Schüffner tried male fern and only obtained 7 hookworms while the next day, using thymol, 1253 hookworms were expelled. He notes that thymol is dangerous when administered to patients with acute or subacute dysentery.
In Brazil a tabloid of 5 grains beta-naphthol combined with 1 grain of phenolphthalein has been generally employed. Using phenolphthalein in this way enables them to dispense with purgation.
Oil of Chenopodium Treatment.—As the result of comparing the relative efficiency of thymol and oil of chenopodium the International Health Board Commission reported in favor of oil of chenopodium. In only 7.6% of the cases treated with chenopodium was there failure to eradicate the parasites while there was noted 23.6% of failures with thymol. The dose of oil of chenopodium recommended was 1.5 cc. given in three divided doses of O.5 cc. at 7, 8, and 9 o’clock in the morning. Two such treatments will remove 99% of worms present in a case. The Commission found the oil more efficient than an emulsion of the oil.
The low diet and preliminary dose of salts, as noted under thymol treatment, are to be recommended although the commission found various purges to have little effect on the results of treatment. At 11 o’clock give a purgative dose of magnesium sulphate.
The maximum dose of oil of chenopodium is usually given as 3 cc. but a number of deaths have followed the administration of doses of from 2 to 3 cc., so that it is better to keep within 1.5 cc.
After effects of treatment, such as dizziness, depression, unsteady gait, partial loss of consciousness, tingling of hands and feet, burning sensation in the epigastric region and nausea are more frequent with chenopodium than following thymol. The toxic symptoms may be greatly delayed and even be postponed for a day or so. A large dose of castor oil seems to be the most important measure in treating a case of chenopodium poisoning. The same methods of stimulation as noted under thymol poisoning are also indicated.
Kantor has treated a large number of cases with oil of chenopodium administered through the duodenal tube. After the bucket had passed the pylorus he introduced into the duodenum about 2 cc. of oil of chenopodium and followed this in six minutes with two (2) ounces of a warm saturated solution of magnesium sulphate. The tube is withdrawn after introducing the salts. Several copious watery stools follow in a short time.
Carbon tetrachloride in a dose of 3 cc. administered in hard gelatine capsules, is recommended by Hall for the removal of hookworms and ascarids. The drug is cheaper, more effective, and, when chemically pure, safer than thymol or chenopodium. It does not depress unstriated musculature or lessen peristalsis, thus eliminating the use of purgatives, which is an item of expense in extensive hookworm campaigns. The drug is of no value in treatment of tapeworms and is as unreliable as other anthelminthics for the removal of whip-worms.
There is a rapidly growing mass of reports concerning the clinical use of carbon tetrachloride, all of which agree in confirming experimental observations regarding its effectiveness, and indicate that a standard dosage as high as 10 to 12 cc. may be safely employed.
After expelling the worms it is advisable to give the patient a tonic containing iron or arsenic. In those cases with a tendency to pernicious anaemia the arsenic treatment is better than that with iron.