40 Henry B. Ward 



and well known as a student of the religious and social customs 

 of the negro races ; it has also been extracted from the meta- 

 carpo-phalangeal articulation (case 87). Ziemann (1905) 

 records that the worm is said by his patients to wander about 

 under the scalp, and others maintain its presence in various other 

 parts of the body. According to report of post-mortems the 

 adult form occurs almost anywhere under the skin, but espe- 

 cially in the appendages (cases 78, 80). 



In view of all the evidence the superficial connective tissues 

 must be regarded as the true seat of the adult parasite, and its 

 occurrence in the eye or indeed in other adjacent parts is more 

 or less accidental and occasional. 



EFFECT ON THE HOST 



When in the eye F. loa is the cause of temporary piercing or 

 lancinating pains as it makes its way through the connective 

 tissue. This pain is also accompanied by the sensation of a 

 foreign body in the eye, and in case it crosses the field of vision 

 there is added an uncertain image of the object. Both the pain 

 and the sensation of the presence of some foreign body cease 

 promptly with the withdrawal of the parasite into deeper tissues, 

 while even repeated visits leave no permanent effect upon the 

 organ other than to produce a very slight elevation of the con- 

 junctiva, as Lota reports from observations on himself which 

 one may consult (p. 49) for further details. In fact, the annoy- 

 ance is so slight and of such brief duration as hardly to call for 

 medical aid at all. Removal from the eye is not difficult when 

 regard is had to the activity of the parasite and its tendency to 

 flee at once when touched by any instrument. Even the natives 

 in Africa practice its extraction with the rudest sort of instru- 

 ments, in some cases using only a hooked thorn. In the earliest 

 cases observed by European physicians it is recorded that such 

 removal is unaccompanied by any . untoward symptoms and is 

 followed by complete recovery in a very brief time. So far as 

 I have found, the same results uniformly follow the removal of 

 the worm, from the anterior chamber as well as from below the 

 conjunctiva. 



310- 



