Chapter X Other Diseases, Mostly Tropical, Known or Thought to Be Transmitted by Insects
Sleeping Sickness
ne of the worst scourges of Africa and one that is to-day attracting world-wide attention is the disease known as trypanosomiasis, the terminal phase of which is sleeping sickness, one of the most ghastly diseases that we know.
Among the Protozoa referred to in one of the earlier chapters mention was made of certain trypanosomes which inhabit the blood of man and certain animals. Very little was known concerning these parasites previous to the beginning of the present century, but since that time several have been found to be of great economic importance. The group is being studied extensively and every day our knowledge of them is increasing so that we now know quite definitely the life-history of several.
Trypanosoma lewisi, a parasite of rats, is perhaps the best known as it is always common where-ever rats are found. Sometimes as many as 30% or 40% of the rats of certain districts are infected. It is thought that these are transmitted from rat to rat by the common rat-louse which serves as an intermediate host. Fleas may also act as disseminating agents.
A few other kinds cause serious disease of animals, but we are more interested just now in the particular one that is causing so much trouble in Africa. This parasite was discovered in 1902 and was named Trypanosoma gambiensi (Fig. 111). Since then it has been found to be widely distributed. Although the natives have doubtless long been subject to the disease caused by this parasite, the recent influx of whites to these regions and the consequent movements of the natives have caused a great spread of the disease so that whole regions are now made desolate, the inhabitants dying or fleeing to escape the uncanny death.
The disease may run its course in a few months or it may take years. The symptoms are various, but infection is usually soon followed by fevers, sometimes mild, sometimes severe, which recur at irregular intervals. Certain glands or other parts of the body may become swollen. More or less extensive skin eruptions occur on all parts of the body and the patient gradually becomes anemic and physically and intellectually feeble. The nervous system seems to be affected by the parasite, either directly or by the action of the toxins it produces. The patient becomes more debilitated and morose with an increasing tendency to sleep, hence the name sleeping sickness. As the stupor deepens the patient looses all desire or power of exertion and as little food is taken he rapidly wastes away and finally succumbs for after this final stage is reached there is no relief.
It is definitely known that a species of tsetse-fly, Glossina palpalis (Fig. 112), which somewhat resembles our stable-fly, is responsible for the dissemination of the disease, and some recent investigators have suggested that certain species of mosquitoes may also carry the parasite from one host to another. There still remains some doubt as to the exact manner in which the fly transmits the disease, but it seems altogether likely that it is an alternative host and does not serve as a simple mechanical carrier. In this respect it is like the mosquito which is one of the necessary hosts of the malaria parasites, and unlike the house-fly which carries the germs of various diseases in a purely mechanical way without serving as a definite necessary host for the parasite.
The tsetse-fly is found only in tropical Africa and is limited in its distribution there to certain very definite, narrow, brushy areas along the water’s edge. If these places can be avoided there seems to be little danger. Those who are fighting the disease have found that if the brush in the vicinity of watering-places and ferry-landings is cleared away such places become comparatively safe. These flies do not lay eggs but produce full-grown larvæ which soon pupate in the ground.
ELEPHANTIASIS
In many tropical regions human blood as well as that of other animals is the normal habitat of certain worm-like parasites (Nematodes). They are not entirely confined to the tropics but may extend far up into the subtropical regions. Five or six different species of these parasites are known, only one of which, however, has been shown to be of any pathological importance, as far as human beings are concerned.
This species, Filaria bancrofti, is not only very widely distributed, but in regions such as some of the South Sea Islands a very large per cent of the natives have the filariæ present in their blood. When these parasites are withdrawn from the circulation and placed on a slide for study they are seen to be minute transparent, colorless, snake-like organisms inclosed in a very delicate sack or sheath. They are but a little more than one-hundredth of an inch long and about as big around as a red blood-corpuscle. These are the larval forms of the parasite and have been called by Le Dantec the micro-filaria.
If blood of the patient drawn from the skin, is examined during the day few if any of these parasites are found, but if it is examined between five or six o’clock in the evening and eight or nine o’clock the next morning they may be found in numbers. During the daytime they have retired from the peripheral circulation to the larger arteries and to the lungs, where they may be found in great numbers.
This night-swarming to the peripheral circulation has been found to be a remarkable adaptation in the life-history of the parasite, for it has been demonstrated that in order to go on with its development these larval forms must be taken into the alimentary canal of the mosquito. Most of the mosquitoes in which the development takes place are night-feeders, so that the parasites are sucked up with the blood of the victim. Once inside the stomach they soon free themselves from the inclosing sheath and make their way through the walls of the stomach and enter the muscular tissue, particularly the thoracic muscles. Here they undergo a metamorphosis and increase enormously in size, some attaining one-sixteenth of an inch in length.
After sixteen to twenty days they leave these muscles and make their way to other parts of the body. A few may be found in different parts of the abdomen, but most of them make their way forward into the head of the mosquito and coil themselves up close to the base of the proboscis, finally finding their way down into the proboscis inside the labium. Here they lie until an opportunity offers for them to escape to the warm blood of a vertebrate. They probably pass through the thin membrane connecting the labella with the proboscis and there find their way into the wound made by the puncture when the insect bites. Whether these parasites can gain an entrance into the circulatory system in any other way is not known. It has been suggested that the mosquitoes dying and disintegrating on the surface of water may liberate the filariæ which may later find their way into the system of the vertebrate host when the water is used for drinking, but most of the investigations made so far seem to indicate that they make their way directly from the proboscis into the new host.
Soon after entering the circulatory system of the human host the parasites make their way into the lymphatics where they attain sexual maturity, and in due time new generations of the larval filariæ or microfilariæ are poured into the lymph, and finally into the definite blood-vessels, ready to be sucked up by the next mosquito that feeds on the patient.
In most cases of infection the presence of these filariæ in the blood seems to cause no inconvenience to the host. They are probably never injurious in the larval stage, that is, in the stage in which they are found in the peripheral circulation.
In many cases, however, the presence of the sexual forms in the lymphatics may cause serious complications. The most common of these is that hideous and loathsome disease known as elephantiasis in which certain parts of the patient becomes greatly swollen and distorted. An arm or a leg may become swollen to several times its natural size, or other parts of the body may be seriously affected.
In some of the South Sea Islands 30% to 40% of the natives are afflicted in this way, some only slightly others seriously. There is little or no pain, but in severe cases the distorted parts often render the patient entirely helpless.
The exact way in which the parasites cause such swelling is not very definitely known. Manson, who has done more work on these diseases than any one else, believes that the trouble arises from the clogging of the lymphatic glands or trunks, thus cutting them off from the general circulation, in which case the affected parts may become distorted. This clogging of the passages is believed to be due to the presence of great numbers of immature eggs which have been liberated by parasites injured in some way before their eggs were entirely developed.
This interference with the lymphatic circulation brings about the anomalous condition of a patient with a serious filarial disease with fewer of the filarial parasites in his blood than one who is not so seriously affected. This is supposed to be due to the fact that the disease-producing parasites have died and that the lymphatics have become so obstructed that any microfilariæ they may contain cannot make their way into the general circulation. Such a patient then would not be as likely to infect a mosquito as would one less seriously affected.
It has always been thought that little or nothing could be done in the way of successfully treating this disease, but quite recently a French physician, who has been conducting a long series of experiments in the Society Islands, announced that he is able to cure many cases by certain surgical operations on the affected parts.
DENGUE OR “BREAKBONE FEVER”
This is another disease of the tropics often occurring in widespread epidemics. It is probably most frequently met with in the West Indies, but may occur in any of the tropical countries or islands. Occasionally it spreads into subtropical or even temperate regions. Several extensive epidemics have occurred in the United States. Once introduced into a community it spreads very rapidly and nothing seems to confer immunity.
The various names by which it has been called well describe its effect on the patient; breakbone fever, dandy-fever, stiff-necked or giraffe-fever, boquet (or “bucket”) fever, scarlatina rheumatica, polka-fever, etc. While the suffering is intense as long as the disease lasts it seldom terminates fatally.
It has always been classed as a very contagious disease and it has not yet been definitely shown that it is not. Recent observations, however, have shown that it is probably caused by a certain Protozoan parasite that is found in the blood of dengue patients and several experiments have been conducted by Dr. Graham which seem to indicate that it is transmitted by mosquitoes. In these experiments, Culex fatigans, a common tropical or subtropical mosquito, was used. The same parasite that is found in the human blood may be found in the stomach and blood of the mosquitoes up to the fifth day after it has fed on a dengue patient.
Sick and healthy individuals were allowed to remain in close contact in a room from which the mosquitoes had been excluded, and the disease was not spread. Mosquitoes that had bitten dengue patients were taken to a higher region where dengue had never occurred and allowed to bite two healthy persons. Both developed the disease and as they were protected from other mosquitoes until they had recovered, the disease did not spread to others of the community. These and other observations seem to make a complete chain of evidence, and most medical men to-day accept the theory as well proved and in their practice take every precaution to prevent the spread of the disease by keeping the infected patient from being bitten by the mosquitoes.
The yellow fever mosquito is also suspected of carrying this same disease, and it is possible that other species are also concerned. If it is true that the parasite can be carried by several different species of mosquitoes this would account very largely for its rapid spread wherever it is introduced into a community. Where it occurs outside the tropics it is only in the warm summer months when mosquitoes are always abundant.
MALTA OR MEDITERRANEAN FEVER
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
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.