About the treatment of the disorder I have nothing to say here, further than to urge the benefits of the preventive measure of cleanliness. Like Zenker and Heller, I have obtained the eggs of oxyurides from beneath the finger-nails of young people. In one lad all the nails had been carefully bitten down to their roots, but from beneath a minute projecting portion that was left on the right fourth-finger I procured two eggs. Their demonstration under the microscope convinced both parent and child of the necessity of frequently employing local and general ablutions. Personal cleanliness is essential. In this connection an able biologist has ventured to hazard a statement to the effect that “probably any infected person who adopted the requisite precautions against reinfection from himself or others would get well in a few weeks without treatment by drugs.” Dr Ransom bases his belief on the known facts of the life-history of this entozoon, as recorded more especially by Leuckart. I regret that I cannot fully share Dr Ransom’s views, and still less should I think it right by my silence to seem to endorse his statement to the effect “that every person who is shown to be infested with those very common entozoa, Oxyuris vermicularis and Trichocephalus dispar, is thereby demonstrated to have swallowed minute portions of his own or another person’s fæces.” This is putting the case too strongly. No doubt the eggs of oxyurides swallowed by ourselves must have previously passed through some person’s rectum; as such, either separately or mayhap collectively, in the body of the maternal parasite. That does not, however, justify the statement, that we “have swallowed” part of our own or of some other person’s excrement. The eggs ought not to be regarded as constituent portions of the fæcal matter. Perhaps Dr Ransom will say that the surfaces of these eggs, being in contact with fæcal matter, must carry infinitesimal particles on their surfaces, and it is to such that he refers. As, however, a large proportion of the ova escape with their parents, whilst they are still lodged within the maternal worm, it cannot be held that these intra-uterine ova carry fæcal matter on their shells. Commonly the eggs are swallowed in the separate, free, and dry state. In water they perish quickly. The act of eating with unwashed hands is a fertile source of infection, more especially if the meal be taken either in bed or in the bedroom.
Bibliography (No. 31).—Alexander, J., “On Vermination,” ‘Lancet,’ 1833.—Anderson, W., “On Santonine, with especial reference to its use in Roundworm and Threadworm,” ‘Brit. Med. Journ.,’ April, 1864, p. 443; also in Braithwaite’s ‘Retrospect of Medicine,’ vol. xlix (synopsis, p. 20), 1864.—Barry, J. M., “On the Origin of Intestinal Worms, particularly the Ascaris vermicularis,” ‘Trans. Assoc. of Fell. and Licent. of King’s and Queen’s Coll. of Phys. in Ireland,’ vol. ii, 1878, p. 383.—Bremser, l. c., s. 79.—Buckingham, “Ascarides causing Erotomania,” from ‘Bost. Journ., U.S.,’ in ‘Med. Gaz.,’ 1857.—Claparède, E., “On the Formation of the Egg and Fertilisation in the Nematoidea,” from the ‘Zeitsch. f. w. Zool.,’ translated by Dallas in ‘Ann. Nat. Hist.,’ vol. i (third series), 1858.—Idem (memoir quoted in the text above), Genève, 1859.—Cobbold, T. S., ‘Worms,’ Lect. xii-xv, 1872.—Idem, ‘Entozoa,’ p. 362.—Idem, ‘Brit. Med. Journ.,’ Aug., 1873.—Idem, ‘Tapeworms and Threadworms,’ 2nd edit., 1872.—Idem, ‘Lancet,’ 1866.—Idem, “On the Development and Migrations of the Entozoa,” ‘Brit. Assoc. Rep.,’ 1864, p. 116.—Date, W., ‘Lancet’ for Feb., 1872, p. 185.—Davaine, ‘Traité,’ l. c., 2nd edit., p. 211, and ‘Synops.,’ p. 95.—Dickinson, “Case of Epilepsy in Children relieved by the expulsion of Worms,” ‘Med. Times and Gaz.,’ Jan., 1863.—Dickson, R., art. “Anthelmintics,” rep. from the ‘Penny Cyclopædia,’ in Knight’s ‘Eng. Cyclop. Arts and Sci. Div.,’ vol. i (column 365), London, 1859.—Dreyfus, “Irritation of the Bladder from Ascarides,” from ‘Journ. de Med.,’ in ‘Lond. Med. Gaz.,’ 1847.—Elliotson, J., “A Lecture on Worms,” ‘Lond. Med. Gaz.,’ 1833.—Idem, “On Worms in the Intestinal Canal,” ‘Lancet,’ 1831.—Idem, “On a Case of Threadworms,” ‘Lancet,’ 1831.—Idem, “On Intestinal Worms,” ‘Lancet,’ 1830.—Heller, A., “Darmschmarotzer,” in von Ziemssen’s ‘Handbuch,’ Bd. vii, s. 632 (see also Anglo-American edit.), 1876.—Küchenmeister, l. c., Eng. edit., p. 356.—Ransom, in Reynolds’ ‘Dictionary of Medicine.’—Smith, A. (and others), ‘Lancet,’ April 29th, 1865, p. 468.—Stricker, W., in ‘Virchow’s Archiv,’ xxi, 1861, s. 360.—Tatham, ‘Lancet,’ April, 1867, p. 457; see also p. 519.—Vix, E., ‘Ueber Entozoen,’ &c., Berlin, 1860; see also “On the occurrence of Entozoa in the Insane, particularly with respect to the Oxyuris vermicularis;” brief notice (‘Allg. Zeitsch. f. Psychiatrie’) in Winslow’s ‘Journ. of Psycholog. Med.,’ vol. i, 2nd series, 1861, p. 158.—Zenker, ‘Verhandl. d. phys. med. Soc.,’ H. ii, Erlangen, 1870, s. 20; and in ‘Tageblatt der deutschen Naturforscherversammlung zu Dresden,’ 1868, s. 140 (also quoted freely by Leuckart, Davaine, and Heller).
Leptodera (Anguillula) stercoralis, Bavay.—In the summer of 1876 Dr Normand, of the French Marine, discovered this little entozoon in the fæcal discharges of soldiers who had been sent home invalided from Cochin-China. The patients in question were the victims of the so-called Cochin-China diarrhœa or dysentery. This disorder is endemic in character, and it had hitherto been regarded as consequent upon a variety of causes other than parasitic. Dr Normand’s discovery, as such, therefore takes equal rank with the analogous revelations made by Bilharz, Harley, Leuckart, Zenker, Weber, Lewis, and Bancroft, in respect of the particular helminthiases in man with which their names are severally associated (Bilharzia disease, Endemic hæmaturia, Cestode tuberculosis, Olulaniasis, Inter-tropical anæmia, Trichinosis, Lymphoid affections, Helminthoma, and so forth), and also, if I may be permitted to say so, with my own determinations in respect of a variety of endemics affecting animals (cestode and nematode epizoöty in the horse, the so-called grouse-disease, the pigeon-endemic due to lumbricoids, &c.).
The Leptodera stercoralis is a minute, smooth-bodied, simple, rhabditiform nematode, measuring when full grown 1/25″ in length, with an average breadth of 1/625 of an inch. The embryos at the time of their extrusion measure only 1/250″ in length, but by the time at which a rudimentary vesicle representing the uterus begins to form, the females have already attained a length of about 1/83″. The males and females are of nearly equal size. The transition from the embryonal state to the higher larval conditions is accompanied by a change of skin, after which the digestive and reproductive organs are gradually but rapidly formed and completed. These changes have been minutely traced and recorded by Professor Bavay, who also compares the entozoon with the genera Rhabditis and Leptodera, in either of which genera the worm might be placed. I have accordingly adopted the nomenclature suggested by Bavay.
Fig. 48.—Leptodera intestinalis. a, Adult female, and separate figure showing a portion of the body with the ova in sitû. The two outlined figures represent profile and front views of the tail, respectively. b, c, Eggs with imperfectly formed embryos. d, Larva. Highly magnified. After Bavay.
As happens in all the kindred helminthiases that are known to be dependent upon the presence of small worms, large numbers of Anguillules are necessary to produce injurious effects upon the bearer. Thus, the evacuations of the Cochin-China patients were found to contain such multitudes of the worms that their numbers could only be adequately estimated at so many hundreds of thousands passed in twenty-four hours. Of course they varied in quantity, not only in different patients, but in the same bearer, from day to day. They are to be found in every stage of growth and development, from that of the intra-ovular embryo and free embryonic state up to sexual maturity. They occupy all parts of the intestinal canal, from the stomach downwards, being also found in the pancreatic and biliary ducts, and likewise within the gall-bladder. According to Bavay, five days suffice under favorable circumstances for the complete maturation of the worm. This readily accounts for their occasional extreme abundance.
I am indebted to the courtesy of Dr le Roy de Méricourt for the original memoirs from which these brief abstracts are taken.
Leptodera intestinalis, Bavay.—This is a larger species, now and then found associated with the above, and, according to Bavay, “in infinitely less abundance.” This species was also discovered by Dr Normand, and has been carefully described by Bavay. Possibly the worm may afford us another curious instance of dimorphism. Be that as it may, it must be provisionally regarded as a distinct form. As its occurrence is by no means invariable, its rôle in relation to the Cochin-China diarrhœa must, as Davaine has likewise remarked, be regarded as of secondary importance. It is readily distinguished from A. stercoralis both in the adult and larval conditions. The full grown worm, although comparatively narrow, is more than twice as long as its congener; moreover, the larvæ, in place of possessing finely-pointed tails, have blunt or truncated caudal extremities. Converting M. Bavay’s millimetric measurements into fractions of the English inch, the average length of the mature worms will be about 1/11″, whilst their breadth does not exceed 1/757″ in diameter.