of one or two fluidounces, made into an emulsion with white of egg and
sugar; children require about half the quantity. The large dose is less
apt to produce the usual objectionable effects of that medicine than
small ones. The only inconvenience caused by it is the heat of the
stomach, some febrile excitement, and fulness of the head or headache
lasting for one or two days. The effects are more apt to occur when the
medicine does not act as a cathartic. The oil usually operates quickly,
killing the worm and producing its discharge. If it does not act in the
course of two or three hours, a full dose of castor oil may be given,
and, if necessary to aid the action of this, enemata may be employed.
To ensure the purgative action of the oil of turpentine it may be
advantageously associated with the castor oil, of each a fluidounce
made into an emulsion.
Another and effective remedy is the root of the male fern, Aspidium
filix-mas, used in decoction or electuary. Stein of Frankfort
recommends the ethereal extract as the best preparation, and prescribes
it in doses of from seven to ten grammes, enclosed in half the number
of gelatin capsules and administered at short intervals within half an
hour. It should be taken in the morning fasting, after taking a cup of
coffee, swallowing the capsules with the aid of a second cup. Half an
hour after the capsules are taken a mixture of castor oil, brandy, and
ginger syrup, of each fifteen grammes, should be administered. The
treatment has proved all that could be desired, and the worm, including
the head, is discharged altogether, rolled into a ball.
The bark of the pomegranate-root, Punica granatum, is also a powerful
and efficient remedy, but often proves very disagreeable from its
producing violent pains in the abdomen, with nausea and vomiting. It
also generally purges, occasioning the discharge of the worm.
Küchenmeister prefers it to any other medicine, given in the form of
decoction prepared by macerating three ounces of the fresh bark in
twelve fluidounces of water for twelve hours, and concentrating the
infusion by gentle heat to one-half. He recommends it to be taken after
fasting a day and the {942} administration at night of two fluidounces
of castor oil. It is to be given in three or four doses within an hour.
Should the medicine not purge, it should be followed by another dose of
castor oil.
Recently, Feraud has recommended the tannate of pelletierin, the
alkaloid of which is derived from the pomegranate-root, as the most
powerful of remedies for tape-worm, the dose for an adult being
one-half to three-fourths of a grain. The patient should fast a day on
bread and milk, and the following morning, before rising, take an
infusion of one-third of an ounce of senna. This should be followed an
hour later by half the medicine diffused in a little water, and the
patient should remain quiet in bed to avoid nausea and vomiting. Half
an hour later the rest of the medicine is to be given, followed in
another half hour by a dose of castor oil. Should there be no stool
after an hour, purgative enemata may be used. In one case twelve beef
tape-worms were discharged together measuring, collectively, fifty
meters.
Kousso, the flower of Brayera anthelmintica, an Abyssinian herb, has
been of late much employed as a remedy for tape-worms, but with many
physicians of experience it has lost favor. Heller speaks of it highly,
and recommends it to be taken in the morning, an hour after the patient
has taken coffee. The dose is from half an ounce to an ounce, and is
conveniently taken in compressed balls or disks, coated with gelatin,
and swallowed at intervals in the course of an hour, aided by mouthfuls
of coffee. Any disposition to vomit should be repressed, which is
rendered easier by taking small mouthfuls of strong coffee or pieces of
ice.
Koussin, an alcoholic preparation of kousso, is also efficient, and has
the advantage over the latter that it does not occasion nausea. It has
been used in the medical clinic of Munich in the dose of 30 grains, and
it has been a very rare occurrence that the result was not all that
could be desired.
The seeds of the common pumpkin, Cucurbita pepo, are extolled by many
physicians as a remedy for tape-worms; and the writer has twice had the
opportunity of observing large specimens of the beef tape-worm which
were expelled after the administration of this medicine. The dose is an
ounce of the seeds bruised into a paste and made into an emulsion. It
should be taken in the morning, fasting, and followed in an hour or two
with a full dose of castor oil.
Santonin, a principle derived from santonica, Artemisia maritima, is
reported as a remedy for tape-worms, but its efficacy has also been
denied. The dose is from two to four grains for an adult, and from
one-quarter to one-half a grain for children over two years. It is best
administered in lozenges prepared with sugar and tragacanth.
The quinia sulphate has also been recommended as an effectual remedy
both in tape- and seat-worms.
As regards the prophylaxis of tape-worms, there are some important
points to which we direct attention.
The evacuations of patients containing tape-worms, their segments and
eggs, should not be carelessly thrown away, at least in places
accessible to animals which may become infected. They should be treated
with boiling water, the heat of which is sufficient to kill all animal
parasites. The handling of living tape-worms and segments should be
avoided, as eggs {943} which may adhere to the hands, if transferred to
the mouth and swallowed, will produce infection.
Meats visibly infested with measles are not fit and should not be used
as food. Raw meat should altogether be discarded as food, both for the
sick and well, and all meats should be thoroughly cooked. As a rule,
meat should not be used so long as it appears red or on cutting emits a
bloody liquid. A large piece of meat requires long boiling or roasting
for sufficient heat to penetrate to the interior to destroy any
parasites that may be present. Even salted meats and hams should be
cooked to ensure against parasitic infection. It is important also to
avoid food prepared by uncleanly persons who may be infested with
tape-worms.
As regards our domestic animals, which are the common source of the
infection of man with tape-worms, they should also be protected from
infection as far as possible. This is to be done by preventing them
from having access to human excrement. As Heller remarks, with this
object the barbarous custom of defecating in every place promiscuously
should be put down with a high hand.[2]
[Footnote 2: Several years since a physician of Texas sent to the
writer a piece of pork, making inquiry as to its condition, and stating
that all the pigs of his vicinity were diseased and their flesh
similarly affected. It contained a number of measles or larval
tape-worms. On giving the information and the probable cause of the
affection of the pigs, the doctor reported in return that there was not
a privy in his village. Until our people are more careful with the
raising of pigs, European governments will have reason for prohibiting
the importation of our pork.]
* * * * *
TÆNIA ECHINOCOCCUS.--SYNONYM: Hydatid tape-worm.
Larval condition: Echinococcus; E. hominis; E. veterinorum; E.
granulosis; E. scolicipariens; E. altricipariens; E. hydatidosus; E.
multilocularis; E. cyst; Hydatid; Hydatid cyst; Acephalocyst.
This tape-worm, in its mature state the most insignificant looking of
its kind, though not strictly an intestinal worm of man, in the
juvenile condition is one of his most dangerous parasites, as being the
source of hydatid tumors. The adult tape-worm lives in the small
intestine of the dog and wolf, in some localities often existing in
these animals in thousands together. From its diminutive size it may be
readily overlooked, concealed or obscured by the villi among which it
is suspended to the mucous membrane. It is about a fourth of an inch in
length, and consists of but four segments, of which the last alone
exhibits the ripe condition. The head resembles in construction that of
the pork tape-worm, being provided with four suckers and a prominent
crown, with from thirty to fifty hooks arranged in a double circle. The
terminal ripe segment exceeds in size all the preceding together, and
before it separates from the series another is ready to take its place.
The ripe eggs contain the usual six-spined embryo as in other
tape-worms.
The mature worm is remarkable for the comparative shortness of its
life, which, according to Siebold, is about seven weeks. Apparently to
compensate for the small number of its segments, the larval form is
endowed with the power of multiplying itself to a wonderful degree.
It is only in the larval condition that the hydatid tape-worm infests
man, and in this state also it infests the ape, the ox and sheep and
other ruminants, also the horse, hog, and indeed many other animals of
the same class.
{944} If the eggs of the tape-worm are swallowed, which may readily
happen by too free intimacy or association with infested dogs, the
liberated embryos obtain access to the intestine. Penetrating the
mucous membrane, the embryos thence may migrate to any part of the
body. From the comparative frequency of hydatid tumors in the liver we
may suspect they mostly enter the portal venous system and take the
course of the blood-current. It is, however, probable that they migrate
directly to their destination, for hydatid tumors are also frequently
seated in the neighboring organs and the abdominal walls. The embryo
tape-worm, once fixed in position, becomes the starting-point of a
hydatid tumor.
When dogs are fed on the liver, or other parts affected with hydatid
tumors, from the sheep or other animals, the scolices are liberated,
and, passing into the small intestine, are there developed into the
mature tape-worms.
Hydatid tumors occur in any of the organs of the body, but are more
frequent in the liver than in all others together. They are common in
the lungs, kidneys, spleen, omentum, and subperitoneal tissue of the
abdominal walls. They are less common in the heart, brain, spinal
canal, the pelvic viscera, and the bones. Mostly but a single tumor is
found in the same person, but occasionally several occur together in
the same or in different organs.
There are several varieties of the hydatid tumor. In man the more
common form consists of a cyst or a group of cysts enclosed in a
connective-tissue envelope induced by the presence of the parasite. The
simple cyst is produced through the transformation of the echinococcus
embryo, and the group of cysts is derived from the former by
proliferation; and hence the first has been called the parent cyst, and
the others the daughter cysts. These also in the same manner may
produce a third series, called granddaughter cysts. The parent cyst, at
first spherical, becomes modified in shape according to the space it
occupies and the resistance to which it is subjected, thus assuming an
oval, lobulated, or other form. It may increase in size to that of a
cocoanut or larger, and may remain simple, but usually is compounded by
proliferation in the production of daughter cysts. These may be few or
many up to hundreds, and range from a minute size up to that of a
walnut, and are spherical or modified in shape by mutual pressure or
other cause. The cysts are filled with a clear watery liquid of saline
taste, but without albumen.
The hydatid cysts are usually composed of an outer thick, translucent,
homogeneous, laminated, glistening, highly elastic membrane, the
ectocyst, and an inner thin, granular, and cellular layer, the
endocyst. From the endocyst originate minute buds, which become the
brood-capsules of the larval worms or scolices. These form little
groups of a few to a dozen individuals suspended within the
brood-capsules, but capable of eversion from them. The individual
scolices, which appear to the naked eye as mere white points, have the
form and construction of the head-segment of the mature Tænia
echinococcus. After death or by violence they become easily detached,
and then float free in the liquid containing them. In some cases the
echinococcus cysts develop no scolices, in which condition they
constitute acephalocysts. Occasionally the echinococcus embryo
undergoes imperfect development, constituting the multilocular hydatid
tumor, rarely found elsewhere than in the liver.
{945} Echinococcal tumors, especially those which have many daughter
cysts, when accessible are remarkable for exhibiting a tremulous
movement when grasped by the hand and quickly tapped with the finger.
Infection through the embryonic form of the Tænia echinococcus, as the
source of hydatid tumors, is productive of the most disastrous
consequences, and has ended in the destruction of many lives both of
men and domestic animals. The parasite is not directly productive of
suffering, but its effects and dangers are proportioned to the size of
the tumor it occasions and the character and importance to life of the
organ in which the latter is situated. With the increase of the hydatid
tumor, usually of very slow growth, it encroaches upon the surrounding
parts, and if these are not displaced they become disorganized and
atrophied.
The liability and frequency of infection with the hydatid disease
appear to be proportioned to the prevalence of intimate association
with the dog. In Iceland, in which it is said every peasant owns half a
dozen dogs, which share his dwelling with him, it is also reported that
one-sixth of all the deaths are due to the hydatid parasite.
Ordinarily, the hydatid disease is beyond the reach of medical
treatment. The mercurials and potassium iodide have been recommended,
but the results are very doubtful. Apparently as an indication how
little hydatid parasites may be influenced by medicine, the following
incident will show: The writer once received for dissection the body of
an English sailor which had been injected with zinc chloride for
preservation. In the abdominal wall in the right iliac region there was
a hydatid tumor the size of a fist. On examination of the tumor it was
found full of daughter cysts, and these contained living scolices,
though the man had been dead several days and the tissues were bleached
by the zinc solution.
Favorable results in the treatment of hydatid tumors are only to be
expected through surgical means when they are accessible.
As a prophylactic measure against infection the avoidance of too
intimate association with dogs is especially to be recommended.
In concluding the chapter on Tænia echinococcus, as a prophylactic
against this and other parasites Cobbold gives the advice that "all
entozoa which are not preserved for scientific investigation or
experiment should be destroyed by fire when practicable, and under no
circumstances whatever should they be thrown aside as harmless refuse."
* * * * *
TÆNIA ACANTHOTRIAS.
Larval condition: Cysticercus acanthotrias.
This species has been but once observed, and only in the larval
condition or that of the scolex, which was first described by Weinland.
About a dozen specimens were found by Jefferies Wyman of Boston in the
body of a woman of Virginia who died of phthisis. They were situated in
the connective tissue beneath the skin and in the muscles, except one,
which was attached to the dura mater. The scolex is distinguishable
from that of the other human tape-worms in possessing a triple circle
of hooks. The mature form of the worm remains unknown.
{946} The Trematodes, or Fluke-worms.
The trematodes or fluke-worms, though allied to the tape-worms, differ
in many important characters. In the mature condition, like the latter,
they are solid worms or are devoid of a body cavity or coelum, and are
with rare exceptions hermaphroditic. They are, however, never compound,
but simple or consist of single individuals, and are provided with a
mouth and alimentary canal, but this is closed or is without an anal
aperture. They have a water vascular system, communicating with the
exterior by a pore at the posterior extremity of the body. They are
commonly of flat, elliptical shape, with a sucker-like mouth at the
fore end, and with a second sucker situated ventrally near the middle.
The fluke-worms are remarkable for their successive transformations and
course of life, and, like the tape-worms, they pass the different
stages of their existence in different animals. A number of species
have been described as infesting man, but most of them are,
fortunately, of rare occurrence.
* * * * *
DISTOMUM HEPATICUM.--SYNONYMS: Fasciola hepatica; Liver-fluke.
This species, the common liver-fluke, occasionally occurs in the human
body, but is especially frequent in the sheep and other ruminating
animals, as the ox, goat, and deer, and it likewise occurs in the
horse, hog, and some other animals. It usually inhabits the liver,
occupying the bile-ducts, but is also sometimes found in the portal and
other veins and in the intestine, and more rarely in abscesses beneath
the skin. It is the cause of the affection in sheep called rot, of
which many thousands die annually.
The liver-fluke is a flat, tongue-shaped, brownish worm about an inch
long and about half as wide. It is invested with minute scale-like
spines. The head end is somewhat prolonged, and terminates in a small
oral sucker, a short distance behind which is a small ventral sucker.
The intestine is forked and much branched. The genital aperture is
situated between the oral and ventral suckers. The commonly yellowish
eggs are numerous and large, oval, and measure about 0.135 mm. long.
The common liver-fluke frequently occurs in large numbers, even
hundreds, in the liver of the sheep, obstructing the bile-ducts and
occasioning more or less destruction of the organ. The eggs pass off
with the bile into the intestine, and are discharged with the
excrement. In water the eggs are hatched, and deliver a ciliated and
freely-swimming embryo. This in favorable positions, such as marshy
pastures, obtains access to small fresh-water snails and penetrates to
the interior of their body. Here the embryo sheds its ciliated
integument and is transformed into a sporocyst. This is an elliptical
pouch containing reproductive bodies, which become developed into
individuals of more elongated form than the sporocyst, provided with a
mouth and stomach, and named redias, or nurses. The nurse penetrates to
the liver of the snail, and there develops within itself new forms
called cercarias, which resemble the parent fluke-worm, but are
provided with a long, powerful tail and have no apparent generative
apparatus. The cercaria escapes through an aperture of the nurse, and
makes its way out of the snail into the water, where it swims about
actively by means of the tail, much in the manner of a tadpole. {947}
The cercaria after a time fixes itself to a submerged plant, becomes
encysted, shakes off its tail, and remains in a quiescent state. If in
this condition, in the feeding of sheep or other animals, the tailless
cercaria or incipient fluke-worm is transferred to the stomach, it
makes its way to the liver, and there grows and is developed into the
sexually mature worm.
Recently it has been ascertained both in England and Germany that the
juvenile state of the fluke-worm is passed especially in the little
fresh-water snail Lymneus truncatulus. As, however, the common
liver-fluke occurs in America, while the last-named species of Lymneus
does not, it is rendered probable that the juvenile condition of the
parasite also occurs in other species of snails. Incidentally, the
writer may here mention that he has found certain of our smallest
fresh-water snails, such as Planorbis parvus, frequenting meadows in
the vicinity of our rivers and creeks, swarming with nurses of several
different species of fluke-worms.
Notwithstanding the frequency of the common liver-fluke in the sheep
and other domestic animals, its occurrence has been rare in man, and in
all the cases reported it has been few in number, either single or from
two to half a dozen. In man it has been found to occupy the bile-ducts,
the portal vein, and abscesses beneath the skin.
* * * * *
DISTOMUM LANCEOLATUM.--SYNONYM: Smaller Liver-fluke.
This species, much smaller than the preceding, is of lanceolate form,
acute behind, smooth, and about a third of an inch long. Its suckers
are moderately large, and the bifurcate intestine is unbranched. It
infests the liver of the sheep and ox and some other animals, and not
unfrequently is found in association with the former species. It
usually does not occur in such great numbers together as in the latter;
from which and other circumstances, as the smaller size and smooth
investment, it does not produce the same serious results. Its
continuous history remains unknown, though it is probable that its
course is similar to that of the common liver-fluke. Several cases are
reported of its occurrence as a parasite in man.
* * * * *
DISTOMUM SINENSE.--Under this head Cobbold has recently described a
species somewhat larger than the D. lanceolatum. It occurs in the liver
of Chinese.
* * * * *
DISTOMUM CONJUNCTUM.--Another species described by Cobbold under this
name, originally found in the liver of an American fox, has also been
detected in man. The worm is about one-fourth of an inch long.
* * * * *
SYMPTOMS.--Cases of fluke-worms in the human liver have occurred so
rarely that we are not prepared to indicate with certainty what may be
the nature of the peculiar symptoms. If the parasites were numerous,
they would give rise to more or less obstruction of the bile-ducts,
with accumulation of bile, accompanied with jaundice and other symptoms
usually attendant on functional disturbance of the liver. As in sheep,
they would occasion dilatation of the bile-ducts, catarrhal
inflammation, incrustation with biliary matters, hyperplasia of the
surrounding {948} tissues, and more or less disorganization and atrophy
of the secretory structure.
TREATMENT.--As regards the treatment, we can say almost nothing. In the
destructive disease of rot in sheep there are no known means to expel
the parasites from the liver. If present in man, as they occur but few
in number, we may hope for their spontaneous expulsion in due time
without leaving any serious result. As a means of prophylaxis persons
should carefully avoid salads prepared from subaquatic vegetables, like
cress, which may harbor little fresh-water snails.
* * * * *
DISTOMUM HETEROPHYES.--This is a small species, about half a line long,
with the fore part of the body covered with minute spines, and having a
large, nearly central, ventral disk. It has been but once observed, and
was reported by Bilharz, in Cairo, as having been found, in the
post-mortem examination of a boy, in the small intestine, in which it
existed in hundreds.
* * * * *
DISTOMUM CRASSUM.--This is the largest of the fluke-worms infesting
man, and measures from one to three inches in length. It is elliptical,
comparatively thick, and smooth. The two suckers have nearly the same
relative size and position as in the D. hepaticum. It inhabits the
duodenum, and has been observed a number of times infesting inhabitants
of China and India.
* * * * *
DISTOMUM RINGERI.--A species by this name, about half an inch long, has
recently been described by Cobbold as infesting the lungs of people in
Formosa and China.
* * * * *
DISTOMUM OPHTHALMOBIUM.--A minute species, described under this name,
has been detected several times in the human eye.
* * * * *
BILHARZIA HÆMATOBIA.--SYNONYM: Distomum hæmatobium.
As a human parasite this is the most important of the fluke-worms,
being the most common and dangerous. It is apparently restricted to
Africa and Arabia, and is especially frequent in Egypt, Abyssinia, the
Cape of Good Hope, and Natal. So far as known, it is peculiar to man
and monkeys, and inhabits the veins, especially those of the portal
system, and it lives on the blood.
The blood fluke-worm is remarkable among its kind in having the sexes
distinct. The female is slender, cylindrical, and tapering toward the
ends, looking more like an ordinary thread-worm than a fluke-worm, and
is about three-fourths of an inch long. The male is about half an inch
long, but wider than the female, which it partially embraces at
maturity by doubling upon it laterally.