In spite of all pressure on the part of relatives, treatment directly against Ascaridæ should not be carried out until the diagnosis is certain.
As regards prophylaxis, much can be done by not throwing the worms, when expelled, on to the dung-hill or into the privy, but straightway into the fire. Metschnikoff[939] has issued a warning against the consumption of unboiled or badly washed vegetables, salad, strawberries, etc., and also against drinking polluted water.
For the expulsion of the worms flores cinæ were formerly considered the most useful means; now, however, santonic lactone—santonin—which is prepared from them, is almost universally preferred. By many, especially in practising among children, flores cinæ are still recommended in the form of Störk’s worm electuary (consisting of flores cinæ, rad. jalapæ, valerian and oxymel simplex). Guermonprez[940] recommends them because he thinks that santonin only excites the worms and consequently causes unpleasant symptoms. Besides, in the form of the above-mentioned electuary, flores cinæ can also be given several times daily with raspberry jelly up to 0·5 grm. to 2 grm. (children and adults).
Santonin is prescribed either in single doses from 0·03 to 0·05 to 0·1 grm. with sugar in the form of powder, or else in oily solution. When given in the latter form the absorption of the santonin in the stomach is excluded and the whole quantity introduced is thus enabled to reach the worms in the intestinal canal. Küchenmeister[941] has already recommended combination of santonin with ol. ricini. Lewin,[942] however, states that ol. morrhuæ, ol. olivarum, ol. cocos and ol. cinæ can also be taken. In prescribing santonin in oily solution Henoch[943] also prefers the combination with ol. ricini. According to Lewin’s direction the prescription would run as follows:—
| ℞ | Santonin | 0· | 2 grm. |
| Ol. ricini. | 20· | 0 grm. | |
| Ol. cinæ æth. | gtt. | iv. | |
| M., d.s. | |||
S., one tablespoonful to be taken two to three times. | |||
If the patients should manifest a repugnance to castor oil, Starke’s ricinus paste may be selected:—
| ℞ | Santonin | 0· | 2 grm. |
| Ol. ricini | 20· | 0 grm. | |
| Ol. cinæ æth. | gtt. | iv. | |
| Sacch. albi. | q.s. | ||
| Pasta moliis. | |||
S., to be used for two days. | |||
If necessary the first-mentioned mixture might be given in gelatine capsules. Small children should be given 0·025 grm. santonin in warm olive oil slightly sweetened with sugar (a teaspoonful) in the morning; if in the course of the forenoon specimens of Ascaris escape, a second dose should follow in the afternoon about two hours after the meal. Older children should be given santonin in combination with castor oil or calomel:—
| ℞ | Santonini | 0· | 01 to 0·02 to 0·03 grm. | |
| Calomelan | 0· | 025 | grm. | |
| Sacch. albi. | 0· | 5 | grm. | |
| M.f.p. D. tal. dos. x. | ||||
| S., one powder about six, seven, and eight o’clock on three consecutive days. | ||||
As santonin causes slight toxic symptoms such as urticaria, vomiting, retention of urine, headache, vertigo, yellow vision (xanthopsia), it is in every case advisable to follow with a laxative to expel the drug from the body as speedily as possible. The urine is coloured yellow from one to two days and assumes a scarlet red colour upon the addition of alkalis; this, however, soon disappears, while it persists in the case of rhubarb and senna.