5 YMPTOMA TOLOG Y 



1971 



until a little vesicle appears on the skin, or the outline of the worm 

 is noticed under the skin, but urticarial eruptions have been ob- , 

 served by several authors and ourselves. The little vesicle bursts, 

 leaving a round hollow, out of which exudes a clear fluid full of 

 larvae, and at the bottom of which lies the vaginal orifice of the 

 worm. After discharging a certain amount of fluid, the anterior 

 end of the worm extrudes through the skin opening, and is either 

 twisted on a stick or fixed in position by a piece of string by the 

 native patient. It is not advisable to pull vigorously on the pro- 

 truded piece of worm, as it is liable to break, and if this happens 

 a serious inflammation of the affected area may result. The wound 

 usually quickly heals after the worm has finally been extracted. 

 The usual site for it to appear is about the feet or legs, more rarely 

 the hands or arms, and still more rarely the head or trunk. 



But all cases are not so simple, and aching or dragging sensations, 

 sometimes accompanied by rigors and fever, may occur. Rarely 

 it enters a knee-joint and causes synovitis or arthritis. Usually 

 there is only one worm, but there may be more. 



Blood. — Dudgeon and Child have investigated the bleed in this 

 disease, and find a marked eosinophilia. The average differential 

 count was as follows: Polymorphonuclears, 63-6 per cent.; lympho- 

 cytes, i8'4 per cent.; large lymphocytes, 2-8 per cent.; mono- 

 nuclears, 1-6 per cent.; eosinophiles, 13 per cent. 



Diagnosis and Prognosis. — There is no difficulty in the diagnosis, 

 and the prognosis is good. 



The X rays are useful in detecting encysted calcified worms, which may 

 cause obscure purulent conditions. 



Treatment. — It is a good plan to massage the area above the 

 vesicle, and try with a little patience to get the worm out whole, 

 or, if it is visible under the skin, to make an incision and remove 

 it. Natives extract the worm by twisting the protruding portion on 

 a stick, every day giving a turn or two. A better plan is to douche 

 frequently with water the part occupied by the worm until she gets 

 emptied of all the embryos, which generally takes place in from. 

 two to three weeks. When all the embryos have been exuded, the 

 worm is either absorbed or tends to emerge, and, no longer resisting 

 extraction, can be easily removed. It has been advised (Emily) 

 to inject a i per 1,000 solution of perchloridc of mercury into the 

 swelling caused by the worm. But this is very painful, and does 

 not appear to be very successful. Some authors have advised the 

 injection of 10 to 15 minims of a 2 per cent, solution of cocaine into 

 the protruding portion of the worm. 



Prophylaxis. — The prophylaxis is very simple — viz., the drinking 

 of only boiled and filtered water. Another simple method suggested 

 by Leiper is to pass steam into the wells. 



THE DERMO-CONJUNCTIVAL FILARIASES. 



These are Loiasis, Calabar swellings, and Dubini's filariasis. % 



