FILAEIA MEDINENSIS. 403 



bloody ichorous discharge flowed for 6 — 7 weeks out of the wound, 

 which gradually healed up to a small point. At this time the 

 worm again came forth, and was fastened with a thread, rolled 

 upon a stick, and drawn out twice a day ; in twenty days the 

 extraction was completed. This last case illustrates the history 

 of the worm very well. Two or three days after the for- 

 mation of the vesicles these open up, or are opened with a 

 lancet, when matter, blood, or sanies, and two or three inches of 

 the anterior end of the worm come forth. This end is carefully 

 pulled, when several inches more frequently follow. All this is 

 coiled round a little roll of linen, a small stick, or a fragment of 

 lead (Avenzoar, Rhazes), which, however, as even Paulus iEginetus 

 observed, is less advisable, and this is fastened over the wound 

 with sticking plaster, and a compress. A cleft stick to fasten the 

 worm into, and Velsch's armoury of peculiar copper instruments, 

 are of no use, according to Bremser. The extraction is repeated 

 twice a day, until the worm is entirely wound out, which usually 

 takes three or four, but in Africa generally several, months. The 

 w r orm rarely comes away in the first operation ; if several worms 

 be present, it may probably be months before the wound, which 

 is to be treated as a simple tumour, heals up; but this generally 

 takes place easily. 



According to Loffier, M'Gregor, Indian surgeons, Bruce, and 

 Pere also, when the worm is felt on the surface of the skin, it 

 may be laid bare, by taking hold of a fold of skin with forceps, 

 making an incision of several inches long, down to the worm, and 

 removing the worm in a loop, or wedging it into a bit of wood, 

 and then pulling alternately now on the one side, now the other 

 side of the worm ; whilst, at the same time, the patient is always 

 kept in a position in which the muscles are relaxed as much as 

 possible. In this way only half the time is employed ; according 

 to Pete, only a sitting of four hours. 



But if the worm is seated in the fleshy parts, if the inflamma- 

 tion, swelling, and pain are great, if the worm resist dragging or 

 breaks off, further assistance from art is necessary. According 

 to Pruner, who also reports that if the worm is not absorbed or 

 encysted, it is removed by suppuration, the aborigines, in the latter 

 case, apply cow-dung, open the tumour or vesicle with a hot iron, 

 and sprinkle over it a vegetable powder (Sattala). To administer 

 internal authclminthics I regard as absurd ; all that is to be done 

 is to combat the general febrile phenomena, but in other respects 



