Guinea Worm
A singular disease affects some persons, though I have never seen this upon a native, and believe it to be peculiar to the region round about Liberia. The person whose case I examined had formerly resided in Liberia, where, doubtless, the disease commenced, but for the last three years previously had resided at Ijaye, in the capacity of cook, for the American Baptist Missionaries, Revs. A. D. Phillips and J. R. Stone and lady, and then resided at Abbeokuta. This is a peculiar ulceration of the leg, immediately above the ankle-bone, where they say it usually commences; the edges of the ulcer, and the cuticle quite up to the edge, and all the surrounding parts, having a healthy appearance, as though a portion of the flesh had been recently torn out, leaving the cavity as it then was. The most peculiar feature of this singular disease is a white fiber, which, coming out from the integuments of the muscles of the leg above, hangs suspended in the cavity (ulcer) the lower end loose, and somewhat inclined to coil (and when straightened out, resuming again the serpentine curves, of course from the elasticity with motion), is supposed to be a worm; hence its name—Guinea worm. The fibre seems in color and texture to be in a normal condition; indeed, there appear to be little or no pathological symptoms about the parts at all, except a slight appearance of vermillion inflammation over the surface of the ulcer, which is more apparent sometimes than others.
What Is Guinea Worm?
I have examined closely this fibre, and from its appearance, color, size, and texture, especially as it is sensibly felt high up in the leg near the tuberosity of the tibia, when pulled by the dangling end, my own impression is that the so-called "Guinea worm" is nothing more than the external saphenus or communis tibiae (nerve) exposed in a peculiar manner, probably by a disease, which, by a curious pathological process, absorbs away the muscular parts, leaving the bare nerve detached at its lower extremity, suspended loose in this unnatural space. I have never seen but this one case of Guinea worm, but had frequent opportunities of examining it; indeed, the patient consulted me concerning it, and by the advice and consent of the very clever native gentleman, Samuel Crowther, Esq., who received his professional education at the Royal College of Surgeons, Lincoln's Inn Fields, London, insisted on my taking the case, which I declined, partly for the want of time to do justice to the patient, and aside from courtesy and equity to the surgeon who had the case in hand, mainly because I knew nothing about it—the best reason of all. The patient was an American quadroon, black nearly in complexion, of one-fourth white blood, from North Carolina. This, of course was a black quadroon.
I should add, that the fiber at times entirely disappears from the cavity (by contraction, of course), when again it is seen suspended as before. This is one reason why it is believed to be a worm, and supposed to creep up and down in the flesh.
Treatment of Diseases—Diarrhoea
The treatment of fever in this part of Africa should be the same as that in Liberia, given on page 280. The best remedy which I have found for diarrhoea is:
℞. Pulv. Rad. Rhei. ʒj.; Syr. Simp. ℥ jv.; Spts.
Terebinth, ʒj.; Tinct. Opii., gtt. x. M. ft.
Pulverized rhubarb, one drachm, (or one-eighth of an ounce); simple syrup, four ounces (or eight large tablespoonfuls); laudanum, ten drops; spirits of turpentine, one spoonful. Mix this well together to take.