The last few years of the nineteenth and the first few years of the present century are marked in the annals of medicine by a great increase in our knowledge of certain parasitic diseases, and, above all, in our knowledge of the agency by which the parasites causing the diseases are conveyed from host to host. Chief among these agencies in carrying the disease-causing organisms from infected to uninfected animals are the insects, and, amongst the insects, above all the flies. Flies—e.g., the common house-fly (Musca domestica)—can carry about with them the bacillus of anthrax, and, if brought into contact with a wounded surface, may thus set up an outbreak of woolsorter’s disease. Flies, ants, and other even more objectionable insects, are not only capable of disseminating the plague bacillus from man to man, and from rat to man, but they themselves fall victims to the disease, and perish in great numbers. They are active agents in the spread of cholera, and the histories of the South African and Cuban wars definitely show that flies play a large part in carrying the bacilli of enteric fever from sources of infection to the food of man, thus spreading the disease. They are also accused of conveying the inflammatory matter of Egyptian The diseases already mentioned are caused by bacteria. But flies also play a part in the conveyance of a large number of organisms which are not bacteria, but which, nevertheless, cause disease, and cause it on the largest scale. Of all the twenty-two orders into which the modern entomologist divides the class Insecta, that of the Diptera, or true flies, is, perhaps, the easiest to recognize, for it is characterized by one very obvious feature, the presence of the fore-wings only. The hind-wings are replaced by a pair of small-stalked, club-shaped ‘balancers,’ which are readily visible in some kinds of fly—e.g., the daddy-long-legs—but in others are by no means conspicuous. Thus it is an easy matter to determine whether an insect be a fly or not. To determine what particular kind of fly it be is, however, a very different affair. At present some forty thousand species of Diptera are known, and have been more or less completely described or figured; and Mr. D. Sharp estimates that this number is ‘only a tithe of what are still unknown to science.’ Further, the group has been rather neglected. Flies, speaking generally, are neither attractive in their appearance nor engaging in their habits, and it is a cause for no astonishment that entomologists have preferred to work at other groups. In considering the part played by flies in disseminating diseases not caused by bacteria, we can neglect all but a very few families, those flies which suck blood having alone any interest in this connexion. From the point of view of the physician, by far the most important of these families is the CulicidÆ, with over three hundred described species and five sub-families, of which two, the Culicina and the Anophelina, interest us in relation to disease. The gnats or In spite of their incredible number—some authorities place it at thirty to forty millions in one man—these minute larval organisms, shaped something like a needle pointed at each end, seem to cause little harm. It might be thought that they would traverse the walls of the bloodvessels and cause trouble in the surrounding tissues; but this is prevented by a curious device. It is well known that, like insects, round-worms from time to time cast their skins, and the young larvÆ in the blood cast theirs, but do not escape from the inside of this winding-sheet; and thus, though they The causes of the periodicity of the appearance of these round-worms in the superficial bloodvessels are not completely understood, but they appear to have more relation with the usual sleeping hours of humanity than with day and night. In individuals who sleep by day and work by night the Filaria nocturna is found in the bloodvessels of the skin during the day. Thus, whilst between 5 p.m. and 7 or 8 a.m. the vessels of the skin of Cox the Hatter would be well peopled by the round-worms, they would only come to the surface in Box the Printer during the daytime, whilst he was sleeping in the lodgings of Mrs. Bouncer. One reason of the normal appearance of the creatures in the blood at night is undoubtedly connected with the habits of its second host, the gnat or mosquito. Two species are accused of carrying the Filaria from man to man—Culex fatigans and Anopheles nigerrimus. Sucked up with the blood, the round-worms pass into the stomach of the insect. Here they appear to become violently excited, and rush from one end to the other of their enveloping sheath, until they succeed in breaking through it. When free, they pierce the walls of the stomach of the mosquito, and come to rest in the great thoracic muscles. Here the Filarias rest for some two or three weeks, growing considerably, and developing a mouth and alimentary canal; thence, when they are sufficiently developed, they make their way to the proboscis of the mosquito. Here they lie in couples, and it would be interesting to determine whether these couples are male and female. Exactly how they effect their exit from the mosquito and their entrance into man has not yet been accurately observed, but presumably it is during the We now pass to the second of the diseases carried by gnats, that of malaria. The parasite which causes malaria is a much more lowly organized animal than the Filaria. It is named HÆmamoeba, and it, too, is conveyed by an insect, and, so far as we know, by one genus of mosquito only, the Anopheles. Hence, from the point of view of malaria, it is important to know whether a district is infected with Culex or Anopheles. The former is rather humpbacked, and keeps its body parallel with the surface it is biting, and its larva hangs at an angle below the surface of the water, by means of a respiratory tube. Anopheles, on the other hand, carries its body at a sharp angle with the surface upon which it rests, and its larva lies flat below the surface-film and parallel with it. The malarial parasite lives in the blood-cells of man, but at a certain period it breaks up into spores, which escape into the fluid of the blood, and it is at this moment that the sufferer feels the access of fever. The presence and growth within the blood-cells result in the destruction of the latter, a very serious thing to the patient if the organisms be at all numerous. If the spores be sucked up by an Anopheles, they undergo a complex change, and ultimately Under normal circumstances, for each Filaria larva which enters a mosquito, one Filaria issues forth, longer, it is true, and more highly developed, but not much changed. The malaria-parasite undergoes, in its passage through the body of the Anopheles, many and varied phases of its life-history. As the Frenchman said of the pork, which goes into one end of the machine in the Chicago meat factories as live pig, and comes out at the other in the form of sausages, ‘Il est diablement changÉ en route.’ The mosquito is as truly a host of the malarial parasite as man, and is as necessary for its full development as is man. Judging by the number and extent of the lesions in the insect’s body, it must suffer far more than man, and it is undoubtedly killed at times, and perhaps fairly frequently, by the parasite. Whoever has watched under a lens the process of ‘biting’ as carried on by a mosquito, must have observed the fleshy proboscis (labium) terminating in a couple of lobes. The labium is grooved like a gutter, and in the groove lie five piercing stylets, and a second groove, or labrum. It is along this labrum that the blood is sucked. Between the paired lobes of the labium, and guided by them (as a billiard cue may be guided by two fingers), a bundle of five extremely fine stylets sinks slowly through the epidermis, cutting into the skin as easily as a paper-knife into a soft cheese. Four of these stylets are toothed, but the single median one is shaped like a two-edged sword. Along its centre, where it is thickest, runs an extremely minute groove, only visible under a high power of the microscope. Down this groove flows the saliva, charged with the spores or blasts of the malaria-causing parasite. Through this minute groove It is an interesting fact that, amongst the CulicidÆ, it is the female alone that bites. The mouth-parts of the male are weaker, and seem unable to pierce the skin. It has been suggested that a meal of blood is necessary for the development of the eggs; but the evidence for this is not conclusive. There must be millions and millions of mosquitoes in sparsely inhabited or uninhabited districts, in Africa, in Finland, in Northern Asia, and America, which never have a chance of sucking blood; and it is impossible to believe that these millions do not lay eggs. The female is undoubtedly greedy. If undisturbed, she simply gorges herself until every joint of her chitinous armour is stretched to the cracking-point. At times even, like Baron Munchausen’s horse after his adventure with the portcullis, what she takes in at one end runs out at the other. But she never ceases sucking. The great majority of individuals, however, can never taste blood, and subsist mainly on vegetable juices. In captivity they cannot last longer than five days without food and drink; but they can be kept alive for weeks on a diet of bananas, pineapples, and other juicy fruits. Anopheles is often conveyed great distances by the wind, or in railway trains or ships; but of itself it does not fly far; about five or six hundred yards—some authorities place it much lower—is its limit. Beyond this distance they do not voluntarily stray from their breeding-places. Both Anopheles and Culex lay their eggs, as is well known, in standing water, and here three out of the four stages in their life-history—the egg, the larva, and the pupa—are passed through. The larva and the pupa hang on to the surface-film of the water by means of certain suspensory In Ismailia the disease has been reduced to an amazing extent, and quite recently remarkable results have followed the use of these preventive measures at Port Swettenham, in the Federated Malay States. Within two months of the opening of the port in 1902, 41 out of 49 of the Government quarters were infected, and 118 out of 196 Government servants were ill. Now, after filling up all pools and cleaning the jungle, no single officer has suffered from malaria since July, 1904, and the number of cases amongst the children fell from 34·8 to 0·77 per cent. The only melancholy feature about this wonderful alleviation of suffering due to the untiring efforts of the District Surgeon, Dr. Malcolm Watson, is that his fees for attending malarial cases have dropped to zero. Thus a considerable degree of success has attended the efforts of the sanitary authorities, largely at the instigation of Major Ross, all over the world, to diminish the mosquito plague. It is, of course, equally important to try and destroy the parasite in man by means of quinine. This is, however, a matter of very great difficulty. In Africa and in the East nearly all native children are infected with malaria, though they suffer little, and gradually acquire a high degree of immunity. Still, they are always a source of infection; and Europeans living in malarious districts should always place their dwellings to the windward of the native settlements. Knowing the cause, we can now guard against malaria; mosquito-nets Another elegant little gnat, Stegomyia fasciata, closely allied to Culex, with which, until recently, it was placed, is the cause of the spread of that most fatal of epidemic diseases, the yellow fever. Like the Culex, but unlike the Anopheles, Stegomyia has a humpbacked outline, and its larva has a long respiratory tube at an angle to its body, from which it hangs suspended from the surface-film of its watery home. It is a very widely distributed creature; it girdles the earth between the Tropics, and is said to live well on shipboard. It breeds in almost any standing fresh water, provided it be not brackish. The female is said to be most active during the warmer hours of the day, from noon till three or so, and in some of the West Indies it is known as the ‘day-mosquito.’ The organism which causes yellow fever has yet to be found. It seems that it is not a bacterium, and that it lives in the blood of man. It evidently passes through a definite series of changes in the mosquito, for freshly infected mosquitoes do not at once convey the disease. After biting an infected person, it takes twelve days for the unknown organism to develop in the Stegomyia before it is ready for a change of host. The mosquitoes are then capable of inoculating man with the disease for nearly two months. The period during which a man may infect the mosquito, should it bite him, is far shorter, and extends only over the first three days of the illness. Very careful search has hitherto failed to reveal the King Solomon sent to Tarshish for gold and silver, ivory, and apes and peacocks, and at the present day people mostly go to Africa for gold, diamonds, ivory, and game. These are the baits that draw them in. Of the great obstacles, however, which have for generations succeeded in keeping that great continent, except at the fringes, comparatively free from immigrants, three—and these by no means the least important—are insignificant members of the order Diptera. We have considered the case of Culex and Anopheles; the third fly we have now to do with is the tsetse fly (Glossina), which communicates fatal diseases to man and to cattle and domesticated animals of all kinds. There are at least seven species of the genus which received its name as long ago as 1830, when Wiedemann first described it. Perhaps the best known species is Glossina morsitans, which was named by Westwood. The members of the genus Glossina are unattractive insects, a little larger than our common house-fly, The tsetse flies rapidly and directly to the objects it seeks, and must have a keen sense of smell or sight, or both, making straight for its prey, and being most persistent in its attacks. The buzzing which it produces when flying is peculiar, and easily recognized again when once heard. After feeding, the fly emits a higher note, a fact recalling the observation of Dr. Nuttall and the present writer on the note of Anopheles, in which animal they observed that, ‘the larger the meal, the higher the note.’ The tsetse does not settle lightly and imperceptibly on the sufferer as the CulicidÆ do, nor does it alight slowly and circumspectly after the manner of the house-flies, but it comes down with a bump, square on its legs. Like the mosquito, the tsetse is greedy, and sucks voraciously. The abdomen becomes almost spherical, and of a crimson red, and in the course of a few seconds the fly has exchanged the meagre proportions of a Don Quixote for the ampler circumference of a Sancho Panza. There is a good deal of discrepancy between the reports of the various sufferers as to the pain of the bite. No doubt different persons are very differently affected, and suffer to very varying degrees. Unlike so many of the blood-sucking Diptera, in which the habit is confined to the females, both sexes of Glossina attack warm-blooded creatures. The fly always seems to choose a very inaccessible portion of the body to operate on—between the shoulders in man, or on the back and belly in cattle The genera of the CulicidÆ which we have considered are found practically all over the world, but the genus Glossina, except that it just reaches Arabia, is fortunately confined to Africa. From the admirable map of the geographical distribution of the fly compiled by Mr. Austen we gather that its northern limit corresponds with a line drawn from the Gambia, through Lake Chad to Somaliland, somewhere about the 13th parallel of north latitude. Its southern limit is about on a level with the northern limit of Zululand. The tsetse, of course, is not found everywhere within this area, and, though it has probably escaped observation in many districts, it seems clear that it is very sporadically distributed. Mr. Austen further thinks that it may occur outside the boundary above laid down, and suggests that the great mortality amongst the horses in the Abyssinian campaign against King Theodore may have been caused by it. Even where the tsetse is found it is not uniformly distributed, but occurs in certain localities only. These form the much dreaded ‘fly-belts.’ The normal The tsetse fly belongs to the family MuscidÆ, the true flies, a very large family, which also includes our house-fly, blue-bottle fly, etc. These flies, unlike Anopheles and Culex, are day-flies, and begin to disappear at or about sunset, a fact noted centuries ago by Dante: ‘Nel tempo che colui, che il mondo schiara, La faccia sua a noi tien meno ascosa, Come la mosca cede alla zanzara.’ The practical disappearance as the temperature drops has enabled the South African traveller to traverse the fly-belts with impunity during the cooler hours of the night. At nightfall the tsetse seems to retire to rest amongst the shrubs and undergrowth, but, if the weather be warm, it may sit up late; and some experienced travellers refrain from entering a fly-belt, especially on a summer’s night, until the temperature has considerably fallen. The sickness and death of the cattle bitten by the tsetse were formerly attributed to some specific poison secreted by the fly, and injected during the process of biting. It is now, largely owing to the researches of Colonel Bruce, known to be due to the The Report of Colonel Bruce, which was issued three years ago, shows that the sleeping-sickness which devastates Central Africa, from the West Coast to the East, is also conveyed by a species of tsetse fly. Writing over a hundred years ago of Sierra Leone, Winterbottom mentions the disease. ‘The Africans,’ he says, ‘are very subject to a species of lethargy which they are very much afraid of, as it proves fatal in every instance.’ Early last century it was recorded in Brazil and the West Indies; and in all probability the deaths which our slave-owning ancestors used to attribute to a severe form of home-sickness, or even to a broken heart, were in reality caused by sleeping-sickness. The severity of the disease, which always terminates fatally, is shown by the fact that in a single island—Buvuma—the population has recently been reduced by it from 22,000 to 8,000, whilst whole districts have been almost depopulated. In one year the deaths in the region of Busoga reached a total of 20,000; and it is calculated that although the disease was only noticed in Uganda for the first time in 1901, that by the middle of 1904 100,000 people have been killed by it. The disease is caused by the presence of a second species of Trypanosoma in the blood and in the cerebro-spinal fluid. The existence of this parasite has now been proved in all Finally, we come to a last class of disease which is of the utmost interest to the agriculturist and settler, and yet at present is but little understood. These diseases are caused by various species of a Protozoon named Piroplasma, and the diseases may collectively be spoken of as piroplasmosis. When they are present in cattle they are spoken of in various parts of the world as Texas fever, tick fever, blackwater, redwater, and many other French, German, Italian, and Spanish The organisms which cause the disease live for the most part in the red blood-corpuscles, but they are sometimes to be found in the plasma or liquid of the blood. Unfortunately, we know but little about the life-history of the Piroplasma, or of the various stages it passes through, but we do know how it is transmitted from animal to animal and from man to man. We have seen that the carrier or ‘go-between’ in the case of the malaria is the mosquito, and in the case of the sleeping-sickness is the tsetse fly. The Piroplasma, however, is not conveyed from host to host by any insect, but by mites or ticks, members of the large group of Acarines, which include beside the mites the spiders, scorpions, harvestmen, and many others. The ticks differ from the insect bearers of disease inasmuch as the tick that attacks an ox or a dog does not itself convey the disease, but it lays eggs—for I regret to say here, as with the Anopheles, it is the female only that bites—and from these eggs arises the generation which is infective, and which is capable of spreading the disease. The tick which conveys the Piroplasma from dog to dog is called HÆmophysalis leachi. The brilliant researches of Mr. Lounsbury have shown that even the young are not immediately capable of giving rise to the disease. The female tick gorges herself with blood, drops to the ground, and begins laying eggs. From these eggs small six-legged larvÆ emerge. These larvÆ, if they get a chance, attach themselves to a dog, gorge themselves, and With regard to bovine piroplasmosis, Koch, and others have distinguished redwater fever, which is conveyed by Rhipicephalus annulatus, and in Europe probably by Ixodes reduvius from the Rhodesian fever, which is conveyed by Rhipicephalus appendiculatus, and I regret to say by a species dedicated to myself, Rhipicephalus shipleyi. The heartwater disease of sheep and goats is I will not weary you with more diseases. I think I have said enough to show that within the last few years a flood of light has been thrown upon diseases not only of man and his domestic animals, but upon such insignificant creatures as the mosquito and the tick. I have tried to show how these diseases interact, and how both hosts are absolutely essential to the disease. We can now to a great extent control these troubles; the old idea that there is something unhealthy in the climate of the Tropics is giving way to the idea that the unhealthiness is due to definite organisms conveyed into man by definite biting insects. We have at last, I think, an explanation of why Beelzebub was called the Lord of Flies. |