ENTOZOA IN THE AREOLAR TISSUE. 213 



The tumour is occasionally of considerable size, and 

 the worm which is contained within it is then dis- 

 charged whole ; the fluid which escapes from the 

 opening is usually of a serous character. 



The diagnosis of the existence of a Guinea-worm 

 is sometimes very difficult, and it is not until after 

 the appearance of a portion of the filaria externally 

 that the nature of the affection can be fully deter- 

 mined, as it is liable to be mistaken for an inflamed 

 vein, or lymphatic vessel, or for some other species 

 of tumour. 



The best method of treatment consists in the 

 gradual removal of the worm, which is efiected by 

 daily winding the protruding portion of it round a 

 small piece of wood, or a roll of adhesive plaster, 

 great care being taken so as not to break the wormi 

 by too forcible traction ; a bandage should be em- 

 ployed so as to prevent the portion of the worm which 

 is extracted from being again drawn beneath the skin. 

 If the parasite be broken, serious results often follow, 

 and there is great local inflammation and sympathetic 

 fever, together with the formation of abscesses and 

 sinuses ; gangrene is sometimes produced as a con- 

 sequence of the accidental rupture of the worm. 

 These comphcations are attributed by some observers 

 to the presence of dead animal matter, and by others 

 to the escape of the embryonic filarise into the 

 various structures by which the adult filaria is sur- 

 rounded. 



Numerous medicaments have been suggested and 

 tried both for the prevention and for the cure of the 

 affection. Assafoetida has been especially recom- 

 mended as a prophylactic, and several writers state 



