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768

GUINEA-WORM

[CHAP.

twice attached to the larger female worm within the sub-peritoneal connective tissue. Charles's description does not exclude the possibility that what he describes as the male worm in coïtu. was really a prolapse of the uterus through the ruptured integument. Daniels, at the post-mortem of a monkey experimentally infected by Leiper six months previously, found three immature females (30 cm. long) and two remarkably small males (22 mm.), which were obtained, one from the psoas muscle and the other from the connective tissue behind the œsophagus.

Fig. 148.—Transverse section of D. medinensis.
(Leuckart.)

Habits.—The habitat of the female guinea-worm is the connective tissue of the limbs and trunk. When mature, and prompted by instinct, she proceeds to bore her way through this tissue, travelling downwards. In 85 per cent. of cases she presents in some part of the lower extremities. Occasionally she presents in the scrotum; rarely in the arms (Fig. 149); exceptionally in other parts of the body, or even in the head. In a proportion of cases the appearance of the worm at the surface of the body is preceded by slight fever and urticaria, as described by Sutherland in 1897 and by Bartet independently in 1898. Arrived at her destination she pierces the derma. Probably in consequence of some irritating secretion, a small blister now forms and elevates the epidermis over the site of the hole, in the derma. By and by the blister ruptures, disclosing a small superficial erosion ½-¾ in. in diameter. At the centre of the erosion, which some-

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