This is also a tropical and subtropical disease that occasionally gets up into the temperate region, sometimes occurring in the United States. The fever begins with a severe headache, and other symptoms follow. It is usually of the remittent type and may continue for some months.

It is caused by minute bacteria (Micrococcus melitensis) and is a very infectious but not usually contagious disease. The germ is readily conveyed by inoculation, and several investigators have sought to show that the mosquito often serves as the inoculating agent. The disease is especially prevalent during the mosquito season, and has twice been conveyed to monkeys by infected insects.

LEPROSY

This loathsome disease has long been known to be caused by a particular bacillus (Bacillus lepræ), but the way in which this organism gains an entrance into the system is still unknown. Many theories have been propounded, but none of them has been well established. Within recent years the possibility of insects carrying the germ and in one way or another transmitting it to healthy individuals has been suggested and much discussed. As the lepræ bacilli are present in the skin and ulcers of leprous patients, insects sucking the blood or feeding on the sores could not help taking some of them into their body or becoming contaminated. These bacilli have been found at various times in the stomach or intestine of mosquitoes, fleas and bedbugs. So it is believed by some that these and other insects, such as lice and flies, may sometimes transmit the disease. On a previous page we have referred to the possibility of the face-mites acting as disseminators of leprosy.

Leprosy occurs most commonly among people where little attention is paid to bodily cleanliness. Such people are usually freely infested with various parasites that thrive well in the filth, so if the germs can be transmitted in this way the carriers are there in abundance.

The fact that the sores usually occur on exposed parts of the body has been pointed to as evidence that inoculation is due to such insects as flies and mosquitoes. It has been noted that leprosy is frequently very common in regions where elephantiasis occurs, suggesting the possibility of the same carrier, the mosquito, for both diseases. So while there is as yet very little evidence one way or the other, insects that are found around leprous patients are to be regarded with suspicion, for until we know more definitely just how the disease is communicated the insects must be looked on as possible sources of contamination.

KALA-AZAR OR DUM-DUM FEVER

This is a very fatal infectious disease of many tropical and subtropical regions, spreading terror among the natives wherever it occurs. It is caused by the presence in the system of Protozoan parasites, the so-called Leishman-Donovan bodies, that have recently been studied by several observers.

Dr. W.S. Patton of the Indian Medical Service has been making some extensive experiments with the common bedbug of India (Cimex rotundatus) which seem to demonstrate fully that this insect is responsible for the transmission of the parasite that causes the disease. He has found the parasite in all stages of development in the bedbug. This, taken with a number of other observations in regard to the tendency of the disease to cling to particular houses, makes a strong case against the bedbug. Manson, however, believes that the parasite may be transmitted by other agents also, possibly by means of flies that visit the sores or in other ways.

ORIENTAL SORE