268 Appendix 



on the ground. Leprosy is always carried to a vir- 

 gin soil by immigrants, or by the effects of lepers. 

 When first introduced into a new country it is en- 

 demic (exists only in imported cases), for fifty to 

 one hundred years, when it suddenly becomes epi- 

 demic (occurs in people who have never been out of 

 the country). Something appears to have become 

 infected, either insects or food, as in Colombia, 

 S. A., where forty years ago, as U. S. Minister 

 McKinney wrote Dr. Ashmead, there were but 400 

 lepers, and to-day there are 30,000. In this case, 

 the insects have become infected. Hawaii is another 

 example of infection from abroad ; the Kanaka race 

 is now being destroyed by epidemic leprosy. At 

 Molokai there are 700 or 800 dogs, all much infested 

 with fleas. Visitors going there by every boat from 

 Honolulu, carry home infected fleas. This would 

 account for the increasing number of lepers in Hon- 

 olulu. The mosquitoes would not go far from Mol- 

 okai and its fish ponds, the fish of which may be 

 contaminated by bacteria from the stomachs of 

 mosquito larvae bred in the ponds, and, being 

 eaten raw, may spread the disease among the 

 Kanakas ; this is also the case with the carp in 

 Japan, where the fish is eaten raw, often, indeed, 

 living. Dr. Sommer, of Buenos Ayres, writes Dr. 

 Ashmead that in Argentina the salt licks of vari- 

 ous animals are the breeding places of leprosy. 

 These places are known to be the congregating 

 point, too, of hosts of fleas, as well as being mos- 

 quito breeding localities. As fleas show the leper 

 bacillus in their intestinal contents, it is reasonable 



