Remarkably fine examples of the adult worm may be seen in the Hunterian Collection, Lincoln’s Inn, and in the Museum of the Royal Veterinary College. The human example is undoubtedly genuine. The dissections in the Hunterian Collection of specimens were made by me in 1865. Objection has been taken to my description of the œsophagus as “spiral.” In Sheldon’s specimen it is certainly twisted upon itself, precisely in the manner in which Davaine has also figured it (‘Traité,’ fig. 68); but I cannot here give further anatomical particulars. Drelincourt found two worms sexually united in the kidney. When once the parasites have gained access to this organ, rapid destruction of the glandular substance follows. Ultimately the kidney is reduced to the condition of a mere cyst or bag, which, besides the worms, contains a quantity of sanguineo-purulent matter. Frequently only one worm is present, but oftener two or three. In the kidney of a puma D’Azara’s friend, Noseda, found no less than six worms, whilst Klein obtained eight from the kidney of a wolf.
Bibliography (No. 28).—Azara, F. de, ‘The Natural History of the Quadrupeds of Paraguay,’ trans. from the Spanish by W. P. Hunter; Valpy’s edit., p. 43, 1837; Black’s, 1838; French edit., p. 313, 1801.—Albers, ‘Beitr. z. Anat. &c.,’ Bd. i, s. 115.—Aubinais, ‘Revue Méd.,’ 1846, p. 284.—Balbiani, “Recherches,” &c., ‘Compt. Rend.,’ 1869, p. 1091; ‘Rec. de Méd Vét.,’ 1870, p. 5.—Bickford, “Spec. of Str. gigas found in the Kidney of a Dog,” the ‘Veterinarian,’ 1859, p. 312.—Blainville, ‘Dict. des Sci. Nat.,’ tab. 29.—Blanchard, ‘Ann. des Sci. Nat.,’ 1849, p. 186.—Idem, in ‘Cuvier’s Règne Animal’ (Masson’s edit.), ‘Les Intestinaux,’ p. 57, pl. 27.—Blasius, ‘Obs., &c.’ (with fig. of Lumbricus in renibus hominis), 1674, p. 125.—Bobe-Moreau, in ‘Journ. de Méd.,’ tom. xlvii.—Boerhaave, ‘Aphorism.,’ 1728.—Bremser (l. c., Bibl. 2), s. 223.—Chabert, ‘Traité des maladies verm. dans les Animaux,’ 1782.—Chiaje, ‘Comp. d. Elmintogr. umana,’ p. 106.—Clamorgan, J. de, ‘La Chasse de Loup,’ 1583 (quoted by Davaine, the worms being described as “serpents et bêtes fort venemeuses”).—Cobbold, ‘Entoz.,’ p. 358.—Idem, ‘Catalogue of Entozoa in the Museum of the Roy. Coll. of Surg.,’ “Descr. of preps. Nos. 19–25,” p. 3, 1866.—Idem, “Parasites of Man,” ‘Midland Naturalist,’ Dec., 1878.—Collet-Meygret, “Mém. sur un ver trouvé dans le rein d’un Chien,” in ‘Journ. de Physique,’ &c., 1802.—Cuvier, see Blanchard (supra).—Idem, ‘Voyage en Sicile,’ and in ‘Ann. des Sci. Nat.,’ tom. xi.—Davaine, C., ‘Traité,’ l. c., deuxième edit., p. 271 et seq. (with full lit. refs. at p. 290).—Diesing, l. c., vol. ii, p. 325.—Dujardin, l. c., p. 113.—Frank, F., “Ein Spulwürm in der Urinblase eines Hundes,” ‘Hufeland’s Journ.,’ Bd. xviii, s. 112.—Jackson, ‘Catalogue of the Boston Museum,’ 1847, p. 317.—Klein, T. K., “Anatomical Description of Worms found in the Kidneys of Wolves,” ‘Phil. Trans.,’ 1729–30, p. 269.—Küchenmeister, l. c., Eng. edit., p. 376.—Leblanc (rep. by Rayer and Bouley), in ‘Bull. de l’Acad. de Méd.,’ 1850, p. 640; in ‘Rec. de Méd. Vét.,’ 1862, p. 800; and quoted by Davaine.—Leuckart, l. c., Bd. ii, s. 353–401, 1876.—Moublet, “Mém. sur les vers sortis des reins et de l’urethre d’un enfant,” ‘Journ. de Méd-Chir. et Pharm.,’ 1758, pp. 244 and 337.—Otto (Anat.), in ‘Mag. d. Gesellsch. naturf.,’ 1814.—Owen, art. “Entozoa,” in Todd’s ‘Cyclop.’—Rayer, ‘Traité des maladies des reins,’ 1841.—Rayger, ‘Sur un serpent qui sortit du corps d’un homme après sa mort’ (quoted by Davaine, l. c., p. 272), 1675.—Schneider, ‘Monographie der Nematoden,’ 1866, s. 50.—Idem (mit Peters), quoted by Leuckart, l. c., s. 382.—Stratton, in ‘Edin. Med. and Surg. Journ.,’ p. 261, 1843.
Dochmius duodenalis, Leuckart.—Much time might be occupied and wasted over the nomenclature of this parasite. In my previous treatise, and for reasons there stated, I placed it under the genus Sclerostoma. On rather slender grounds Dubini formed the genus Anchylostoma for its reception, but Von Siebold thought that, on account of the absence of symmetry in the arrangement of the so-called dental organs, Dubini’s genus might very well be allowed to remain. Bilharz, Diesing, Küchenmeister, Wucherer, and others have retained the genus as either Anchylostoma or Anchylostomum. Schneider keeps it amongst the Strongyli; but after all that has been said and written there can, I think, be no doubt that if Dujardin’s genus Dochmius is to be retained at all, Dubini’s worm must be placed in it. The comparisons instituted by Leuckart afford sufficient proof of the intimate alliance as between Anchylostoma and Dochmius. Professor Molin thought to meet the difficulty by calling the worm Dochmius anchylostomum, but the specific term, duodenale, should certainly be retained.
Fig. 41.—Male Dochmius duodenalis, with bursa separately enlarged. After Küchenmeister.
This worm was discovered by Dubini at Milan, and though at first thought rare, it is now known to be tolerably common throughout Northern Italy. The worm has also been recently found by Dr Kundrata at Vienna, in an Austrian subject. According to Pruner, Bilharz, and Griesinger, it is abundant in Egypt. Griesinger believed that about one fourth of the people of that country suffered from anæmic chlorosis, solely in consequence of the presence of this worm in the small intestines. From Wucherer’s observations especially, we know that Dubini’s worm is not limited to the localities above mentioned, for it occurs in the western tropics, in Brazil, and even in the Comoro Islands.
The worm may be described as a small nematode, the males measuring 3/8″ or rather more, whilst the females extend to very nearly 1/2″ (12 mm.). The head is pointed and tapering, and bent forward, having the mouth directed towards the ventral aspect. The oral opening is armed with four asymmetrically disposed, unequally-sized, horny, conical, converging teeth. The neck is continuous with the cylindrical body, which is 1/80″ in thickness. The body terminates in a straight cone-shaped, or rather sharply-pointed tail in the female, the caudal extremity of the male ending in a partially inflexed, blunt point. In the male there is a cup-shaped, bilobed bursa, the membranes of which are supported by eleven chitinous rays, ten being simple, whilst the median, or odd one, is bifurcated at the summit. The mode of reproduction is viviparous. Adult males and females occur in the proportion of one of the former to three of the latter.
As above mentioned, it was Griesinger who first pointed out the clinical importance of this entozoon. He first explained the manner in which the worm produces anæmia, the persons attacked losing blood as if they were being bitten by innumerable small leeches. Like the rest of their kindred, these worms are veritable blood-suckers. In the first instance the views of Griesinger met with opposition, but they have since received abundant confirmation. Whilst Küchenmeister’s ‘Manual’ furnishes an excellent account of the disorder as known in Europe, we are chiefly indebted to Wucherer for what is known of the disorder in Brazil. The experiences recorded in the ‘Deutsches Archiv für Klinische Medicin’ for Sept. 27th, 1872 (s. 379–400), were amongst the last that appeared from the pen of that gifted and amiable physician. As little or no notice of his writings appears to have been taken by professional men in this country, I depart somewhat from the design of this work when I venture to abstract a few of the clinical particulars which he has supplied. Their importance in relation to sanitary science is obvious, inasmuch as these parasites are introduced into the human body by drinking impure water, or, at least, water which either contains the free larvæ of the worm, or the intermediary bearers that harbor the larvæ.
It should be borne in mind that Dubini’s original discovery was made at Milan in 1838, whilst Griesinger’s recognition of the worm as a cause of the Egyptian chlorosis resulted from a post-mortem examination made on the 17th of April, 1851.
In the journal above mentioned, Wucherer records his own discoveries as follows (‘Ueber die Anchylostomunkrankheit,’ &c.):—“Although Griesinger with well-founded confidence gave an account of his ‘find’ and its significance, yet it remained for a long time unnoticed and unutilised, till at length a case led me to corroborate it. During my many years’ residence in Brazil, especially during the first year, I had very frequent opportunities for witnessing the tropical chlorosis, but seldom to treat it, as it is one of those diseases for which Brazilians seek no medical assistance. Its treatment falls to the lot of the curiosos, curadeiros (quacks), who employ the fresh pulp of a species of fig as a remedial agent with the best results. On the 13th of December, 1865, I was called to the Benedictine monastery in Bahia to see a slave of the order suffering from hypoæmia. The patient was about thirty years of age, married, a strongly built mulatto. He was a field laborer on the Ingua plantation of the order, who exhibited in a conspicuous degree all the symptoms that occur in hypoæmia except the diarrhœa. He was well nourished, but strikingly pale, his whole face, but especially the eyelids, being œdematously swollen, as also were the feet, legs, and hands. The hands and feet were very cold. His appearance betrayed the most horrible anguish or low despondency. With difficulty only could he raise himself, being obliged to lie down again immediately on account of his weakness. Auscultation revealed a diminished respiratory murmur, and bronchial expiration in both lungs. The pulse was very rapid and small, the patient complaining of pain in the region of the heart. He had frequent palpitation when he moved, and he complained of pain in other parts of the body. His abdomen was much distended by gases, but not sensitive to pressure from without, except in the region of the stomach. The urine was clear, its specific gravity 1007 to 10231/2°. Under great difficulties he resided for several months after his marriage at Inhatâ. Earlier he had been on the estates of the order at Rio de S. Francisco. He there suffered for a long time from intermittent fever, but at Inhatâ he entirely recovered. At Inhatâ the slaves frequently suffered from hypoæmia, but in S. Francisco not at all. He appears not to have made any misuse of brandy. The slaves of the order were well cared for, and supplied with good and wholesome nourishing food. The patient had already, for a long period, treated himself with steel wine, yet was continually getting worse and worse. He had not taken the pulp of the fig. As I was unaware he had suddenly become so ill, they hastily despatched a message to the town. There was no good to be expected from the further employment of iron, and the patient was in such a condition that from the very first I despaired of his recovery. I immediately prescribed the pulp of the Gammeleira (Ficus doliaria), but it could not be easily obtained. Considering that the Gammeleira would have a drastic effect, I therefore prescribed two grammes of elaterium, to be divided into eight doses, of which he should take one every three hours.” Dissatisfied with this advice, however, Dr Wucherer goes on to say that on reaching home he carefully looked up the literature of the subject. “In a ‘Geologico-Medical Report’ by Professor Hirch, recorded in the ninety-sixth volume of ‘Schmidt’s Jahrbucher,’ I found how Griesinger had recognised the Anchylostoma as the cause of the Egyptian chlorosis, which was clearly identical with our hypoæmia. He had employed this commended anthelmintic. I resolved the more to prescribe the pulp of the Gammeleira when I found it described as a worm-expelling remedy in Martin’s ‘Systema Materiæ Vegetabilis Braziliensis.’ The next morning, however, when I arrived at the monastery I learnt that my patient died about two hours after a slight evacuation. Only after much resistance would they permit the sectio cadaveris. I merely opened the abdomen, and was surprised to find everything as Griesinger had described. During the next season, through the courtesy of my colleagues attached to the General Infirmary at Bahia, especially of Drs Silva Lima, Faria, and Caldos, I was enabled to open more than twenty bodies of anæmically deceased individuals. All were selected as miserably poor in condition, but only five were bodies of persons in whom hypoæmia was diagnosed, and in these there were a great number of Anchylostomes in the small intestine. The intestines of the other bodies contained either none, one, or a few.” Dr Wucherer next states that he compared the characters presented by his entozoa with those given by Dubini, Diesing, and Von Siebold, and found a perfect agreement throughout. He sent several examples to Griesinger, who also established their identity, and communicated the results of his investigations accordingly (‘Archiv für Heilkunde,’ 1866, s. 387. See also Leuckart, ‘Die Mensch. Par.,’ Bd ii, s. 411). Dr Wucherer also forwarded a number of specimens to Dr Weber, who published a brief account of them with excellent figures (‘Path. Soc. Trans.,’ vol. xviii, 1867, p. 274). As mentioned in the text of his memoir (s. 394), Dr Wucherer also transmitted some strongyloids to myself. “The publication of my observations,” adds Dr Wucherer (‘Gazeta Medica da Bahia,’ 1866, p. 27 et seq.), “had a result in that Dr J. R. de Moura, of Thersepolis, in the province of Rio de Janeiro, sought for Anchylostomes in the bodies of tropical anæmics (Hypöæmikern). He at once found these parasites, as stated in the same journal (for 1866, p. 132). As occurred to myself, he saw no enduring results from the application of the remedies which appeared to be called for, whilst he well knew that unprofessional persons (Nichtärzte) succeeded in obtaining marked results by the exhibition of the pulp of the Gammeleira (Ficus doliaria). The anthelmintic action of this remedy was also unknown to him.” Dr Wucherer then records how his discovery of these entozoa was announced by Dr Jobini to the Rio academy, and how Dr Moura’s observations were subsequently communicated, adding remarks upon the interesting discussion that followed. The general opinion was that the Anchylostomata were not the primary and necessary cause of this tropical anæmia, but rather a co-operating agent in its production. Against this view Dr Wucherer afterwards very properly protested (‘Gazeta,’ Jan. 15th, 1868). In the mean time, says our author, “Dr le Roy de Méricourt, prompted by my first communication, had invited the physicians of the French colony to seek for Anchylostomes. Drs Monestier and Grenet, at Mayotta (one of the Comoro Isles, which lies about 12° S. lat. to the north-east of Madagascar), ascertained the presence of entozoa in hypoæmics. Dr Grenet sent the duodenum and a portion of the jejunum of an hypoæmic corpse to Le Roy de Méricourt, who compared the Anchylostomes with Davaine’s description, and recognised them as examples of A. duodenale.”