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99 



infected had been in habitual contact with dogs. They are inclined to think that infection Leish- 

 may be derived from the dog, and that in this animal the disease runs a benign course, maniosis— 

 Their work, which is of a preliminary nature, requires confirmation, but is at least continued 



The presence of Leishmaniosis in the Sudan was first determined by Neave, who 

 reported a case in a child from Meshra-El-Kek. For a considerable period thereafter no 

 further cases were recorded, but recently, thanks to the work of Captains Cummins and 

 Bousfield, of the Egyptian Medical Service, a considerable number of instances of the 

 disease have been brought to light. In addition, as already mentioned. Dr. McTier Pirrie 

 fell a victim to it, and I have found the parasites in the splenic smears of several cases sent 

 me for diagnosis from Wad Medani. A second fatal case in a European has recently occurred. 



As Captain Cummins furnishes a special paper on this important subject there is no 

 need to enlarge upon it here. 



Its distribution has yet to be fully woi-ked out, but it seems commonest in the Kassala 

 and Sennar Provinces, at least at the present time. So far G. lectularius is the only 

 species of bug found in the Sudan, but it is possible that G. rotundatus vyill be discovered in 

 the regions where kala-azar is endemic. 



I have little doubt but that the disease is much more common than is generally supposed 

 and that hitherto it has been overlooked or not recognised. Every effort will have to be 

 made to arrest its spread should it show signs of extending beyond its present known limits. 



Leprosy. In looking over the recent literature relating to leprosy, one notes the 

 tendency to attribute the disease in the first instance to the bites of insects. 



Thus Mugliston' of Penang suggests that Acarus scablei may be the carrier of infection. 

 He found that of 77 lepers, 44 had itch on admission, 11 of the others remembered having 

 itch, and from the remaining 22 no history was obtainable. He thinks it possible that the 

 bacillus of leprosy may be conveyed either m or on the insect. 



Bassewitz-* also cites a case where in all probability leprosy was conveyed by the 

 parasite of scabies from a leper to his attendant. The incubation period was two and a half 

 years. 



Goodhue^ of the Leper Settlement at Molokai, Hawaii, reported the finding of the 

 bacillus of leprosy both in the female mosquito, Gtdex pungens, and in the bed-bug, Gimex 

 lectularius. He is inclined to think that the bug is a greater factor than the gnat in the 

 spread of leprosy. 



Smyth' of Lebombo states that in his diocese there are tribes which till quite recently 

 have been free from European influence. The cases of leprosy amongst them are sporadic. 

 These natives eat and drink out of the same pots ; if there be food, no matter of what kind, 

 they all share alike. They practically live altogether, with one exception — no healthy 

 person ever sleeps with a leper, or one suspected of leprosy. In the case of married people, 

 they have intercourse, but it is always in the daytime if one is a leper. The children of such 

 parents appear to be normal. The sick are isolated in a hut or huts quite close to the 

 village, but no healthy man or woman sleeps there. Smyth argues with some force that if 

 the intermediate host were winged, it would fly from hut to hut, and therefore leprosy would 

 spread in the villages in a way that it does not seem to do ; if it were infectious, like some 

 other diseases, people would catch it from the common spoons and cups ; if it were due to 

 food, all who eat that food would be liable to get it. Therefore we are driven to the 

 conclusion that the Cimex lectularius, or some similar wingless parasite that feeds at night, is 

 the means of conveying it from man to man. 



Hutchinson^ adduces the following arguments against the insect theory : — 



1. If such conveyance were possible, how account for the disappearance of the disease in the fifteenth and 

 sixteenth centuries from England and from Europe ? 



» Mugliston, T. C. (July loth, 1905), "On a Possible Mode of Communication of Leprosy." Journal of Tropical 

 Medicine, p. 209, Vol. VIII. 



- Bas.scwitz, E., Miinch. Med. Wocli., 1905, No. 41. 



■• Goodhue, B. S. (August, 1906), "The BacUlus Leprae in the Gnat and Bed-Bug." Indian Medical Gazette, 

 p. 342, Vol. XLI. 



* Smyth, W. R. (December 8th, 190G), " Leprosy." British Medical Journal, p. 1670, Vol. II. 



' Hutchinson, .1. (December 22nd, 1906), " Mosquitoes and Leprosy." British Medical Journal, p. 1841, Vol, II. 



• Article not consulted in the original. 



