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presence, animal, existence, parasite, digestive and diagnosis

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ENTOZOA - class of disorders is next to be noticed, which, like the pre ceding, owe their existence to the presence of a cause which is wholly adventitious, and is recognizable to the senses, but differs from them in this respect—that, in place of depending on the pre sence of foreign animal or vegetable matter, or of some mineral poison, their symptoms are due to the presence of a parasitic animal, living not upon the surface of, but within the human body, having a distinct and separate existence, and endowed with certain powers of reproduction.

The chief point to be noticed in regard to diagnosis is that the symptoms alone cannot be taken as conclusive evidence of their presence; and, however distinct the indications may appear, we are not justified in asserting that they have this cause until speci mens of the parasite have been seen.

Two divisions only of this class are included in the table of diseases, because the others are comparatively rare and unimport ant; and, it may be remarked, that these present special sources of interest, with reference to diagnosis, because of their relations to other forms of disease ; they are the intestinal entozoa and the echinococcns hominis ; the latter closely connected with the oc currence of hydatids, the former associated with disorders of the digestive organs.

§ 1. Echinococcus.—Within a very recent period, careful ob servation has proved that this creature is only a transformation or stage of development of the ta3nia, and this in some measure accounts for its comparative frequency. The discovery is preg nant with interest to us as physiologists; but, as physicians, we are more concerned with the very different habitat of the animal in its two extremely dissimilar conditions of existence. In the form we are now considering it is found in hydatid cysts, and would seem to be in some way concerned in their production. We have not yet learned to recognize the distinction between the acephalocyst, in which this parasite is present, and those in which it has not been found after death ; and, therefore, the question of diagnosis is limited to the recognition of the existence of the cyst, except in rare cases, in which its contents are evacuated and the echinoc,occus seen during life. Any points of interest will, there

fore, be recorded when we come to the consideration of cysts as one of the forms of morbid growth.

§ 2. Intestinal Worms present themselves in three principal forms ; as broad or tapeworms, round worms, and threadworms.

a. Tapeworms, so named from their appearance, are discharged as a number of flat fragments of various leng,ths, crossed by trans verse joints, where Reparation is liable to take place, and each portion of the animal which is discharged has, consequently, a square termination. They are of two species : 1. Tsenia solium, marked by notches on either side, irregularly alternating along the edges of the flat body, one of which occurs between every two joints, and is situated rather nearer to the lower than to the upper one. 2. Ttenia lata, or Bothriocephalus latus, marked by a line of depressions, one for each segment, running down the centre of one of the flat sides of the parasite.

Their presence is apt to be overlooked because they give rise only to such symptoms as may readily be regarded as those of dyspepsia ; pain of a gnawing character at the epigastrium, un easiness after food, cough and headache, usually accompanied by a craving appetite ; the patient is out of health, and generally somewhat emaciated. This craving is to be distinguished from the large c,onsumption of food which sometimes accompanies emaciation in the course of a wasting disease, when the digestive apparatus has not been deranged ; and also from the ravenous appetite of diabetes. In the former there is no disorder of the intestinal canal, in the latter there is thirst as well as hunger; when the symptom depends on the presence of tapeworm, there is always derangement of the digestive organs, and the sensation is one of craving rather than of hunger.

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