SECT. LVIII.—ON ASCARIDES.
Ascarides, as we formerly mentioned, are a kind of intestinal worms resembling earth-worms, being formed about the extremity of the rectum and the beginning of the sphincter ani, and occasioning a great itching of the parts. This species is formed by bad diet, cold, and indigestion of the food. Wherefore they are to be discharged, in children, by suppositories of honey with a moderate quantity of salts or natron; but in adults by acrid brine, or a decoction of centaury with natron and honey, or of colocynth, or of wormwood, or of chamæleon, or of alkanet, or of bastard saffron, or of hyssop, or of pennyroyal, or of calamint, or of lupines. After the injections we may anoint the rectum with these simples: Acacia, or hypocistis with natron, or Syriac sumach with liquid alum; and in those which are bound, with Lemnian earth in wine, and with these compound medicines, the trochisk of Andron and the like. And we may give them an injection of cedar-rosin with a syringe having many perforations, such as those used for the uterus; or salted flesh is to be adapted to the part and secured with a bandage, as long as it can be allowed to remain, and changed often. In general all those infested with worms derive benefit from fumigations with the hairs of ichneumon. The food should contain wholesome juices, and such as are easily distributed over the system, neither increasing the cause which engenders the worms, nor allowing the strength to sink; and on that account we may give some diluted wine. And we must give food frequently on that account, and in order that the worms may not bite the intestines for want of their food. The best time for taking food is when the worms are full. If there be a defluxion of the belly you may be sure that the worms are on the increase, the food not being properly distributed, and we are to give soups with a mixture of astringents, such as pears, apples, and pomegranates, more especially such as are acid; and we may apply to the belly, externally, astringent remedies as mentioned above.
Commentary. On this curious subject consult Hippocrates (Aphor. iii, 26; De Morbis, iv, 27); Aristotle (H. A. v, 9); Celsus (iv, 17); Cælius Aurelianus (Pass. Tard. iv, 8); Scribonius Largus (36); Serenus Samonicus; Marcellus (31); Octavius Horatianus (ii, 30); Dioscorides (pluries); Galen (Meth. Med. xiv; Isagoge;) Aëtius (ix, 39); Oribasius (Morb. Curat. iv, 90); Actuarius (Meth. Med. i, 21); Nonnus (172); Myrepsus (8); Avicenna (iii, 16, 5); Serapion (iii, 30); Averrhoes (Collig. vii, 37); Avenzoar (ii, 7, 22); Haly Abbas (Theor. viii, 28; Pract. vii, 29); Alsaharavius (Pract. xvii, 2, 9); Rhases (Divis. 169; Contin. xxvi); Alexandri Tralliani Epistola ap. Alb. Fabricii Bibl. Græc. xii, 602, and ed. Ideler, 1842.
Hippocrates states that the round and broad lumbrici are often passed with the first discharges from the bowels of children. This is a fact very difficult to account for. When, and how did the seed of the worm get access to the belly of the child? He rejects the opinion that the rings of the broad lumbricus (tænia) which are passed from the bowels are its offspring. He says it does not occasion death, but continues to live as long as the man lives.
Aristotle divides intestinal worms into the lumbrici teretes, the l. lati, and ascarides. He remarks that the broad produce something resembling the seeds of the gourd. He believed in spontaneous generation.
The pomegranate seems to have been a popular remedy for intestinal worms. Cato the Censor gives directions for medicating wine by the addition of pomegranate and fennel, of which, he says, “Id vinum tinias perpurgat et lumbricos, si sic concinnes.” (De re rust. 127.)
Celsus treats of the lumbrici lati and teretes. For the cure of the former he recommends a draught containing lupine and the bark of mulberry, with the addition of hyssop, pepper, or scammony. He also recommends emetics with garlic, or pomegranate rind with some nitre. For the teretes he recommends the same, and also the seed of nettle, or of cabbage, or mint, or wormwood, or hyssop with mead, or the seed of cresses with vinegar. He advises, likewise, to eat garlic, and use clysters of oil.
Scribonius Largus directs first garlic and old soft cheese to be eaten, and then Macedonian fern to be taken with honey. After four hours a mixture of aloes and scammony with honied water is to be given, and a clyster of warm water administered. He also recommends wormseed and the shavings of hart’s horn. Marcellus mentions the same remedies.
Serenus Samonicus recommends hartshorn, calamint, garlic, southernwood, coriander, pennyroyal, horehound, &c.
The beginning of the chapter of Cælius Aurelianus on lumbici unfortunately is lost. He mentions the usual symptoms which accompany them, namely, occasional deliquium, agitation, grinding of the teeth, change of colour, convulsions, &c. Worms are discharged by the mouth or anus, sometimes single, and at other times in great numbers rolled up in a ball; sometimes dead, and at other times alive; and they are of various colours. For ascarides he recommends when there is inflammation of the rectum an injection of oil, to which may sometimes be joined a decoction of wormwood and centaury. But if bloody scrapings of the bowels are discharged, he directs us to give a decoction of pomegranate-rind, and, if the complaint continue, equal parts of burnt paper and of arsenic, to the amount of six drs., with the infusion of plantain. Surely there must be some mistake as to the amount of the dose, for so great a quantity could not be injected with safety. When there is putrefaction he recommends an injection of salt water, with other suitable remedies. When complicated with any other disorder he properly directs us to pay attention to it; after which the animals may readily be discharged by drinking oil, or a decoction of sebesten plums (myxæ), or of liquorice: these things, he says, will obviate constriction and swelling, while by lubricating the bowels they will promote the discharge of the worms. When complicated with relaxation he recommends astringents externally and internally, such as vinegar with honey, lupine, the shavings of hart’s horn, &c. Sometimes, he says, in order to expel them we must have recourse to acrid substances, such as onions, garlic, mustard, cresses, cardamus, assafœtida dissolved in vinegar, wormwood, &c. In stating the detail of the treatment he mentions various other anthelmintics, such as the hiera of aloes, gentian, mulberries, squills, spurge, alkanet, colocynth, and scammony. All these things may be given by the mouth or in injections, with a considerable admixture of oil. For the lumbricus latus he directs, first, an emetic of oil, and next day a clyster with nitre or salt. Saltish things are also to be given in drink, with liquorice, or scammony, or polypody, &c. When the animals are discharged, to prevent a renewal of the complaint, he recommends friction, vomiting, acrid food, calefacient plasters, sinapisms, paroptesis, and the like.
Pliny recommends the ashes of hart’s horn for tænia. (H. N. xxviii, 59.)
Dioscorides ascribes anthelminthic properties to various acrid and bitter substances, such as garlic, cresses, fern, gith, mulberry, pomegranate rind, lupine, cabbage, nettle, hyssop, mint, calamint, wormwood, wormseed, rue, coriander, thyme, &c. Similar remedies are recommended in the ‘Euporista,’ which is falsely ascribed to him.
Galen mentions that bitters in general are destructive of intestinal worms. The teres, he adds, is killed by the absinthium; but the latus and ascaris require stronger medicines, such as the filix. The author of the ‘Isagoge,’ a work generally ascribed to Galen, divides intestinal worms into the broad, the round, and the ascarides. The round are about the length of a span or somewhat more, especially such as are formed about the stomach. The ascarides are short, and form in the rectum. The broad, called also fasciæ or tæniæ, from their resemblance to tape, are said to be sometimes the length of the intestines. The round are most common in children, the ascarides before manhood; and these are difficult to remove except by bitters, elecampane, and acrid food.
Oribasius treats briefly of lumbrici, recommending for the l. rotundus, southernwood, wormwood, calamint, gith, &c., taken internally or applied outwardly; for ascarides, the juice of calamint, and cedar rosin, in like manner; and for the tænia the bark of the root of mulberry, and the roots of fern in honied water, and also the root of the white chamæleon and costus.
Aëtius gives a full and accurate detail of the symptoms and treatment of lumbrici, but as his remedies are much the same as our author’s, it will be unnecessary to deliver any account of them. He remarks, that anthelminthics either kill worms by their acrimony, or remove them by their bitterness, or irritate them so as to expel them, or by lubricating the parts facilitate the expulsion of them.
Actuarius gives a sensible account of the formation of worms, which he ascribes to putrefaction or indigestion. White worms, he says, are the product of indigestion, but the red, and those of any other colour, arise from putrefaction.
Nonnus merely abridges our author’s account of this subject.
The ingredients in the compositions recommended by Myrepsus, are such as aloes, scammony, southernwood, and bitter almonds.
Octavius Horatianus gives a good account of worms, but it contains scarcely anything that is not to be found in our author’s. He says, that from long experience he had great confidence in a purgative draught consisting of scammony, the ashes of burnt peas, euphorbium, and nitre, given in sweet wine. But garlic, and other acrid things, are to be first eaten.
The Epistle of Alexander Trallian on worms, first published by Hieronymus Mercurialis, and afterwards by Albertus Fabricius, and again lately by Ideler, contains an interesting exposition of the ancient views on this subject. He divides intestinal worms into three genera: the ascaris, the strongylus or round, and the latus or broad. He remarks that the small worms (ascarides) are generally found in the large intestines, the round in the small intestines, and hence they are often vomited up; while the broad worms (tænia) are sometimes as long as the intestines, some having been discharged sixteen feet in length. He states that they are engendered by corruption of the food, and putrefaction of crude humours. He lays down at great length the plan of treatment, which he varies according as they are with or without fever. His remedies consist of cathartic, acrid, oily, acid, and bitter substances. Of purgatives he mentions aloes, scammony, and hellebore; of acrid articles, garlic, cresses, and the like; of oily medicines, the oil of roses, castor oil (oleum ricini), and common oil boiled with rue; of acids, salt and nitre (soda); and of bitters, southernwood, wormwood, hyssop, fennel, and the like. For the expulsion of the strongylus he speaks favorably of a decoction of gagate stone (jet). For ascarides and lumbrici he recommends a lavement prepared from juniper. He concludes his treatise by stating that “ten thousand” other things had been recommended as anthelminthics by the ancients.
Avicenna in his account of worms condenses all the information contained in the Greek authors, but we do not find that he supplies anything new. He in particular copies freely from Aëtius and our author. The same may be said of Serapion, who recommends wormwood, bitter lupines, calamint, peach leaves, cabbage, onions, thyme, colocynth, &c. Averrhoes says that the lumbrici in general are removed by bitters, such as wormwood or wormseed, but that the cucurbitini (tæniæ) require strong medicines. Of the pineæ nuces he says, “Occidunt vermes qui sunt in ventre.” (Collig. v, 42.) Probably this hint may have led to the use of turpentines for the cure of tænia. Avenzoar attributes the formation of worms to ill-digested food in the stomach, and recommends much the same remedies as the Greeks. Haly Abbas describes the three species of worms, and details the symptoms of them. He remarks that these animals are to be killed by medicines of a hot and dry nature, such as bitters. He recommends wormwood, fern, and the like, pounded with honey, vinegar, &c. The remedies mentioned by Alsaharavius are oils, bitters, and drastic purgatives. He treats of lumbrici very fully. Rhases recommends in general terms bitters; for the round, wormwood, for the broad, (tæniæ, called by him semina cucurbita) seriphium, bitter lupines, narcissus, &c. And for the ascarides he directs us to apply a suppository of wool dipped in the gall of a bull. He remarks that they occur most frequently in autumn, being engendered by fruit. He states correctly that they often bring on epilepsy, and looseness of the bowels. He much commends the oil of unripe olives.
Vegetius recommends nearly the same medicines for removing the vermes of cattle as those already mentioned, namely, wormwood, cresses, coriander, fenugreek, and the like, boiled in oil, and administered by the mouth and in clysters. (Mulom. i, 44; see also Columella vi, 25.)
According to Michaelis and Sprengel the ancient Brahmins were acquainted with the anthelminthic properties of the dolichos pruriens.
We have stated above that the most celebrated of the ancient savans believed in the spontaneous generation of animals. This doctrine, although generally rejected at the present time, has been advocated by many modern naturalists of great eminence, such as Baron Buffon and Professor Rudolphi. Virey gives a very impartial statement of the arguments for and against this physiological doctrine. (See Hist. des Mœurs et de l’Instinct des Animaux, ii, 121.) Mr. Madden, the traveller, relates that the bark of the pomegranate is still considered in the east as a specific, not only for ascarides, but also for the tape-worm. He says, “I have rarely seen it fail in the cure of tænia. They make a decoction of two oz. of the fresh bark in a pint of water, this they drink daily till the worm is expelled, which it generally is the third day.” (Travels in Egypt, ii, 371.)