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.
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.
This disease, once supposed to be confined to the Orient, is now found to be rather widely distributed throughout the tropics, where it is sometimes very prevalent. It is caused by the presence in the system of a parasite very similar to or identical with the one causing _kala-azar_ and is regarded by some as a modified form of that disease. The patient is affected with one or more serious sores or ulcers which usually occur on exposed parts of the body.
The parasite that causes the disease is supposed to be carried by insects either directly or indirectly.
In the latter case the insect may act as an intermediate host.
Dogs and camels are also attacked by this disease and may be sources of infection.