'IRAQ AND THE PERSIAN GULF' [‎275r] (552/862)

PUBLIC HEALTH AND DISEASE 425
to the actual incidence of the disease, which has no very characteristic
clinical features, unless they be the diversity of symptoms and the
prolonged fever. It may be confused with very many other febrile
diseases unless recourse be had to laboratory examination.
In Iraq a study of the sera of patients which had been sent for
laboratory examination for evidence of other infections revealed a
considerable prevalence of brucellosis. Of 350 sera sent for typhoid
reactions, 27 reacted positively with B. melitensis and the organism
was isolated from 9 out of 10 of these positive sera. Evidence of
brucellosis was also found by the examination of sera sent to the
laboratory for the diagnosis of syphilis. The great variety of symptoms
displayed by this disease is shown by the fact that cases had been
originally diagnosed as one or other of the following diseases: enteric
fever, malaria, sciatica, arthritis, lumbago, tuberculosis, influenza,
pneumonia, and liver abscess. The disease is very rarely fatal, but
the average duration of illness in ambulatory cases was as much as
44 weeks before diagnosis, and of cases confined to bed 16 weeks.
Samples of milk and blood from cattle, goats, and sheep, obtained
from Baghdad, Erbil, and Sulaimaniya, showed evidence of heavy
infection with Brucella in all three areas. Human infection arises most
frequently from the consumption of raw milk or milk products.
Close association with infected animals is a less common cause of
human infection.
Leishmaniasis
This is the name given to a group of diseases caused by the invasion
of the body by a small parasite of the genus Leishmania. The visceral
form of the disease, a serious febrile condition, caused by L. donovani,
and sometimes called kala-azar, does not appear to occur in Iraq.
L. tropica is the cause of dermal leishmaniasis, characterized by single
or multiple ulcers of the skin, usually without detriment to the general
health of the patient. The ulcers are often slow to heal and may leave
unsightly scars and disfigurement. Oriental sore and Baghdad boil
are two of the names given to this complaint. It is extremely prevalent
throughout Iraq. The vast majority of cases receive no skilled medical
treatment. Between the years 1927 and 1939, 32,131 cases were
treated in the medical institutions of Iraq.
Infection with L. tropica renders the patient immune to further
attack, but the immunity is somewhat slow to develop, only becoming
operative when the original sore has completely healed. It was
formerly the custom among Jews in Baghdad to inoculate their