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Micro laria also migrate to the eye, and causes scarring of the cornea the covering of the eyeball, which leads to sight defects and ultimately blindness Figure The itching and dis guring nodules and blindness are sources of great distress to patients, who may be stigmatised and rejected by their communities. If you suspect that a patient may be infected, you should make a referral for laboratory con rmation and treatment. Microscopic investigation of a skin snip taking samples from the skin can identify the micro laria and con rm the diagnosis.

Integrated vector control measures to reduce the population of black ies, through application of insecticides in vegetation where vectors breed, and environmental management to reduce vegetation around fast owing rivers where people live. Personal protective clothing to avoid the bite of black ies by covering exposed skin with clothing and wearing headgear in endemic areas. Community members fully participate in the programme and the drugs are delivered by trained village drug distributors, supervised by Health Extension Workers and Practitioners like you.

Rapid case detection and referral, particularly for complicated cases involving sight loss. When urine contains clouds, it should be noted whether they are towards the top or the bottom, and what is their colour. Those which sink and have the colours previously mentioned as favourable are to be judged a good sign. Those which rise and have the colour said to be unfavourable constitute a bad sign.

You must not be deceived if these appearances result merely from a diseased condition of the bladder, for they may then indicate not a disease of the whole body, but merely of that organ. The most helpful kind of vomiting is that in which the matter brought up consists of phlegm and bile, as well-mixed as possible, and is neither thick nor particularly great in quantity. The vomiting of dark green, livid or dark material, no matter which of these colours, must be considered a bad sign.

The quickest death is denoted by the vomiting of livid matter if it has a foul smell. In all diseases which affect the lungs and sides, sputum should be brought up early and, in appearance, the yellow matter should be thoroughly mixed with the sputum. It is not so good if it only comes about some while after the beginning of the pain, that the sputum is brought up and it is yellow, or light brown, or the cause of much coughing, or if it be not thoroughly mixed. It is a sign of danger if the yellow matter is not diluted; and white, sticky and nummular sputum is not beneficial.

In all diseases of the lungs, running at the nose and sneezing is bad, whether it existed before the illness or supervened during its course. In cases of pneumonia, the production at the beginning of the illness of yellow sputum mixed with a little blood is a good indication of recovery. All sputa are bad which do not relieve the pain; the worst are those which are dark in colour as stated above. Those empyemas which begin to suppurate while the sputum is still bilious are especially signs of a fatal issue, whether the bilious matter is brought up separately from the pus or together with it.

Most specially, if the empyema appears to start from sputum of this sort when the disease is in its seventh day, the patient who brings up such sputum may be expected to die on the fourteenth day, unless a good sign makes its appearance. The good signs which may appear are these: to bear the illness easily, to have good respiration, to be free from pain, to cough up sputum easily, to have the body evenly warm and soft all over, not to suffer from thirst, to have the urine, stools, sleep and sweating of the types described above as good.

If all these signs appear the patient is not likely to die; but if only some of these signs appear, he may die although he will live longer than fourteen days. Other empyemata burst as a rule, some on the twentieth day, some on the fortieth and some reach sixty days. The beginning of an empyema may be reckoned for calculation from the day on which the patient first had a fever, or when he had a rigor, or when he said that a heaviness replaced the pain in the spot where he feels discomfort.

The discharge of pus must be expected according to the stated intervals reckoned from this day. In cases where the empyema is unilateral, the patient should be made to turn over on the side affected and then asked whether he has an ache in that side.

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