Fig. 105.—Guinea worm (D. medinensis). Rolled on a stick for gradual extraction. (From Greene’s Medical Diagnosis.)
Treatment.—By douching the point of exit we may cause the uterus to empty itself in about three weeks. At that time we may commence extraction by intermittent traction by winding the worm around a large toothpick or similar object. If undue force is exerted the worm may break off and abscess formation or sloughing result.
Macfie has reported success in treating 23 cases of dracontiasis with tartar emetic. He gave 1 grain intravenously every other day and found that it was not necessary to give more than 6 grains in the course of treatment. The inflammation quickly yielded and the discharge from the sore ceased rapidly.
CHAPTER XXIII
THE SCHISTOSOMIASES
General Considerations
There is a group of diseases, caused by trematodes of the family Schistosomidae, to which we apply the name schistosomiasis. The Schistosomidae differ from other human flukes (Trematoda) by not being hermaphroditic and by having nonoperculated eggs. From these eggs a ciliated embryo (miracidium) emerges which gains entrance to certain species of molluscs. In this intermediate host the miracidium gives rise to a sporocyst, which latter forms daughter sporocysts. These emerge from the mother cyst and enter the digestive gland of the mollusc and produce cercariae.
These cercariae show an absence of a pharynx and upon the rupturing of the sporocyst are discharged from the mollusc and furnish the infecting stage for penetrating the skin of man or other animal.
There are those who think the entrance is effected through mucous membranes, especially those of the mouth, genitalia and anus and even the nasal mucosa.
It is generally admitted that infection by drinking water, containing the ciliated embryos, is impossible, owing to the rapidity of their destruction by solutions of HCl of similar strength to that of the gastric juice.