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In childhood the presence of worms in the intestine is an extremely common trouble, and one which may be met with in all ages from infancy upwards. Most of the varieties found in man gain entrance into the digestive tract through the ova, which are either swallowed with water and such foods as salads or cresses; or are carried to the mouth by the fingers.
The three commonest varieties of intestinal worm are; in order of frequency, thread or pin worms, roundworms, and tapeworms. Each is fully dealt with under its own heading.
In general it may be said that their presence is always associated with an unhealthy condition of the mucous lining of the bowel, due to faulty hygiene, diet and constipation. In the healthy bowel worms do not multiply. In thrcadworm infection the best drug by the mouth is santonin, given in combination with an aparient, although effective treatment is met with a simple raw clove of garlic given twice daily until the worms are purged. Santonin is also effective in roundworm, although male fern and thymol have their advocates. Male fern is almost specific against tapeworms as is the rind of the fruit pomegranate.
Hydatid disease (q.v.) is a serious disease due to infection with the larval form of a special tapeworm, taenia echinococcus.
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Described by the generic term of roundworms or nematodes from the Greek word nema, a thread, the following worms are found in the human alimentary tract: ascaris lumbricoides, oxyuris vermicularis, ankylostoma duodenale and the trichocephalus dispar. The filaria bancrofti which is found in the lymphatic system, the filaria medinensis, localised in the connective tissue of the lower extremities, and the trichinella spiralis, found in the muscles and sometimes in the intestinal canal, are also included among the roundworms.
Ascaris Lumbricoides. Found in the ox, pig and man. It is very similar to the ordiuary earthworm in appearance, and inhabits the small intestine. The chief source of infection is through the pollution of water.
Oxyuris Vermicularis. Commonly known as the threadworm. It is found chiefly in children, its habitat being the large intestine and rectum. Infection takes place through swallowing the ova from contaminated water or food.
Anklostoma, or Strongylus Duodenalis. More commonly known as hookworm. It produces a very severe anaemia, known as ankylostomiasis, hookworm disease and miner's anaemia. This worm is most prevalent in tropical climates. Infection takes place usually through contamination of water or food in districts without sanitary arrangeinents; it may also occur through the skin.
Trichocephalus Dispar. Has a peculiar hair-like anterior extremity and inhabits the caecum.
Filaria Bancrofti. Found in the lymphaticsof the extremities and trunk. This worm is localised to subtropical and tropical climates, and its intermediate host is a mosquito, culex fatigans. The filaria medinensis, or Guinea worm, is unknown in Europe, and is chiefly confined to the greater portion of Asia; West Africa and parts of Brazil. The human being is infected through water in which the embryo of this worm exists.
Trichinella Spiralis. Found in the voluntary muscles of the body, it gives rise to a disease known as trichinosis. These worms are peculiarly parasitic to rats and are conveyed by them to the pig.
The roundworm shown in the illustration is ascaris lumbricoides. It inhabits the small intestine and causes varied symptoms. 2. Male; average length 8 inches. 2. Female; average length 14 inches. 3. Head seen from above, and, 4, from below. 5. Egg in its shell. 6. Transverse section of adult female.
Their Life Iiistory and Means for Their Destruction
By the use of meat which is raw or insufficiently cooked different kinds of tapeworm make their way into the human body, one coming from beef, another from pork, a third from fish, notably the sturgeon; that is to say, the ox, the pig and fish act as intermediate hosts. For the echinococcus, man serves as the intermediate host.
Merozoa or cestodes, more commonly known as tapeworms, are distinguished from other internal worms by their segmented bodies and the absence of any digestive system. They are, with very few exceptions composed of a head or scolex by which they attach themselves; and a, body of variable length, consisting of segments or proglottides numbering, according to the species, from three to several thousands, which taper off as they near the head, this narrow portion being called the neck. The complete worm is known as a strobilus.
The majority of cestodes occur in vertebrate animals all over the world, and invariably select the small intestine to live in. The four kinds found in man are the taenia echinococcus, taenia saginata, tacnia solium, dog, beef and pork tapeworm; and the bothriocephalus latus (q.v.), which is more scientifically named the dibothriocephalus latus (fish tapeworm).
Anatomy. The scolex or head is usually a blunted cone in shape and bears hooks or suckers or sometimes both, by which the worm attaches itself to the mucous membrane of the bowel. The suckers are called bothria, and in one species they are extremely shallow and mobile and are known as phyllidia.
The variety of form and the complication of structure of the scolex in cestodes are very variable. The suckers may be found in pairs, or fused together, resembling a tube, or they may be provided with stalks, and in one variety they are cup-shaped. The hooks are usually found arranged in a circle.
The segments or proglottides vary considerably in size, number and shape, but usually are flat, rhomboidal and hollowed out on the lower surfaces around the insertion of the next segment. The taenia echinococcus has only three segments, whereas over four thousand are found in the echinobothrium. In all cestodes the segments develop from the scolex, progressing in size and maturity until the complete development of the contained female organs of generation has been attained.
Generally the matured segments become detached in groups at periods of time, but usually after a year or two the remainder of the proglot tides may be detaohed in one chain a leaving only the head behind.
Each segment is encased in a thick, skin-like structure enclosing a plasmic mass called the mesenchyme, embedded in which are the nervous, excretory, muscular and generative systems. There is no dieestive system, as tapeworms obtain nourishment by absorption and osmosis (q.v.) through the covering membrane of the segments. Their only food is the chyle in the small intestines of their hosts. Each segments contains both male and female reproductive organs.
Life History. The life history of these worms can be divided into larval and adult stages, as these are passed in different hosts. The taenia saginata is found in the ox, the taenia solium in man, and the taenia echinococcus develops its adult stage in the dog, though it passes its larval existence in man, and the dibothriocephalus latus in fish; infection can thus be carried by eating uncooked pork and fish or partially cooked animal flesh.
The eggs of the tapeworm, which are oval or spheroidal cells measuring 1/5 of an inch in diameter, develop into embryos with six hooks and may reach their different hosts by a variety of ways. They may hatch out as ciliated organisms, as in the bothriocephalus, having the power to exist in water for a week, where they are swallowed by a fish or mollusc or they may be passed out through the bowel in a segment or as free ova, when they may be eaten by some animal.
The larval stage of the cestode is characterised by the invagination of the scolex of the embryonic larva into a sac or cyst, formed by the lateral expansion of the body, which becomes filled with a toxic fluid. The encysted larva then sheds its tail and begins to grow proglottides from its free end. This condition is known as a cysticercoid, but when the cyst wall is formed by the lateral extension of the body and tail it is called a cysticercus (q.v.). These cysts may grow to the size of an orange.
A very remarkable phenomenon concerning the cystic development of the larval stage is the formation or budding on the internal surface of the cyst wall of other smaller cysts, containing what are termed daughter scolices or csyts.
Incidence. The taenia solium is most frequently found in Western Europe especially in countries where uncooked pork is eaten. The dibothriocephalus latus is most prevalent in parts of Russia, more particularly in coastal districts, or in the neighhbourhood of rivers or lalces, where fish forms the main article of diet. The taenia saginata is widely distributed in Northern India and in parts of the world where cattle are supervised by natives.
A, head of taenia solium, the pork tapeworm, showing suckers and ring of hooklets. B, segments, or proglottides, of taenia solium and of taenia saginata, the beef tapeworm. C, portion of taenia solium showing neck and segments. D, egg; E, embryo; F, cyst; and G, developed cyst of taenia solium. In F the head is coiled spirally and depressed, while in G it is unwound. H, brood capsule of taenia echinococcus, or hydatid worm.
Preventive Measures.
It is essential that raw beef or pork sausages, smoked ham or dishes made from uncooked liver of these animals, also smoked or uncooked fish, should not be eaten. The flesh of the pig in any form should always be carefully inspected for the presence of the cysticercus, which constitutes the condition known' as measly pork: curing or smolcing is not sufficient to destroy the larvae of these worms. A prolonged temperature of 176˚ F. will destroy the parasites, but as it takes about eight hoars for this temperat,ure to reach the centre of a large ham, such a joint should be either cut in half before cooking or boiled for at least that period of time. Freezing will not kill the larvae. Personal cleanliness is most essential in every infected individual if transmission to others is to be avoided.
For the successful cure by an anthelmintic (q.v.) it is necessary that the alimentary tract be, as far as possible, empty. It is advisable to prescribe a liquid diet during the previous day and to administer first thing in the morning a saline purgative, followed in two hours time by the drug to be employed.
Some authorities recommend that the doses should be divided, and the second portion given after an interval of two hours; whereas others advise that quarter doses should be administered at intervals of 15 minntes. If purging has not occurred within 4 to 5 hours after the anthelmintic has been taken, another saline purgative should be given. If the drugs administered are male fern or thymol, castor oil must not be given, as the oil dissolves some of the poisonous constituents which may thus be absorbed into the blood.
The resulting motions must be most carefully examined for the minute head of the worm; if this is not found it is probably wise, instead of repeating the treatment, to await repetition of the symptoms, as segments of the worms should be seen within four months.
Suitable Drugs.
Of all remedies that have been employed for the cure of tapeworms male fern (q.v.) is the best. The most reliable preparation is the liquid extract of the British Pharmacopoeia; unfortunately it is very nauseous but this can be overcome by prescribing it in mucilage.
Some authorities recommend the addition of other anthelmintics such as turpentine, which can be added to male fern in suitable doses. This combination is very useful in dislodging a persistent fixed head, especially that of the taenia solium. Turpentine is a most valuable drug for this purpose, and when prescribed alone it is usually given in doses of 4 drachms. In larger doses it is liable to cause poisoning. Thymol is another drug often used successfully in the cure of cestodes. It should never be combined witth turpentine or any other oily substance, as the oil acts as a solvent, allowing the thynol to be absorbed. Kousso and kamala are also very useful taenicides, but the latter is apt to purge violently if given in large doses. Punica granatum (pomegranate), or more usually its alkaloid pelletierine (q.v.), in the form of the sulphate or tannate, is largely employed in the East. Areca nut (q.v.) has been used, but is now more generally employed in veterinary practice.
Oxyuris vermicularis is the name given to the thread or pinworm which frequently infests both children and adults, although the former are much more commonly affected than the latter. The worms breed in the appendix. The male worm measures about an inch in length. The female is nearly an inch long. After being fertilised it passes to the rectum, where it lays its eggs or passes out of the anus. Another species of threadwortn is trichocephalus dispar, popularly known as the whipworm (q.v.).
The chief symptoms caused by these worms are irritation in the neighbourhood of the anus, frequency of micturition and sometimes a vaginal discharge in girls. The children often become nervous, thin and ill, since the presence of the worms usually indicates a catarrhal condition of the large bowel, usually due to a faulty diet. A quarter clove of raw garlic may be given to a child of two years on alternate nights for a week, and an enema of quassia or salt and water every evening for eight days. A saline purge of magnesium sulphate should be given in the morning. Children suffering from worms must sleep in separate beds, and very great care must be taken to prevent their sponges, towels, etc., being used for other people.
The threadworm, oxyuris vermicularis, inhabits the colon, and in the lower, part of the gut gives rise to much irritation, frequently making its way through the anus.
Also known as schistosomiasis, this is the name given to a parasitic worm which enters the humau body and causes a ohronic disease, bilharziasis, the chief symptorn of which is the passage of blood in the urine. This disease is very prevalent in Egypt. It is also found in the Sudan and other parts of Africa, in parts of Asia, in Cyprus and Mauritius.
The majority of those who suffer from this disease experience no harmful effects whatever, but in some there is very great suffering, caused by secondary diseases of the urinary or intestinal organs which the presence of the parasite may set up.
Eggs of the parasitic worm Bilharzia magnified 90 diameters.
The blood which is passed varies very much in quantity and comes as a rule at the close of the act of micturition. Exercise and strain increase the amount, and the symptom may be first noticed after a period of increased physical effort.
In infected persons the parasites which cause the disease are found in large numbers in the portal vein and its tributaries, where they breed, and lay their eggs in the tissues of the individual. The walls of the bladder are a favourite site for the deposition of the eggs, and through the w alls the eggs escape into the bladder itself. The haemorrhage noticed by the sufferer is caused by the slight wounds made in the bladder walls by the ejected eggs. The eggs are passed during micturition, and many find their way into ponds and other collections of water; those that fail to do this perish. In fresh water the eggs hatch out free swimming larvae, and these make their way into the bodies of certain freshwater snails, which are always found in the infected districts. In the snail they multiply and develop until mature, when they escape from the snail and pass into the water.
The creatures thus liberated have the power of penetrating the skin of human beings, and any unsuspecting individual who goes for a swim or a bath in this water is at once liable to infection. Having gained admission through the skin they make their way to the portal vein and develop into the mature worms. This mode of infection was discovered by Leiper in Egypt in 1916.
The disease can be cured by injecting a solution of tartar emetic into the blood stream of the patient; this meets and kills the adult parasites, thereby preventing egg-laying.
Inflammatory states and tumour growths of both bladder and bowel, which are apt to arise as a result of the irritation produced by the parasites and their eggs, require special and careful treatment.

BILHARZIA: LIFE HISTORY OF WORM The stages of growth are as follows: 1. Embryo in egg. 2. Egg swollen in water. 3. Embryo hatched. 3. Embryo at period of inhabiting mollusc. 4. Mollusc, temporary host. 6. Larva leaving mollusc to enter human host. 7. Adult male. 8 Adult female.

WORMS: In Animals.
The parasitic worms of the domestic animals fall into three classes: trematodes, or flukes; cestodes, or tapeworms; and nematodes, or roundworms.
Most of the important forms are treated under their own headings. There are many other forms however, of less importance but worthy of mention.
The hookworms of man are very important parasites but those of the domestic animals have not been studied to the same extent, and the amount of damage which they do is unknown. Hookworms occur in the dog and cat, pig, sheep and cattle.
Associated with the hookworms in ruminants are the so-called nodular worms, which pass part of their life history in nodules on the intestinal wall. They do little clinical harm, but render the gut useless for sausage skins, etc. In the caecum of all the domestic animals are found forms which differ only in very small details from the human whipworrn (trichocephalus). They seem to do no harm at all.
A very important filaria-like worm is found in cattle in Australia where it lives just below the skin, causing firm fibrous nodules or worm nests.
TAPEWORMS: In Animals. All domestic animals, except pigs, are subject to tapeworm infestation as explained above, the parasites inhabit the intestines of one host and the cystic stage is passed in another host.
Threadworms in animals are more usually known as pinworms (q.v.).