WORMS, AS A DISEASE OF INFANCY. As we have elsewhere (see ASCARIS, ENTOZOA, TAPEWORM, and VERMIFUGES) treated of the natural history of the worms infesting the human subject, and of the remedies to be employed for their expulsion, we shall mainly confine ourselves in this article to the symptoms which are usually considered to be indicative of the presence of worms in children. These symptoms are, however, in reality, only evidence of irritation of the mucous membrane of the intestinal canal, which may be due to other causes thau worms, as, for instance, the presence of indigestible matter, unhealthy secretions, or the existence of a morbid condition of the membrane itself. "Indeed, the latter," says Dr. Evanson, "would seem necessary, in many instances, for the production of any symptoms, although worms were present.; as they have been passed by children in perfect health, who experienced no inconvenience on their account. Even the evacuation of worms does not prove that the symptoms present were caused by them, though doubtless they are likely to have been aggravated thereby. The worm may have been but an accidental accompaniment—amaorbid condition of the mucous membrane being the true source of the symptoms."—On the Diseases of Children, 4th ed., p. 345. Although all the symptoms commonly referred to the presence of worms may exist without them, yet there is a group of symptoms which pretty certainly indi cate their presence, and which, when occurring together, should, at all events, excite our suspicions. These symptoms are divisible into (1) those dependent directly on the pres ence of worms in the intestines; and (2) those connected with the sympathetic relations of the digestive organs, and due to some form of reflex nervous action.
(1.) " Worms," says Dr. Evanson, " may be suspected to be present when a child looks pale and grows emaciated, while his belly swells and becomes hard—a gnawing, pungent, or twisting pain being felt in the stomach or about the nave]. The appetite is usually precarious, at times voracious; the breath is fetid ; and the bowels often deranged, being alternately purged or costive, and much mucus passed in the stools.
There Is commonly picking of the nose, or irritation (often excessive itching) is felt in the lower part of the bowels; and when a child is old enough, he may complain of a sense of sinking or fainting, which seems to attend particularly on the irritation caused by worms. When symptoms are present, and cannot be accounted for by the existence of disease of the mucous membrane or of the mesenteric glands, we have good reason for believing that worms are their cause."—Op. cit., p. 347.
(2.) Among the most marked sympathetic symptoms are those of the head. The sleep becomes unquiet, and the little patient is liable to start up suddenly from slumber; grinding of the teeth is common; the pupils are often dilated, and there may be head ache, and sometimes convulsions—symptoms painfully like those of hydrocephalus (q.v.), but often disappearing ou the expulsion of worms. A dry cough, unaccompanied by any signs of disease of the thoracic organs, is regarded as a sympathetic or reflex symptom of worms; and vomiting, hiccough, diarrhea, tenesmus, and bloody stools often accompany their presence. The round-worm ((marls lumbricoides) may be present in the small intestine (its ordinary scat) in large numbers without occasioning any dis turbance; but when it does give rise to symptoms, the most prominent are sharp colicky pains about the navel, faintness, great emaciation, and voracious appetite. The thread (ascaris or oxyuris vermicularis) chiefly occurs in the rectum, where it often exists in large numbers, looking like bits of cut thread. In a recently voided stool they are seen to be in rapid motion; hence they are called asearides (from the Greek askaridzein, to jump), and hence also, in all probability, the great distress which they occasion as compared with the quiet round-worms, The characteristic sign of the presence of these *read-worms is the itching and irritation felt in the rectum.