Second only in clinical importance is the little four-spined strongyle (S. tetracanthus). The sexes, often seen united, are nearly of equal size, the largest females reaching nearly 3/4″. They infest the cæcum and colon, and have been found in all varieties of the horse, ass, and mule. The worm occurs in immense numbers and is a true blood-sucker. Its presence occasions severe colic and other violent symptoms, often proving fatal to the bearer. As already announced, in connection with my account of the tapeworms of the horse, this little worm may produce a virulent epidemic (epizoöty). In the sexually-immature state the worm occupies the walls of the large intestine, where it gives rise to congestion, ecchymosis, inflammation, and the formation of pus deposits. The species is readily recognised by its bright red color, by the four conical spines surrounding the mouth, by the two neck-bristles, and by the long three-lobed hood of the male, the posterior three-cleft ray having a rudimentary or fourth branch attached to its outer edge. In some specimens sent to me by Mr Whitney, I found this supplementary process fully twice as long as Schneider has represented it.
From the earliest times this entozoon has been confounded with the palisade worm. Rudolphi and several of his successors, and also in recent times Ercolani and Colin, regarded this worm as the progeny of Strongylus armatus. During my earlier examinations I likewise fell into the error of describing the immature worm as representing a new species. The parasites described by me as Trichonemes (T. arcuata) were identical with those which Prof. Dick had previously described as “worms at different stages of growth,” in his MS. sent to Dr Knox, 1836. Parasites of this kind were described by Dr Knox as “Animals similar to Trichina;” by Diesing as the “Nematoideum equi caballi;” by Mr. Littler as “Extremely small ascarides,” in a letter to Mr Varnell; by Mr Varnell himself as “Entozoa in various stages of growth;” and by Prof. Williams as “Entozoa from the intestinal walls,” in a letter to myself, dated March 13th, 1873. In reference, however, to Mr Varnell’s account of Mr Littler’s specimens I may observe that the appearances which he at first merely described as “blood spots,” he afterwards characterised as dark points “containing young worms in various stages of growth.”
As regards the course of development of this worm we have yet much to learn. Although the worm is a frequent cause of epizoöty in this country it appears to be but little known on the Continent. Krabbe makes no mention of the helminthiasis set up by the four-spined strongyle, but he points out that the young occupy the mucous membrane, in which situation they lie coiled so as to present to the naked eye the appearance of little dark spots (Husdyrenes Indvoldsorme, 1872, p. 17, ‘Aftryk. of Tidsskr. for Vet.’). However, Leuckart’s account of the appearances presented in a case brought under his notice is instructive. He writes:—“I have hitherto had only a single opportunity of examining the strongyle capsules in the intestinal membrane of the horse. Their presence is limited to the cæcum and colon, but they are so abundant in this situation that their numbers may be estimated by many hundreds. It was thus likewise in the case in question, the investigation of which by myself was rendered possible through the friendliness of Prof. Haubner of Dresden. The capsules were of oval form, and glimmered through the mucous membrane as opaque spots, mostly from one to three millimètres in size. In several of these capsules nothing was found beyond a greasy mass of a brownish color, which might readily be taken for a tuberculous substance; but the greater number of them contained a coiled worm, from three to six millimètres long, their breadth being 0·15 to 0·26 mm. (which is 1/166″ to 1/99″). They exhibited a highly colored stout intestine, and a thick-walled oral capsule of 0·022 mm. in depth and 0·025 mm. in breadth. On the dorsal side two three-cornered chitinous lamellæ arise from the shallow floor of the small oral capsule. The cuticle, notwithstanding its firm structure, was still destitute of annulations. The tail (0·15 to 0·18 mm. in length) was strongly marked off from the rest of the body, being of a slender cylindrical form with a rounded-off extremity. The development of the sexual apparatus had not yet commenced. Notwithstanding the great differences of size presented by the body, the structure of all examples was exactly the same to the minutest particular, without exception. Also the smallest specimens, which scarcely measured one millimètre, found in capsules of 0·3 mm. in diameter, were distinguishable only by the absence of the oral cup, whose position was represented by a slender and thickened chitinous cylinder, as obtains in the earliest parasitic juvenile condition of Dochmius trigonocephalus. The transformation to the form presenting an oral cup occurs through a moulting, which is accomplished already in examples of 1·5 mm. in diameter. Later, also, the worms cast their skins in their capsules, without, however, changing the oral cup. In regard to the final purpose of this metamorphosis, my investigations have left me entirely in the lurch; nevertheless, I do not entertain the smallest doubt that the worms which I have here described are the larval forms of Strongylus tetracanthus.”
Fig. 64.—Fæcal cysts or pellets containing the larvæ of Strongylus tetracanthus. Specimen (a) being enlarged (b) to show the protruding head and tail (c) of the worm. Original.
From numerous examinations I have satisfied myself that the worms after escaping the walls of the intestine—and they may often be observed in the very act of passing—re-enter the lumen of the bowel to undergo another change of skin prior to acquiring the adult state. This they accomplish by rolling themselves within the fæcal matter of the horse’s intestine. The best examples I have seen of this phenomenon occurred in a case for the clinical particulars of which I am indebted to Mr Cawthron. Most interesting was it to notice these immature worms, each coiled within a sort of cocoon, which Mr Cawthron termed a cyst. All the forty little cocoons more or less resembled pills, the bright red color of their contained worms strongly contrasting with the dark color of the cocoons. They consisted of compressed débris, which under the microscope showed many common forms of vegetable hairs and parenchyma, besides raphides and chlorophyll-granules. Internally, there was a cavity corresponding with the shape of the worm. In one instance I noticed that the worm had nearly completed its ecdysis, a portion of the old skin still remaining attached to the tail.
As already remarked, the evidence respecting the frequency and destructiveness of this little worm in England is now quite overwhelming. In a series of papers contributed to the ‘Veterinarian’ (too long for full quotation here), I have endeavoured to do justice to the “finds” and observations of those members of the veterinary profession who were good enough to supply me with valuable notes and communications. In particular must my indebtedness to Mr Rees Lloyd be acknowledged, for, as previously observed, he it was who first recognised the parasitic character of the Welsh epizoötic outbreaks. In the Deangunid and Talybont districts these strongyles proved terribly fatal to mountain ponies. It appears that the owners of the animals, as soon as they perceived anything amiss, at once disposed of them by sale, evidently anticipating fatal results sooner or later. The facts connected with some of the isolated cases brought under Mr Lloyd’s care are especially interesting, as showing the virulence of the symptoms set up. Thus on the 9th of Feb., 1875, some time after I had identified the species from specimens he had sent me, Mr Lloyd writes as follows:—“The last case I had was one which had been sold in this way, and which had suffered now and then from colicky pains for the space of about two months. The animal had been drenched with febrifuges and rubbed with stimulating liniments about the throat. However, I was sent for one evening, about an hour before the patient’s death. I soon diagnosed the case as parasitic, and at the same time considered it to be a hopeless one. I remained with it the whole of the time, of which about forty-five minutes of the most acute pain was borne by the trembling beast, which was leaping, rolling, and tossing itself about with astonishing rapidity. The bulging eyes, gnashing teeth, foaming mouth, and sharp peculiar hoarseness, were pitiable to behold; when suddenly all was silent, he quietly rose to his feet, and nipped the grass as if nought had troubled him. I then trotted him quietly up a few yards of rising ground in the corner of the field, when he immediately got down to rise no more. The next day I examined him, and found myriads of the four-spined strongyles, a large number being encysted.” Mr Rees Lloyd’s account of this case is so graphic that I have reproduced it without abridgment. Speaking of another patient, a mare, he says, “she had voided thousands of these parasites, and was in a frightfully emaciated condition, but beyond a craving appetite there was little else to be noticed.” Notwithstanding the few diagnostic indications afforded, Mr Lloyd, being led by the history of the case to suspect worms, at once examined the fæces, when he discovered thousands of these minute nematodes. Clinically, these facts ought not to be lost sight of. In addition to Mr Lloyd’s cases I have received valuable particulars of others at the hands of Prof. Williams, Messrs Cawthron, A. Clarke, T. Gerrard, D. M. Storrar, and J. W. Whitney.
Practically, it is important to inform the persons most interested that an active “drench” may be serviceable in dislodging the free intestinal worms, but the administration of purgatives must not be persevered in. As in the somewhat parallel case of Trichinosis in the human subject, the fatality of the disorder depends not upon the free and mature worms, but upon the migrating and sexually-immature forms. All attempts by means of active drugs to poison the entozoa, when once they have gained access to the tissues (whether actually capsuled or not), are worse than useless. By all means let the animals have a dose of aloes in the first instance, followed by warm bran mashes; but thereafter let every care be taken to support the patient’s strength. Especially should the exhibition of turpentine be avoided. Without doubt the cause of this, as of other similar epidemics, is primarily referable to atmospheric conditions which favor the multiplication of parasites. As the practical man cannot alter these climatal changes, he must do his best to check the disorder by removing the victims to new localities; or, if the animals must remain in infected districts, by supplying them with various kinds of artificially prepared fodder, supplemented by carefully filtered water. In this way, I believe, epidemics may be arrested, but they cannot be stamped out altogether, except by the adoption of measures which would be alike impracticable and unwarrantable.
Passing to the consideration of other intestinal nematodes, the next in importance is the large lumbricoid (Ascaris megalocephala) found in all solipeds, including the zebra. Whilst the male worms rarely exceed seven inches in length, the females sometimes reach seventeen inches. Science is indebted to Schneider for setting at rest all doubt as to the specific distinctness of this worm. The far larger number of caudal papillæ at once distinguishes it from the lumbricoid of man and the hog. The equine Ascaris may occur in any part of the alimentary canal, but the small gut forms its proper head-quarters. The entire course of development of this worm has not been traced; nevertheless, Heller found human lumbricoids measuring less than the eighth of an inch. It is not likely that any intermediate host is necessary for the growth of the larvæ, prior to their access to the definitive host. I have reared the larvæ in impure water and in moist horse-dung, up to the size of 1/30 of an inch. They were then furnished with a completely-formed digestive apparatus. Davaine kept the intra-chorional embryos alive in water for five or six years. His experiments on rats, dogs, and on a cow, led to no decisive results; but it is important to know that the eggs of lumbricoids effectually resist dryness. According to Davaine, however, embryonal development is thus arrested (except in Ascaris tetraptera of the mouse).
Seeing how readily the most ordinary attention to cleanliness must suffice to prevent lumbricoid helminthism, it is scandalous that so many severe cases of disease from this source should ever and anon turn up and be reported. In no properly conducted stable are these large entozoa ever to be seen in any considerable numbers; for so long as the water-supply is good and the fodder clean there is no possibility of infection. A fertile source of infection, however, results from allowing horses to drink at foul road-side ponds and from open waters in the vicinity of stables and paddocks where foals are reared. Into the clinical bearings of the subject I do not enter, but a host of interesting records of lumbricoid disease may be found in veterinary journals, both home and foreign. These have their counterpart in the very similar cases recorded in the medical journals, and quoted by me in the 34th bibliography of this work. From Sonsino’s report these worms do not appear very common in Egypt, but the veterinary inspector, Dr Zunhinett, had occasionally met with them. From Messrs W. Awde, J. B. Wolstenholme, and other English veterinary surgeons, I have received notes of interesting cases, but in this connection I can only further refer to the published cases of Messrs Anderson, Boddington, Cartwright, Harrison, Moir, and Wallis. The French cases, by M. Cambron and by M. Véret, are particularly instructive. Many of the cases give fatal results. In one fatal instance a pupil of mine counted over 1200 of these worms, and in a similar fatal case Mr Lewis reports that he found the small intestine literally crammed, some thousands of worms being huddled together in large masses.