730 THE ANIMAL PARASITES OF MAN 



pointed out by v. Samson that in Russia the infection of peasants 

 who work in the fields was specially frequent. It is noticeable how 

 frequently the affection begins on uncovered parts of the body (face, 

 hands, arms) ; but that fact, on the whole, is not in conflict with the 

 statement (Kengsep 1 ) that the disease makes its first appearance 

 over the nates, because children often sit on the ground and play 

 with that part of their body uncovered. A case observed by us was 

 that of an elderly lady who did not do this and was properly clothed, 

 yet showed the typical lines of creeping disease on the nates, and 

 asserted again and again that she had the feeling as if a worm were 

 creeping under her skin. 



The disease occurs in children as well as adults, so that age, sex 

 and calling offer no determining point etiologically. 



The clinical symptoms of the disease consist in the sudden 

 appearance of itching and burning ; if the cause is looked for one 

 perceives a red line, raised but little above th- surface of the skin, 

 with irregular curves, never branched, but often entwined, broadening 

 more or less rapidly at one end (i to 15 cm. in twenty-four hours). 

 The larva can be seen sometimes with a lens under pressure of the 

 skin as a dark spot ; formations of pus, such as other larvae produce, 

 are not noticed ; now and again there is a formation of little vesicles 

 (Hamburger, 2 v. Harlingen, 3 Bruno, 4 Ehrmann, 5 Brodier and 

 Fouquet, 6 Rawnitzky 7 ). It may happen that the parasite burrows 

 through a small region of the skin with many close curves for some 

 time; on the other hand, observations exist where it covered large 

 tracts in a short time. The itching and smarting cease in the place 

 left by the larva, so that the patients even in the shortest tract can 

 point out at which end the larva is, even if they have not watched 

 the lengthening of the tract. Very rarely the larva invades the 

 mucous membrane of the mouth, the nose, and the conjunctiva, 

 proceeding from thence to the external cutaneous area. 



The localization of the affection is very varied ; the primary seat 

 has been observed on the glntei muscles (Lee, Kengsep, Morris, 8 

 Rille, Seifert) and their surroundings (Stelwagon, Hamburger, 

 Bruno), on the lower extremities (Stelwagon, Lenglet and Delaunay, 

 Hutchins, Moorhead, Lee, Crocker, Schmid, 9 v. Harlingen), on the 



1 Kengsep, Derm. Centralbl.^ 1906, vii. 



2 Hamburger, Journ. of Cut. Dis., 1904. 

 8 v. Harlingen, loc. cit. 



4 Bruno, v. Rille and Riecke, " Handb. d. Hautkrankh. v. Mracek." 



5 Ehrmann, loc. cit. 



6 Brodier and Fouquet, Bull, de la Soc.franf. d. Derm., 1904. 



7 Rawnitzky, loc. cit. 



8 Morris, Brit, fount. Derm., 1896. 



9 Schmid, Verein der Aerzte in Steiermark, February 12, 1900. 



