THE GUINEA-WORM.
This did not frequently appear in the Indian army while they were in Egypt: on the voyage thither, however, it prevailed very much, and a great deal of it came under my own particular notice. On my return to India I found, that, in the manner of its first appearance, as well as in its progress afterwards, much of what I had observed was considered, by medical men, as new and remarkable. I shall, therefore, give some detail of it here: though this may be going a little out of my way, it may be useful. When cases of this disease crowded on me, and with the very severe symptoms with which they appeared, I was both perplexed and embarrassed; and I regretted much the not having had a previous knowledge of the disease.
This disease, as will be shewn by the table, was but little seen in Egypt. It appeared only in two European corps, the 86th and 88th regiments; and in two native Indian corps, the 1st and 7th Bombay regiments. It is a disease, of which I believe that we know but little. Industry and attention might be usefully employed in the investigation of the natural history of the dracunculus.
In September, 1799, the 86th regiment relieved the 84th in the fort of Bombay. The 86th remained in the king’s barracks there until October, 1800, at which time they were relieved by the 88th regiment from the island of Coulabah.
The 86th, on coming into the fort of Bombay, had never had a case of the Guinea-worm; and they continued free from it till the setting in of the monsoon of 1800. The king’s barracks in the fort are close to the bazar in Bombay. Here Mr Dean, the surgeon of the 86th regiment, remarked, that the Guinea-worm prevailed very much among the natives. In the course of the monsoon, nearly three hundred cases of this disease appeared in the 86th regiment. I saw, at one time, one hundred cases of it in Mr Dean’s hospital.
The 88th regiment, from the time of their arrival in India, in June, 1799, till October, 1800, was quartered in the island of Coulabah, distant one mile from Bombay. During the fifteen months of their stay at Coulabah, only one case of Guinea-worm appeared in the regiment; and this happened, as they were about exchanging quarters with the 86th regiment, in an old man, debilitated with repeated attacks of hepatitis and dysentery. No case appeared in the 88th regiment in October, nor for nearly a month after their coming into the king’s barracks in Bombay; but, in that part of November which immediately preceded their embarkation for service, three cases occurred.
The artillery, 86th and 88th regiments, as already mentioned, were embarked, at Bombay, for the Egyptian expedition. In the course of the voyage to Ceylon, a case of Guinea-worm first appeared in the detachment of the 86th regiment, on board the Minerva; and, thereafter, six cases in the 88th regiment, on board the same ship.
On our arrival at Point de Galle, in Ceylon, we found that the disease was unknown in his Majesty’s 19th foot, among the Sepoys who came from Bengal or Madras; in the Malay corps: and, as far as I could learn, among the inhabitants. During our stay in Ceylon, a few cases made their appearance in the 86th and 88th regiments on shore. On sailing from this island for the Red Sea, only three hundred and sixty men, of the 88th regiment, with the artillery, were embarked in the Minerva. Two companies of the 88th were embarked in a small vessel, the Fancy. Another vessel, the Hope, was provided for the detachment of the 86th regiment, and two officers of the 88th were embarked with them.
Soon after sailing from Ceylon, the Guinea-worm made its appearance among the 88th, both in the Minerva and Fancy: in the Minerva, particularly, it increased with alarming rapidity. By the time we reached the Straits of Babelmandel, we were in a most alarming state. Of three hundred and sixty men, whose services we had reason to expect daily might be required, one hundred and sixty-one were at this time crippled and laid up with this loathsome disease. Though contrary to every account which I had had of the disease, many circumstances at this time led me to suspect that it was infectious, and I, at length, thought it prudent to treat it as such.
The officers remarked, that it prevailed most in particular parts of the ship, and much more in some companies than in others. This, at length, so much struck the commanding officer, that the sick were separated from the sound: the men with the Guinea-worm were all placed on the orlop-deck, and the rest of the men occupied the gun-deck. At this time, too, extraordinary precautions, regarding cleanliness and ventilation, were adopted. Much lumber and luggage were stowed away, and the space between decks, which hitherto had been lumbered with it, was made open and clear, fore and aft. The decks were daily well washed with boiling water, and the nitrous fumigation was kept constantly going on throughout the ship. Besides the usual bathing three times a week, of all on board, the soldiers were made to wash their hands and feet regularly twice every day at the ship’s head.
In a little time after adopting these measures, we could perceive the disease to diminish. The number of fresh cases reported, decreased daily; and at the time of our casting anchor in Kossier Roads, though there were on the sick list many bad ulcers from the Guinea-worm, no fresh case had appeared for some days before.
During the voyage, 199 cases had appeared from 360 men of the 88th regiment; and several cases occurred among the ship’s crew; but not a single case occurred among the artillery. This struck every one on board, very early, as remarkable; yet these men had the same provisions, drank the same water, and in every other circumstance were situated as the men of the 88th regiment, except that they were kept separate. From the outset, the artillerymen were accommodated apart, on the gun-deck, in a spot divided off for themselves. Not one of the officers, either of the artillery, 88th, or belonging to the ship, had the Guinea-worm. From the strong circumstances which in its course appeared, every officer on board was impressed with the opinion of its being contagious, and was inclined to use every precaution of prevention; from which, most probably, all escaped this filthy and severe disease.
Those embarked in the Fancy, were not so fortunate; few of the men there escaped the disease. Of eight officers of the 88th, three caught it. Mr Bruce, then the assistant surgeon, was one of these: he had a worm in each leg. The Fancy was obliged to return to Bombay; most of the men were disabled by this disease; and the season was too far advanced for her getting up the Red Sea.
Among the 86th regiment in the Hope, only three cases occurred; and one of the two officers of the 88th, on board, was one of them.
I find, by my case-books, that in the part of the 88th regiment which continued in the Minerva, the disease appeared as follows:
| From the 9th to the 24th December, | 6 | cases on the passage to Ceylon. |
| From the 25th Dec. to 14th Feb. | 4 | ditto at Ceylon, on shore. |
| From the 15th to the 28th Feb. | 39 | ditto at sea, after leaving Ceylon. |
| In March | 103 | ditto at sea. |
| In April | 39 | ditto at sea. |
| In May | 8 | ditto at sea, till landing at Kossier. |
| Total of cases | 199 |
I have purposely excluded the cases which occurred in the 88th, on board the Fancy, or among the 86th regiment.
The disease was pretty uniform in the manner of its appearance. The patient was first sensible of an itching; and, on looking at the part, generally observed a small blister: sometimes I have seen three or four small blisters, and the part having the appearance of being stung with nettles. When the blister was snipped, a piece of mucus of the breadth of a sixpence was seen underneath, which being removed, the head of the worm was seen. It was in general firmly attached, and required force to detach it from the parts underneath. When detached with the forceps, we twisted it round a ligature or piece of lint, and thus, often on the first day, succeeded in extracting a foot, or even two, of the worm. It resembled much what is called bobbin, and was about the same size. It was transparent and moist, a white liquid being seen in it. We continued, daily, extracting as much of it as would come out with gentle pulling. It was always dangerous to pull strongly, for fear of breaking the worm: it then occasioned the most acute pain, and there followed much swelling, with inflammation of the neighbouring parts, sometimes of two or three weeks continuance, when the worm would shew itself at another part, as at first, with itching and a blister.
It seldom appeared to be deeply seated; generally, under the cutis, or among the tela cellulosa, when we could often trace it in its course, and sometimes see it: sometimes it was under the fascia, and but seldom among the muscles.
If not ushered in with fever, it was almost always attended with it in its course: when there was considerable inflammation, it ran very high. In seven cases, mortification took place, and very large sloughs were cast off. In a few cases, there was a very considerable and alarming hæmorrhage.
By presenting itself at different places, it would often leave two or three large, foul, and fistulous ulcers in different parts of a limb. When the inflammation has run very high, as I have often seen of the whole leg or thigh; and when a profuse suppuration followed; the worm frequently has come out dead, often in pieces, with the sanies, by which, probably, it had been eroded and killed.
Frequently, after extracting one worm from a patient, a second, a third, or even a fourth, would appear: after getting one out of a leg, a second would appear in the other, a third in one hand, and a fourth in the other hand.
The Guinea-worm, I believe, has been seen in every part of the body. Though the extremities appear to be its favourite seats, yet the face, breast, back, penis, &c. are not exempted from its visits. I heard of a gentleman in Bombay who had one in his scrotum and penis, and of a lady who had one in the pudenda.
The following I extract from my case-book and notes, taken on board the Minerva, by which it will be seen that the extremities are as much more frequently its principal and first seat, as in the itch.
| Feet | Legs | Thighs | Scrotum | Groin | Hands | Arms | Body | Total Cases. | |
|---|---|---|---|---|---|---|---|---|---|
| Feb. | 34 | 3 | 1 | — | — | 1 | — | — | 39 |
| Mar. | 70 | 21 | 5 | 2 | 2 | 3 | — | — | 103 |
| April | 20 | 9 | 5 | — | — | 3 | — | 2 | 39 |
| Total | 124 | 33 | 11 | 2 | 2 | 7 | — | 2 | 181 |
As to the causes of the appearance of the Guinea-worm, and the mode in which it is generated, I must confess that I have no account that I could venture to offer here.
In different parts of the world, the water drank is accused of occasioning intestinal worms, as the tænia in Switzerland, and the tænia and the teretes in the West Indies; where, likewise, I have heard the mucilaginous vegetables eaten assigned as a cause of the frequent appearance of worms. In Russia, there is a worm, the lumbricus militensis, common near swampy grounds. In Russia and in Siberia, in the same situations, the tænia infernalis prevails. But, after what has been here stated, we cannot bring the water, drank on board the Minerva, or at Bombay, to account for the Guinea-worm which prevailed: in fact, the water came from different and distant quarters, Bombay, Ceylon, and Madras. Besides, the officers of the 38th, and the artillery, drank the same water, and escaped.
No case of Guinea-worm had been known among either the Lascars or European sailors in the Minerva, when the 86th and 88th embarked in her.
I have good reason to think that the spreading of the Guinea-worm may be stopped, whenever it does appear. The means which we adopted appeared to succeed. Extreme attention to cleanliness is indispensably necessary.
In India, the native doctors are much more successful in getting out the worms, than Europeans. After long feeling with their fingers, for the body of the worm, they make an incision as nearly as they can judge over its middle, and, pulling the worm by a duplicature of it, draw out both ends of the worm at one time. I have often endeavoured to imitate this practice. My sense of touch was not so delicate, and did not guide me so correctly, as it did the Hindoo doctors; but I always found that when, on cutting down to it, I got on the middle of the worm, and, by the forceps, pulled this out, I could with ease extract a large portion, and, not unfrequently, the whole worm.
Leeches, astringent and sedative lotions, cataplasms, fomentations, &c. were applied, as required by the circumstances of the case. A good deal of attention was paid to the disease, in all its stages; and several experiments were made on the worm, which, however, it is needless to detail here.
After using a variety of articles, in the treatment of the Guinea-worm, and making them enter the system by the absorbents, I think that unctuous substances succeeded the best, particularly mercurial ointment. Passing an electrical shock through the part had no effect.