147 



difficult to obtain evidence of insect bite in a given case. In Panama 

 the natives accuse a fly which they call " mosca boyana," and in Brazil 

 a fly called " cotunga " is the reputed carrier ; while at Manaos, 

 A. da Matta believes Dermacentor eledus to be the agent ; Flu, in 

 Surinam, also implicates the Ixodidae, In Paraguay, /hiihhjomma 

 striatum, A.fossum and A. cajemiense have all been regarded as carriers, 

 and the forest workers attribute the disease to the bites of Simuliidae. 

 Brumpt and Pedroso have arrived at the conclusion that Tabanids 

 are far more likely carriers, in that they only attack exposed parts of 

 the body, which agrees with the usual distribution of the ulcers, while 

 the localities in which the disease is most readily contracted are 

 those frequented by these flies. Species of Stonioxys, which might be 

 equally incriminated, are far more rare in the forests than in the 

 pastures, in which ulcerative leishmaniasis is never acquired. In 

 Peru, a Simuliid is popularly regarded as the carrier. So many insects 

 have been accused of causing the disease that the evidence at present 

 does not clearly point to any one group of them. Migone has reported 

 that in treating leishmaniasis he has frequently observed that the 

 disease first manifests itself on small abrasions of the skin, and that 

 it is possible that some such break in the surface is necessary for the 

 entrance of the causative organism and that the bite of almost any 

 fly might provide the necessary condition ; the author has made a 

 similar observation with regard to Biskra boil. There appears to be 

 no doubt that American leishmaniasis is inoculable and transmissible 

 from man to man, as outbreaks among otherwise healthy forest 

 workers in South America frequently follow on the arrival of an infected 

 subject. Man appears to be the chief reservoir, possibly also dogs. 

 In Paraguay the natives regard the rattle-snake as the natural host 

 of the virus of " buba." When coiled up in the forest it is almost 

 always attended by a cloud of Simuliidae, and numbers of Amblyomma 

 striatum are to be found attached to its body ; the author does not 

 regard the evidence as in any way scientific, though the gecko is 

 suspected of being a reservoir of the virus of oriental sore. It is possible 

 that, given suitable conditions of environment, the flagellates of insects 

 and Acarids may become pathogenic to man, and the author and 

 Franchini have shown that mammals may be infected with those of 

 fleas and mosquitos, and that their blood will contain organisms 

 bearing a great resemblance to those found in leishmaniasis. These 

 researches require further prosecution, especially as regards the 

 flagellates of Simuliidae and Phlebotomies, insects which abound in 

 countries where cutaneous leishmaniasis is endemic. 



Migone (L. E.). Buba, or Leishmaniasis americana, in Paraguay. 

 Further investigations on the Etiology of Leishmaniasis americana. 



— Trans. Soc. Trap. Med. & Hyg., London, viii, no. 7, June 1915. 

 pp. 219-225 and 226-230. 



During recent years a disease called buba has appeared in the north 

 of Paraguay, among the native workmen in the large industrial estab- 

 lishments of these regions, in the Yerba Mate plantations, and in the 

 lumber forests. An ulceration of a chronic character and slow develop- 

 ment, attacks the uncovered parts of the body- — the feet, legs, arms, 

 neck and face^ — and later invades the mucous membranes of the nose, 



