REVIEW—TROPICAL MEDICINE, ETO. 99 infected had been in habitual contact with dogs. They are inclined to think that infection may be derived from the dog, and that in this animal the disease runs a benign course. Their work, which is of a preliminary nature, requires confirmation, but is at least suggestive.

The presence of Leishmaniosis in the Sudan was first determined by Neave, who reported a case in a child from Meshra-El-Rek. 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 worked out, but it seems commonest in the Kassala and Sennar Provinces, at least at the present time. So far O. lectularius is the only species of bug found in the Sudan, but it is possible that OC. rotundatus will be discovered in the regions where kala-azar is endemic.

T 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 scabiei 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 fromthe remaining 22 no history was obtainable. He thinks it possible that the bacillus of leprosy may be conveyed either zm 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, Culex pungens, and in the bed-bug, Ocmex 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 oneisa 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 Oimez 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 :— _ _ i. 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 15th, 1905), “On a Possible Mode of Communication of Leprosy.” Journal of Tropical Medicine, p. 209, Vol. VIII.

* Bassewitz, E., Minch. Med. Woch., 1905, No. 41.

* Goodhue, E. 8. (August, 1906), “The Bacillus Lepre in the Gnat and Bed-Bug.” Indian Medical Gazette, p. 342, Vol. XLI.

“ Smyth, W. R. (December 8th, 1906), “Leprosy.” British Medical Journal, p. 1670, Vol. II.

* Hutchinson, J. (December 22nd, 1906), “ Mosquitoes and Leprosy,” British Medical Journal, p. 1841, Vol, II.

* Article not consulted in:the original.

LCo ff 1 att fA , ) Garrat Leishmaniosis— continued