Diagnosis.—No symptoms are to be relied upon in the diagnosis of intestinal worms. The only sign from which we can draw any positive in ference, is the appearance of the creatures or their eggs in the stools. Therefore, if, from any cause we suspect their presence in the bowels, we should at once adopt appropriate treatment, and order the evacuations to be carefully searched for signs of the parasites. A microscopic examina tion of the matters discharged from the bowels will often discover the presence of the ova.
Treatment.—With the exception of the tmnia, worms are usually ex pelled readily in young subjects ; but it is less easy to prevent their frequent reproduction. In all cases where children continue to be in fested for long periods with the oxyures or lumbrici, the bowels will be found to be the seat of a chronic mucous flux. There can be little doubt that in such cases the ova lodge in the abundant secretion and find in it a congenial medium for development. Therefore, in all such cases, the special means adopted for relieving the bowels of their unwelcome tenants must be conjoined with other measures for arresting the chronic derange ment of the mucous membrane and restoring the intestinal canal to a healthy state. These measures consist in the adoption of a careful diet, from which sweets and farinaceous matters are in great part excluded ; in the frequent use of mild aperients to clear away mucus accumulated in the alimentary canal ; and in the administration of alkaline and other reme dies to check hyper-secretion from the mucous membrane. This subject is referred to elsewhere (see page 127).
Thread-worms are most effectually and easily removed by the use of enemata. For this purpose, lime-water, or an infusion of quassia, or a solution of common salt (a teaspoonful to four ounces of water), may be employed. In using these agents, the bowel should first be cleared out by a copious injection of warm water. Afterwards, five or six ounces of the special enema should be administered, and be retained for a few min utes by pressing the anus before it is allowed to escape. In obstinate cases, santonin (one grain to a child of four years old) should be added nightly to a dose of the compound liquorice powder or other mild ape rient ; and five grains of tartarate of iron, with one or two drachms of the compound decoction of aloes, diluted with water and sweetened by a few drops of spirits of may be given two or three times a clay.
Looseness of the bowels in these cases is readily arrested by a dose of castor-oil. The nocturnal itching may be greatly relieved by the appli cation to the fundament of an ointment composed of equal parts of un guentum hydrargyri and lard, as recommended by Dr. R. Liveino- ; or by the use of a salve made by rubbing up one drachm of finely powdered camphor with an ounce of lard. In all these cases, the greatest cleanliness must be observed, and after each action of the bowels the parts should be well washed with soap and warm water.
In the case of lumbriei, santonin is especially indicated. The remedy is best combined with a dose of calomel. Thus, for a child of five or six years old, two grains of the former may be given with half a grain of the sub chloride of mercury every night for two or three nights, and be followed each morning by a purgative dose of castor-oil. Employed in this manner, the drug rarely fails to bring away the round-worm, if one of these crea tures is hidden in the bowels. Santonin is a remedy which should not be given in too large doses. In some children it causes vomiting ; in others it produces giddiness, with impairment of vision, so that all objects seem tinted with a green or yellow colour. Usually, it increases the amount of urine and gives a yellow tinge to the secretion.
For children who, on account of vomiting or other toxic effect of the medicine, cannot take santonin without discomfort, some alterative remedy must be used. Cowhage (the hairs of the mucuna pruriens) may be pre scribed in doses of thirty to sixty grains, given twice a day in treacle or glycerine. Dr. W. Roe speaks highly of the sulphites, especially the bi sulphite of soda, and recommends ten or fifteen grains to be given three times a day in water sweetened with spirits of chloroform and flavoured with tincture of orange-peel. Neither of these remedies has any laxative action. Each should, therefore, be always followed by a purgative dose of aloes, senna, castor-oil, or other mild aperient. Oil of turpentine is an other useful vermifuge. • It can be given in a morning dose of two drachms (for a child of six) combined with an equal quantity of castor-oil.