Yet, after all the studies of the past decade, the old belief that pellagra is essentially of dietary origin is gaining ground. Goldberger, Waring and Willets (1914) of the United States Public Health Service summarize their conclusions in the statement, (1) that it is dependent on some yet undetermined fault in a diet in which the animal or leguminous protein component is disproportionately large and (2) that no pellagra develops in those who consume a mixed, well-balanced, and varied diet, such, for example, as that furnished by the Government to the enlisted men of the Army, Navy, and Marine Corps.
Leprosy
Leprosy is a specific, infectious disease due to Bacillus lepræ, and characterized by the formation of tubercular nodules, ulcerations, and disturbances of sensation. In spite of the long time that the disease has been known and the dread with which it is regarded, little is known concerning the method of transfer of the causative organism or the means by which it gains access to the human body.
It is known that the bacilli are to be found in the tubercles, the scurf of the skin, nasal secretions, the sputum and, in fact in practically all the discharges of the leper. Under such conditions it is quite conceivable that they may be transferred in some instances from diseased to healthy individuals through the agency of insects and other arthropods. Many attempts have been made to demonstrate this method of spread of the disease, but with little success.
Of the suggested insect carriers none seem to meet the conditions better than mosquitoes, and there are many suggestions in literature that these insects play an important rôle in the transmission of leprosy. The literature has been reviewed and important experimental evidence presented by Currie (1910). He found that mosquitoes feeding, under natural conditions, upon cases of nodular leprosy so rarely, if ever, imbibe the lepra bacillus that they cannot be regarded as one of the ordinary means of transference of this bacillus from lepers to the skin of healthy persons. He believes that the reason that mosquitoes that have fed on lepers do not contain the lepra bacillus is that when these insects feed they insert their proboscis directly into a blood vessel and thus obtain bacilli-free blood, unmixed with lymph.
The same worker undertook to determine whether flies are able to transmit leprosy. He experimented with five species found in Honolulu,—Musca domestica, Sarcophaga pallinervis, Sarcophaga barbata, Volucella obesa and an undetermined species of Lucilia. The experiments with Musca domestica were the most detailed. From these experiments he concluded, first, that all of the above-named flies, when given an opportunity to feed upon leprous fluids, will contain the bacilli in their intestinal tracts and feces for several days after such feeding. Second, that considering the habits of these flies, and especially those of Musca domestica, it is certain that, given an exposed leprous ulcer, these insects will frequently convey immense numbers of lepra bacilli, directly or indirectly, to the skins, nasal mucosa, and digestive tracts of healthy persons. Additional evidence along this line has recently been brought forward by Honeij and Parker (1914), who incriminate both Musca domestica and Stomoxys calcitrans. Whether or not such insect-borne bacilli are capable of infecting persons whose skin and mucosa are thus contaminated, Currie was unwilling to maintain, but he concludes that until we have more accurate knowledge on this point, we are justified in regarding these insects with grave suspicion of being one of the means of disseminating leprous infection.
Various students of the subject have suggested that bed-bugs may be the carriers of leprosy and have determined the presence of acid-fast bacilli in the intestines of bed-bugs which had fed on leprous patients. Opposed to this, the careful experiments of Thompson (1913) and of Skelton and Parkham (1913) have been wholly negative.
Borrel has recently suggested that Demodex, may play a rôle in spreading the infection in families. Many other insects and acariens have been suggested as possible vectors, but the experimental data are few and in no wise conclusive. The most that can be said is that it is quite possible that under favorable conditions the infection might be spread by any of the several blood-sucking forms or by house-flies.
Verruga peruviana
Verruga peruviana is defined by Castellani and Chalmers as "a chronic, endemic, specific, general disorder of unknown origin, not contagious, but apparently inoculable, and characterized by an irregular fever associated with rheumatoid pains, anemia, followed by granulomatous swellings in the skin, mucous membranes, and organs of the body." It has been generally believed by medical men interested that the comparatively benign eruptive verruga is identical with the so-called Oroya, or Carrion's fever, a malignant type. This view is not supported by the work of Strong, Tyzzer and Brues, (1913).