INTESTINAL PARASITES

299

These species of worm are found in the adult as well as in the child. In America we generally see the beef tapeworm. The Tania solium is the common tapeworm of Europe. When the mature proglottides are eaten by cattle, the ova wander into various tissues and become encysted as cysticerci.

TREATMENT. The cylindrical worm is driven out by the administration. of santonin, gr. j to ij, ter in die, and saline laxatives.

The thread worm is removed by enemata of garlic boiled in milk.

The tapeworm in man flourishes in the small intestine, and the only certain indication of its existence is the passage of links or sections with the stools. Give a saline laxative twenty-four hours before giving the following remedy:

M. S. Give in two doses, one half at 7, the remainder at 9 A. M. The patient should eat little between the saline and the remedy. Or give No. 2.

R Pelletierine tannate,.

Oleoresin of male fern,
Chloroform,.

Syrup,.

gr. jv;
mxxx;

mv;

3j.

M. S. Take in one dose after a saline laxative, fasting in the mean time.

Give a tablespoonful of castor oil two hours after the remedy has been taken.

Should the worm not be expelled, the remedy can be given a second trial after a week of preliminary medication, as follows:

M. S.: Ten drops on sugar four times a day.

During this week the patient should frequently eat pumpkin seed and herring salad, also strawberries if they are in season.

A good tapeworm remedy in capsules is for sale in the shops under the name of Dietrich's tapeworm remedy.

Rare Forms: Ankylostomiasis Hook Worm Disease.-Dr. R. T. Hewlett, in the Practitioner for November, 1904, writes:

"Ankylostomiasis, the condition resulting from the presence of the intestinal worm, the Ankylostomum, or, as it is now termed, the Uncinaria, is a disease of very wide distribution, occurring over something like three fifths of the habitable globe. Attention has recently been specially directed to it from its occurrence in the Dalcoath Mine, Cornwall. In America it is widely spread, but the parasite here, the Uncinaria americana (Stiles),

is a different species from that of the old world. The chief difference between the U. duodenalis and the U, americana are the replacement of two of the ventral recurved clawlike hooks of the buccal orifice of the former by a pair of semilunar plates, and by the egg of the latter being larger than that of the former. The larvæ, which develop in mud from the ova voided in the excreta, enter the body either by the mouth or through the skin without perceptible lesion. From the skin they pass into the lymph or blood vessels, are swept into the general circulation, and eventually reach. the lungs, whence they pass from the blood vessels into the pulmonary alveoli. From the time the larva perforate the skin until they reach the lungs, they remain of the same size; but as soon as they reach the air vesicles they begin to grow rapidly. They pass into the bronchioles, up the bronchi and trachea, and, emerging through the glottis, pass down the œsophagus to the duodenum, where they become sexually mature. In order, therefore, to prevent infection, it is necessary, not only to safeguard the food, but also to protect the bare skin.

66

The drugs of value in the treatment of ankylostomiasis are thymol and male fern. According to Lutz, 'after a light meal at 11 a.m., give calomel, 0.5 gramme, and powdered senna, 2 grammes, divided into four doses, one hour apart. The last dose may be omitted if sufficient action is secured by the three others, and if the full amount does not accomplish its end, more senna should be given; after this nutritious and easily digested liquid food is the proper diet. This insures liquid evacuations, after which thymol is given in 5 to 15 grain doses, in capsule, at intervals of four hours, until four capsules are taken, after which a dose of Epsom salts is given."

Anguillula intestinalis is the name of a parasite found in the stools in cases of colicky diarrhoea of the Asiatic zone. In the treatment, thymol and male fern are advised to be given internally.

Amoeba Intestinalis. (See also Amoebic Diarrhoea.)

1. The intestine of man may be infected with two varieties of amœbas, one pathogenic (Entamaba dysenteria), and the other non-pathogenic (Entamaba coli).

2. Entamaba coli, the non-pathogenic variety, is found in 65 per cent of the healthy individuals studied, and in 50 per cent of individuals suffering from diseases other than dysentery, if a saline cathartic has been administered. 3. These organisms can be easily distinguished in both fresh and stained specimens.

4. They differ widely in their method of reproduction, and this is the most important method of distinguishing them.-C. F. Craig, M.D.

ENTEROPTOSIS; SPLANCHNOPTOSIS; GLÉNARD'S DISEASE Definition. A general term applied to a falling or dropping of the abdominal viscera due to inherent or acquired weakness of the tissues.

C. Schwerdt, of Gotha, Germany, has reported ninety-five cases (eightynine in women, six in men). In sixty-nine cases the stomach was displaced (?) or atonic; in eighty-six cases the right kidney was movable. The liver and spleen play but a rare part in this condition.

Clinical Features.-The clinical features of enteroptosis are a sense of fulness in the epigastrium, nausea, eructations, vomiting, obstinate con

INTESTINAL PUTREFACTION AND TOXÆMIA

301

stipation, abdominal distention, and colic, and in more marked cases pain in the back and polyuria, and often in cases yet further advanced pain in the diaphragm, palpitation, dyspnoea, sleeplessness, mental depression, and melancholia-a clinical picture so often spoken of as "purely functional" or "neurasthenic," but which may be referred, with some show of reason, to a condition of "anatomical changes" existing and demonstrable.

The essential element productive of this dislocation is possibly a lessened intraabdominal pressure which has its origin in a lax, atonic anterior abdominal wall. Such a condition exposes the hollow organs, otherwise supported, to the influence of gravity

when filled with their normal contents, and one part after the other tends to fall, pulling other parts with it.

Pre

The essence of the disease is to be sought for in the atonic and enervated condition of the nervous system. disposing factors are heredity, methods of living, all chronic diseases, the corset, and insufficient care during pregnancy and after. From this the conclusion is drawn that it is purely a constitutional disease. The anatomist, the pathological anatomist, and the clinician are, unfortunately, not in accord in determining what is normal and what is pathological in the position of various abdominal organs, and particularly the stomach.

FIG. 113.-ABDOMINAL SUPPORT, PLAS-
TER AND WEBBING (Dr. B. Schmitz).

Treatment. The wearing of a well fitting plain abdominal support (without special pads for the support of special organs) is the proper treatment for enteroptosis. Regulation of the bowels and the cool douche to overcome 66 nervousness give satisfactory results. In some instances it will be necessary to fasten a wandering kidney, which may be the source of annoying reflex symptoms. Dr. A. Rose improvises an adhesive plaster support for enteroptosis.

INTESTINAL PUTREFACTION AND TOXEMIA; AUTOINFECTION FROM

THE INTESTINES; INTESTINAL ANTISEPSIS

When fermentative changes in the gastrointestinal tract proceed beyond a certain point, they become a menace to comfort and health. Some persons experience little discomfort; others suffer severely.

Amylaceous Fermentative Dyspepsia produces acetic, lactic, butyric, and other acids and carbonic acid and other gases, giving rise to distention, pain, soreness of the abdomen, acid urine, divers neuralgias, hemicrania, and intercostal neuralgia, with and without constipation or diarrhoea, vertigo, etc.

Putrid Proteid Fermentation produces sulphuretted hydrogen, carbonic acid gas, and aromatic bodies, such as indol, skatol, and ptomaines or toxines,

giving rise to malaise, fever, nervous depression, sleeplessness, melancholia, headache, vertigo, hemicrania, anorexia, or urticaria.

The gases formed provoke pain by distention, and the organic acids interfere with normal digestion and irritate the mucosa of the intestine (catarrhal inflammation of the intestine in children who eat too much candy).

The gases in both varieties may cause dyspnoea and suggest heart lesions and asthma (asthma dyspepticum).

Intestinal putrefaction in infants may give rise to very high temperatures and convulsions, and an early recognition is of prime importance. In renal, hepatic, and cardiac disease intestinal fermentation is a serious complication, and the great value of laxatives is obvious. Undue intestinal fermentation is also seen in anæmia, chlorosis, and leucemia-in fact, anæmia and hæmorrhagic phenomena may result from intestinal fermentation. Epileptoid seizures and possibly chorea are caused by intestinal indigestion. In the present state of our knowledge scurvy must be looked upon as a chronic ptomaine poisoning from prolonged intestinal putrefaction. In all such cases the ethereal sulphates are found in the urine. As a practical test, the test for indoxyl in the urine is here given: Mix equal quantities of urine and strong HCl. Add a drop or two of freshly prepared chlorinated lime and a small quantity of chloroform, and shake. The indoxyl present will be converted into indigo blue by the chlorinated lime and show a blue color in the layer of chloroform. This is of value as a chemical test.

Management of Intestinal Fermentation.-Sufferers from autoinfection must take only perfectly sound food and such articles as are least apt to become the source of putrid fermentation within the intestines. Persons who are liable to "bilious attacks" and attacks of "sick headache" or dyspeptic vertigo must be careful in indulging in the pleasures of the table, and avoid late dinners with wine and rich food. Children should not be allowed to have much cake or candy, and must avoid unripe or overripe and spoilt fruit. The management of indigestion in infants is discussed in the pædiatric section of this book.

DIET IN INTESTINAL INDIGESTION. -No inflexible rule of diet can be given. Fresh bread, sweets, rich pastry, leguminous foods, cabbage, dense cheese, mayonnaise, beer, and sweet drinks increase flatulence and must be avoided. Milk is well borne by some and not by others. Stewed fruit is usually well tolerated. Smoking may have to be stopped for a time. In some instances a change to a vegetarian diet is followed by marked improvement.

EXERCISE is a desideratum, such as walking, bicycling, rowing, riding, exercise with the punching bag, and gymnastics.

BATHS.-A cool sponge bath is always beneficial.

MEDICATION. There is always marked improvement following free Adults may take:

catharsis.

R Podophyllin.,.

Calomel.,...

Pulv. aromat..

Sacchar.,...

M. S.: For one dose.

gr. to 1;

gr. x;

gr. ij;

gr. x.

INTESTINAL PUTREFACTION AND TOXÆMIA

303

On the following day five drops of dilute HCl in water may be given after each meal. When there is a tendency to constipation, a "lapactic" pill at night, or a teaspoonful of Carlsbad salt each morning in a cup of hot water will help.

Abdominal massage is beneficial. Hot water or hot peppermint tea once a day is also helpful.

Children may take:

R Calomel.,.

Sacchar.,.

.

gr. j;

gr. x.

M. S.: One such powder every hour until six are taken.

Or we may order castor oil or citrate of magnesia or rhubarb and magnesia, followed by two drops of dilute HCl in a teaspoonful of essence of pepsine after eating. Infants should receive no breast or bottle milk for six to eight hours, and should have farinaceous water instead of sterilized milk in hot weather.

Enteroclysis is helpful in intestinal indigestion in adults and children. Irrigation of the colon is a simple and valuable procedure.

Intestinal antiseptics of the salol and naphthol group are in the market by the score. The best antiseptic for the bowel is its own action, and the writer has been more successful in the management of indigestion on the lines laid down than by the administration of the modern coal tar derivatives. In gastrointestinal fermentation, and in indigestion secondary to cardiac, renal, and hepatic disease or acute infectious disease, we administer peppermint tea or dilute HCl after each meal, or

R Tinct. iodini,.

Syr. simplicis,

Aq. menthæ,

gtt. x to xx;
3jv;

3jss.

M. S.: A teaspoonful every hour or two, or several times a day. This is to be used in connection with saline irrigations of the colon.