676 THE ANIMAL PARASITES OF MAN 



affected part ; it occurs more rarely in the arms, certain parts of the 

 back, the head, neck, scrotum and penis ; in a superficial position 

 the worm can occasionally be felt through the skin. In most cases 

 there is only one worm and one abscess, but here and there one finds 

 patients with three, four or even up to eight worms, and very excep- 

 tionally still more, as in the cases described by Poupee-Desportes 1 

 (fifty worms) and by Harington 2 (seventeen worms). 



Diagnosis offers no difficulty when the worms are presenting or 

 can be felt under the skin. 



The inhabitants of the native home of the guinea worm, as a rule, 

 quietly wait till it has got so far out that it can be conveniently 

 grasped ; it is then bound round with thread and fastened between 

 the tips of a split piece of wood and slowly wound out. In ten to 

 twelve days it can be wound out in this way. Emily 3 makes injec- 

 tions of a i in 1,000 solution of sublimate either in the neighbour- 

 hood of the worm or directly into its body. Mense 4 managed to 

 remove the worm in one sitting by laying a wad of cotton wool 

 soaked in chloroform on the exposed portion, thus stupefying it. 

 Our therapeutic observations (Frangenheim 5 ) favour the free laying 

 open of the existing abscess and the consequent complete extraction 

 of the worm. 



Prophylaxis depends on care in the use of water in the guinea 

 worm countries, especially dangerous being permanent waters infested 

 by Cyclops sp. 



Filaria bancrofti. 



The parasitism of this filaria leads to the formation of lymphangitis, 

 elephantiasis, chyluria, orchitis, chylocele, abscesses, lymphatic varices, 

 perhaps also to chylous ascites and chylous diarrhoea. 



Lymphangitis usually attacks the extremities, beginning generally 

 with a rigor and swelling of the lymphatic vessels with adjoining 

 lymph glands. The lymphatics become hard, knotty and extremely 

 painful, the overlying skin red and swollen in longitudinal lines 

 (Looss), high fever sets in with, to some extent, severe general dis- 

 turbance. After some days the attack subsides, the swelling then 

 partially disappears, but not completely, and often abscesses develop 

 in consequence of the lymphangitis. Children, as a rule, suffer from 

 such lymphangitic attacks (Finucane 6 ). 



Diagnosis is not easy, for many other causes frequently produce 

 lymphangitis. 



1 Poupee-Desportes, see Looss, " Handb. d. Tropenkrankh.," 1905, i. 



' 2 Harington, Brit. Med. Journ. , 1906. 8 Emily, see Looss he. cit. 4 Mense, ibid. 



3 Frangenheim, Volkmann's Samml. klin. Vortrcige, 424. 



6 Finucane, Lancet, 1907. 



