Handbook of Medical Entomology

by William A. Riley; O. A. Johannsen

"As our knowledge of pellagra accumulates, it is more and more evident that its origin is in some way closely associated with the domicile. The possibility that an insect whose association with man and his immediate environment is, at the best, casual and desultory, can be active in the causation of the disease becomes increasingly remote."

"Our knowledge of the biting habits of Simulium is not complete, but it is evident, as regards American species at least, that these are sometimes not constant for the same species in different localities. Certain species will bite man freely when opportunity offers, while others have never been known to attack him. To assume that the proximity of a Simulium-breeding stream necessarily implies that persons in its vicinity must be attacked and bitten is highly fallacious. In Spartanburg County attacks by Simulium seems to be confined to the immediate vicinity of the breeding-places. Our records and observations, exceedingly few in number, refer almost exclusively to such locations. Statements regarding such attacks, secured with much care and discrimination from a large number of persons, including many pellagrins, indicate conclusively that these insects are seldom a pest of man in this county. A certain number of the persons questioned were familiar with the gnats in other localities, but the majority were seemingly ignorant of the existence of such flies with biting habits. This is especially striking, in view of the fact that the average distance of streams from the homes of the pellagra cases studied was about 200 yards, many being at a distance of less than 200 yards, and that 78 per cent of these streams were found to be infested by larval Simulium. Such ignorance in a large number of persons cannot be overlooked and indicates strongly that our belief in the negligible character of local attacks by Simulium is well founded."

"In localities infested by 'sand-flies,' mosquitoes, etc., these pests are always well known and the ignorance described above is very significant."

"Such positive reports as we received nearly always referred to bites received in the open, along streams, etc., and observations made of their attack were of those on field laborers in similar situations. Males engaged in agricultural pursuits are almost exempt from pellagra in Spartanburg County. During the season of 1913, in some two or three instances, observations were made of the biting of Simulium and some additional and entirely creditable reports were received. These observations and reports were under conditions identical with those referred to in the reports of 1912 and confirm the conclusions based on the observations of that year. I would repeat with emphasis that it is inconceivable that a fly of the appearance and habits of the prevalent species of Simulium could be present in such a region, especially about the haunts of man and attack him with sufficient frequency and regularity to satisfactorily account for so active and prevalent a disease as pellagra without being a well-known and recognized pest."

"In connection with the conditions in the Piedmont region of South Carolina, it may be well to cite the results of a study of those in the arid region of western Texas."

"In May, 1913, in company with Capt. J. F. Siler of the Thompson-McFadden Pellagra Commission, I visited the region of which Midland in Midland County is the center. This region is very dry and totally devoid of running water for a long distance in every direction. The only natural source of water-supply, a few water holes and ponds, were visited and found to be of such a nature that the survival of Simulium, far less its propagation in them, is absolutely impossible. The nearest stream affording possibilities as a source of Simulium is 60 miles away, while the average distance of such possibility is not less than 100 miles."

"Artificial sources of water-supply were also investigated carefully and were found to offer no opportunity for the breeding of Simulium."

"At Midland the histories of five cases of pellagra were obtained, which gave clear evidence that this place or its immediate vicinity was the point of origin. Persons of long residence in the country were questioned as to the occurrence of such flies as Simulium and returned negative answers. These included a retired cattle owner, who is a man of education and a keen observer, an expert veterinarian stationed in the country who has the cattle of the country under constant observation, and a practical cattle man, manager of a ranch and of wide experience. The latter had had experience with 'Buffalo gnats' in other localities (in the East) and is well acquainted with them. His close personal supervision of the cattle under his charge, makes it practically certain that he would have discovered these gnats had they been present in the country."

"At the time the study was made, Simulium was breeding and active in the adult state in the vicinity of Dallas, Texas, in the eastern part of the state. We have here a region in which cases of pellagra have originated, yet in which Simulium does not and cannot breed."

Other possible insect vectors of pellagra have been studied in great detail and the available evidence indicates that if any insect plays a rôle in the spread of the disease, Stomoxys calcitrans most nearly fills the conditions. This conclusion was announced by Jennings and King in 1912, and has been supported by their subsequent work.