368 The Philippine Journal of Science 1915 
It is a well-known fact that in cases of the nodular type 
recrudescences apparently occur at varying intervals, to be 
followed by feverish attacks with accompanying swelling and 
congestion of the nodules and a new outcropping of lesions. 
This condition is well recognized by the lepers at Culion, and in 
the Tagalog language the condition is termed alabajar. I have 
not had the opportunity to make repeated examinations in these 
cases, but the symptoms suggest a true bacterzemia. 
It is generally believed that each case of leprosy takes origin 
from contact with another case for a varying period of time. We 
have no definite knowledge at the present time as to the exact 
method of transmission, but one well-established fact seems to 
be that intimate contact is necessary. In adults such contact 
can easily be accounted for by the sexual relation, and in 
children by familiar relations which are more or less intimate. 
Even with such close contact, infection is rare, as is shown by 
the following figures taken from a report on the health conditions 
at Hawaii. Of 225 healthy natives living in the same house as 
lepers only 4.5 per cent acquired leprosy. Among the married 
only 9 out of 181 contracted the disease from their leprous wives, 
or husbands, as the case might be. 
Many writers have endeavored to involve the insect world as 
bearing an epidemiologic relation to the disease. Thus flies, 
bedbugs, cockroaches, head lice, mites, and ticks have all been 
hailed as carriers and conveyers of leprosy bacilli, but there is 
still no proof of actual guilt. When we stop to consider the 
ubiquity of acid-fast bacilli in nature, and the habits of feeding 
of these insects, one wonders if almost all of the reported positive 
findings of leprosy organisms in different insects are not errors. 
My own experience in this line consists in one series of observa- 
tions. Three hundred fifteen bedbugs were collected at Culion 
from the beds in hospital, from houses, and from clothing. 
Fifteen of these bugs were examined individually by dissecting 
out the mouth parts and the intestinal tract, crushing between 
slides, and making a smear. Acid-fast bacilli were found in the 
intestine in one instance. The remaining bugs (300) were 
ground up in lots of 50 in sterile salt solution and centrifuged, 
and smears were made. An average of 100 smears was examined 
from each lot. Acid-fast bacilli were found four times, making 
a total of five times for the entire number of bugs. 
Much stress has been laid by various writers on the importance 
of examining the nasal mucus, but unless there is a leprous ulcer 
of the septum, this is of little significance. The mere presence 
