126 TROPICAL MEDICINE AND HYGIENE 



this was supposed to be part of the uterus protruded 

 through the mouth, but Leiper has shown that it is 

 through an opening close to the mouth and not the 

 mouth itself. In this milky fluid innumerable embryos 

 are present. The process can be repeated at intervals 

 when the leg is brought into contact with water : in the 

 intervals, as a rule, no embryos are discharged. The 

 object attained is clear ; when the embryos can be dis- 

 charged into water the parent worm discharges them. 

 At this stage there is some inflammatory swelling round 

 the aperture, but this is usually slight. 



By constant repetition of these discharges of larvae the 

 Guinea-worm empties itself and can be gradually and 

 slowly withdrawn. The inflammation increases from the 

 first, so that the patient is unable to walk. Frequently 

 by injudicious attempts at extraction the worm is killed 

 or broken. The broken end is withdrawn into the con- 

 nective tissue, and in these cases the embryos are dis- 

 charged into the connective tissue of the host, and severe 

 inflammation, often with abscess formation, is set up and 

 may extend along the whole of the sinuous track occupied 

 by the worm. Complete disablement then occurs, and 

 there may even be general. septicaemia. 



The native method of extraction of the worm aims at 

 avoiding these complications by withdrawing the worm 

 very gradually. The head when it emerges is seized and 

 caught in the fork made by partially splitting a piece of 

 wood, or it may be tied to a piece of twine. The worm is 

 rolled up On the piece of wood, a small stick, only slight 

 traction being exercised. The erxtaction of the worm may 

 be aided by dashing cold water on the skin, when more of 

 the worm will protrude and can be coiled up. The stick 

 with the worm coiled on it is fixed close to the opening 

 and secured. In a few hours more of the worm will have 

 protruded, and this part can also be rolled on to the stick. 

 The wound usually heals rapidly. Provided no accident 

 has occurred this method is good, and if the opening is kept 

 aseptic is highly successful. Some authorities endeavour 



