It rarely, if ever, produces any symp toms, even when occurring in enormous numbers.
Anchylostoma duodenale (Dochmius duodenalis, or Strongylus duodenalis) is a small worm which inhabits the upper part of the lesser intestine. It is very commonly found among the inhabitants of the tropics, especially in Egypt, and occasionally in other localities.
The female has a cylindroid body of from 5 to iS millimetres long; the male is from 6 to 10 millimetres. The cephalic end is curved toward the dorsal surface. It is provided with a mouth, very near its extremity, pointing to the ventral side and armed with four incurving teeth on the ventral border and two on the dor sal border, all arranged perpendicularly. This acts as a sucking or biting apparatus by which the parasite fixes itself firmly on the intestinal surface, from whence it draws out blood for its nourishment. The spots over which the worm has at tacked itself may be recognized post-mor tem as areas of ecchymosis, in the centre of which is seen a. white spot showing a central perforation. Occasionally the deeper parts of the mucous coat are pene trated.
The eggs are oval in shape from 44 to 67 millimetres long, and from 23 to 40 millimetres broad. They are similar in appearance to, but smaller than, the eggs of Ascaris lumbricoides. The first stages of their cleavage take place in the human intestine, and if these are voided so that other human beings may receive them (which is chiefly through the drinking of muddy water, where they develop still further), they develop into complete sex ual maturity in their final host.
is the most im portant symptom of anchylostomiasis, which is also known under the names "Egyptian chlorosis," "miner's cachexia," "mountain or tunnel and "brick-makers' anaemia." When a large number of parasites are introduced into the intestine an intense acute anemia develops, but when only a few are pres ent the symptoms are more chronic. Be sides the anaemia, there may be variable appetite, nausea, pain in the epigastrium, constipation or cliarrhcea, and hypertro phy and dilatation of the heart, and, in the acute form, dyspncea and dropsy.
Diagnosis.—The diagnosis is made by finding the eggs in the faces. These are oval, about 0.05 millimetre long, and with a thin transparent shell. There is
no operculum as in the ovum of the oxyuris.
Treatment.—In the districts in which this disease occurs all drinking-water should be thoroughly boiled and latrines should be systematically employed.
Among drugs, thymol is considered a specific, and, according to Sandwith, should be given in doses of 30 grains in a wafer with 6 drachms of brandy at S A.M. and again at 10 A.M. At 12 a dose of castor-oil should follow. The day before and the day after the thymol the patient is to be kept on a diet of milk and soup. This treatment is repeated once or twice until no eggs can be found in the faces with a microscope.
The recognized treatment is thymol administered as follows: 15 to 30 grains (1 to 2 grammes) repeated four times at intervals of one and one-half to two hours. if the bowels do not act spon taneously in twelve hours after the last dose, a purgative should be given. It is well to clear the bowels the day before with a purgative, and place the patient on liquid diet. The fact that thymol is poisonous must not be lost sight of. and the patient should be carefully watched. Since the drug is freely soluble in al cohol, ether, turpentine, chloroform, oil, glycerin, and certain alkaline solutions, these should be withheld during its ad ministration.
In seven or eight days the stools should again be examined, and if the ova are still present the same program should be carried out and repeated until all the parasites have been destroyed. The treatment of the anaemia from uncinariosis is the same as in that sec ondary to any other cause. T. A. Clay tor (Amer. Jour. fled. Sciences, Jan., 1902).
Trichina spiralis occurs in two forms: the trichina of the intestines and the trichina of the muscles—phases of their development. Sexual maturity is reached in the intestines, where it appears as a small, white, hair-like worm, the female 3 millimetres in length, the male much smaller, readily visible to the naked eye. In shape it is long and narrow, the in testinal canal beginning with a muscular mouth acting as an intestine. The or gan increases in calibre, passes down into the food-canal, and is surrounded throughout its length by a row of large cell-bodies. The eggs develop into em bryos within the uterus and are set free at birth.