470 Proceedings of the Royal Physical Society. 
ground, or who have carried earth or water. In 1190 cases 
I saw, the feet were affected in 556 cases, the legs in 274, 
the thighs in 104, the scrotum in 4, the penis in 3, labia 
majora in 3, abdominal walls in 1, the breast in 2, the back 
in 143. I never myself saw it in the head, arms, or else- 
where. The average time of incubation after the ova is 
deposited within the skin appears to be from three to six 
months. It is only when the worm arrives at maturity that 
the patient first becomes really aware that he has contracted 
the disease. He suffers from a severe attack of fever, the 
stomach becomes uritable, bilious vomiting takes place, and 
attention is now first attracted to the situation of the guinea- 
worm. Intense itching is felt, with a sensation of a thin 
cord underneath the skin; occasionally also a small pimple 
or blister can be seen, and when this occurs in a district 
infested by the guinea-worm, it may generally be regarded 
as a sufficiently diagnostic sign, especially if accompanied by 
any swelling. 
The development of this characteristic blister or vesicle 
always coincides with the advance of the worm to the surface 
of the body. The blister may sometimes be as large as half a 
walnut, and may be attended also by an eruption resembling 
nettlerash. When this vesicle is opened, it is seen to be filled 
with either a glary, whitish fluid, or with the reticular portions 
of the true skin, the areola being a meshwork filled with serum, 
at the centre of which a small aperture is visible, in which 
the extremity of the worm will be found. As the worm 
protrudes from the skin, it should be secured to a small piece 
of twig or crowquill and gradually withdrawn. Great care 
must be taken not to break the worm, as if it is broken 
extensive and destructive inflammation in the connective 
tissue occurs. The prognosis in general is good if the case 
be treated carefully, but it may cause distortions of the lower 
extremity, such as talipes equinus, permanent enlargement of 
the internal maleolus, permanent contraction of the leg or 
the thigh, and sometimes permanent anchylosis of the knee 
joint, or gangrene of either toe, foot, or leg. 
Preventive Treatment.—Never walk bare-footed in a region 
where the worm is endemic; do not bathe in muddy pools. 
