DISEASES OF CONNECTIVE TISSUES 



THE SUBCUTANEOUS FILARIASES. 



Definition. — The subcutaneous filariases are infestations of the 

 subcutaneous tissue by the adult worms of species belonging to 

 the Filariidae other than Filaria hancrofti Cobbold, 1877. 



Remarks. — The form of filariasis caused by F. hancrofti is detailed 

 in Chapter LXVL, and now we consider those in which the adult 

 worm lives in the subcutaneous tissue. The varieties of this form 

 of filariasis are dracontiasis, or guinea-worm infection, and dermo- 

 conjunctival filariasis. 



DRACONTIASIS. 



Synonyms. — Dracunculosis, Turkish disease. 



Definition. — Dracontiasis is the infection of man with Dracunculm 

 medinensis (Linnaeus, 1758), the guinea-worm (p. 651). 



History. — The disease has been knowr from very remote periods, 

 and- it is probable that the fiery serpents which attacked the 

 Israelites in the desert were guinea-worms, and that the serpent on 

 the stick was an illustration of the method of extraction advised. 



Plutarch (a.d. 50-117) gave an account of the disease as seen on 

 the shores of the Red Sea, while Galen (a.d. 131-210), who never 

 saw a case, called the disease ' dr acont iasis. ' Oribasius also mentions 

 it and the worm, and Aetius, quoting from Leonides, says that it 

 occurs in the legs and arms of people in Ethiopia and India. Paul 

 of i?^gina stated that in India and in the upper part of Egypt there 

 was a class of worms called ' dracunculi,' formed in the muscular 

 parts of the body such as the arms, thighs, and legs, and under the 

 skin in the sides of children, which moved, and after a time the skin 

 opened and the head came out. He advises that this be fixed with 

 a piece of lead, the part placed in hot water, and the worm gently 

 pulled, when it will come out by degrees; but if during this process 

 it breaks, there will be much pain. Pollux calls it a corrupted 

 nerve, and Actuarius writes about its presence in Egypt. Avicenna 

 calls it Vena medwa, after Medina, where it was common. He notes 

 the bleb which it makes in the skin, and its protrusion after the 

 bleb bursts. He recommends ligatures above the worm and baths 

 to make it come out. Huly Abbas says that it occurs in India, 

 Egypt, Ethiopia, and Libya, while Avenzoar notes that it is most 

 common in negroes. Albucasis, Rhases, Bertapalia, and Guy de 

 Cauliac, all mentioned the disease, and the last named calls the 

 worm Vena civilis vel medina, while Audry considers it to be an 

 animal. Other writers on this subject are Joao Rodrigues de 

 Castell Branco (1511-1568), Linscholeri (1599), and De la Motte 

 Lambert (1666). In 1674 Velsch wrote a book on the subject and 

 S'iw guinea-worms everywhere. 



The scientific study of the disease and its parasite dates from the 

 work of Fedschenko in Central Asia, in 1870, when he discovered its 

 development in the cyclops, the integument of which he believed 

 the ypung worms pierced. 



