If, however, the nervous symptoms supposed to be produced by lumbrici must be looked upon as somewhat problematical, there are other phenom ena which can be referred with much greater certainty to the irritation set up by the entozoa. Severe abdominal pains of a colicky character are not uncommon in children who suffer from these creatures ; and looseness of the bowels, occurring chiefly at night, is occasionally produced by this agency. I have seen several cases of this kind where a diarrhoea, after per sisting for months, ceased immediately that the worm was got rid of.
A little boy, aged four years and a half, was said to have been troubled for three months with persistent looseness of the bowels. The purging was never very severe, but was always worse at night. The motions were said to be very slimy, and after a dose of oil, usually contained thread worms. The child often complained of colicky pain and tenesmus. He had been slowly wasting from the time the purging first began. The occurrence of nocturnal looseness of the bowels, combined with the appearance of the tongue, which was very flabby, slimy, and drab-coloured, with large fungi form papillae at the sides of the dorsum, made me suspect the presence of a long-worm. I ordered a powder containing one grain and a half of san tonine and half a grain of calomel to be given every night for three nights, and to be followed each morning by a dose of castor-oil. After the first powder the child passed a long-worm, and the diarrhoea ceased from that. time. He then rapidly regained flesh.
Ai a rule, lumbrici become active at night, and may pass upwards into. the stomach, or downwards into the colon and rectum. They have been known to issue spontaneously from the mouth of a child during sleep, or to appear from the bowel without being discharged in a stool. Their pres ence in the stomach may give rise to nausea and retching. Sometimes they pass into the common bile-duct and cause jaundice, by obstructing its chan nel. If jaundice rapidly developes in a child who is known to be troubled with this parasite, we should think of the possibility of this rare accident having happened. Sudden dyspncea has been known to arise. In some instances, at least, this has been discovered to be due to the actual penetra tion of the worm into the air-passages. Thus, Andral has known death to
occur from this cause ; and Arronsshon has reported the case of a little girl, aged eight years, who, after suffering for two hours from distressing dyspncea and cough, suddenly, after a violent paroxysm of cough, ejected a. long-worm and was immediately relieved. In other cases, the difficulty of breathing has been attributed to direct pressure upon the larynx and trachea. by a number of worms in the gullet, or to reflex action, propagated from the intestine ; but these explanations are neither of them very satisfactory. It has been so much the tendency to attribute every kind of discomfort arising in cases where worms are present to the irritation of the parasitic creatures in the bowels, that probably sufficient care has not been always taken to ex-. elude other and less obvious causes of the symptoms.
Lumbrici are sometimes present in very great quantities. The largest number I have known to occur together in one child has been twelve ; but they are sometimes much more numerous, and may even amount to several hundreds. When thus multiplied, the worms may form bundles, which impede the passage of the contents of the bowel, and are said in some cases to give rise to the symptoms of obstruction.
The tape-worm is often found in children and sometimes in infants. One child who came under my own observation began to pass the joints at the age of fifteen months. Other observers have met with the worm in still younger subjects. • These, however, are exceptional cases, but in older children, of five or six years and upwards, the affection is as common as it is in the adult. In these patients, little disturbance appears to be excited by the parasites. Pallor and loss of flesh are often complained of ; but these symptoms, as in the case of the other species of parasite, ap pear to be due less to the worm than to the mucous derangement of the bowel with which its presence is usually associated. Headache and dis colouration of the lower eyelid also often occur, and may be attributed to the same catarrhal condition. Often, however, the digestion remains good, and the child, except for occasionally passing segments with the stools, is to all appearance well.