PARASITES, DISEASES DUE TO. Intestinal Parasites.
Parasites which infest the human in testinal tract may be divided into (1) nematodes, or round-worms; (2) trema todes, or sucking-worms; and (3) ces todes, or tape-worms.
Nematodes (Round-worms).— All round-worms occurring as parasites in man belong to the order of Nematodes. They have long, slender bodies of sim ple outline, without segments or append ages. The males are usually smaller than the females. Some nematodes as found in the human intestines are quite harmless, but others are more dangerous; a few pass into more sensitive tissues and organs, producing disturbance or even dangerous injuries.
Ascaris lumbricoides, the common round-worm, is in color a yellowish or reddish brown, cylindrical in shape, and tapering at the ends, somewhat similar in appearance and shape to the earth worm. The female is from 20 to 40 centimetres in length; the male is smaller and provided on its posterior extremity with the bend like a hook, carrying two projections or processes. The female produces an enormous num ber of eggs, which, when fully developed, possess a double shell, around which is an albuminous envelope. These are found almost anywhere in the intestinal canal, but chiefly in the smaller intes tine, and are very resistant to external influences. These ova mature and de velop into the round-worm in the intes tine, requiring no intermediate host. They attain sexual maturity in from ten to twelve weeks after the eggs have been swallowed, at which time the length of the female is 20 to 30 centimetres and that of the male 13 to 15 centimetres.
Symptoms. — The presence of the round-worm only rarely produces any I symptoms in its host; even then they are often most obscure. In children, how ever, it sometimes causes a variety of forms of intestinal irritation, which tends to precipitate nervous disturb ances. Peiper and others suggest that these nervous symptoms are caused by an irritating toxin, derived from the round-worms. Chauffard, Marie, and Tauchon describe a condition called typholumbricosis as due to this sub stance. This is a complex of fever, foul breath, and intermittent diarrhoea, which continues for a month or more (Osier), and sometimes is accompanied by pro longed coma (Voucka), or follicular en teritis (Concetti). These parasites, as shown by Thermals, often act as the basis of neurasthenic, hysteriform, epi leptiform, and choreiform disorders, and occurring usually in subjects offering no neuropathic antecedents. There can be
no doubt of the importance of an ex amination of the fasces, for ova, in all obscure cases presenting reflex neuroses.
The round-worm occasionally finds its way into normal or abnormal openings in the surface of the intestinal canal, and thus produces mechanical disturbances. They are sometimes found in the faeces, and are occasionally ejected from the mouth while vomiting. They have also been known to obstruct the common gall duct, enter the larynx, and in other ways cause more or less grave disturbances.
Possibility of mistaking certain cases of asearis for more serious disorders emphasized. A child may be seized sod denly with convulsions which soon are followed by coma, and a provisional diagnosis of meningitis may be made until the cause is discovered in the stools and rapid recovery takes place after santonin and calomel. The num ller of worms found does not seem to govern the severity of the symptoms. since in quite severe cases only a few were present. An excessive secretion of -.aliva seems to be a valuable symptom from a diagnostic point. J. P. 'Saab (Aliinehener med. Wochen. May 13. 1902).
Treatment.—For the removal of the lumbricoid worms nothing has been found to equal santonin, which, if judi ciously used, is almost always satisfac tory. It must be borne in mind that very considerable ill effects have followed the excessive or prolonged use of this drug, not only xanthopsia, but hebetude or torpor, and in some instances death. Coppola calls attention to the fact that as a result of the catarrhal condition pro duced by the parasites a large amount of lactic acid is sometimes found in the intestines which favors the solution of santonin and its consequent absorption. Ile, therefore, prefers the use of santo ninoxim, in double or triple doses, as equally active, but less absorbable and non-toxic. Santoninoxim is a crystalliz able body obtained by Cannizaro after subjecting santonin in an alkaline solu tion to the action of hydroxylamin. The dose of santonin should not be above V, to 7, grain if frequently repeated, or 1 to 1 grains a day in children from one to six years (Demmi). A good rule is to give to a child of from two to four years from V, to V, grain of santonin along with the same amount of calomel, and after a very light supper composed of Vo glass of milk, each night, for three successive nights. Naphthalin is recom mended by Engel: from V, grain to 1 grains, four times a day, for three days.