History and Geography

This is a very old infection, which many believe to have been the "fiery serpent" said by Moses to have attacked the Israelites when they were on the shores of the Red Sea. At least one calcified Dracunculus worm has been discovered in the mummy of a 13-year-old Egyptian girl who died around 1000 B.C., and a treatment for this condition may be described in the Ebers Papyrus.

Some Greek and Roman writers described the infection, and it was Galen who named it "dracontia-sis." The ancient medical practice of treating infections by winding the worm slowly around a stick is thought by some historians to have been the origin of the Staff of Aesculapius. Several medieval Ara bian physicians described dracunculiasis. Of these, Avicenna gave the first detailed clinical description of what he called "medina sickness," because the infection was then so common in Medina. Shortly before, Rhazes showed that the swelling caused by the infection was due to a parasite.

Sixteenth-century European travelers mentioned having encountered cases of the disease in Persia and the Congo. It is said to have been called "Guinea worm" for the first time by another European who saw persons suffering from the infection on the Guinea Coast (West Africa) early in the seventeenth century. The disease is also mentioned in the traditional legend by which the Dahomeyans explained the founding of their ancestral cult. Although G. H. Velschius described the parasite clearly in his monograph, published in 1674, it was left for Linnaeus (Carl von Linné) to give the worm its modern scientific name of Dracunculus medinensis in 1758.

British army medical officers reported seeing cases of dracunculiasis among British military personnel serving in India in the nineteenth century, and a large punitive English expedition sent to invade Ethiopia in 1868 also suffered greatly from the same disease. The role of the copepod intermediate host in the life cycle of the parasite was discovered only in the 1870s, by a Russian, Aleksei Fedchenko.

The geographic extent of dracunculiasis shrank considerably during the first half of the twentieth century, largely, it appears, because of gradually improving standards of living, and especially standards that have produced better water supplies. The disease was eliminated from the southern area of the Soviet Union in the 1930s by means of a deliberate campaign, and from Iran in the 1970s. With the advent of the United Nations-sponsored International Drinking Water Supply and Sanitation Decade in the 1980s, India and several other endemic countries began national campaigns to eradicate dracunculiasis. In 1986, the World Health Assembly adopted a resolution calling for the elimination of this disease country by country. It appears likely that this ancient disease will not plague humankind much longer.

Donald R. Hopkins

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