8 Bulletin No. 159 



first place the eruption on the hands began apparently 

 about the bases of the fingers and extended thence upward 

 to the elbows, where it stopped abruptly. On the legs it 

 seemed to begin at the feet, affecting the upper surface and 

 extending to the knees, where it terminated in a well 

 marked line. On the head and neck it affected in all cases 

 examined only the skin constantly exposed, and terminated 

 at the hair and at the collar. Yet in some instances re- 

 recorded there is an extension of the affected skin down 

 upon the chest, coinciding somewhat closely with the open- 

 ing in the shirt front. One such case, which I did not 

 have a chance to see, was reported to me as residing at 

 Old Straight Creek, above Pineville. All of these conditions 

 seemed consistent with Dr. Sambon's theory that an insect 

 carries the virus of the disease from ill to well, attacking 

 the exposed skin and injecting into it something, bacteria 

 or protozoa, which gives rise to the disease. 



Furthermore the disease is contracted and afterward 

 becomes active in early spring at just the time when our 

 gnats of the genus Simulium come from the water in greatest 

 numbers as adults. 



Again it often affects children, who constantly go bare- 

 footed and bare-legged in this region and are disposed to 

 play and wade in the streams. Women, too, were affected 

 more than men, about the arms and neck generally, but also 

 in some cases on the feet and calves. Men go less fre- 

 quently perhaps with the limbs bare, and are much less 

 often attacked. The skin trouble appears upon the trunk 

 rather rarely, though cases are on record of parts generally 

 kept covered by clothing becoming affected. 



With these facts in mind, it was with very great in- 

 terest that I examined a case at Moss's Camp above Pine- 

 ville which seemed to oppose the idea of insect agency in 

 the disease. The case was that of a middle aged woman 

 whose arms showed in a marked manner the symmetrical 

 development of the skin lesions, so often mentioned by 

 writers on the ailment. It was interesting further because 

 it was then (Sept. 1) in an active condition, whereas all the 



