may become cretified, and in this condition may be felt, years afterwards, as a hard convoluted cord under the skin of the leg, or be discovered only on dissection. (Fig. 149.)
Treatment.— Formerly it was the custom, so soon as a guinea-worm showed herself, to attach the protruding part to a piece of wood and endeavour to wind her out by making a turn or two of this daily. Sometimes these attempts succeeded; just as often, the worm snapped under the strain. The consequences of this accident were often disastrous. Myriads of young escaped from the ruptured ends into the tissues, and violent inflammation and fever, followed by abscess and sloughingj ensued; weeks, or months perhaps, elapsed before the unhappy victims of this rough surgery were able to get about. Too often serious contractions and ankyloses from loss of tissue and inflammation, and even death from septic trouble, resulted.
If a guinea-worm be protected from injury, and the part she occupies frequently douched with water, her uterus will be gradually and naturally forced out inch by inch and emptied of embryos. Until this process is completed she resists extraction; possibly the hook at the end of her tail assists her to maintain her hold. When parturition, in from fifteen to twenty days, is completed, the worm is absorbed or tends to emerge spontaneously. A little traction, if practised then, may aid extrusion. Traction, however, must not be employed so long as the embryos are being emitted. The completion of parturition can be easily ascertained by the douching experiment already described.
Emily, a French naval surgeon, has introduced a system of managing guinea- worm cases which bids fair to shorten treatment and obviate the serious risks of the old winding-out system. By means of a Pravaz's syringe he injects the body of the worm, if she chances to be protruding, with solution of bichloride of mercury, 1 in 1,000. This kills the parasite; after twenty-four hours, extraction is usually easily effected. If the worm has not shown herself externally, but can be felt
