46 Henry B. Ward 



reached sexual maturity. As already emphasized, all the evi- 

 dence points to an extremely slow growth of the parasite and 

 to conformable delay in reaching sexual maturity. Unless this 

 evidence has been entirely misconstrued, and a more rapid attain- 

 ment of sexual maturity is possible under some undetermined 

 circumstances, the view of Manson fails to account completely 

 for the facts in the case. In the case of Milroy the swellings 

 began witliin two years from the time of entrance into the infected 

 region ; furthermore, the parasite extracted three years later was 

 a male, and so far as known only a single parasite has been pres- 

 ent in the body of this patient. 



In view of these facts I venture to suggest another feature 

 which may not be without its bearing on the production of these 

 swellings. The parasite will, from time to time, discharge from 

 its body waste materials which in their very nature are toxic and 

 hence likely to cause such local changes as the Calabar swell- 

 ings. The action in this case would be chemical rather than the 

 mechanical irritation from the discharge of embryos. The ulti- 

 mate decision in this matter must necessarily await the accumu- 

 lation of further evidence. So far as facts at present on record 

 are concerned none of the causes advanced thus far are sufficient 

 to explain the rarity of the tumefactions in cases of multiple 

 infection by the parasite. 



5. Clinical Data 



clinical notes on cases 53 and 54 



by w. f. milroy, m.d._, omaha 



Batanga is a settlement situated in Germaii territory, on. the 

 western coast of Africa in about 3° north latitude. In 1897 Mr. 

 K., an American of German parentage, became a resident of this 

 place. About two years later he -first observed upon his body a 

 tumefaction which, in that country, is known to foreigners as 

 "the African swelling," and which is by common consent at- 

 tributed to a parasite. To the natives this parasite is known as 

 the eye worm because of a disposition it exhibits to frequent the 

 neighborhood of that organ. 



316 



