SECT. LIX.—ON DRACUNCULUS, OR THE GUINEA-WORM.
In India and the upper parts of Egypt a class of worms called dracunculi, resembling the intestinal, are formed in the muscular parts of the body, such as the anus, thighs, legs, and in the sides of children, under the skin; and they move in a perceptible manner. Then in process of time at the extremity of the dracunculus matter is formed in the part, and the skin being opened the head of the dracunculus comes forth. But if the worm be dragged it occasions pains, and particularly when it breaks. Wherefore some say that it is proper to fix a piece of lead to the worm in order that its discharge may not take place at once, but gradually with the weight of the lead. Some disapproving of this practice, inasmuch as the worm is apt to break with the weight of the lead and occasion violent pains, direct the part to be put into hot water, in order that the dracunculus being warmed may come forward, when it is to be seized with the fingers and dragged forth by degrees. But Soranus is of opinion that the dracunculus is not an animal originally, but a nervous concretion, which has only the appearance of moving. Whether this or the former be the true account of the matter, it appears to Soranus, Leonides, and others, that they are to be treated with the affusion of warm water, and digestive cataplasms made of honied water and the flour of wheat or barley; and they approve of sometimes using a plaster possessed of similar properties. Wherefore that from bay-berries, and the one from honey are proper. For by the use of these the dracunculus or concretion dies and falls out. But when suppuration takes place, if it does not fall out, the skin is to be divided, and the part being laid open, that which is contained in it is to be taken out, when a tent is to be put into the skin, and then the treatment for suppurations is to be applied.
Commentary. The following authors treat of the vena medinensis, or dracunculus, now generally called the Guinea worm: Galen (De Loc. Affect. vi, 3; Isagoge;) Aëtius (xiv, 85); Pollux (Onomast. iv); Plutarch (Symp. viii, 9); Theophrastus (H. P. ix); Actuarius (Meth. Med. vi, 8; iv, 16); Avicenna (iv, 3, 2, 21); Avenzoar (ii, 3, 20); Haly Abbas (Theor. viii, 18); Alsaharavius (Pr. xxviii, 12); Rhases (ad Mansor. vii, 24; Cont. xxvi.)
Galen admits that he had never seen the dracunculus, and that therefore he could not be positive respecting its origin and nature. He had known many persons, however, who had seen it, and was inclined to believe that it is of a nervous nature, and resembles lumbrici only in colour and thickness. The author of the Isagoge states that dracunculi resemble varices, and that when they project or move about they occasion great pain, and are to be removed by making an incision of the skin as for varices.
Plutarch briefly mentions the dracunculus as being a disease which had newly attacked the inhabitants of the country adjoining the Red Sea.
Aëtius professes to derive his account of the dracunculus from Leonides. He says, like our author, that it is formed most commonly in the legs and muscular parts of the arms in India and Ethiopia, and that the generation of it is not dissimilar to that of intestinal worms. He adds, that in process of time suppuration takes place at the end of the worm, when an opening is made in the flesh, and the head of the dracunculus protrudes. If dragged out considerable disturbance is produced, especially if the worm should be broken, for what remains occasions the most excruciating pains. He directs us, therefore, to put a ligature round the arm, and to tighten it every day so that the dracunculus may come forth by degrees without breaking. The part is to be washed with honied water, with oil in which wormwood or southernwood has been boiled, or with some such anthelminthic decoction; but all acrid things are to be avoided for fear of inflammation. He recommends us to forward suppuration by means of maturative cataplasms, and the other means mentioned by our author.
Pollux calls the dracunculus a piece of corrupted nerve which sometimes comes from the sores of Ethiopians, but seldom troubles other people.
Actuarius, like our author, mentions that the dracunculi occur most commonly in the region above Egypt, being generally formed in the muscular parts, and that in process of time the part becomes livid and suppurates. They are killed, he adds, by bitter and acrid things.
Avicenna comprehends in his account whatever information could be gleaned from preceding writers. He says the dracunculus is called vena medine, from Medine, the name of the country where it is most prevalent. It occasions a blister in the part which bursts, when a red and somewhat blackish substance protrudes and gradually increases in length. He directs us to correct the habit which gives rise to it by baths, humid food, and the like. His treatment is similar to that of Aëtius and our author, namely, binding a ligature round the arm, fastening a piece of lead to the worm, using fomentations of warm water, and the like.
Haly Abbas mentions the vena as being a worm which forms principally in the legs of the inhabitants of warm countries, such as India, Egypt, Ethiopia, and Lybia.
Avenzoar says that the complaint most commonly attacks negroes, being formed by gross humours, for dispelling which he recommends internally various sharp and acrid medicines, such as squills, nettles, colocynth, &c. He further directs a piece of lead to be bound firmly over the worm so that it may be made to crawl out gradually, which, however, he says, will not be accomplished in less time than a year.
Alsaharavius states the danger of breaking the worm (vena). He recommends the same treatment as Avicenna. The conclusion of his chapter on the dracunculus decides him to be the same person as Albucasis.
Albucasis recommends us to fasten to the end of the animal a piece of lead from one to two drs. in weight, and thereby to extract it gradually. He says that in some cases the animal is as long as fifteen palms, nay, that he had seen one twenty palms long.
Rhases says that the dracunculus takes place in hot and squalid bodies, and is formed by the use of potherbs and fruits. He recommends gradually increased doses of aloes, and when the animal protrudes it is to be wrapped round a leaden reed one dr. in weight, so that it may be dragged out gradually. He cautions us not to leave any part of it in the body. He also approves of incision as described by our author. In his ‘Continens’ he collects the opinions of Galen, Paulus, and others. He says that it forms most commonly in the bodies of persons who bathe frequently, and drink much wine. He says that he had seen it extracted by making free incisions.
See an interesting account of the guinea-worm in No. 66 of the ‘Edinburgh Medical and Surgical Journal,’ by Mr. Scott, surgeon, Madras.
Bertapalia, Guy of Cauliac, and all the early modern writers on medicine, repeat the ancient accounts of the vena civilis vel medine. They direct us to extract it by attaching a small piece of lead to its extremity. Ambrose Paré adopted Galen’s notion, that it is corrupted animal matter; but Andry held that it is a real animal. It appears, however, from some statements which we have seen in the periodicals of the day, that some of our English surgeons in the East Indies still advocate the doctrine of Galen; but we are inclined to think that the other opinion is the more correct one.