It is not advisable, in ordinary cases, to continue the use of anthelmin tics if the first doses have been given without effect. It must not be for gotten that all the symptoms of worms (i.e., of irritation of the bowel) may be present although special remedies fail to produce any sign of the creatures in the stools. If, therefore, after a few trials, no lumbricus is discovered, we should attribute the symptoms to the general intestinal derangement, and take the necessary steps to bring the disorder to an end.
The successful treatment of tape-worm in the child is often a matter of no little difficulty. Probably the softer mucous membrane in the young subject adapts itself more readily to the action of the suckers than is the case in the adult, for in my experience it is comparatively rare for the head to be discovered in the evacuations. The joints can be readily ex pelled, but the head too often remains behind. In all these cases, great care should be taken in the examination of the stools. All the visible joints should be first removed. The matter should then be diluted with water and emptied slowly from one vessel into another, with every precaution that the liquid excreta is thoroughly searched by the eye as it passes over the side of the utensil. The sediment remaining should be then again diluted and strained through a fine sieve. By this means, the head, if it have passed from the bowel, can scarcely escape notice.
Various kinds of vermifuge are relied upon in the treatment of these parasites. Kousso, kamala, filix mas, turpentine, and a decoction of the fresh bark of the pomegranate root have all their advocates. Filix mas, which is the favourite remedy for the adult, is uncertain in the case of children. For young subjects, it is best combined with kamala. A drachm of powdered kamala is made into an emulsion with mucilage, and then triturated in a mortar with a drachm of fern-oil, adding water slowly to make a three-ounce mixture. It is important that the remedy be given The child should be allowed to take nothing but a little water after his mid-clay dinner. The draught should be given on the following
morning, divided into two portions, of which the second half must be taken at an interval of three hours after the first. Kamala has an aperient action of its own. This method of treatment, therefore, seldom requires the assistance of a purgative, as is necessary in the case of male fern-oil given alone. After the two draughts have been swallowed, the patient should still continue his fast until the worm comes away in the stool. I have found children bear this method of treatment well, and it is often effectual. If the draught excite vomiting, it should be repeated, preceded by a small dose (ill, ij.—iij.) of laudanum to quiet the irritability of the stomach.
Kousso is preferred by some. The remedy is given in doses of two or three drachms divided into two portions, and given at an interval of half an hour in milk. The draught should be taken in the early morning, and should be followed in an hour after the second dose by a spoonful of castor oil. The principal objection to this method of treatment is the large quantity of the drug which it is necessary to swallow in order to produce any satisfactory effect. The same objection applies to the decoction of pome granate bark. If these remedies fail, turpentine should always be tried. This oil may be given in one large dose, or in smaller quantities frequently repeated. In the large dose it may be administered as recommended for the lumbricus. In smaller quantities, Dr. H. Davies recommends half a drachm to be mixed with honey and given in a draught with mucilage and water every six hours. Every second morning he orders a powder of calomel and the compound scammony powder.
In all cases where there is much derangement of the bowels, and large quantities of mucus are passed in the stools, a rigid diet, from which starchy matters and sweets are carefully excluded, should be enforced for at least a week before the special treatment is undertaken. This precaution greatly increases our chances of success.