome varies in length, but is quite unlike T. diiiiiirphi/n. There is: 1. A shoi't form rather resembling 7'. ikiuiuu, but measuring about ]5/( in length; 2. An intermediate form about 18m in length and showing very little free tiagellum ; 3. A long form about 21m in length. No pike-head forms were noted, such as are seen in T. divKirphon or T. jjecaudi and sometimes in the trypanosome of camels. A point which is very noticeable is that the blepharoplast is situated close to the 1 ouiided posterior end of the parasite. The short forms resemble the typical T. iinnnin in that the undulating membrane is but slightly developed and there is hardly any free flagellum. The breadth was found to vary between l-o/x and 2-25|H, but I was unable to see Morphology any definite thin and broad forms, such as are readily visible in 7'. tliiuorpliDn or T. iircamll. One form, 17m in length, yielded the following measurements: — From posterior end to posterior end of nucleus ... ... 7-5 M Nucleus ... ... ... ... ... ... ... ... 2 ,, From anterior end of nucleus to beginning free flagellum ... 6 ,, Free flagellum ... ... ... ... ... ... .. 1-5 ,, In none of the forms is the free flagellum very pronoitnced, but in some of the long, thin forms it may reach a length of 3m- The general impression conveyed by a study of stained preparations of this Probably a specific trypanosome is that it differs from the other types found in the Sudan. It is certainly not ,rvnanosome 'P. HiuiHin, the form hitherto found in cattle, and it is of course impossible, on morphological grounds alone, to come to any definite conclusion regarding it. The question, however, is one of very considerable importance, especially as regards trade with Erythrea and Abyssinia, and personally I have little doubt that the parasite is the same as that described by Memmo,' Martoglio and Adani as causing the disease Gladn in Erythrea. This form of trypanosomiasis attacks cattle, sheep and goats ; guinea pigs, rabbits, dogs and monkeys being refractory, as are also mice, rats and fowds. The symptoms resemble nagana (7'. hracei) or surra {T. evansi), but cedemas and skin lesions are absent. Nervous symptoms are marked towards the end of the disease. Abyssinian sheejj and goats die of the disease in 12 days. The horse is susceptible and dies in about one 5''ear, the donkey in five months. The suspected fly is a Tdlmniis or Jlipp(d)Oi!C(l . It would appear that the trypanosome of this disease is probably T". razalhmii, the cause of t. oiuitl'uiii Sounia, described in various papers by Cazalbou,-Laveran,'*Bouffard,^ Bouet,"' and other French ' Memmo, Martoglio aud Adaui, Ann. d'Liiimc Spcr., 1905. Reference in Nabarro, D., " Trypanosomes and Trypanosomiasis." 1907. 2 Cazalbon, T;. ''. R. StK. Illnl.. t. LXII, No. 21. ■■' Tjaverau, A. (May 2.5111, 1907), '■Trypanosomes du H.int. Niger." Ann. de /'/n.^fihit /'nsfnir, i. XXI. •* Bonffard, 0. (December 2r>t\\, 1907), " La Souma." Ibid. ■■' Bouet, G. (December 1211i, 1907), " Les Trypanosomiases de la Haute Cote d'lvoire." niiil. 32 TKYI'ANOSOMIASIS IN THE ANGLO-EGYPTIAN SUDAN authors, and which affects cattle, horses and mules. In the last-named it runs a more chronic course. The symptoms in cattle, as described by Cazalbou — rough staring coat, lachrymation and diarrlitt'a — resemble those mentioned liy Meade, and the trypanosome which I have described has certain points in common with T. cazallumi, notably the position of the blei^haroplast, the poorly developed undulating membrane with few folds and the rounded posterior end. It is true that the Sudanese trypanosome appears to vary in length, which is not a characteristic of the Souma trypanosome, but this is not a very important matter, as witness the variations met with in T. hriicei. The films being old, and having been exposed to great heat before reaching me, did not stain very well, so possibly the appearance of forms lacking the free flagellum was due to this cause. In the absence of extended investigations, one can only say that this cattle disease is very likely the same as that found in Erythrea. As the latter is due to a trypanosome conforming to the T. eazallioni type, and as the symptoms of the Sudan disease resemble Souma, it seems reasonable to suggest at least that T. cazidlmiii, wiiich certainly seems to be a distinct entity, is the trypanosome concerned. One must note, however, that a trypanosomiasis of horses (Hallen) and of cattle (Savoure) exists in Abyssinia. It is believed by these authors to be surra introduced from India. Brumpt, however, from a consideration of the commercial relations of Ogaden with the infected regions of Abyssinia, concludes that the disease is identical with the true tsetse disease of the Juba Valley and of British and German East Africa generally. This may be true nagana due to T. bnirei, and one must not lose sight of the fact that this Kassala trypanosomiasis may also be nagana. There is nothing against such a supposition and much in its favour. Here, again, the strain must be tested and cultural methods employed. f Rare form Tli Yr ANOS OMI AS IS OF MuLES \ [ Gonmion form I wo types of jt yfi\\ }jy lemeuibered that in the Second Report allusion was made to a short mule disease t ^ t ■ , , n trypanosome found in the blood of mules which had come trom the Bahr-El-Ghazal Province. My notes on this parasite were unfortunately lost, but some measurements made for me by Mr. Archibald show that it varies in length, from about 74," to 11-2;'. There seems little doubt that this mule trypanosome is in reality T. iiituniii, but as Dr. Wenyon met with the disease during his journey, and was able to carry out some work upon it, which is detailed in his report, there is no need for me to say iiioi-e about it, except that I was able on one occasion to inoculate a gerbil successfully from one of the dogs inoculated by Dr. Wenyon. Up to date, therefore, the following forms of animal trypanosomiasis have been found to exist in the Sudan [see Plate I.) : — 1. Trypanosomiasis of mules and horses, due to T. dintdrpliuii or T. pi'ninili, found on the White Nile and Sobat and in the Bahr-El-Ghazal Province. This seems also to affect cattle and camels in the Bahr-]51-Ghazal Province. (iS'ef Dr. Wenyon's Report.) There is also a donkey trypanosomiasis, which in all probability is due to '/'. tl / imirj.jltini or 7'. jK'ciinih'. 2. Trypanosomiasis of camels, due possibly to '/'. sniiiliuipiisi'. Found in Kordofan. 3. Trypanosomiasis of cattle due to T. mnniiu. Found chiefiy on the White Nile and Sobat. (Si-v notes by Dr. W^myoii, who has found a form with a free flagellum.) Trypanosomiasis of mules due to a small trypanosome which is almost certainly T. iiiutinii. Found in the Bahr-El-Ghazal Province and probably on the White Nile and Sobat. Jr. Trypanosomiasis of cattle due to a new trypanosome. Found in the Kassala Province. Probably either 'V. cazulbuui or T. briicei. PLATE II (i.'J/, R, D. MO'R Herpetomonas Parasites his luhyopunctntus. Encysted and free forms , . / <.v.,„ X 1000 (/mw;. Letslutinyi Siam R. D MniR Haimogregarine and trypanosome of the Khartoum toad {Bu/o re^ulm-is) Ghunn Stain X '^OO diam. H.SiMOGRECrAKINE OF THE JEHHOA 35 which appears to retain its characteristic size and shape throughout the iUness it induces. At the same time, I admit that tlic last word has not been said about this trypanosome either, and it is a pity that the laboratory strain obtained from Dr. Wenyon was lost at the time of the fire, as one had hoped to reach some definite conclusion regarding it. Doubtless, however, we will in time arrive at a correct understanding regarding all the different species found in the Sudan, and, for the present, Plate I., on which are grouped all those hitherto found, should materially aid those engaged in blood examinations and veterinary work. H.'KMOOrvEGAUINE OF THK JkUHOA By the Dikectok Hiemogrecjarina jaculi (Balfour) According to the laws of nomenclature the above must be the name of the hsemogregarine of jerboas described in the Second Eeport, and not H. halfouri (Laveran) as there stated. Further observations have been made on this parasite, but all efforts to find an extra-corporeal stage in an insect host have met with failure. lu the first place, however, one may consider the blood conditions. In the case of other haemogregarines of mammals, notably H. gerhilli (Christophers) and H. fniiamhidi (Patton), careful differential leucocyte counts have been made of the blood of infected and of non-infected animals. The discovery of uninfected jerboas (J. »/sa Stain x 1000 ^///i«/. Sl'IKOl'lI.K'rOSIS OF SUDANESK FOWLS -V.) and no spirilla can be demonstrateil in the blood. The guinea pig was found to Ijo insusceptible, and ill monkeys only a local oedema followed inoculation. It was shown that fresh serum acted in the same manner as infected blood, that the spirilla agglutinate very rapidly in serum, and that after 48 hours all their movements cease and the serum ceases to be infectious. Such serum possesses immunising properties, and this power is destroyed in twenty minutes by a temperature of 55° C. Serum passed through a Berkefeld filter loses its virulence, but possesses immunising properties. A fowl which has recovered from the disease was found to possess an absolute innnunity. ihe qursnon fjf iniTiHinilv Thus 2 CO. of blood fiom a fowl recovered for a period of one month, given 48 hours before a virulent injection, wholly protected from infection. There was not even elevation of temperature or loss of weight. A second injection only produced a transient effect. Preventive serum mixed with virulent serum for five minutes rendered the latter harmless, as a general rule. 2. Levaditi' then took up the subject and obtained rather different results. He found Work i>y the guinea fowl was refractory — showed that the crisis was, properly speaking, a lysis, and that death might occur either before or after this lysis. In the inoculated disease he found the illness usually lasted four to six days before the lysis occurred. Other points noted by him were : — («) Young fowls never show the lysis, Init die three to eight days after inoculation. (b) In tick infection the incubation period is five to six days (c) There is no local multiplication of spirilla — i.e. at site of inoculation. They divide transversely. (d) The disappearance of the spirilla is not associated with phagocytosis in the perijjheral blood. This is accomplished by the macrophages of the spleen and liver. Sometimes red blood corpuscles or their free nuclei are taken up by the leucocytes. (c) A susceptible young fowl inoculated with defibrinated blood, 26 hours after lysis, and apparently quite free from spirilla, became infected. This showed that spirilla were present, though they could not be demonstrated. (/) A mono- and sometimes a polynuclear leucocytosis, together with basophilia of the erythrocytes, and the presence of large (splenic?) vacuolated mononuclears in the blood. These increase in numbers before the so-called crisis. ({/) The agglutination is not permanent, the spirilla regaining their freedom in from 4 to 35 minutes. False clumping is probably due to the abrupt change produced when the blood is taken for examination. {h) True agglutinins and imniobilisines appear after the crisis. (i) No granular transformation of spirilla occurs. Levaditi also discussed the cause of the crisis and opposed the view of Gabritschewsky,- who, as regards Sj]- anserina, believed that it was brought about by anti-bodies in the blood. Levaditi upheld the phagocytic theory, pointing out that the last spirilla remaining in the circulation are wholly unchanged, and advancing experimental proof to show that his theory regarding the splenic and hepatic macrophages fully explained the mechanism. These arguments need not be given in detail. 3. Sakharoff^ had previously discovered a similar disease attacking geese in the The discasf Caucasus. He named the spirillum Sp. anserina, and found that it was pathogenic for '" ^^^^ ' Levaditi, G. (March 25th, 1004), " Contributions it I'Etude de la Spirillose des I'oules." Ann. dc VInstitut Vasteur. Vol. XVIII. ■- Gabritschewsky, Q. Ccni.f. liakl., Vol. XXIIL, Nos. 9-18; Vol. XXVI., Nos. 10, 10, 17; Vol. XXVII., No.'2. ' Sakharoff, G. V. Ann. de I'Insliltil Pasteur, p. o(J4, Vol. V. 40 SPIROCH.ETOSIS OF SUDANESE FOWLS Hereditary transmission The disease in [ndia the young chicken, though, according to Cantacuzene,' the fowl rarely succumbs. The disease induced is very like that caused by Sp. gallinaruni. Yellow caseous granulations are found in the liver post mortem. 4. Borrel-^ was the first to demonstrate by a special and somewhat intricate process the apparent presence of peritrichous fiagella in .S'^;. gallinarum. I think the present tendency is to regard the appearance as of the nature of an artefact. 5. Levaditi and Manouelian'' further investigated the subject, and concluded that — (i.) Brazilian septictomia is not exclusively due to a proliferation of S^h (jaUinarmn in the blood. The parasite invades tlie various glandular tissues, and enters into intimate contact with the divers cellular elements. Unlike Treponema pallidum, however, it does not seem to penetrate into the protoplasm of the cells. (ii.) The crisis is due to phagocytosis by the macrophages of the spleen and liver. (iii.) The parasite can infect the egg of the bird inoculated experimentally. 6. At a later date, Levaditi^ entered into the question of the disease in the embryo of the fowl. One need not follow him into this field, but merely note his conclusions that — (i.) Spirillosis is not hereditarily transmissible to embryos born of infected fowls. This is possibly because infected eggs may not be capable of fecundation and segmenta- tion, or because the spirilla which have invaded them may die off during the long process of the " birth " of the egg. (ii.) These embryos are immunised against infection by Sp. ijallinarum, tliis inniiunity being proliably of a passive nature. It is ill this paper also tliat he explains the deatii of adult fowls which have survived the crisis as due to the action of a toxin liberated from the spirilla after their death in the protoplasm of the phagocyte. 7. So far as I can find out, spirillosis occurring naturally in poultry was not described, save in Brazil, until I'' encountered it in Khartoum fowls towards the close of 1906.' This is the disease forming the subject of the following paper. {See. page 44.) 8. Eeaney,' having noted this discovery, looked for and found the disease in fowls at Agar, in India, and, in the course of his second paper, mentions that Banuernian had found a spirillum in a chikor partridge in the Bombay Zoological Gardens. He thinks the tangles of spirilla may be the result of rapid division. 9. Montgomery,'* also in India, was the next observer. Apparently he had not noticed the Sudan work or Reaney's paper, for, after mentioning !Marchoux and Salimbeni's discovery, he says : " Its occurrence in other parts of the world has not since been noted " ; but, in the course of his own, he mentions that Pease had observed a disease in ducks at Lahore, which he attributed to spirochfetes observed in the blood. Montgomery describes the parasites as being, as a rule, from 7 to 9 /n in length, and ' Cantacuzene, .J. (1899). Ann. de rinstitiit Pasteur. - Bon-el, A. (January '20th, 1900), "Oils et division transversale chez le spirille de la poule." C. R. de la Soc. de Biol. '■' Levaditi, H. Y., and Manouelian (November 2.5th, 1906), "La spirillose des enibryons de poulet." Ann. de VInstitut Pasteur. ' Levaditi, G. Y. (November 2,5th, 1906), "La spirillose des embryons de poulet." Ann. de I'lnstitut Pasteur, Vol. XX. = Balfour, A. (March 30th, 1907), "A Spirillosis, etc., of Domestic Fowls in the Anglo-Egyptian Sudan." British Medical Journal, p. 744, Vol. I. " Nuttall, however, in his Harben Lectures tor 1908, states that Bitter informed him that spirochetosis uceurs in fowls round about Cairo, and that the condition has also been reported from Australia. " Eeaney, M. F. (May lltli, 1907), "Spirillosis of Domestic Fowls." British Medical Journal, Vol. I. Ihul. (November, 1907), ibid. Indian Medical Gazette. - Montgomery, R. E. (February, 1908), " On a Spirochete occurring in the Blood of Chickens in India." Journal of Tropical Veterinary Science, Vol. III., Pt. I. PLATE VI f 9 ^ A # # tes, after a vaiying but comparatively short time, lose their motility when kept SPIKOCH-T.TOSIS OF SUDANESE FOWLS 45 a "^^X .~'~d between slide and cover glass. They are more easily recognised in preparations stained by the Giemsa or Leishman methods, the former being on the whole the more satisfactory. I employ the made-up fluid Giemsa, supplied by Griihler in a strength of 7 drops of the stain to 4'5 c.c. of distilled water. The tilm is fixed for ten minutes in absolute alcohol, then placed tilm side down in a special staining dish or in a shallow Petri capsule with its ends supported by tiny glass rods (broken pieces of vaccine capillary tubes serve the purpose) and the stain is poured in. Staining is continued for a quarter of an hour or longer, the film is washed, dried, and examined under a r.j-in. oil immersion. Staining for five or even ten minutes is usually insufficient, and, as will be seen, led to mistakes being made and caused erroneous impressions. Plate v., fig. 1, shows the different aspects presented by the stained parasite. In Fig. 6 rt shows a form in which three chromatic dots are clearly visilile. They occur in the course of the nuclear helix, for as in other spirochaetes the nucleus is diffuse, and examina- tion with the highest powers of the microscope shows that there is a central nuclear core surrounded by a periplast. I think it is this periplast which gives the appearance of an undulating membrane described by Prowazek for Sp.galliiiarum, while a frayed, fragmented periplast doubtless furnished the peritrichous flagella demonstrated by ISorrel. In a, as in all the other forms, the pointed ends of the parasite are well seen ; b shows an appearance which suggests longitudinal division. I have never seen transverse division occur in this spirocluete ; c is one of the short thick forms, which some have supposed to be a female gamete. Another not quite so broad is also shown. Both d and e represent types of the parasite in which there are breaks or gaps in the central core, the nature of which is considered later ; tj is one of the long combined forms in which it would seem two spirochietes are united by their extremities ; while h shows a fairly long thin form, claimed by some to be a male gamete, in which the spiral turns are small and numerous; and k is a form of similar length, but with only a few large spirals; / shows clumps of the parasites in the condition of pullulation preceding the crisis. The remaining drawings show common forms, either outstretched or curved and loo])ed. As regards size, there are short forms containing 4 spirals and measuring 9 " in Fift 6 — ITorms of Fowl Spirochiete iD the pcripbera \AnoA Slaimng methods Various forms of parasite 46 SPIROCHETOSIS OF SUJIANESE FOWLS The leucocytes Incubation period The disease in CTuinea fowls length, inedium forms with 5 sph-als ami a length of 12 ,", fairly long forms with 8 spirals like /i, measuring 16'5 /' in length, a very fre(iueiit size, and extra long forms with as many as 9 spirals and possessing a length of 19'5 in. In addition, there are the combined forms exhibiting the appearance of a thin filament in the centre where the two parasites are in opposition by their fine extremities. The types of leucocyte found in the infected l)lood are shown in Plate V., fig. 2. Large, vacuolated mononuclears, like those described by Levaditi, are present, and so are basophilic lymphocytes. In the chronic stage I am inclined to think that there is constantly an eosinophilia. In some cases it is certainly very marked. In a bird dead of the acute disease but little is found post mortem. There is marasmus, evidence of anaemia and congestion, and enlargement of the spleen — the organ varying much in size. Sometimes the liver is also congested and enlarged. All the embedded specimens of organs — lung, spleen, liver, kidneys and lymph glands — were, as stated, lost in the fire, and one has not been able to study the histo-pathology of the acute disease to any extent. Nor has it always been easy to secure fowls showing spiroehsetes in their blood, while, owing to the fact that many Sudanese fowls possess a natural or acquired immunity, it was difficult to maintain the strain. Inoculation of the blood of one of the Leghorn fowls into a gerbil gave negative results. As in Brazilian septicaemia, so here, there is what may be called a crisis prior to which the spirochaetes agglutinate into clumps, and immediately after which they are not to be found in the blood by ordinary methods of examination. The temperature, as a rule, is high, about 109" F., and falls at the crisis. The post- critical aspect of the disease will he discussed separately, as it presents special points of interest. In the case of the Leghorn fowls, numerous larvae of Argas ticks were found clinging to the bare patches under their wings. An apparently healthy Sudanese fowl was put into the infected hen-run, and in two days showed spiroohaetes in its blood. It was put into the fowl- house on December 4th, on December 6th it was found infected, but not severely, and by December 9th all parasites had disappeared from its peripheral blood. It continued to improve, but on the 17th was found to have passed into what I have termed the "after phase" of the infection, and ran a chronic course with eventual complete recovery. Several other experiments showed that the tick was effective. In one instance a female tick, fed on a fowl with spirochaetes in its blood, was dissected after Christophers' method, and the entry of a spirochaete into one of the eggs was observed, or at least an appearance very suggestive of this procedure. The incubation period in experimental inoculation seems to be about forty-eight hours. It is difficult to determine the time accurately, as at first the infection is usually very slight, and may not be recognised until the parasites have multiplied considerably in the blood. I found no local multiplication, i.e. at the site of infection. As regards other birds, I recently found a spirochcBtosis in geese at Khartoum North, which I have reason to believe is due to the same parasite, and in which there is an "after phase" precisely similar to that occurring in the fowl disease. I have never found pigeons affected, and I have not used them in experimental work. Dr. Wenyon found guinea fowls on the White Nile with spirochaetes in their blood, and discovered infected fowls in the Southern Soudan, so that probably the disease is wide-spread. We now know that a specific tick is not required for S^j. gallinarum, and that three species of Argasida can transmit that parasite. It is quite probable that several are operative in Sudan spirochaetosis, but so far Argas persicus only has been proved to be a carrier. I have several times tried to inoculate gerbils, but have invariably failed. It is probable that this is an avian spirochaetosis, non-transmissible to mammals. SPIE0CH.?5T0SIS OF SUDANESE FOWLS 47 After iJhase. — We will now consider certain curious appearances found in the l)lood of sick fowls, the precise nature of which was at first unknown, hut which eventually proved to be constantly associated with spirochajtosis, and indeed to constitute a phase in the clinical picture of the disease. While looking for fowls suffering from spirochaetosis, I found a large proportion of hirds in the Khartoum market exhibited intra-corpuscular bodies in their blood, the erythrocytes only being affected. Such birds might be brought in very ill indeed, with symptoms closely resembling those seen in spirochiBtosis, as in the case of the cock shown in Fig. 5. This photograph was taken when the bird was practically m extremis, exceedingly emaciated and somewhat dyspncfiic. The condition of the legs and feet is due to infection by the ascarid Sarcoptes mutans, and has nothing to do with the general disease. On the other hand, the birds, when the infection is slight, may scarcely show any sign of illness, though as a rule some emaciation is evident when one palpates the breast. It was soon apparent that the condition ended either in complete recovery or in death. In the The ■ ' after phase ' January 24 25 20 Februahy 4 5 6 7 101° 9S° -Chart showing temperature changes in spirochsetal fevei- former case the bodies entirely vanished from the corpuscles and the birds became strong and healthy ; in the latter, the bodies might either remain about the same in number, or might rapidly increase both as regards infection of different red cells and as regards multiple infection of individual red cells, and the unfortunate bird passed into a truly pitiable condition of extreme marasmus. Appetite, however, was usually preserved nearly to the end of life. Death may occur quietly or be preceded by convulsions. It was noticed that the illness associated with the presence of these bodies differed from Temperature t- 1 1 1 I curves spirochaetal fever. It was non-febrile, indeed the temperature might be slightly sub-normal, and usually fell several degrees before death {see Chart, which is that of a hen with a very severe infection which terminated fatally). 48 S]^IR0C'H,=RTOSIS OF SUnANRSF, FOWLS ("ontlitions iiiHuenciiii; I'ecovery Staining of endoglol)ular forms Description of endoglobular forms A typical case Recovery, if the infection was not too severe, seemed to depend largely on the oare taken of the birds. If these were well fed and well housed, it often occurred that, while in the market, the vendors, who readily recognised the condition if there were any symptoms at all, cast the fowls out of the coops, letting them fend for themselves — a sentence of death in most cases. Post mortem, there is uo gross lesion of any kind visible, and nothing is seen to account for death beyond the great emaciation. Blood condition. Stained films.— It is convenient in the first instance to consider the appearance presented by a stained film. The Leishman and the Giemsa stain, or Borrel blue and eosin, all answer well as tinctorial agents, and the blood may be stained as for the malarial parasite. It was found to be a mistake to stain for more than ten minutes, as this tended to obscure such structure as the bodies possess. On the whole, perhaps, the last- mentioned method shows the structure of the bodies best, and it specially emphasises what is undoubtedly the chromatin which they possess. A glance at Plate VI., fig. 1, will reveal the fact that the bodies are situated in the extra-nuclear portion of the red blood corpuscles. I have never seen a free form, living or stained, though several times I have been nearly deceived, and almost imagined that such existed. The l)odies may be close to the nucleus, so close as to touch it, or they may be quite at the rim of the corpuscle, or occupy a half way position. There may be only one of them in a corpuscle— this is frequently the case — or there may be as many as seven. In such a case the bodies are usually small, and arranged close together. Two, three, or four are commonly present. In these multiple cases the bodies may be near each other or widely separated. They are very protean in form, and less so in size. Fig. 8, A shows a diagrammatic drawing of a bird's red corpuscle in which I have placed the commonest shapes met with in the peripheral blood. Those at the top and bottom of the corpuscle are undoubtedly the most frequently encountered. In a few cases I have seen a body lying close to the edge of the corpuscle, and apparently associated with a gap in the corpuscular envelope. This appearance is, however, distinctly rare, but added to the difliculty of diagnosis. As regards size, the smallest stained ijodies, usually ring- or flame-shaped, measure about 1-5 micron. ; the largest, which are often found in the lungs, are frequently 3'5 fi in their greatest diameter. A few measure as much as 4 ^i. It will be seen that we have " coccoid " or solid spherical forms, "ring" forms enclosing a vacuoloid space, similar "ring" forms wliich look as though a membrane stretched half-way or wholly across them, " ring " forms with central dark-staining portions, signet-ring shapes, flame-shaped forms closely re- sembling some of the piroplasmata of mammals, irregular forms, somewhat star- shaped forms with dots round their periphery and granules in their interior, tiny crosses and granular broken-up forms suggesting ii iiriori a sporing condition. Plate VI., fig. 2, is a representation of the peripheral blood of the hen whose temperature chart is given. On admission, this bird was extremely ill, and its peripheral blood contained a large number of these bodies. It smelt foully and exhibited tremors and marked anajmia. It was put in a comfortable cage, given bedding and plenty of food and water. As a result, it improved for a time, and, though it was not easy to be certain on this point, I believe the bodies % A'ucleus m . diilUnii 11. Eventually I ' witnessed under the microscope in a few cases the entry of spirochaetes into red blood corpuscles, and in one instance the formation of a body very closely, though not exactly, resembling those described in the fresh blood of infected birds. I think, therefore, the chain of evidence is now complete, and before going on to describe one or two cases in detail and to discuss some aspects of the condition and refer to its treat- ment, it may lie interesting to refer briefly to the work of the above-mentioned authors. Taking Lingard first, apart from the observation above noted, he described and figured - certain " protozoic " forms in the blood of cattle in India, which I think niight possibly be explained on the supposition that they are eudoglobular forms of the spirocluetes discovered by Lingard himself in Indian bovines. Moreover, in this connection one would note that the so-called cytamceba of the frog, observed by the Liverpool observers •' in West Africa, is exceedingly like some of the bodies P'^'''^^'"^ in fowls' corpuscles. I should think it is quite possible that it may really represent an endoglobular stage of a spirochaete. Breinl described and figured .S'p. duttoni lying in the substance of the red corpuscles, but the appearance is totally unlike anything met with in fowls, the parasite being in the form of a looped spiral thread or skein, and apparently not undergoing any contraction or encystation. At the same time Breinl noted that in the spleen and liver the spirochsetes formed skeins which became encysted forms that broke up into small red granules {vide Eeview Supplement, " Spirochcetosis," i^gc 191). Prowazek's paper is, however, the most important. He first saw the entry of the spirochaetes into the red blood corpuscles in a test-tube experiment where very diluted inactive serum was added to spirochaete material which had been washed and centrifuged twice, and therefore contained little complement. Under such conditions it was easy to observe that the parasites actually migrated into the red corpuscles, as in some cases the corpuscles had died and were " thrown " to and fro by the very mobile spirochiotes. In some cases the parasite transformed the erythrocyte into the shape of a pear. Later, this stage was recognised in cover-slip preparations or in hanging drop, and to a less extent in quickly dried films. It was noted that the spirochietes entered the corpuscles, singly or two together or, but seldom, in threes, and moved in the coi'puscles in a circle in a very lively manner, quite different to that exhibited by the parasites in the free serum. Prowazek was inclined to regard this behaviour as the formation of a special resting stage, but noted that nothing definite could be determined until it had been studied in the tick. The spirochsetes were observed to migrate into old as well as into the young corpuscles, which are more oval and have various kinds of granules in them. In some instances the parasites were also seen to leave the corpuscles they had entered. All these appearances are well illustrated. This cell parasitism, like that met with in Treponema and .S'^'. anodontce, tended to confirm Prowazek in liis view that Sp. gallinarum was a protozoon and not one of the bacteria ; but we must not lose sight of Kruse's observations on bacillary invasion already cited. In this pax^er also Prowazek enters very fully into the morphology of Sp. gallinarum, specially mentioning the apparent conjugation of thin and broad forms, or of the spherical masses of protoplasm which may be formed upon the spirochaetes. When on two different Observations of von Prowazek ' Balfour, A. (February 1st, 1908), " SpirochiBtosis in Sudanese Fowls." Journal of Tropical Medicine and Hygiene. - Lingard, A. (.July, 1907), " Home Forms of Spirochetosis met with in Animals in India." Journal of Tropical Veterinartj Science, Vol. II., No. 3. " Annals of Tropical Medicine and Parasitolo (jy (December 9th, 1907), Series T.M., Vol. I., No. 3. 54 SPIllOCH.ETOSIS OP SUDANESE FOWLS Possible intra- corpuscular fission parasites these may unite and mingle, and suggest i-estiug stages pvior to peculiar sexual processes. All this, however, requires confirmation, and need not be further discussed at present. Personally, save in one instance (Fowl I., ridi' infra), I have not seen these proto- plasmic balls in the case of the Sudan spirochaete. A comparison I have studied Prowazek's paper and diagrams closely, and have come to the conclusion : — 1. That in the Sudan spirochaete, cell-parasitism is much more frequent than in the case of the Sj}. gallinarum strain with which he worked. Indeed, it appeared to be the rule rather than the exception, and, if cai'efully looked for, will be found in nearly every case which recovers from the acute disease. 2. The cell infection is often much more severe in the case of the Sudan spirochaete, and multiple invasion is common. A glance at Plate VI., fig. 1, will confirm this statement. At the same time I will not go so far as to say that each of the bodies in the corpuscle represents a spirocluete, which, let us say, has passed into a resting stage. In the fresh blood I have seen appearances which suggest that the spirochaete may undergo transverse division at several jjoints within the corpuscle, and that each segment then contracts and encysts, forming the smaller class of the endoglobular bodies. Apart from what has been seen this would explain some of the peculiar appearances and the great difference in size and shape which exists between the bodies. In some eases they are produced by a complete parasite, which has become coiled up, and the central core of which has degenerated ; in others they represent fragments of a spirochaete which has divided into several parts, each part tending to contract and possibly encyst. May not this also explain the reason for the apparent breaks or gaps seen in stained specimens of the spirochaste, these being tlie points at which the intra-corpuscular fission takes place ".' 3. It is possible that the spirochaetes may leave the corpuscles, but I have never seen this occur. I have, however, witnessed one of the spherical bodies bulging out the envelope of the corpuscle as though it were endeavouring to get free. One has to ask. Is this a new species of spirochaete? Does its life-history entitle it to be classed separately from Sp. gallinaruml Before dealing with this aspect of the subject, about which little can in any case be said, it will be well to record more fully some of the cases observed. In the first place we take a fowl (Hen 20), the temperature chart of which has been given {imjc 47). This was a bird which came in when in the "after phase," and the following Illustrative are the notes upon its condition and subsequent history : — '^ases Q^gj, J, Jaiiiiari/ IdtJi, 1907. White and speckled fowl brought in from the market, Khartoum. Very ill and extremely emaciated. Masses of the larvae of Argas pcrsicus adhering to the bare patches of skin under its wings ; smelt foully ; was anaemic and suffering from tremors of the body. Tlie blood showed that there was very heavy infection of the red cells, often multiple. The fresh blood was preserved for several days between slide and cover glass, but nothing special was noted. In this case also, as in others, wet films were fixed by osmic acid or in Flemming's fixative ; but these measures produced no change in the appearance of the bodies, and failed to yield any fresh information. January '20th. A considerable quantity of citrated blood inoculated subcutaneously into Fowl 21 with negative results. Either Fowl 21 was immune, or the blood is not infective in the " after phase " when no free spirochaetes are present in it. As mentioned, however, inoculation has several times proved successful during the " after phase," but I am inclined to think that in these cases undetected free spirochietes must have been present in the blood Exit from corpuscles never witnessed SPIKOCH.T.TOSIS OF SUDANESE FOWLS 00 used for inoculation, as well as the endoglobular forms. The point is a little difficult to decide, owing to the presence of so many immune birds, and this difKeulty could only be obviated by rearing a special lot of chickens and employing them in the work. I hope to carry out investigations in this direction. Jamoanj 21st. Bird distinctly stronger and improved in condition, no doubt owing to care and good feeding ; but, on January 2oth an enormous infection was present, and in many corpuscles as many as five, six, or seven bodies were present. As indicated, this may not represent invasion by a corresponding number of spirochietes. After this the infection seemed to diminish in severity, no doubt because some of the incorporated spirochsetes had broken down and been discharged as tiny granules from the corpuscles. The blood was examined every day till February 1th, when a distinct increase in the number of bodies was apparent. February 9th. A great infection was visible. The bird was somnolent and prostrate. Death occurred, preceded by a marked fall of temperature and convulsions. Post mortem. — There was no gross lesion of any kind visible. Neither spleen nor liver was enlarged. There was some congestion of the renal vessels, and the kidneys had a mottled appearance. Smears were uiade from the heart's blood, lungs, liver, spleen, kidneys, cerebro-spinal Huid and bone-marrow. The last named was dark red and fluid. In all, the bodies were present in the red cells. The lung smears were the most interesting. In these many corpuscles were seen in which the extra-nuclear cytoplasm had apparently vanished, but where large, irregular forms of the bodies still remained, doubtless retained by an unstained envelope from which the haemoglobin had escaped. The substance of the bodies was broken up into little rods and dots which took on the chromatin stain. Some of these bodies were 4 /.< in either diameter. In this case and in two others I was able to study sections of the spleen, lung, liver and kidney. The tissues were fixed in perchloride of mercury and alcohol, embedded in paraffin, and stained with Leishman and eosin-haematoxyhn. Beyond what appeai'ed to be a kind of chronic venous congestion, I could detect nothing abnormal, save, perhaps, in the liver of Hen 20, where there was a marked leucocyte infiltration round the periphery of the lobules and extending into them between the cells. I compared these sections with those prepared from the organs of a healthy fowl. The nest cases are of greater interest because the condition was followed through from the acute stage to the "after phase," and some interesting inoculation experiments were performed. Case II. — Fowl I. — December 22nd, 1907. Admitted suffering from spirochaetosis. Infection severe and bird distinctly ill. December 23rd. Spirocheetes numerous. Blood, about 5 c.c. in each case, taken froai wing vein and inoculated into — (a) Fowl 33, which showed a large number of intra-corpuscular forms ; (6) Fowl J, which showed intra-corpuscular forms in very small numbers. N.B. — In neither case was the inoculation successful. December 26th The crisis had occurred, and all the spirochaetes had vanished from the blood. About 5 c.c. were inoculated into — (i) Fowl K, a healthy young bird. N.B. - Eesult negative. From December 25th to December 29th, the bird improved in health, and the examina- tion of its peripheral blood was uniformly negative, both as regards free spirochtEtes and 56 Si'lROCH.4:TOSIH OF SUDANESE FOWLS endo-glohular forms. The Ijlood was not again examined till Januari/ 1st, 190S, when spirochietes were again found present in considerable numbers, and a few endo-globular forms were also found. Januari/ 2nd. Condition much the same, but the number of intra- corpuscular forms had increased. In fresh films a curious appearance was seen as if stationary but "rippling" parasites had surrounded a colourless nucleated cell (piobably an erythrocyte, which had lost its hasmoglobin), and had formed a kind of girdle round it. No further change was noticed though the blood was under observation for a long time. In lilood examined microscopically in a Nuttall's thermostat a spirochaste was distinctly seen to penetrate into a red cell, and to break up into four colourless, motionless short rods. No further change was noticed until the whole corpuscle shrunk and disintegrated. In blood kept sealed up under the cover glass for some time, and then smeared and stained, the appearances shown in Plate VI., fig. 2, were exhibited. In one corpuscle a large form is seen enclosing in its loop, portions of the extra- nuclear portion of the red cell, which is evidently becoming vacuolated. Prior to this I had thought these large forms were late stages in the history of what I fancied was a special parasite, but this indicated to me that the appearance was really due to the incorporated spirochiete, soon after its entry, having formed a loop before contracting and producing vacuolation of the red cell. In another corpuscle a spirochtete is seen attached at one end to what is either a solid spherical body or one of the protoplasmic balls described by Prowazek. About 5 c.c. of blood again inoculated subcutaneously into (ii) Fowl K, which had remained quite healthy and with normal blood. N.B. — Fowl K was found to be infected on December ith, when it showed a small numlier of spirochietes in its lilood, and eventually passed into the " after phase." Its history will be detailed. On this date {January %id) it was also noted that many of the spirochetes in the blood of Fowl I. were applied end to end. No clumps were seen. December 2n(l. All the free spirochaetes had again vanished and the number of intra- corpuscular forms had increased. By December 5th, the number of bodies had greatly increased, and by December 6th, appearances suggesting multiple infection were common. All this time, even after prolonged staining, and repeated and prolonged examination, no spirochaetes could be found, nor did they ever reappear in the peripheral blood. December 8th. On this day an enormous increase of the bodies was found. The bird was worse, and one eye had become inflamed, a condition which resulted in perforating ulcer of the cornea. After this the history is one of progressive anaemia and weakness without much change in the blood condition, until the bird died on January 15th, 1908, twenty-five days after being admitted witli spirochEetosis, and fifteen days after the commencement of the " after phase " i.e. the finding of intra-corpuscular spirochaetes. Smears were made from the lung, liver, spleen, and bone-marrow. The lung smears alone presented anything of special note, and here it was quite evident that the bodies had in many instances been discharged from the corpuscles, leaving large vacuoles in them. That this was the case was further evidenced by the large number of bodies broken up into granules. The appearance was that of a vacuole, with its edge staining a deep purple colour and its interior, if one can speak of the interior of a vacuole, being partly tilled with the granular debris of the central core of the parasite. What may have been free granules were also seen in the smears. Portions of the organs were prepared and kept embedded in paraffin, but these were most unfortunately all lost in the fire on May 11th. SPIROCHETOSIS OF SUDANESE FOWLS 57 Case III. — Fowl K. Young healthy bird. December 26th. Inoculated, as noted, with negative results, with post-critical blood of Fowl I. January 1st, 1908. Again inoculated with l)lood of Fowl I. containing spirochaetes both free and intra- corpuscular. January ith. E^ound infected with free forms of spirochtete only. January bth. No free spirochgBtes could be found, but in one tihu two undoubted intra-corpuscular forms were found. Bird seemed well. Weight, 940 grams. Tempera- ture, 107-7° F. January 1th. Neither form of spirochsete found to-day, despite a long search and heavy staining. January 8th. Temperature 108-6° F. Very interesting specimens. In the fresh blood, at room temperature, a spirochsete was seen to enter a corpuscle, but tlie formation of the intra-corpuscular form was not observed. In fresh blood, kept in the thermostat at the fowl's temperature, a spirochaete was distinctly seen coiled up at one end of a corpuscle and evidently in the process of forming one of the endo-globular bodies. The spirochsetes had therefore recurred. A well marked ribbon form, with chromatin dots, a break in the middle and filiform extremities was seen. There were numerous " tangles " in which the chromatin dots in the central cores were very evident. January 9th. The appearances were the same. 5 c.c. of citrated blood were inoculated into (a) Fowl L, wliich iippeared to be healthy. On January llth this bird showed a few intra-corpuscular forms, but as it had never shown spirochiBtes it is probable that the bird had not been a clean one, i e. had been recovering from a spirochtete infection, and that the bodies had been missed. This shows one of the difficulties attending the work in a place where, though the disease is common, the infection may be very slight, especially towards recovery from the " after phase." Fowl K never became very ill. It had the disease in a mild form, though it presented a good many intra-corpuscular forms in its blood. Nothing of special note was observed till January 18th, when a great diminution in the number of the bodies was found. This continued. On January 26tli, scarcely any could be found. Weight 820 grams. By March 2%ul, the bird had become strong and well, and weighed 995 grams. On Ajml 15th, it was again inoculated with the blood of a fowl suffering from severe acute spirochaetosis, but it proved immune, although on one occasion — on April 20th — a single intra- corpuscular form was noticed. As it is far more common to get birds in the "after phase" than when they have spirocheetes in the blood, and as the latter condition can, as mentioned, be leadily prevented and cured, experiments were begun to find if the exhibition of 'Orsudan' could save birds suffering from a severe "after phase." Unfortunately the work, which had not advanced very far, was interrupted by the fire, and there is no use detailing the few cases treated. One point only may be mentioned, that the 'Orsudan' seemed to stimulate the leucocytes to phagocytic action, for what seemed to be intra-corpuscular forms were found in the mononuclears. Mention has been made of a similar condition in geese. I believe it is due to the same spirochiEte. At least the disease runs a similar course, though in goslings tender feet and paresis or paralysis of the legs is a marked symptom. We know that geese can be infected with Sp. gallinarum, and the fact that geese, after showing free spirochaetes in the blood, exhibited the same intra-corpuscular bodies as the fowls, helped me to the ultimate diagnosis. One is inclined to doubt the existence of a special Sp. anscrtna, and it is worth noting Trealinenl of " after phase ' The disease in geese W SPIKOCH.ETOSIS OP SUDANESE FOWLS that ill a gosling dead of the disease I found in tlie spleen a caseous nodule similar to the caseous yellow granulations described in the livers of geese which have succumbed to the attack of Sj;. anserina. There is probably one special avian spirocha3te for domestic birds at least, which was first named Sp. gallinarum. I do not think I can claim to have found a new species in the Sudan spirochtete, solely on account of its great tendency to cell-parasitism. This is certainly much more marked than in Prowazek's cases, but may perhaps be explained by the different breed of fowls or the different climatic conditions. It may have something to do with changes undergone in the tick.' I regard this " after phase " as a definite stage in the life-history of the parasite. As Prowazek says, it may be a true resting stage, and I am inclined to think that it provides for re-infection. The tiny granules into which the intra-oorpuscular forms break up may possibly be of a " spore " nature, and play a part in the lung, where, as noted, they are most commonly found. Breinl's hypothesis mentioned in the Eeview Supplement (jMge 191) is interesting in this connection, but at present little definite can be said, and owing to the minute size of the granules it will be a matter of extreme difficulty to find out what becomes of them. I had hoped by an examination of sections to determine something regarding them, but the tissues were lost. After the fire, however, the tissues of one fowl with a small intra-corpuscular infection were secured, and Dr. Wenyon kindly examined them for me at the London School, fixing and staining in block by Levaditi's method.- The sections, unfortunately, yielded no information. As regards the season of the year when spirochsetosis is most common, I can give no opinion. It seems to occur all the year round. At any time almost, birds in the "after phase" can be found in the market at Khartoum, but it is not easy to pick up a bird with the free forms in its blood, or one with a large infection at the intra-corpuscular stage. That the condition is one of great importance there can be no doubt, in a country where there is a large trade in fowls, and where these birds and their eggs form specially valuable articles of diet, as, indeed, is the case iu most tropical countries. There is no evidence of any human disease lieing associated with the condition in fowls. I am indebted to Dr. Beam for the excellent photographs of the sick birds, and to Dr. Wenyon and Captain Olver for kindly discussing the matter with me. Professor Laveran and others also were good enough to take an interest in the subject, while, as stated. Dr. Sambon recognised the true nature of the condition before I had got together all my proofs, and while I was still in some doubt as to its precise significance. RouTiNK Work The following is a list of the various examinations conducted in the bacteriological laboratory since the last list was compiled for the Second Report. All entomological examinations and reports on plant diseases have been performed by Mr. King and are not included. The period of work covered is twenty months : — • ((/) Morbid secretions and exertions ... ... ... 28 (//) Blood 253 ((■) Bacteriological apart from (a) ... ... ... ... 48 ' .\ recent paper iu the Journal of Tropical Medicine and Hi/yiene (AugiLst 1st, 1908), meutious the discovery (if fowl spirochfetusis by Galli-Valerio in Tunis, and suggests that the North African disease is distinct from that met with in Brazil and is due to a different species of spiroclu-pto. f4alli-Valerio believes the Tunisian spirocbietosis to be the same as that found in the Anglo-Egyptian Sudan. = Levaditi, C (October-November, 190G1, " Les Nouvelles Rechercbes sur I'fitiologie et la P.athologie cxperimentale de la Syphilis." Folia /iwmaloloyira. Nos. IU and 11. MISCELLANEOUS NOTES 59 ((/) Parasites apart from ((/) and (/>) ... ... 19 ((') New growths ... ... ... ... ... ... 16 (/) Other pathological conditions ... ... ... ... 2G ((/) Medico-legal ... ... ... ... ... ... 2 Space does not permit of any detailed reference to the various conditions encountered, and in any case only a few were of special interest, and these for the most part have received notice in the Review Supplement. Miscellaneous Notes Captain P. E. Vaughan has again been good enough to send blood slides from various Haiiei-iiiia species of animal in the Bahr-El-Ghazal Province. Halteridia have been found in the bloods of the following birds which have been kindly identified for me by Mr. A. L. Butler from skins or descriptions sent him by Captain Vaughan : — iSerinuK Icterux (Bonn et Vieill.). Counnon yellow-fronted Serin. Neaphron Monachuf: (Teuun). Brown Scavenger Vulture. Trarhi/plwnns Anmudi (Des Murs). Arnaud's Spotted Barbet (very probably). Hii-nitdo ^thiopicn (Blauf). Abyssinian Swallow (probably). Buho Cinerascenus (Guerin). Grey Eagle Owl. Merops Nubicus (Gur.). Nvrbian Bee-eater. Turtur Auritus. Turtle Dove. A large number of blood smears from different kinds of mammals, both herbivora and carnivora, such as the elephant, buffalo, many kinds of antelope, wart-hog, etc., have been examined, but in none of them were any parasites or any pathological conditions found. This is somewhat remarkable, as the majority come from a trypanosomiasis region haunted Trypanosomes by tsetse flies. As regards the antelopes it may be, as Captain Olver thinks, that though ''" 'g ga"T= trypanosomes are not to be found in the peripheral blood, encysted or latent forms will be found in smears from the internal organs, notably the spleen and liver. This is a matter of considerable interest for, as is well known, the relationship of the large game of Africa to trypanosomiasis remains a somewhat vexed question, and on its determination important issues may depend. As regards reptiles, the blood of Bafo regularis, the common toad in Khartoum, was Blood found to harbour in many cases both a trypanosome and a hajmogregariue. Both, I think, {he common have been previously described, the former being T. rotatoriuiii (Mayer). As regards the Khartoum latter I have been unable to trace the reference, but a very similar form has been noticed in the Algerian toad.' The trypanosome in Khartoum toads has only been found in two of its forms, though three are known to exist in the blood of this toad, and, indeed, have been found by Wenyon in the Sudan. The third is a much longer form than those shown in Plate III., fig. 2, which is inserted to demonstrate the difference between reptilian and mammalian trypanosomes, and to contrast the haemogregarine of the toad with those of snakes and lizards («;'rfe Plate III., fig. 1). In the stained blood films of toad's blood, one has often found the corpuscular nucleus in infected erythrocytes curiously displaced, sometimes lying almost at right angles to the long axis of the cell, and consequently superimposed upon the contained parasite. This condition is, in all probability, caused by blood changes, induced by the method of preparation, but it seems worth noting as one has seen no reference to it elsewhere, and the appearance is sufficiently striking. ' There is a mention of what is probably the same parasite in the Aniinh nf Tfti,i,;d Meilie.me and I'amsilologij (Noveinl)er, 1907), Vol. I., No. 03. Sanitaky Notes. Khartoum By the D I k e f t o k Historical. — It is ahvays instructive, as well as interesting, to trace the sanitary history of any town or locality, and this is especially the case in the Tropics, where, of late years, conditions have rapidly altered in many places owing to increase of knowledge and the recognition of the primary importance of proper and adequate sanitary measures. In tlie Second Report of these Laboratories, the remarks of Schweinfurth, regarding the prevalence of malaria in old Khartoum, were quoted and commented upon. On this occasion one has gone fui'ther atield. Khartoum is not an ancient city, and in the past the literature dealing with it, save that of a military nature, has not Ijeen extensive It would appear that the town itself was founded Ijy Mohammed Ali, somewhere aliout 1830. No doubt prior to this date there had been habitations — fishermen's huts and such like — on the site later occupied by the town, but the latter may be said to date from about 1830, when a fortified camp was established on the land between the two Niles. In 1839, the Governor, Khursed Pasha, taught the Khartoumers how to make and use bricks for building purposes and persuaded them to give up tlieir huts of skin and reeds.' By 1846, Khartoum had become a place of considerable importance. Petherick,'-' who visited it then for the first time, speaks of an agreeable stay which he made there in March, but notes the low-lying situation, the danger of inundations, and the consequent necessity for embank- ments. He also testifies to the irregular construction of the town, and the jDresence of narrow and tortuous streets. Otherwise he does not comment upon its sanitary or insanitary condition. At that time there were only five European residents, apart from the few Roman Catholic missionaries. In 1860, this number had increased to twenty-five. Petherick mentions the rainy season, but adds that there are usually only two or three heavy falls of rain during the summer, and that the sandy soil soon absorbs the water. Meiiys visit. In 1850, George Melly,' an enterprising Liverpool man, and his family, penetrated as far as '^5° Khartoum. In the work edited by his son we read of the town possessing about 3000 houses and a population of 30,000. There was a large garrison -10,000 infantry and 2000 cavalry. There were no wide thoroughfares, though here and there a space resembling a square could be encountered.^ The climate, it is noted, was pleasant in December, and it is interesting to learn that figs, bananas, pomegranates, and "cream fruit" were grown in the gardens together with grapes and oranges. How few of these are obtainable at the present time ! The archi- tecture of the houses was primitive, and the streets are stated to be quite impassable after rain in the summer season, so much so that " no one attempts to quit his dwelhng during a rainfall." Melly actually brought tinned salmon with him, supplied by Messrs. Fortnum and Mason, and produced it at a dinner with great success. Sir Samuel Sir Samuel Baker, ■ however, is the first to give us some idea of Khartoum from a sanitary Baker's first standpoint. He visited it in 1862, and descrilres it as a miserable, filthy, and unhealthy spot. visit, 1862 < J ' J I The houses were chiefly built of unburnt brick, the town was densely crowded with a population of 30,000. It possessed neither drains nor cesspools, its streets were redolent with nuisances, and dead animals were allowed to He about in them. On his return to Khartoum after his Nile voyage he found malignant typhus raging. Out of 4000 black troops, only 400 remained alive, and he again speaks with disgust of the filthy and crowded alleys. ' Gleichen, Count (1905), "The Anglo-Egyptian Sudan." 2 Petherick, .J. (1S4()), ■' Egypt, the Sudan, and Central Africa." ' Melly, G. (18-51), " Khartoum and the Blue and White Niles." ' Its wide streets, planted with trees, and tine open spaces constitute one of the features of modern Kliartoum, thanks largely to the zeal and energy of its Governor, Colonel E. A. Stanton. ■ Baker, Sir S. W. (1867), " Albert Nyanza." SANITAIIY NOTES. KHAKTOUM 61 In 1870 ' he found the population hail fallen to about 15,000, but otherwise the town remained unchanged. In October he speaks of it as a hateful spot. " Nothing," he says, " can ^" •'^•""">-'' . ^ ^ f^' J ' Baker's second exceed its misery at this season." He again alludes to the absence of drainage, the presence visit, 1870 of mud, the dense population, proliably in reference to crowded dwi'llings, for it had diminished one half, and above all to the "exaggerated stench." "These," he remarks, "have vanquished the European settlers." " No wonder ! " we are inclined to say, and pause a moment to comment on the evil effects of the overcrowding. Jennings- has recently written of the terribly insanitary conditions of the towns in Abyssinia at the present day, where " the inhabitants could not survive at all but for the merciful dealings of a tropical sunhght, which can well-nigh convert the smell of a pole-cat into the aroma of a nosegay." Now the same, or even a mightier sun, is and was operative at Khartoum, and there can be no doubt that it was in some measure the overcrowding which led to such dire effects resulting from insanitary surroundings. Moreover, one must distinguish between sun plus dryness, and sun plus moisture, as will be seen when we come to deal with prevailing conditions. Our next and last author is Felkin,-' a medical man who was at old Khartoum in 1880, Feikin's visit, and remarks : " I noticed a great difference in Khartoum since my first visit eighteen months ' ° previously. The sanitary arrangements were in much better condition, but it is a great mistake that the town is built on its present site. As it lies on low ground at the junction of the Blue and White Niles, in the Khai'if a great part is inundated ; on the other side of the Blue Nile there is much higher ground, and the town if j^laced there would naturally have been more salubrious. In spite of these disadvantages it is rapidly improving, the grand Government buildings were nearly finished, many good houses and a large hospital are being built, while shops of a better class are already opened." So much for the past, and the city which was swept out of existence l)y the Mahdi and the Klialifa. Let us very briefly consider the sanitary problems presented by that new Khartoum which has arisen on the ruins of its predecessor, and has spread to that northern bank of the Blue Nile which Felkin quite correctly believed to be a better site for the capital. Khartoum is situated on latitude 15° 29' North and is 1255 feet aliove the level of the Mediterranean, the figure for Khartoum North being 12f)9 feet. Site. —The main town, on the southern bank of the Blue Nile, is placed, according to Site Ward, in a fine high and healthy situation, l)Ut in reality on a bed of alluvium, part of which is below Nile level at full flood, and the banks of which are exposed to the scouring action of the river, which annually eats into them and carries masses of soil down stream. As a result this southern bank has had to be protected by a huge wall of masonry. If the Blue Nile were ever to reach its highest known level it would surmount its southern bank, and in the absence of preventive measures would flood the central part of the town, which lies in a hollow. To the south of this depression the ground rises very considerably, and spreads away to the bare treeless and wind-swept desert, which, while contributing to the healthiness of the city, furnishes the sand that in the haboub season sweeps upon the town and envelops it in a black or yellow mantle of acute discomfort. On the northern side of the Blue Nile the banks are bold and high, and here Khartoum Kiianoum North has been placed, with its railway station, stores, barracks, and large native settlement. ^""'' ' Baker, Sir S. W. (1874), -'Ismailia." - Jennings, Captain (1906), " With the Abyssinians in Somaliland." Journal of Tropical Medicine, p. G"2. » Wilson, C. T., and Felkin, B. W. (1880), " Uganda and the Egyptian Sudan." * Ward, .). (190.5), " Om- Sudan : its Pyramids and Progress." 62 SANITAKY NOTES. KHAKTOUM Population A glance at the map, page 75, will explain the general situation for all practical purposes. There can be no doubt that Pelkin's criticisms, from a sanitary standpoint, were fully justified, and his view as regards the new Khartoum is shared by many, including Sir Charles Watson, who served on General Gordon's staff. There may, however, have been good and weighty reasons for rebuilding the town on its old site, and it must be confessed that Khartoum North is a dusty spot. Still, had the whole town been on the northern bank, the southern could have been cultivated freely, without much risk of mosquito invasion, the outlook would have been pleasant, on green gardens, palm groves and dura fields, while the problem of sanitation — especially as regards water supply and sewage disposal — would have been greatly simplified. Now one has to cater for two towns instead of one, and two towns separated by a wide and often rapidly-flowing river. This same river too would to some extent have mitigated the dust nuisance produced by the southern haboubs, for the stretch of water has often a remarkable effect in diverting or aborting the lesser sand-stoimas. As regards the geology of the site, the alluvial deposit of clay and sand extends to a depth of about 70 feet, and is then replaced by a comparatively porous sandstone. Layers of this Nubian sandstone are found to a depth of some 300 feet, and in them occur beds of gravel, some of which are water-bearing. Strata of clay are said to seam tlie sandstone, but reliable evidence as to their presence is lacking. The surface soil for the most part consists of loose sand. Where this is absent or has been blown away by wind action, black-cotton soil is found, a soil very liable to cracks and fissures, some of which extend to a considerable depth. Thus the nest of a jerboa, containing two adults, was found 12 feet from the surface at a point immediately to the south of the Gordon College. The whole site of the town, as mentioned in the last Eeport, is honeycombed with shallow wells, there being now over 800. These will be considered in more detail when we come to the section dealing with water supply. PoimlaUon. — The calculated population for 1908 is — Ivhartoum 14,872 Khartoum North 21,672 Total 36,544 Meteoroloi^ical conditions Some actually place the population of Khartoum North, owing to the recent influx of natives, at 50.000, but I am certain this is an over-estimate. I believe 25,000 is nearer the mark than the figure given, and for Khartoum one works upon a basis of 16,000 in arranging for sanitary needs. Of this 16,000 I should say there are some 400 British (with the British regiment 1000), about 3000 other Europeans, mostly Greeks and Italians, the remainder being chiefly Egyptians, Copts, Syrians, Levantines (a coniprehensive term), Arabs, Sudanese (partly Arali, partly negro), and Nilotic negroes. There are as a rule about 3000 native troops — Egyptians and blacks — quartered both in Khartoum and Khartoum North. Owing to its geographical position and to the river trade, people are constantly coming and going, and hence, as previously stated, malaria infected persons frequently (Plate VII), and at times filaria infected individuals, are added to the number of inhabitants. Meteorological Conditions. —Throngh the kindness of the S.M.O. Khartoum, I am able to sulimit a table of meteorological conditions compiled by Sergeant Squire, E.A.M.C, attached E.A. The recording work for the Egyptian Survey Department has recently been taken over by the laboratories, and is under the charge of Mr. Goodson, Assistant Chemist. The following results give a very fair idea of the kind of climate enjoyed by Khartoum. Some of the later humidity figures were not worked out, but the mean may be taken at about 38 per cent. PLATE VII '.', <• I r» ^ R. D. Mdir Mai.ignant Malaria Amoeboid forms of parasite, one of which resembles a trypanosome in shape and in the arrangement of the chromatin Giemsa Stain X ^^^O "''"" SANITAllY NOTEH. KHAKTOUM 63 EXTUACTS FltOM Meteokoloqical Obsekvations takek at Khabtoum C a c _ u rt y c5 ca d d *S ^ a; rt El 11 -« OS l.r Rein.'irks > o s 11 s s 111 ■a |. " c. ° c. MM. " c. "C. 1902 July to December 39-0 •23-4 47 llG-4 — — S.S.E. & S.W. No records prior 1903 January to to July, 1902 July ■ ... 26-9 11-0 31 Nil 45-0 6-0 N.N.B. 1903 July to in in December 38-7 25-1 36 17-6 April January S.S.W. 1904 January to July ■ ... 31 -09 16-31 32-9 Nil 45-0 7-0 . N.N.E. 1904 July to iu iu December •39-10 25-16 41-7 34-5 April and Jlay December S.S.W. 1905 January to July " ... 32-8 14-8 36 Nil 45-5 8-3 N.N.E. lOO.T July to in in December 39-5 26-0 42 15-52 June December S.S.W. 190G January to July ' . . 31-81 14-39 — Nil 45-5 10-0 N.N.E. 1906 July to in in December 38-1 26-16 — 90-4 April and May January S.S.W. 1907 January to July " ... 33-19 15-92 — Nil 45-3 7-7 N.N.E. 1907 July to in in December 37-47 24-95 — 188-0' April January S.W.S. 1908 January 1 to middle } 30-5 13-85 — Nil — — N.N.E. of May J ' Note.— Iu 1907, August was the month in which most rain fell. The heaviest daily rainfall was on August 15th, and amounted to 45 mm. Prom aI)out the middle of November to the beginning of March, the climate as a rule is climate excellent, with the exception of occasional hot snaps, often occurring about the end of December or beginning of January, and high winds associated with dusty days in February. With these exceptions Khartoum enjoys bright sunshine, a dry heat tempered by cool breezes— occasionally too cool, perhaps— and comparatively cold nights. There is not, as a rule, however, that sudden change in temperature so liable to induce abdominal complaints and chills. On the whole, during these favoured months, the climate may be said to be equable. It will be seen that the lowest temperature in the year is usually recorded in January or December. Prom March onwards the temperature commences to rise, and attains its maximum in Rainfall April, May, or June. Prom the beginning of July to the end of September may be termed the rainy season proper, though a few showers may occur in May and June, and there may be a considerable fall in October. One has known a few drops of rain occur in March, but, as will be seen from the table, the raiu-gauge record for the first six months is invariably nil. The months of May, June, and July especially are, as a rule, made exceedingly unpleasant by the visit of sand-storms, which may turn day into night and night into a period of torment. i)i,si-sioni.s They usually sweep down upon the town from the south, and are sometimes followed by torrential rain and accompanied by thunder and lightning. They vary much in frequency and duration. Sometimes there may be three or four in the course of a week, at other times a week or ten days may elapse without any such disagreeable exhibition. They may last a few minutes or many hours. One of a peculiar type endured for 48 hours, nnd well-nigh rendered life unendurable. These haboubs have a marked effect on health conditions, as they tend to occur about nightfall, often ruin a night's rest, and may carry infected dust into food and drink, while the worry and annoyance to which they give rise, play no small part in producing that nervous irritability so characteristic of the Tropics. 64 SANITARY N(1TES. KHARTOUM Conditions modifying; the climate Mosquito work The rainfall, as will be noted, varies within considerable limits. In some years there are only a few heavy showers, in others, rain falls frequently over a period of several months, and the town, ill-prepared for such deluges, is repeatedly flooded, necessitating the construction of emergency trenches, and entailing considerable trouble and discomfort. At the same time rainy summers are usually cool summers, and thus bring their own compensation. The damp period of the year, such as it is, occurs in September and October, and it is at this time that hot unpleasant nights may be experienced. Otherwise the nights all through the summer are comparatively cool, although, of course, this is not the case inside houses, which have been heated by the sun all day until they resemble ovens. The cool night is experienced by sleeping on the flat roof of the house or well away from it on the ground. There can, I think, be Uttle doubt that proximity to the Nile modifies the climate of Khartoum, which is certainly slightly difl'erent from that of the desert villages to its immediate south. Doubtless also the presence of numerous gardens, plays a small part in adding humidity to the air and diminishing the temperature. On the whole, however, Khartoum possesses a desert climate with all its advantages, and though at certain periods distinctly trying and disagreeable, it cannot be termed unhealthy or relaxing. What ill effects it produces are to be attributed to its monotony and to the action of intense sunlight and heat on the nervous system, together with tlie irritation induced by the haboubs. These latter, indeed, to some extent, play the part that mosquitoes enact in other parts of tlie Tropics, that of keeping their unfortunate victims awake and miserable, and this leads us to the consideration of the — Mosqidtn Worl;. — On this occasion there is no need to enter much into detail regarding the mosquito brigade work in Khartoum. After nearly five years' experience we are in the position of knowing, with considerable accuracy, what can be accomplished in the way of mosquito reduction \v(n'k in Khartoum and Khartoum North by a brigade of seven native inspectors, controlled by a couple of British sanitary inspectors. One of these latter is responsible for Khartoum, the other for Khartoum North, while the steamers and boats are looked after by a special native inspector. It has been found that of the places liable to become infected, some 800 in all, these being for the most part wells, the number infected can be kept at from 3 to 4 per cent. In the suumier after heavy rain the number may rise to 7, 8 and even 10 per cent., but is quickly reduced. With the means at our disposal we have not been able to completely abolish the mosquito, but that insect is now distinctly rare in Khartoum, and is, as a rule, only represented by one species. Cider, fatigans. It is true that occasionally Strijuiiii/id fasciafa has re-appeared, but it has never gained a footing in the town. The same is true of the anopheline, Fijretiiphtinia custaUs, and as regards this mosquito a few notes may be of interest. It has recurred on several occasions, but only once did it establish itself for any time, and, as previously, its presence was associated with a snuxll outbreak of malaria. The facts are interesting. The mosquitoes, which bred out in river pools above and beyond the confines of the An oiitbreakof towu, acquired their infection from old and recrudescent malaria cases in the British Barracks. Several men sleeping near these cases in hospital developed a quartan infection. The next victims were three out of four boys, who, it was found, were accustomed to sleep under an electric light at the Gordon College Workshops — the building, be it noted, which is next the British Barracks on the west; following this a Government official was attacked, and about a week before he fell ill I saw, but failed to kill, a female Pyretophorus costalis in the house adjoining the one in which he lived. In all these cases the infection was quartan and locally acquired. The only other case, cropping up at the time and also quartan, was that of a cook at the Grand Hotel. With the destruction of the few larvae found, the small malaria !Y THE FALLING BlUE NiLE, OPPOSITE THE EASTERN SECTION OF KhARTOUM The presence of fish in these poois. as a rule, prevented mosquitoes breeding out in them Fig. 10.— Pools left by the falling Blue Nile in the Sandbank. East of the British Barracks. Khartoum AHopheliius bred out in some of these pools which did not contain fish old Khartoum I >erris a^ a liu \iciflc 66 SANITARY NOTES. KHAETOUM epidemic came to an end. Curiously enough, adult mosquitoes were never seen at the British Military Hospital, and the number present must have been very small. Very occasionally other species are introduced, probably by the steamers. These are mentioned by Mr. King (.see Report on Economic Entomology). There is still need for constant watchfulness, and it is worth remembering that both Mosquitoes in Sir Rudolph Baron von Slatin and Father Ohrwalder, of the Austrian Mission, testify to the fact that in the old days Khartoum was a perfect hot-bed of mosquito life. Indeed, the latter has stated that he has been driven to go and stand up to his neck in the Nile to escape the attacks of these voracious blood-suckers. In the Second Report one quoted Schweinfurth as to the prevalence of malaria, and it is remarkable in what very tiny collections of water Pi/retophonis cogtalis will breed. The smallest of puddles amongst the stones by the river-edge, so long as it lasts for any time (and this is often the case owing to percolation through the sand), will serve the purpose, and such places are very apt to be overlooked, A good motto for the brigade would be, " Do not put too much faith in the native inspector." If well watched and controlled he does admirably, being remarkably quick at detecting the smallest larva> ; Init he cannot be always trusted and must be supervised. A few experiments have been made in order to test the value of hcn-in iilii/iiKisii. as a larvicide. In carrying out these I had the assistance of Mr. King. The roots of the plant were kindly supplied by Dr. Power, of the Wellcome Chemical Research Laboratories in London, but efforts to obtain other species of the plants from Kew Gardens failed. The following are the details of the tests made. In all cases the water employed was that in which the larvu3 were found, and controls were instituted : — 1. November 4th, 1906. Three half-grown larvae of Ca/cj- fatUjanx placed at 1 p.m. in au emulsion consisting of 1 c.c. supernatant fluid from an alcoholic extract of Derris root (gm. 27 in 50 c.e.J in 150 c.c. of water. The emulsion smelt .strongly of the drug and was of an opaque colour. llcmilt. No immediate effect and no effect after half-an-hour. Condition that night not noted. All tiie larvse found dead on the morning of November 5th, 190G. 2. NuvcMiber 7th, 1906. Pour half-grown Culrj- fatiijnns larvae placed at 10.45 a.m. in 150 c.c. (jf water containing 5 c.c. of above fluid. Emulsion very opaque. liesall. No immediate effect. All dead iu one-and-a-half hours. 3. November 8th, 1906. Four half-grown C'a/c.i- fiitit/an.'; larvae placed at 11. .50 a.m. in 150 c.r. of water containing 1 c.c. of the shakcn-up Derris extracts, i.e. supernatant fluid and debris. Rcsall. No immediate effect beyond evidence of irritation, the larvae twisting and " Ijiting their tails." Two dead and the other two dying iu one hour. All dead in one-and-a-half hours. 4. November 21st, 1906. One lively Gidex fati'jans larva placed in a 5 per cent, filtered watery extract of Derris uliijliiosii, a dark reddish-brown liquid with a strong odour. The larvae died in 25 minutes. Eight lively half-grown Cu/e.t- fatii/rins larvae placed in 150 c.c. of water to which 1 c.c. of above watery extract added. No immediate effect. 5. November 25th, 1906. One lively Ciihr fiitiiiniis larva and one pupa placed iu a 2'5 per cent, watery extract as above. Result. Larva dead after twenty-oue hours; was alive after four hours. Pupa alive after twenty -four hours. 6. November 27th, 1906. No. 5 repeated with same result. 7. November 29th, 1906. Five lively Ciller fatu/ctus hirvie placed iu 1 per cent, watery extract of powdered Derris root. Rraull. Moribund .after two hours; all dead in three hours. 8. December 2nd, 1906. Pour active Cale.efatitjan!s larvse placed in a 0'5 per cent, watery extract as al)ove. Jieftull. No immediate effect. One found dead after four hours; others lively. All dead after twenty-two hours except one, which, however, died after forty-eight hours. 9. January 1st, 1907. Several larvffi of Cii.le.efit/i;/(rtis and one of I'yreldphnriis eo.^ln/i.i placed in a similar 0'5 per (^ent. watery extract at 11.20 a.m. Resii/t. All alive at 1.30 p.m. All dead the following morning. In order to see if the tannin in the Derris root had anything to do with its lethal action, two larvte and one pupa of Ciilc.e fatii/nii.'! were placed in a 1 per cent, watery extract of SANITARY NOTES. KHARTOUM G7 Acacia arahica bark. Uesidt : No effect in two hours. The pupa liatclied out and the hirvae were alive after twenty-seven hours, although the liquid was of a deep orange-red colour. A 10 per cent, watery extract proved fatal to two CuIpx fatigans larviE in twenty-one and twenty-three-and-a-half hours respectively. It is evident that in Dcrris ulujinoaa. we possess a larvicide of considerable potency, but, in the Sudan at least, the difficulty in obtaining Derris root prevents it being used. Moreover, Vogel, who has used the bark of the root of Derris elUptica, found that while in a strength of 100 milligrams to 5 grammes of water it killed larvaj in one day, it was also destructive to fish life. It would, therefore, appear that even in those regions where they are indigenous, the various species of Derris have only a limited use as larvicides. Of more general interest are the recommendations drawn up witli a view to the irrigaiion insertion of special clauses in all future irrigation concessions in order to aid in the ™" prevention of malaria. These are as follows : — 1. Irrigation channels should be constructed on a higlier level than the siirronnding land, so that when the How of water in them ceases they may drain dry. 2. They should be constructed of such material and in such manner as to prevent leakage. :!. Their banks and beds should be kept in good repair, and the beds even, to prevent the formation of pools. 4. " Dead ends " of irrigation channels should be reduced to the smallest size compatible with efficiency, so tliiit water will not stagnate in them. ."i. Vegetation should be periodically cleared out of tlie channels. 6. Sluices should be constructed so that tlien; is no leakage to form stagnant puddles. 7. Where jjossible, fish should be introduced, and kept in the main channels to destroy the tarva;. 5. Lands where water is apt to stand should have proper surface drainage. 9. Crops, such as sugar-cane, rice, and otliers which require to stand in wat(U', should not hi' gi-own witliin lialf a mile of any town or village. 1(1. If an engine or pump should happen to break down, particular care should Ije taken to deal with stagnant I)uols, and petroleum should be used where necessary. 11. Gases of malarial fever, and any prevalence of mosquitoes, should be uotilicd to the governor of tlie province by the manager of the concession. So far as Khartoum is concerned, these rules are followed out by the Manager of the Sudan Development and Exisloration Company at Khartoum North, and though there is a large area of land under cultivation there, it is very rarely that one has to complain of the presence of mosquito larv;B. This shows what can be accomplished by care and attention and a great deal is due to Mr. Harold Hall for his help and co-operation in safeguarding the town. Clotiiing. — One had intended making some remarks as regai'ds clothing, but perhaps i.lothing sufficient has been said on this subject in the Eeview. Whatever be the hygienic value of the damoor (native cotton) clothing, in such general use, it is certainly comfortable, light, fandy durable, and of a good appearance. Combined with black or orange underclothing, it would probably meet every requirement. In the Sudan, true " Solaro " garments seem to lose their colour quickly, and, so far as I know, have not proved a great success. Of more importance possibly is the question of Housing and House Construction. — .Vnd here I have been fortunate enough to receive tlie Housing; kind help of Mr. W. H. McLean. He has, at my request, written tlie following paper and ■""' '^""5'" ^ ... oil constructio prepared the plans illustrating it specially for this Report : — D W E L M N (i - H U U S E S IN THE T E P I I ' S (With special reference to the Sudan) By W. H. McLe.vn, A.Ct.T.O., assoc. m. inst. c.e., Lecturer on Civil EMiiNKKiiiNo, Gordon Colleoe, Khautoum, Municipal Enoinker, Kiiahtolm The suitable housing of white men in the Tropics is a matter of considerable importance. One of the greatest enemies of such men is the sun, and protection from its injurious etl'ecls is from lisht and heat 68 SANITAKY NOTES. KHAUTOUM necessary. It is known that exposure to an excessive amount of sunlight is harmful, causing ProteLtion nervous and other diseases ; the bhxck man is abeady sufficiently protected from the injurious light rays by the pigmentation of his skin, and he has, therefore, only to shield himself from the heat rays. The white man, on the other hand, must be protected from both the light and the heat rays, yet he is very often to be found living in houses in the Tropics which are obviously only suitable for temperate climates, and in which even a black man would feel uncomfortable. The native houses are generally well darkened, with only a few small openings, and they are often really healthier than the houses occupied by the white men. Eesidence in dark houses apjjears to be practically harmless. The early cave dwellers of Europe carried on the human species for millenniums in perfect healtli. The ancient Eomans understood the effects of light, and it was one of their axioms that " a man must protect himself from the rays of the sun." The Americans in the Philijipines seem to have neglected this, with disastrous results, and in this connection Major C. E. Woodruff, U.S.A.,' says that " The Spaniards who lived in the Philippines did not appreciate the dangers of light because they were brunettes and they made but little provision in their homes to escape the dangers. Blonde Teutons in India, on the other liand, see the necessity for this protection, and build great covered porches around their houses for this express purpose. As far as I have learned, Americans are falling into Spanish ways and making no provision to jirotect themselves from the fatal rays of light. American houses must have big verandahs whose roofs come well down. It is safe to say that there is not a residence house in the Philippine Islands fit for a blonde man to live in. I challenge contradiction of this violent statement. " The roof of a porch or verandah must come down so low that a person seated in the room cannot see the sky ; that is, the lower edge must be aliout four feet above the floor line, or approximate screens be built to that level." There are certain important points in connection witli a dwelling-house in the Tropics which ought to be borne in mind when either building or selecting a house. Site. — It is better that the house should not be in the midst of native huts, or near stagnant water. An elevated and dry site, on sloping ground Init not in a lioUow, should always be chosen if possible. Foundations. — On a sandy clay, such as is found on the banks of the river Nile, the foundation should be carried deep enough to avoid disturbance by the surface cracks. From I'OO to 2'00 metres is generally sufficient, and the maximum load on the foundation should not exceed one ton per square foot (1 kilo, per sq. centimetre). If the building is near the river edge this load ought to be somewhat reduced, or the foundation reinforced with steel, to prevent cracking of the walls caused by the rise and fall in the water level and the consequent unequal settlement. On a site liable to be flooded the ground floor should be at high flood level, and all walls should he substantially built up to that level, and a damp-proof course of bituminous sheeting or other material inserted. Walls. — In a dry locality, mud walls may be quite satisfactory, and they have the advantage in that they do not retain and radiate the heat like stone or brick walls. Where heavy rains are to he expected it is, of course, advisable to build in brick or stone. The ceilings need not be higher than 4-00 metres, which is sufficient for ventilation purposes. Masonry walls should be protected by verandahs from the direct rays of the sun, as, if not so protected, they will heat up during the day and radiate the heat all night. Ventilators in the walls near the roof are a great advantage, and they should be made to ' Woodruff, C. E., •■Tlu' Effects of Tropical Li^lit on White Men." London : Kebman, 1110.5. SANITAl'.Y N'OTKS. KHAKTOt'M 69 close in onlri' to keep out dust. Wimlow opiiiiin^s in wiill^; not jirotcctcil hv vcrandalis should be few anil small. Roofs. — All roofs must be ihiuk enough auil of a })i'oper niatenal to stop both tlic heat and the light rays. Eoofs of corrugated iron alone, or of boarding covered with some waterproof material, are not sufficient protection, liut if the underside of the joisting is wood lined, and an S e cPi. W. H McLi!». 5 M.r.ts Fic. 12 Figs. II and 12.— Designs for Dwelling-houses in the Tropics airspace left between, the result is more satisfactory. A common form of roof is of " zibla " (a mixture of stable manure and earth), which is laid on boarding or on straw matting and rope netting. This is quite satisfactory, especially it a wood ceiling lining is added, and the " zibla " is protected from the weather by a waterproof covering. Another common form is of rolled steel joists with brick jack-arching between, and covered with a waterproofing material. This appears to be one of the most satisfactory types ofiroofing. 70 SANITAHY NOTES. KHAKTOUM If constructed as a double roof, as shown in section, Fig. 11, it is of course by far the most desirable arrangement. The outer roof is of very light construction, and the air space between prevents any heat-rays passing through, and the light-rays are completely cut ofl'. Access to the roof should be given by an inside stairway, and the parapet walls raised, or screen walls built to provide sleeping accommodation. The disadvantage of the flat roof is the difficulty of keeping it watertight. In localities with a heavy rainfall the sloping roof is therefore jDreferable. Fig. 12 shows the cross-section of a wooden bungalow with a sloping roof, which is extended to form the verandahs on both sides. Verandahs. — These should be provided on all sides of the house, or at least on the sides subjected to the sun's rays. They should be not less than three metres wide, and constructed of timber if possible, which is cooler than masonry, as it does not retain the heat. They should come well down in front to a level at least half the height of the window openings, and it is recommended that they should even come down to within four feet from floor level. All verandahs should be ventilated on the roof near the ridge, and should have a ceiling lining with an air space between the joists, as shown in Fig. 11. The same figure also shows iiow the whole verandah may be enclosed by having a close boarded or lattice parapet and folding shutters above. Such a verandah, from which all hot air is excluded during the day, is sure to be very comfortable in the evening. Bathroom and Latrine. — The bathroom and latrine may be either detached from the house and approached by a separate verandah, or it may be a separate room of the house approached from the verandah. An outside latrine placed against a boundary wall to facili- tate cleansing, is the best arrangement where a conservancy system exists. Servants' Qiuirters. — The outhouses and servants' quarters should be well away from the house, but the kitchen might be placed somewhat nearer and connected to the house with a covered passage if possible. Colours. — The colour of the materials or of the paint, affects to some extent the coolness of the house. In this connection. Major Woodruff says that " the glare from white houses is very harmful. I have seen marked suffering in army posts before we abandoned the dangerous practice of painting everything white, and resorted to the colours found in nature to which our eyes are adjusted — the greens, dark yellows, and browns. It is a matter of common knowledge that, in a city, the glare from white houses is a great nuisance to the neighbours, and has been known to cause serious eye diseases. Hence, no white houses should be permitted in cities ; the red colour from the brick is bad enough, but the best colours are those above mentioned. In the Tropics these rules are doubly important, for the glare from the whitened walls is dreadful. " In addition, white lead is known to absorb the infra-red rays as well as lampblack, and consequently it is a ' warm ' paint in the sunshine, and will cause a tropical house to heat up." General. — When planning the house, care must be taken that so far as possible every room will get some share of the prevailing wind. The coolest houses are those wdth the rooms arranged round a central hall or courtyard, and those having two floors are generally preferable. Figs. 13 and 14 show plans of suggested arrangements. The house should be surrounded by a drain, and the water from the rain-water pipes should be carried well away from the house. Dr. W. J. Simpson ' recommends that there should also be a pavement all round, sloped away from the basement, or a gravel walk ; if the gravel is sharp it forms an obstacle to snakes. Beyond this, short grass is best, and all trees should be so far away as not to obstruct the ventilation or cause dampness. Any excavations ' ■• The Maintenance of Healtli in the Tropics." m W. H. 7iU:t.r.AS ^ IP -^■ Fig. 14 Figs. 13 and 14. Plans for Dwelling-houses in the Tropics SANITAKY NOTES. KHARTOUjr or depressions in the ground around or near the honso should he levelled iqi to prevent pools forniiug during the rains. Special door and window frames, covered with tine wire netting, should be ])rovided in localities infested b_y mosquitoes or other insects. .\11 windows must have outside sun-shutters with louvres. Woodwork should he protected from the attacks of white ants hy painting with any of the special preservatives now on the market. The foregoing are merely general rules and suggestions ; the actual type, of house l)est suited to any given locality will depend upon the conditions obtaining and the materials available. I '•illtlllllcil BY THE DiKECTOR (■()iiserv;iiu V Coiificrvancy. — Under this heading we consider 1. Sewage collection and disposal. '2. Waste water collection and disposal. 3. Eefuse collection and disposal. 1. The bucket system is in vogue, hut, owing to the customs of the majority of the inhabitants, one cannot speak of a dry earth system. At first Khartoum was served by the ordinai-y pattern of latrine bucket, Fig. 15, the Crowley cart, Fig. 17, and a system of deep trenches. One need scarcely enlarge on the abominations and danger of the so-called " ironclad." The bucket is emptied into it, and often on and over it, so that very frequently streams of filth travel dow-n the back of the receptacle and drip upon the ground. This insanitary juggernaut pursues its way, suiTouuded by a cohort of flies, and emitting a disgusting stench. Its contents, too, often splash and slop over, the cover being rarely closed by (K.wiey cans the careless native, and, when closed, being of httle use to prevent leakage. Occasionally the receptacle tilts, turns upside down, and discharges its contents upon the public thoroughfare. TllL- 1,1(1 nielhod I.atiine liuckets. type Fig 15.— Sanitary Pails. Khartoum On the left, the old type, now abandoned In the centre and on the right, the new tyre, with air-tight cover In wet weather it was not uncommon for several carts to stick fast in the nuid or in the heavy stmd outside tlie town, so that, in despair, one had to oi'der the contents to be buried on the spot. I wonder how many of the inhabitants ever saw a Crowley cart emptied at the trenches ! It was an instructive sight. The sides of the trench became fouled, the cart became more fouled than before, and the men became fouled in many cases. Then this uncleanly vehicle. SANMTAUY NOTES. KHARTOT'M 73 He is fined if such buckets be They are not too heavy, although The new method liali' scraped out, went ndliiij;- biick to town foi' another load. It is vvtdl-nigb inipossibli^ to keep these carts clean, and utterly impossible to work them in a sanitary manner. Worse than all, the buckets, after beint; emptied into them, were cleaned on the spot, cleaned (save the mark !) with a pot brush and a handful of dry sand. This was going on m Khartoum day in and day out, and the surface soil was becoming more and more contaminated. Thanks to the powerful sun, even this insanitary state of matters did not seem to be prejudicial to health ; but one maintained that, given a wet summer, its effects would be speedily apparent. Such a summer occurred before there had lieen time to get the new system into working order, and the result was an epidemic of dysentery, not veiy severe perhaps, but sufficiently annoying, the cause of considerable distress, and incapacitating a considerable number of people for work. After carefully considering the condition of things in Khartoum, it was resolved to abolish the Crowley cart and to substitute a system whereby the bucket, and its contents, properly fitted with an air-tight lid, could be removed and carried to the place of ultimate disposal, its place being taken by a clean pail. The dirty bucket could then be thoroughly cleaned at a spot well away from the town and returned to take the place of the one in use. At the same time it was resolved to do away with the old brick latrines, which were built on a very bad principle, were unsightly, liable to become flooded, and had, in most cases, fallen into disrepair, so that they could not be kept clean. A glance at the map, ])« Ground S ECTION A.B Scale- Ins /2 o I , I I I J I I L loFt J Fig. 20.— Useful Type oi- iNLiNEKATOk. modified after Mokkus 80 SAXITAKV NOTKS. KHAKTOl'M The closed metal tank has not yet had a fair trial, and it is evident that the results will have to he controlled and tested hy chemical and hacteriological analyses. In any case, the scheme is likely to furnish useful information against the day when a w^ater-carriage system and proper biological tanks ai'e in existence. At Khartoum North trenching alone is in vogue. The soil here, a good sandy loam, is very suitable, and the quantity of sewage to be dealt with is much smaller. The trenches are now not in the best position, though at the time the land was chosen no fault could be found with it. The extension of the town, however, necessitated by the important work on the Nile Bridge, has altered matters. It is hoped to carry the tramway system further out into the desert. At the same time, beyond occasional nuisance caused by unpleasant odours borne by the north winds, these trenches have not caused any trouble or illness, so far as can be ascertained. Though both towns are now well served by public latrines, it has been found impossible to prevent the native easing himself wherever and whenever possible. He takes advantage of the least bit of cover, and the nuisance is specially prevalent after darkness has set in. Apart from the breeding facilities afforded to flies by the scattered masses of human excrement, the river bed at low Nile gets badly fouled, and though during the dry season little danger is to be apprehended, the outlook is different with a rapidly rising river and with the advent of rain. Moreover, at Khartoum North the increase of the native population has been so great that one cannot hope to meet its requirements by going on building large latrines. The people live in huts and tukls, and though they keep their villages wonderfully clean, the surrounding desert soon becomes an insanitary area. It was evident that the only way to cope with this state of thnigs was to erect small incinerators. The type adopted is shown in the plan. Pig. 20, and is a modification of that recommended bv Morris.' Sweepers are employed to clean the ground. The material, if necessary, is dried in the sun, and is then Ijurned, a little oil being used as fuel. So far only two incinerators have been erected, one at Khartoum and one at Khartoum North. They have been found to act well, to cause no nuisance, and they are cheap. It is hoped to increase their number next year. I understand that the Sudan Medical Department intends to follow suit, and to deal with the excreta from the long line of native villages to the south of Khartoum on this principle. This will certainly prove an advantage, as during the haboub season the insanitary condition of the ground near these "daims," as they are called, was, I think, a source of danger to the town. It is in India that tliis system has been chiefly advocated and adopted. Hamilton '^ deals with the use of small incinerators for cantonments, and their form has been elaborated by Haines,'' who introduced the boilers for urine, and who states that the secret of avoiding smell is to have a good filtering layer of rubbish on the top of the material to be consumed.^ The pail system is admittedly on the plan adopted long ago at Singapore and elsewhere. Last year several interesting papers appeared on this subject, and we specially note those from Burma, where it is termed the " Bassein " system. There are some points of comparison between the Burmese and Khartoum methods which call for notice. Entrican "• describes liis district conservancy in detail. The l)uckets have a lid of this shape n. ■ — ^ ^ whicli is pushed down inside the j)ail and seals it effectually. I fear the raised edge would speedily ' Morris, W. A-. (October, 1907), •' Incinerators in Cantonments." Indian Medical Gazette. - Hamilton, H. l.\pril, 1907), "Small Incinerators." Itnd. » Haines, H. A. (.June, 1907). Ibul. ' Otlier references to this system will be found in tlie Indian Medical Gazette for .July. November, HIOS. and in the Journal of the Roijal Aniii/ Medical Coi/is for September, 1908. • Entrican, .1. (February, 1907), " Some Notes on the Conservancy of the Smaller Towns in Burma." Indian Medical Gasette. 2^ Odugc Galv ttjrrugaled Sheeting T.mbcr Latt.. 24 Gauge Galv Corrugated Sheeting 2i'«"2;f:iL All Stanch. ons S-'S R S J rCopC b'' * to form Gurter __J c»-«9-«*/(. Plate t.LE V ATI ON 5e.cti or n-« ♦ o- — ►fc Entrance ( . . -4 i M e r o D O' o: L bupporlmg seat to be on thii side of stanchions Storage for spare buckets Buckets femotfcd-fron • nside -.6"o" D Q^ O O Women I --.J9- — i Timber Doo' 1---!:^ ,-!- — ^ r" — " \ I y.:SJ 2)^all lo Centre 2 Fall totentre /'^zili; I wH ^, rv -^ cem4n>^rendered JT^;3^ •tZJ— lU H- -!L PLAr Plan of FouNDATlO^ Irm2 6 I 1 I — I - 3cale lO FiG 2 1. — Elevation , Section and Plans of Public Latrine. Khartoum 82 SANITARY NOTES. KHAETOUII become bent in Khartoum, rendering the cover useless. I am inchned to think our tvpe of liil, tliougb more expensive, is preferable, although the rublier does get cut through at times and the clips become damaged. Otherwise the schemes seem very similar, though no light railway is employed by Entrican. This, however, is the case at Bassein, where such is in use, fitted with turn-tables. Here also they have a plan of painting one set of buckets w'ith a red band, the other with a Ijlack band. This is to ensure that the cleaners change the buckets properly. Thus, on one day red-banded buckets will be in use, on the succeeding day black-banded, and so on. The adoption of this principle has been considered for Khartoum, but we have such a large number of buckets, and the work is so arranged that it would not be easy to carry it out. One prefers to rely on constant inspection and the infliction of heavy ])enalties for faulty work. Entrican has wood ashes, oi' sawdu-it, placed in the clean buckets. These substances are light, absorbent, and prevent splashing. They are not easily obtained in Khartoum, and would pi'esent no advantages, besides being undesirable for the tanking process. One has, however, advocated the substitution of the dry sand by a little petroleum, which prevents smell, keeps away flies, and lessens the weight to be carted. The number of sand users is small, but J have not been able to introduce the petroleum system so far, as it entails slight extra expense and trouble on the part of the householder, and for some aesthetic reason the Governor was opposed to it. Its only real disadvantage is the risk of splashing at the time the pail is in use. Special sweepers' quarters are advocated ; from experience I know this to be advisable. They exist in Khartoum, and efforts will be made to house the cleaners at Khartoum North. Entrican recommends one acre to every 109 inhabitants, but then Burma has a moist climate and a heavy rainfall. At Khartoum we have one acre for every 2000 people, and so far this allowance has proved sufficient. At Khartoum North we can get as much land as we require. No land is trenched a second time without being cropped — a wise provision. He allows one public latrine seat for every 60 inhabitants. This seems a liljeral allowance, but much depends on the habits of the population, and on the number of private closets. Several clearances of buckets in the day have to be carried out. In Khartoum double clearances are required for the civil and military hospitals, the quarters of the public works departments, and, in the winter season, the hotels. There are a few interesting notes regarding public latrines. As flooring, railway cinders are used, and this is declared to be much better than cement. Sand is also advocated, but is said not to be so good. In Khartoum I do not think a sufficient supply of railway cinders could be obtained, and, both as regards this and sand, the carting away of the fouled floor and its replacement w'ould entail considerable expense. No water is used in cleaning the latrines, the seats being rubbed down with dry sand. I have not tried this procedure, but it would seem to have some advantages. The use of lamps at night in the latrines is strongly advocated as a means of making them more popular and preventing natives going to earth in any convenient spot. This has every- thing to recommend it. Hamilton, already quoted, finds that a mixture of one part kerosine, one part tar, and four parts mud mortar makes a good latrine floor. If desired, crude carbolic, under 4 per cent, strength, can be added as a deodorant and disinfectant. Wastewater 2. Waste Water Collection and Disposal. — The term "waste water" includes bath, kitchen, and scullery efHuents, bedroom slops, urine, storm waters and the waste waters derived fi'om mineral water factories, shop washings, and so on. The question is a serious one, for as soon as an ample water supply is an accomplished fact this waste water wnll greatly increase in volume. In the case of the British Barracks, it is SANITARY NOTES. KHARTOUIM 83 Refuse removed twice daily in Crowley carts and discharged upon the desert, about one and a half miles to the south of the town. In the case of the Gordon College, a system of surface irrigation has been devised, and this, on a less elaborate scale, is operative at the Grand Hotel, both of these buildings liaving extensive grounds under cultivation. Elsewhere, for the most part, waste water is simply thrown out upon the streets or into the yards. This is an insanitary proceeding and may at times give rise to danger. We know, for instance, that urine may contain the bacilli of typhoid fever, Malta fever and tuberculosis. Schemes have been proposed for dealing with the waste water by means of surface drainage, but the difficulties, owing to the lack of proper fall, appear to be insuperable. Where a large volume of waste water has to be dealt with it will be necessary to provide cemented, covered pits, and remove the contents by a cart to which a pump and hose are affixed. All this is very undesirable, tor it is difficult to get a water-tight pit constructed, and such places tend to serve as mosquito breeding-places ; but it appears unavoidable until a water-carriage system is installed. The water collected could be discharged into the septic tanks. 3. Collection and Disposal of Be/use. The Sanitary Service is only responsible for the removal of refuse from the town and its final disposal. Metal dust-bins are provided for the reception of road sweepings. It is collected, usually along with a great quantity of sand, by the town carts, which bring it to the conservancy collecting station. There it is discharged into large trollies and drawn out to the trenching-ground, where a two-celled destructor of a simple pattern has been erected. The refuse is for the most part light, dry, and inoffensive, consisting of straw, stable debris, paper, rags, old tins and broken bottles. It does not yield a useful slag, but provides plenty of heat for the boilers. To prevent so much sand being collected, the carters have been supplied with hand riddles, but it is difficult to get them to use these as frequently as they should. Dead animals are removed beyond the confines of the town and left to the vultures, which speedily pick them clean. An effort is to be made to cremate these carcases in the destructor now that the latter possesses an additional cell. Water Supply. — The whole question of the future water supply for Khartoum is still sub Water supply jtulice, and I have no desire here to enter into the realms of controversy. Hence this section will be dealt with very briefly. In the first place, we will consider the present system, and then deal with the proposed improved supply from a bacteriological standpoint. Dr. Beam deals with it from the chemical. At present, then, as in the past, the town mainly derives its water directly from the Blue Nile. This river varies greatly at different seasons of the year. In the summer and early autumn it is fully a quarter of a mile in width, possesses a rapid current and is laden with silt. Its waters are then turbid and carry a large quantity of suspended matter. In the winter and early spring it shrinks very considerably, so much so that its deptli becomes insignificant and many sand banks appear. Of late years, during the months of April and May, more than half its bed has been dry. The current becomes sluggish, and this year the so-called "green water," due to the abundant growth of a species of Alga, Fig. 22, has made its appearance. The chemical composition of Blue Nile water has been the Blue Nile subject of study by Dr. Beam (vide Eeport of the Chemical Section, Second and Third Eeports). ^^'"'' Bacteriological examinations have been conducted in the course of the present year, samples being taken close to the bank and from the middle of the stream opposite the site of the water- works at Burrfe, and also by Mr. Archibald from the middle of the river opposite the Gordon College. Unfortunately, some of the results were lost in the fire, and one cannot give full details. One knows, however, that in the month of January, 1907, the number of organisms in 1 c.e. of the water taken close to the hank above the town was between 300 and 400 (agar count at 37° C, 48 hours incubation), while in a sample taken from the centre of the stream at Burre in February, 77 organisms were found per 1 c.c. In May, a 84 SANITARY NOTES. KHARTOUM Method of supply Shallow wells sample taken from mid-stream, opposite the Gordon College, gave 84 organisms per 1 c.c. Water taken from near the bank contained excretal (" Flaginac"), B. coli, in 1 c.c, while this organism was present in 5 c.c. in water from mid-stream, but was not found in 0-02 c.c, O'l c.c. and 1 c.c. of such water. At present the water is collected anywhere along the banks. It is baled by the water porters into canvas sacks, carried by donkeys, and is then distributed throughout the town. Nearly every household possesses zeers, large earthenware filter jars, into which the water is put, and the clear filtrate is used for drinking and other domestic purposes. Water for the troops is collected at a special place above the town, and, as far as possible, the water porters are made to take their samples up-stream, but it is impossible to exercise any special 1000 ifinm. Deep wells at I'une Fj^. 2':;. — Form of Alfta oausinft " fereen water" m the Blue Nile control in this direction when some three miles of foreshore on each bank have to be watched, and the control has to be-committed in large measure to the Egyptian police, who are practically useless for sanitary purposes. Care is taken to prevent water being taken from pools at low Nile. The river water is very palatable, and as long as the river is not stagnant it does not, despite statements to the contrary, appear to be a cause of communicable disease, largely, I believe, because enteric fever is rare, because the bulk of water is very great, because saprophytic organisms successfully combat the pathogenic, and because most of those who drink unfiltered and unboiled Nile water are not very susceptible to such disease conditions. At the same time, it is baeteriologically impure, and it is a very disquieting fact that the town has still to rely chiefly on a supply which is readily open to contamination in the presence of an epidemic of cholera, enteric fever or dysentery. Moreover, the method of supply leaves much to be desired, and would have been improved ere this, but that the new works were begun nearly four years ago, and one has lived in hopes of seeing the new supply supersede the old. So far these hopes have not been realised. Water is also obtained from the numerous shallow wells, but such water, which is always impure from a bacteriological and chemical standpoint, and is usually hard, is not generally employed for drinking purposes. It is used for washing, cooking, irrigating gardens aud watering animals. It is sufficient to say that, as a rule, B. coli of a " flaginac and excretal " type is often present in so small a quantity as 0"02 c.c. In a few cases the drinking of such shallow well-water appears to have induced dysentery, and in one instance this was associated with tlie presence of Bacillus pyocyaneus. The relation of the level of the water in these wells to that of the Blue Nile is a very interesting subject, which is now being studied. Charts are being prepared by tlie Irrigation Department, and Mr. Drummond, of the Gordon College, has kindly collected some data as regards the village wells at. Burr6. The work, however, is not yet complete, so that it is not desirable to tabulate it at present. The proposed supply is to be derived from a chain of seven deep wells sunk at BurrS ; the one nearest the Nile lieing 30 feet from its southern bank. The deepest of these wells is 300 feet in depth, and they undoubtedly tap a deep water which Dr. Beam has shown contains SANITAKY NOTES. KHABTOUM 85 analysis of Burre water supply considerable quantities of iron and manganese. The bores are protected down to a depth of 70 feet by iron tubes, but these tubes terminate, not in an impermeable bed of clay, but in porous sandstone. As Dr. Beam has entered somewhat fully into the matter in his Chemical Eeport there is no need for me to be discursive here, and one may at once proceed to a consideration of the results obtained in the bacteriological examination of the water from these wells. A sample taken on January 1st, 1908, after 48 hours' pumping from Well No. 3, the temperature of the water being 28° C, yielded 48 hours agar plates incubated at 37° C, which were uncountable even when only 0-2 c.c. of the water was tested. There were certainly over 2000 colonies per 1 c.c. and B. coli was present in 0'02 c.c. The organism differed only from " flaginac '' B. coli in not producing gas in a lactose medium. On January 11th, 1908, another sample was taken after prolonged and nearly continuous Bacteriological pumping for shx days. Result. — Agar count as above = 1,126 colonies per 1 c.c. B. coli (" flaginac ") in 0'02 c.c. It was evident that the water was contaminated, and an effort was made to secure a better sample from this well. On January 19th, a test was made. The number of organisms per 1 c.c. had fallen to 218, but true " flaginac " B. coli was present in 1 c.c. of the water. On February 23rd, a partial e.xamination was made of the water (temperature =30° C.) from Wells 1, 2, 4, 5 and 6, after 72 hours' continuous pumping, and 328 colonies per 1 c.c. were found, and B. coli in 1 c.c. as before. On March 1st, the water from the same wells was again sampled, after a prolonged pumping trial, and there proved to be 368 colonies present per 1 c.c, while, as usual, " flaginac " B. coli was found in 1 c.c. and larger quantities. It was not present in 0'02 c.c. or O'l c.c. Bacillus cntcritidis sporogenes was present in 500 c.c, but not in 1000 c.c. of the water. Streptococci were present in O'l c.c. Enough has been said to show that the water at the time these tests were made was bacteriologieally impure. It was, indeed, condemned without any hesitation. It remains to be seen what future examinations will reveal, but I have all along held that, topographically, the conditions are not satisfactory, and it is of special interest to note that a distinct ratio appears to exist between the number of organisms in the well-water and the number found in the Blue Nile. There are just about four times as many in the former as in the latter, while B. coli is found in 1 c.c. of the former and 5 c.c. of the latter. One is led to the conclusion that Blue Nile water is making its way into the unprotected bore-holes, and doubtless the increased temperature brings about a multiplication of the organisms. At the same time, one must not forget the presence of shallow, unprotected wells, and of an old native cemetery at no great distance, while a recent paper by Dawson' has pointed out that, in India, black clay soil may act as a culture medium instead of as a filter. Dawson's paper is very valuable in the light of what has been found at Khartoum, where the whole water question is on a very unsatisfactory basis. Personally, I am persuaded that we would be well advised to sink tube wells in the river sands, and so obtain a clear and practically inexhaustible supply which could be properly filtered under careful supervision, the filter action being controlled by frequent bacteriological tests. Certain it is that at pi-esent the Burr6 deep well-water is quite unfit for consumption, while the presence of iron and manganese in it has resulted in the growth of Crenothrix polyspora in the pipes. Fortunately, the representations from the laboratories have been effectual in preventing this water being supplied to the town. Bacteriologieally, many more examinations will have to be conducted throughout a whole year before our knowledge of the conditions can be considered complete. Space does not permit of any more extended ' Dawson, A. W. (January, 1907), "The Supply of Drinking Water in India, and its Connection with the Sub-soil Water." Journal of tlie Royal Institute of Public Health. 86 .SANITARY NOTES. KHAKTOUM .^erated waters Milk, sources of supply Faulty conditions consideration of this all-important subject, but suflicient has been said to indicate how matters stand, and to point the lesson that it is essential, in considering a water supply, to carry out careful preliminary tests from an engineering, geological and sanitary standpoint before any scheme is embarked upon. Aerated Waters. — There are now no less than seven factories tor their manufacture in Khartoum, and three at Khartoum North. The drinks chiefly supplied are soda-water (so- called), lemonade, ginger ale, orangeade and " roman," the last being a preparation flavoured with syrup of gi-enadillas. The colouring matter of orangeade consists of Orange B, which Weyl found to be slightly poisonous to dogs. I do not think, however, that the quantity found, even in many bottles of orangeade, could be pronounced injurious. At the present time, filtered river water is alone permitted to be used in the manufacture of aerated waters. The provision of a Doulton or Pasteur-Cliaraberland filter of suflicient capacity is insisted upon. Every factory has to be inspected by the Sanitary Inspector and Medical Officer of Health before it starts work ; they are all frequently visited. It is, of course, impossible to make sure that the instructions given are always faithfully carried out, but as recently some evasion of the sanitary regulations was detected, samples are now seized for analysis whenever considered desirable, and steps will be taken to punish more severely than hitherto those who througli carelessness or wilful negligence endanger the public health. In a few of the factories the arrangements are very good, but, as a rule, the bottle- washing and cleaning could be improved by the introduction of up-to-date appliances, while improved apparatus for adding the flavouring agents are desirable. An insanitary procedure, once in vogue, was the use of old cork^. These were collected from the streets, neighbourhood of cafes, etc., by boys and sold to the factories. After an example had been made of a few delinquents, this trade in old corks came to an end. Ice. — The ice is supplied from a large factory at Burre where a sulphuric acid machine is in use. The ice itself is made from condensed steam, and, so far as quality goes, leaves nothing to be desired. Steps were taken to improve the method of transport. No fault has been found with the storage methods in vogue, but the handling and distribution leave something to be desired. It is not easy in a country served by native labour to remedy completely such defects, but the Sanitary Inspectors pay attention to these points and issue a warning when necessary. Milk. — The milk supply of the town is derived from two sources: — 1. Prom cows at the Government farm, which is under the control of the Director of Lands and Agriculture. This a limited and somewhat expensive supply, mainly intended for British residents. The milk, which is of good quality, is issued in proper bottles, and, as a rule, care is taken to see that it is in a cleanly condition. On one occasion only has it been necessary to make a complaint regarding the milk. 2. From goats and a few cows owned by villagers in the various " daims " to the south of the town. Some of this milk comes from villages six to eleven miles away. It is brought into Khartoum very early in the morning, being carried on the heads of women, who then go their rounds and supply their customers. At an early date it was apparent that this system of milk supply was faulty in the extreme. In the first place, the women used earthenware pots (burmas) for the conveyance of the milk. These are to some extent porous, and, as a result, could not be properly cleaned. Than the walls of these vessels, no more favourite site for the multiplication of micro-organisms could well be imagined. The tops were uncovered, and dust had free access to the milk, or, if care was taken to prevent this, the means used consisted in stuffing a few rags — often filthy rags— into the mouth of the jar. It was found also that the vendors frequently washed their hands in the milk, while it was quite the custom to dilute it with SANITARY NOTES. KHAKTOUM 87 any water which was convenient. The tilthy mixture, which at times was sold to an unsuspecting public, certainly did not deserve the name of milk. Measures were at once taken to control this trade. The women were all registered, proper milk-cans were supplied, and offenders were severely punished, though only after matters had been carefully explained to them, and when there could be no doul)t as to their disobedience being wilful and not merely the result of ignorance. All this did some good, but it was not sufficient. The women cannot always be under observation, and they evade the by-laws. If the Egyptian policeman was of any use from a sanitary standpoint, the measures taken might suffice ; but he is, as a rule, a monument of stupidity, so far as sanitary affairs are concerned, and often aids and abets the offender through the kindliness of his heart and the thickness of his head. The milk supply, then, is still of doubtful quality, and the method of employing calabashes as cups wherewith to measure it out does not improve it. Hitherto the staff of sanitary inspectors has been so small that it has not been possible to go further, hut next year it is hoped to institute a reform. The vendors will bo made to bring the milk in pi'operly covered cans to a central station. There the milk will be transferred to other cans owned by the Sanitary Service. Each can will be provided with a padlocked cover and with a tap for delivery. When tilled the can will be locked so that milk can only be obtained from the tap. The inhabitants will be notified of the change, so that they have only themselves to blame if they do not see the milk directly supplied from the can. In the evening the cans will be returned to the station for cleansing purposes, and the women will be given the vessels, for milk transi3ort, which in the meantime will have been properly cleaned. Whenever desired, samples of the milk will be taken for analysis before it is sent out to the consumers. This seems to me the best way of dealing with the difficulty. It is simple and should prove effective. I fear it can only be applied to Khartoum, at least at first. Later, if found to work well, I hope to introduce it at Khartoum North. It is only fair to add that, despite the faulty conditions which have obtained, there does not seem to have been much illness produced by the dirty and watered milk. The native baby is breast fed, and so, I think, for the most part are the Egyptian, Syrian, Greek and Italian infants. It is to these communities this milk is chiefly sold. In the summer of 1907 there was a considerable amount of infantile diarrhoea, however, and this may have been due to the faulty milk supply. Of course, one has to remember that, owing to the habits of the consumer, a good milk may quickly deteriorate after being supplied to them, owing to faulty storage and other causes. This, as mentioned in the Eeview Supplement, is specially apt to occur in the Tropics. Slaughter-house. — A new slaughter-house, built on the same lines as those in Egypt, was erected in 1906. So long as it is carefully looked after, and there is a sufficiency of labour and of water, no great fault can be found with it. If not properly managed it soon becomes a much greater nuisance than the primitive native slaughtering place, which consists of a yard with a few poles and trenches into which the blood is run and the offal is cast. This is the kind still in use at Khartoum North, and it is remarkable how sweet and clean it can be kept. In Khartoum the blood and sweepings pass into a cement tank, and are baled out into a Crowley cart, which also removes the offal and manure. The contents are dealt with at the sewage trenches, being in part pitted and in part spread out as a feast for the vultures, which make most efficient scavengers. I believe the provision of lairs at the slaughter-house has tended to improve the quality of the meat, and efforts have been made to secure better apparatus for hanging the carcases, while the well has been covered, a pump supplied, and the water distributed by gravity from an iron and covered tank. The inspection of meal is in the hands of the Veterinary Department. Proposed remedy ,\Iilk and disease Slaughter- house SANITARY NOTES. KHAKTOUM Cold stoiatre Infectious diseases Notifiable diseases Markets. — These are interesting places, and have undergone several changes of late years. Proper sheds have been built, the floor of the meat market has been cemented, and the butchers are required to supply zinc-covered tables. The latter are railed ofi', so tlie general public cannot sprawl over them and handle the meat, as was formerly the case. Dogs are now excluded, save when the Egyptian policeman fails to observe a hungry pariah prowling about under his very nose — too frequent an occurrence. To do him justice, when his attention is directed to the matter, he makes up for his negligence by the energy with which lie expels the intruder. Tripe and internal organs generally are sold in a special place. The filthy habit of inflating the lungs l.iy blowing down the trachea was in vogue, but this practice has been stopped and bellows are provided for the purpose. The fish market is provided with brick and cement slabs, but might be improved if money was forthcoming. The frying of fish is one of our few noxious industries. Still, being conducted in the open air, it causes very little nuisance. The fowl market is not a cheerful spot, the birds being crowded into small wooden coops which are piled one on the top of the other. Fowls are treated with great cruelty in the East, and I think efforts should be made to improve their lot generally. Apart from the humanitarian point of view, it would pay to see that they are better looked after, and not carried about in bunches with their legs tied together and often left lying in the hot sun. The poor creatures must frequently perish for lack of water. Moreover, the methods of storage expose the fowls to the attacks of lice, mites and ticks. They often get into a miserable condition through the irritation and loss of blood produced by these parasites, while, as will be shown, spirochetosis is common amongst them. So is scaly leg, fowl diphtheria, and most of these avian diseases predisposed to by lack of care and cleanliness and by overcrowding. If only funds were available, much might be done by erecting tick-proof fowl-houses and by aiding the vendors to improve their stock. As it is, no means are available for this purpose, which is one reason why chicken meat is often so tough and unsavoury in Khartoum. The young pigeons suffer less, not being confined in the same way. Turkeys die of tuberculosis, pneumoconiosis, avian diphtheria, and several other complaints. I have known one succumb to a malignant tumour of the brain, a glio-sarcoma perforating the skull. In the suk, jerked meat (dried in the sun) is sold, so is fish — flesh, bone, and cartilage being all crushed up together till it is impossible to tell from mere inspection of what the mass consists. It is well cured and seems wholesome. The sale of partially dried and stinking animal intestines, beloved by the Sudanese, has been prohibited, though they would appear to be able to devour such abomination with impunity. Its very odour, however, constitutes a nuisance. Cold storage would benefit the food supply in Khartoum, and so would careful attention to the rearing of fowls, and the improvement of breeds in cattle and sheep. Cold storage plants on the river steamers would enable venison, guinea fowl, fruit, and other delicacies to reach the Khartoum market, while refrigerators might also be useful on the trains running to and from Port Sudan. Lastly, we proceed to discuss : — Infectious Diseases. — It may he said at once that, considering its latitude, Khartoum is wonderfully free from communicable disease. Absolutely reliable statistics cannot be presented, although notification is in force, but each year we can gain a very fair idea of the extent to which infectious disease is present and in which forms it has existed. The following diseases are notifiable: — Anthrax, Beri-beri, Cerebro-spinal Fever, Chicken-pox, Cholera, Dengue, Diphtheria, Dysentery, Erysipelas, Pilariasis, Glanders, Enteric Fever, Hydrophobia, Leishmaniosis SANITARY NOTES. KHARTOUM 89 (Kala-azar), Leprosy, Malaria (locally acquired), Malta Fever, Measles, Plague, Pneumonia, Eelapsing Fever, Smallpox, Trypanosomiasis, Typhus Fever, Whooping Cough. Of these, the following have been present since 1904 : — Gerebro-spiual Fever (one case only until May and June of this year, when three eases occurred), Chicken-pox, Dengue (one case only — imported). Diphtheria, Dysentery, Erysipelas, Enteric Fever (rare, some cases amongst British troops). Hydrophobia (one case only), Leprosy, Malaria, Measles, Pneumonia, Smallpox (one case only). Trypanosomiasis (one case only, imported). Whooping Cough. So much has been written about these diseases under their appropriate headings in the Eeview that little need here be said. The reason so many were made notifiable was to enable one to become acquainted with the forms of infectious disease which occurred. As regards chicken-pox, I would point out the great desirability of checking this disease at first, whenever possible. Although rarely fatal, it causes some suffering and may entail much annoyance and some expense to the parents of patients, while it may also interfere with education. Furthermore, if chicken-pox be prevalent, initial cases of smallpox may easily be missed, and before things can be remedied an epidemic of variola may lead one to regret that more rigid measures were not adopted in the case of varicella. The question of dysentery requires more detailed consideration, for it is intimately concerned with the question of conservancy, and it is interesting to note the effect that the change in the latter has had upon the incidence of the former. Unfortunately, my detailed statistics on this point were destroyed by tire, but I take the following passages from the M. 0. H. report for 1907. Amongst the Egyptian military there were 96 cases of dysentery notified from October, 1906, to the end of September, 1907. Of these, the great majority occurred amongst Egyptians, and it is quite certain that some of the cases notified were not dysentery at all. Bilharzial disease of the rectum is very apt to be mistaken for dysentery in the absence of microscopic examination of the fseces. Although there were four battalions in Khartoum, in addition to the Medical Corps, Works Department, and Stores and Supplies Dysentery in Department men ; and only Artillery, small Railway and Stores Department staff, and one i-^hartoum battalion in Khartoum North ; no less than 49 of these 96 cases occurred in Kliartoum North, where the old conservancy method still persisted. Moreover, when we come to consider the monthly incidence table, we find that, in the case of the Khartoum units, with the exception of the third battalion, which had four cases in August, most of the dysentery cases occurred prior to May, about which time the effect, if any, of the new system should have been becoming evident. Turning to the units at Khartoum North, we find that the largest number of cases amongst the Artillery occurred in July, and amongst the first battalion there were more cases in the summer than at other seasons. While these statistics are interesting, one must not make too much of them, because, after all, the number of cases is small, and doubtless other factors have to be taken into considei-afcion. At the same time, I believe the faulty conservancy methods in vogue accounted in large measure for the small epidemic which occurred during the wet summer of 1906, when there were in all 134 cases — 24 being civil, 107 Egyptian military, and 3 amongst the British regiments. Now the summer of 1907 was even wetter than that of 1906, but a radical change had been made in the collection and disposal of excreta, and during the year 1907 the total number of cases notified was 104, of which 6 were civil, 96 Egyptian mihtary (already analysed), and 2 imported. During the present sanitary year, which ends in September, there had been notified, amongst a greatly increased population, up to the end of July, only 35 cases, of which 25 were civil, 8 were Egyptian military, and 2 were imported. My contention has always been that dysentery cases are most apt to crop up in places where there is much fouling of the soil, as in the neighbourhood of prisons and barracks; and it would certainly seem to be borne out by these figures, for a very marked 90 SANITARY NOTES. KHAETOUM Water supply and intestinal complaints The Blue Nile supply and enteric fever improvement has taken place in the case of the Egyptian soldiery. Some of this, however, is due to greater care in diagnosis. It is noteworthy that in 190G the outbreak terminated with the rains. I am of opinion that but little of the dysentery occurring in Khartoum is, strictly speaking, water-borne, but that it is chiefly due to the fouling of food and drink by infected dust, and this view is supported by the facts I have recorded, and by a consideration of other statistics available — for instance, the returns of monthly incidence of infectious disease. This is a question which also concerns enteric fever, and I pass to a brief consideration of that disease in its epidemiological aspects, as met with in Khartoum. My remarks regarding it apply more or less to dysentery as well. It has been stated that one need look no further than tlie present water supply of the town to account for the presence of cases of diarrhcua, dysentery and typhoid fever in it during 1907. Now it is easy to make such a statement, but quite another thing to prove it true, and if it is erroneous it is likely to do harm by limiting the sanitary outlook and tending to confine preventive measures to one source of evil. No one denies that the present water supply is a possible source of danger, but that it is an actual source remains to be proved. All the evidence goes to show that it is not the chief factor in causing these diseases, or, at least, that it has not l)een so in the past. Take the year in question — 1907. We find there were 8 cases of dysentery amongst the civilian population, 2 of which were imported ; and 15 cases of enteric fever, of which 5 acquired infection outside Khartouin. Thus, during one year, amongst a population of, say, 35,000 people, there were 6 cases of dysentery and 10 of enteric fever, and yet we are informed that the general water supply was to blame ! Even supposing a good many cases were not notified at all, the numbers do not point to the drinking-water as a cause. But it may be held that these cases should not be considered with reference to the whole population, but only with reference to those susceptible to attack by such diseases, presumably a population numbering about 3000. It is true this would be a fairer computation, at least as regards the 10 enteric cases, but we find that 2 of these occurred amongst soldiers at the British Barracks, where the drinking watei-, even though taken from the river above the town, is carefully boiled, while some of the other cases were natives, and so outside the 3000 susceptibles. As regards dysentery, it has yet to be proved that the native is not susceptible. The disease is not uncommon in Egypt, and Egyptian soldiers in the Sudan are certainly liable to be attacked. We know that the native of India suffers heavily from this disease and his surroundings and mode of life do not differ markedly from those of the native of the Sudan. As a matter of fact, most of our dysentery notifications refer to native cases, and, as I say, there is nothing to show that dysentery is chiefly water-borne, and much to indicate that, in the past, it has been due to infected dust gaining access to food and drink. It is further asserted that it is the rise of the river, sweeping a foul foreshore, which is to blame. If this were so, one would expect that most of the cases would occur late in June and during July and August. As regards enteric fever, such has not been the case in the past. Taking the present sanitary year, we find that in November, December and July, respectively, one case occurred ; there were two in May and four in June. As regards the cases in June, two of which at least acquired infection in May, there is little douljt that infection was derived from Nile water, for the river was very low, and in places practically stagnant. It was no longer self-purifying to any extent. In other years the greatest number of enteric cases has usually occurred in October, when the Nile is running full. Owing to the loss of my statistics, I am unable to present figures in detail, but the facts are as stated, and there is nothing to show that the river supply is the chief source of infection. At the same time, it should be abolished as soon as possible and a satisfactory supply substituted for it. Taking the dysentery cases for the present sanitary year, it is instructive to find that they have been fairly equally distributed throughout the past ten months, the greatest number (four) SANITAKY NOTES. KHARTOUM 91 Dysentery and Dust Disinfection in any one month occurring in December. Here, again, there is no evidence that the Nile water is markedly at fault, and the conditions which formerly in large manner determined both the presence and the monthly incidence of dysentery in Khartoum are now in part lacking. I refer, of course, to the fouling of the surface soil, and to the summer rains. There can be little doubt that, given dry conditions, even persistent fouling may produce but little evil results in the presence of a powerful and sterilising sun, and personally 1 believe that this partly explains why we do not have extensive outbreaks of epidemic disease when the Nile begins to rise. The tilth and refuse which have accumulated on the sand-banks and foreshore, the deposit of which it is very difficult to prevent, has been practically sterilised by the intense heat and light or ever it is washed away by the rising river. As the fouling goes on daily, some of it, of course, if infected, must be in an infectious condition when carried down stream, but this state of things cannot be at all common, especially as regards enteric fever, for, as stated, this disease is rare in natives, and it is these who chiefly, under cover of night, use the dry river bed as a place of convenience. With what has been said on page 73 we may conclude this consideration, remembering, however, that our efforts must be devoted to combating every faulty sanitary condition, and that general statements of the type indicated ai'e to be carefully avoided, or, if made, to be adjudged at their proper value. Disinfection. — The town possesses a Thresh " Emergency Disinfector," but the Sanitary Service has permission to employ the steam disinfector at the Military Hospital — a privilege of which it has several times availed itself. A Mackenzie spray has also been suppHed, and it is intended to introduce the knapsack spray as modified by Robertson. When fumigation is required, the formalin and permanganate method with preliminary moistening of the atmosphere, is employed. A cart for the conveyance of infected bedding, clothing, etc., is in use. I believe the introduction of the portable Clayton system would be beneiicial, especially as the river steamers could be fumigated, and mosquitoes thus destroyed. As a matter of fact, we have, as a rule, very little disinfection to perform. Vital Sto^/s/ics. -Unfortunately, under present conditions, it is not possible to present Vital statistics statistics which can be considered absolutely reliable. Hence, it is better not to attempt the task. It is unfortunate, for nothing better indicates the sanitary growth of a town than a series of reliable statistics detailing birth rate, death rate, infantile mortality, and incidence of infectious disease. It is hoped ere long that we may be in a position to record these properly. At present I can only append the cases of infectious disease notified during the years 1904-1907 inclusive, and those for the months of the present sanitary year. Each sanitary year commences in October, and I can present the records of the past ten months. Of late I have been classifying the returns under the three headings — Civil, Egyptian Military, British Barracks. Considerations of space prohibit the insertion of the tables of monthly incidence which, except in a few instances — enteric, dysentery and diphtheria — are not of special interest. 1903-4 This was the first year during which notification was in force, and the returns were far from reliable. One would only note that 1 case of cerebro-spinal fever and 5 cases of diphtheria occuired. 1904-5 Chicken-pox, 19 (the majority occurring in the Civil Prisons at Khartoum and Khartoum North) Diphtheria, 4 Hydropholiia, 1 Dysentery, 1'2 Measles, 50 Enteric Fever, 4 Smallpox, 2 Infectious disease statistics 92 SANITAliY' NOTES. KHAKTOUM The other notifiable diseases were not represented, with the exception of epidemic pneumonia, which scourged the Civil Prison, Khartoum, accounting for 41 cases and 10 deaths. 1905-6 Egyptian .Military 107 4 1 A case of mumps was notified, 6 cases of pneun 4 eases of scarlet fever at the British Barracks. Civil Corebro-spinal Fever 1 Chicken-pox ... 28 Diphtheria Dysentery 24 Enteric Fever 6 Measles 25 British Barracks i Imported Total 1 28 2 2 2 1 134 1 7 18 26 ia amongst the civil population, and 1906-7 Civil Egyptian Military Bi Bar •itisb raollp,n^™.<)r//^y^ ■ .V/(. Bennqi • / M 'I Scale of Miles M ,'7 M , \ ID S -0 20 30 40 50 Fort UhtunLiy •.' 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