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.