As regards the symptoms produced by lumbrici, these vary according to the situation they happen to occupy. The symptoms are also modified by age and temperament. In the stomach and intestines they give rise to colic and shooting pains about the abdomen, followed generally by dyspepsia, nasal itching, nausea, vomiting, and even diarrhœa. Occasionally death supervenes suddenly. A singular case of this kind (the particulars of which I only gathered from a local newspaper) occurred in a boy, thirteen years of age, at the County Gaol at Hertford, in 1873. From Dr Evans’s statement, made at the coroner’s inquest, the sole cause of death appeared to be due to pressure on the windpipe by a worm lodged in the gullet. Sometimes there is cerebral disturbance, attended with general restlessness and convulsive twitchings during sleep. Thus, Dr Woodman has recorded a serious case of convulsions arising from lumbricoid worms, in which, however, a cure was effected by expulsion of the worms. An anonymous writer in the ‘Medical Gazette’ records a case of epilepsy from this cause, whilst another writer in the same journal (1839) mentions an instance where two lumbrici and one tapeworm were associated in the production of similar phenomena. But a much more striking case is also given (anonymously) in the ‘Gazette’ for 1874 (p. 415), where a single lumbricus caused the bearer to be a lunatic for eight years. The victim suffered from cataleptic fits, which lasted for two or three weeks at a time. M. Petrequin, in his ‘Traité Pratique,’ records two cases of amaurosis in young girls produced by lumbrici. A fatal case is recorded by Petrenz, where 200 worms produced enteritis, and another fatal case is given by Roger from perforation (1848). Cases of perforation are also given by Young, by Blair (1861), by Mondière (1839), by Buchner (1851), by Sheppard (1861), and by Luschka (1854), the worms in this last-mentioned case occupying the cavity of the pleura. Cases of severe irritation affecting the genito-urinary organs are given by Dreyfus, Buckingham, and others; and one or two instances are reported where these worms have been discharged from several parts of the body (Neilson, 1833). I may add that the third fasciculus of a work illustrating the collection of morbid anatomy in the Army Medical Museum at Chatham gives a case of lumbrici occupying the biliary ducts and gall-bladder. I find, moreover, two additional cases of perforation of the small intestine, one of which appeared in the ‘London Medical Gazette’ (1827) and the other in the ‘Lancet’ (1836).
During the Franco-German war Dr Reginald Pierson, as he afterwards informed me, removed a lumbricus from an abscess formed in the abdominal parietes of a soldier. But amongst the most curious cases (illustrating the wandering habits of these parasites) are those severally described by Barwell (1857), Williams, Prichard, and the Messrs Stockbridge. In Barwell’s case an Ascaris was expelled from a child who had swallowed the brass “eye” of a lady’s dress. Through the circular loop of this eye, used as a toy, the Ascaris had partly thrust its body, and becoming thus strangulated, it probably perished before it was evacuated. In Prichard’s case (1859) one or two lumbrici had similarly trapped themselves in the eyes of buttons swallowed by the patient, and one worm, not contented with a single strangulation, had succeeded in passing its body through two buttons. In 1842 Mr T. G. Stockbridge gave a similar case, in which he, not inaptly, spoke of these “hooks and eyes” as constituting a new remedy or “worm-trap” for lumbricus, and singularly enough, a namesake (W. Stockbridge), in the succeeding year, also recorded a like instance of the “mechanical expulsion of worms” by metallic buttons. Again, a third correspondent in the ‘Boston Journal,’ under the initials A. M., spoke of an open-topped thimble as constituting another new “worm-trap,” whilst he gave a case of lumbrici penetrating “metallic suspensor buttons.” There is also the case reported by Williams, who, at a meeting of the Boston Society for Medical Improvement, exhibited “a lumbricus with a dress-hook attached” (1857). Lastly, another lumbricus, trapped in the same way, may be seen in the Museum of the Royal College of Surgeons at Edinburgh.
Owing to the presence of a peculiar irritating vapour which is given out by these lumbricoids, particularly when fresh, several observers have experienced curious symptoms. Thus, Miram on two occasions, when examining A. megalocephala, was attacked with sneezing, excessive secretion of tears, with swelling of the puncta lacrymalia, and Huber also experienced a troublesome itching of the hands and neck after examining specimens of A. lumbricoides. In like manner I have myself had watery suffusion of the eyes (when collecting the perivisceral fluid for Marcet’s analyses: see Bibliog.), and Bastian has given a detailed account of the serious effects which the poison produced upon him. In Bastian’s case even spirit specimens produced irritation. The attacks of catarrh and asthma were so persistent and severe that they lasted for six weeks at a time. So sensitive was Bastian to the lumbricoid-miasm that he could not even put on a coat that he had worn during his investigations without experiencing fresh attacks of sneezing and other catarrhal symptoms. The attacks became periodical, occurring between five and six in the morning, being accompanied by dyspnœa and a distressing spasmodic cough. Bastian, in short, was quite a martyr in the cause of nematode anatomy.
Bibliography (No. 34).—Abousson, L., “On the Presence of Worms (lumbrici) in the Air-passages,” from ‘Arch. Gén. de Méd.,’ in ‘Med.-Chir. Rev.,’ 1836.—(Anonymous), A. M., “Another New Worm-trap—an open-topped Thimble in the Nostril (also notice of metallic suspender buttons penetrated by Lumbrici),” ‘Bost. Med. and Surg. Journ.,’ vol. xxvii, p. 121, 1842–43; see also T. G. and W. Stockbridge.—(Anon.), “Lumbrici expelled by Bismuth,” ‘Bost. M. and S. Journ.’ (from ‘Gaz. des Hôp.,’ ‘Journ. des Connaiss. Méd.,’ and ‘Boletin del Inst.-Med.-Valenc.’), 1859.—(Anon.), “Case of one Tapeworm and two Lumbrici causing Epilepsy,” from ‘Bull. du Midi’ and ‘Gaz. Méd.,’ 1839.—(Anon.), “Case of Perforation of the Ileum by Ascarides,” from ‘Hufl. and Ossan’s Journ.,’ in the ‘Lancet,’ 1836.—(Anon.), “Case of Lumbrici in the Biliary the Ducts and Gall-bladder,” note and fig. in third fasc., illust. the Coll. of Morb. Anat. in the Army Med. Mus. at Chatham, 1838.—(Anon.), “A Lumbricus causing Catalepsy, with Fits lasting two or three weeks; Cure by Vomiting,” ‘Lond. Med. Gaz.,’ 1847, p. 415.—Archer, E., “On a Case of A. lumbricoides producing alarming symptoms,” ‘Lancet,’ 1857.—Barwell, “Case of Ascaris expelled by the swallowing of a foreign body,” ‘Lancet,’ 1857.—Bastian, H. C., “On the Anatomy and Physiology of the Nematoids, Parasitic and Free,” ‘Phil. Trans.,’ 1866, p. 545; for the account of his poison-symptoms, see footnote, p. 583.—Batterbury, R. L., “Jaundice due to the presence of Lumbrici,” ‘British Med. Journ.,’ Nov., 1878, p. 721.—Bigelow, H., “Worm in an Abscess,” ‘Bost. Med. and Surg. Journ.,’ vol. xxxiii, p. 486, 1836.—Blatchley, C. C., “Two Cases of A. lumbricoides, attended with Abscesses, followed by large purulent discharges, and Worms therein,” ‘New York Med. and Phys. Journ.,’ vol. i, new series, p. 209, 1829.—Bonfils, E., “Lesions and Path. Phenomena caused by Lumbrici in the Biliary Ducts,” from ‘Arch. Gén.,’ in ‘Brit. and For. Med.-Chir. Rev.,’ 1858, and in ‘Amer. Journ. of Med. Sci.,’ vol. xxxvii, 1859.—Bradford, J. T., “Singular Case of Worms (Lumbrici),” ‘Bost. Med. and Surg. Journ.,’ vol. xxviii, 1843.—Brigham, A., “Worms in the Bladder simulating ‘Stone,’” ‘Amer. Journ. Med. Sci.,’ 1837; ‘Med.-Chir. Rev.,’ 1837; ‘Quart. Journ. Calcutta Med. and Phys. Soc.,’ vol. ii, p. 132, 1838.—Buchner, “On the Perforation of the Intestinal Canal by Worms (with ref. to two cases),” from ‘Med. Zeitung,’ 1850, in ‘Med.-Chir. Rev.,’ 1851.—Calderwood, “Treatment,” ‘Brit. Med. Journ.,’ Jan. 30, 1875.—Chapman, N., “Case of 68 Ascarides causing Pulmonary Disease,” in his ‘Dis. of the Thoracic and Abd. Viscera,’ p. 263, and in ‘Med.-Chir. Rev.,’ 1845.—Chiaje, Delle-, in ‘Rend. dell’ Accad. di Napoli,’ 1846 (“Anat.,” p. 403).—Church, J., “On A. lumbricoides,” ‘Mem. Med. Soc. Lond.,’ vol. ii, 1789.—Claparède (l. c., Bibl. No. 33, for development).—Clark, P., “Discharge of a Lumbricus through the Male Urethra,” ‘New York Journ. Med.,’ 1844, rep. in ‘Lancet,’ 1844, and in ‘Edin. M. and S. Journ.,’ vol. lxiv, 1845.—Cloquet, ‘Anat. des vers Intest.,’ 1824.—Cobbold, “On Sewage and Parasites, especially in relation to the Dispersion and Vitality of the Germs of Entozoa,” ‘Med. Times and Gaz.,’ Feb. 25, 1871, p. 215.—Idem, ‘Entoz.,’ p. 302–315.—Idem, ‘Worms,’ lect. xvi, p. 3.—Idem, art. “Ascaridæ,” in ‘Maunder’s Treasury,’ 1862.—Colvan, J., “Case in which Eleven Round Worms of the species A. lumbricoides were removed by Anthelmintics,” ‘Dubl. Med. Press,’ vol. xxvi, p. 211, 1851.—Cutler, J. H., “Death by Worms (a large Lumbricus being found in the Wind-pipe),” ‘Bost. Med. and Surg. Journ.,’ vol. lxvi, p. 392, 1862.—Czermak, in ‘Sitz. d. k. Akad. d. Wissensch.,’ 1852 (“Anat.,” s. 755).—Davaine, in his ‘Traité,’ l. c., 2nd edit., syn. xcvii, and p. 122–235 (with details of forty-five cases); see also his memoir “On the Development and Propagation of the Trichoceph. dispar and A. lumbricoides,” from ‘Comptes Rendus,’ in ‘Ann. Nat. Hist.,’ vol. ii, 3rd series, 1858; also in the ‘Journ. of Pract. Med. and Surg.,’ Eng. edit., vol. i, 1858, and in the ‘Veterinarian,’ vol. xxxii, p. 700, 1859, from ‘Proc. of Acad. des Sci.,’ in ‘Bost. M. and S. Journ.,’ vol. lix, p. 157, 1858–59.—Idem, art. “Entozoaires,” in ‘Dict. de Méd. et Chir. prat.’—David, J. B., “Cases of Perforation of the Intestines by Worms,” from ‘Gaz. Méd. de Paris,’ in ‘Dubl. Med. Press,’ 1840, p. 223.—Diesing, ‘Syst. Helm.,’ ii, p. 166; and in ‘Revis der Nemat.,’ l. c., s. 660.—Douglas, J., “Worms (Lumbrici) evacuated at an Ulcer of the Groin,” ‘Med. Ess. and Obs.,’ vol. i, 2nd edit. (vol. i, 5th edit., p. 179), p. 222, 1737.—Dowler, B., “Case of Worms in the Urinary Bladder,” from ‘New Orl. M. and S. Journ.,’ in ‘New York Journ. Med.,’ new series, vol. xiv, 1855.—Dubini, ‘Entozoografia umana’ (“Anat.,” p. 148).—Dupuytren, “Lumbricus passed by the Urethra,” from “Clin. Lect.,” in ‘Lond. Med. and Surg. Journ.,’ 1846, p. 14.—Dyce, R., “On Lumbrici and the Causes of their Prevalence in the Mauritius,” ‘Lond. Med. Gaz.,’ 1834.—Evans, T., “Lumbricus causing Death,” rep. of coroner’s inquest in the ‘Herts Advertiser and St Alban’s Times’ for Feb. 8, 1873.—Gervais (and Van Beneden), ‘Zool. Med.,’ ii, p. 118.—Gilli, “Account of a Case in which 510 Worms (Lumbrici) were voided by a Child,” from ‘Giorn. d. Scienze Med. di Torino,’ in ‘Med.-Chir. Rev.,’ 1843.—Goopta, G. D. D., “On Suicide and Lumbrici,” ‘Ind. Med. Gaz.,’ July, 1874, and ‘Lond. Med. Rec.,’ Aug., 1874, p. 502.—Heller, A., “Darmschmarotzer,” in Von Ziemssen’s ‘Handb.,’ s. 612–631.—Holland, G. C., “A peculiar Case of Nervous Disease or Derangement of the Nervous System (associated with A. lumbricoides),” ‘Edin. M. and S. Journ.,’ vol. lxiii, 1845.—Howall, “Abscess of the Groin, with discharge of Lumbrici,” ‘Lond. Med. Gaz.,’ 1845, and ‘Edin. M. and S. Journ.,’ 1846, p. 241.—Johnson, W. G., “Case of forty Lumbrici in a Boy who died with Traumatic Tetanus,” “Rep. of South Mid. Br. of Brit. Med. Assoc.,” in ‘Brit. Med. Journ.,’ 1858.—Kell, “Perforation of the Intestines by a Worm,” ‘Lond. Med. Gaz.,’ 1828.—Kilgour, T., “Case in which Worms in the Nose, productive of alarming Symptoms, were removed by the Use of Tobacco,” ‘Med. Comment.,’ vol. viii, 1783.—Kirkland, “Case of Lumbricus in an Abscess of the Liver,” rep. in his book, entitled ‘An Enquiry,’ vol. ii, p. 186 (quoted by Richter and Davaine), London, 1786.—Küchenmeister, ‘Manual,’ Eng. edit., p. 410–427.—Leidy, J., ‘Proc. Acad. Phil.,’ 1856, p. 50.—Lente, F. D., “Lumbricus in the Stomach causing Dyspnœa,” in his “Rep. of Cases occurring in the New York Hosp.,” in ‘New York Journ. of Med.,’ vol. v, new series, p. 167, 1850.—Lettsom, “Case of Lumbricus evacuated from an Abdominal Abscess,” ‘Trans. Med. Soc. Lond.,’ and ‘Lond. Med. Repos.,’ 1817.—Leuckart, l. c., s. 152–258.—Lieberkühn, in ‘Miller’s Arch.’ (“Anat. of A. suilla”), 1855, s. 331.—Luschka, “Case of Lumbrici within the Pleura,” from ‘Virch. Arch.,’ in ‘Med.-Chir. Rev.,’ 1854.—Lowne, B. T., “The Anatomy of the Round Worm,” ‘Trans. Roy. Micr. Soc.,’ 1871, p. 55.—Maesson, “On a Worm found in the Bubo of a Woman 36 years of age;” see ‘Entozoa and Parasites, being a ref. to numerous papers;’ from “Valentin’s Repertorium,” in ‘Month. Journ. of Med. Sci.,’ vol. ii, p. 559, 1842; also in ‘Micr. Journ. and Struct. Rec.,’ p. 85, 1842.—Marcet, W., “Chemical Exam. of the Fluid from the Peritoneal Cavity of A. megalocephala,” ‘Proc. Roy. Soc.,’ 1862, No. 72, p. 69.—Martin, D. T., “Large number of Worms (140 examples of A. lumbricoides) discharged from a Child five years old,” rep. from the “Stethoscope,” in ‘Bost. Med. and Surg. Journ.,’ vol. xliv, p. 301, 1851.—Mattei, R., “On a Case of two Lumbricoid Worms, which had penetrated during life into the liver, and were demonstrated by Prof. G. Pelizzari to his pupils in the Sch. of Path. Anat. of Florence,” from ‘Gaz. Med. Ital. Toscana,’ in ‘Dubl. Quart. Journ.,’ vol. xxiv, 1857.—Michel, “Case of Epilepsy in a Girl ten years of age, caused by Lumbrici,” from ‘Journ. des Connaiss. Méd.,’ in ‘Amer. Journ. of Med. Sci.,’ vol. vi, p. 451, 1843.—M’Laggan, J., “Gangrenous Sore from a large Worm in the Parietes of the Abdomen,” ‘Med. Comment.,’ vol. ii, 1774, p. 80.—Molin, in ‘Sitzungsb. d. k. Akad.,’ 1859, s. 23.—Mondière, “On Perforation by Worms (three cases),” from ‘L’Expérience,’ in ‘Med.-Chir. Rev.,’ 1839.—Moore, E. D., “Example of A. lumbr. ejected by the Mouth,” ‘Prov. Med. and Surg. Journ.,’ 1852.—Morgan, J., “Case of Perforation of the Stomach, probably by a (Lumbricus) Worm,” ‘Lancet,’ 1836.—Morland, W. W., “Ejection of numerous Lumbrici from the Mouth, impaction of the small intestine with Lumbrici, (of which 365 were removed post mortem),” ‘Bost. M. and S. Journ.,’ vol. lvi, 1857.—Idem., an “A. lumbr. of unusual size (over 17 inches long),” ‘Rep. of Bost. Soc. for Improv.,’ in ‘Bost. M. and S. Journ.,’ vol. lviii, p. 62, 1858.—Neilson, “Discharge of Worms from various parts of the Body,” ‘Med.-Chir. Rev.,’ and ‘Lond. Med. Gaz.,’ 1833.—Omond, R., “Case of Lumbricus attended with Hæmoptysis,” ‘Edin. Med. Journ.,’ 1856.—Owen, R., art. “Entozoa,” l. c.—Padley, G., “Jaundice and Lumbrici,” ‘British Med. Journ.,’ Dec. 14, 1878, p. 877.—Petrenz, “Case of fatal Enteritis produced by (200) Lumbrici,” from ‘Clarus and Radius’ Beitr. zur Pract. Heilk.,’ in ‘Dubl. Journ.,’ vol. xi, 1837; also in ‘Lond. Med. Gaz.,’ 1837.—Playfair, “Case of Lumbricus (69 specimens) cured by the Mudar,” ‘Calc. Med. and Phys. Soc. Trans.,’ vol. ii, p. 407, 1826.—Pomeroy, C. G., “Escape of Worms (17 Lumbrici) from the Navel of a Child,” ‘Bost. M. and S. Journ.,’ vol. xxi, 1840.—Prichard, A., “Case of Lumbricus,” ‘Rep. of East York and North Lincoln Br. of Brit. Med. Assoc.,’ in ‘Brit. Med. Journ.,’ 1859.—Royer, “Case of Intestinal Perforation by a Lumbricus,” report in ‘Lancet,’ 1856.—Rumsey, N., “Cases of Lumbricus and Tænia associated with Hæmoptysis,” ‘Med.-Chir. Trans.,’ 1818.—Sandwith, H., “Remarks on Worms in the Peritoneal Cavity, with a case,” ‘Brit. Med. Journ.,’ 1861.—Schleifer, “Case of a Deaf and Dumb Child restored after the discharge of Worms (87 Lumbrici and innumerable Oxyurides),” from ‘Œsterr. Med. Wochensch.,’ in ‘Amer. Journ. of Med. Sci.,’ vol. viii, p. 473, 1844.—Schneider, A., ‘Monog. der Nemat.,’ s. 36.—Idem, “On the Nervous System of Nematoda,” from the German by Busk, ‘Quart. Journ. Micr. Sci.,’ 1863.—Schultze, “Case of Stuttering occasioned by Worms,” from ‘Med. Zeit.,’ in ‘Med.-Chir. Rev.,’ 1837.—Sheppard, “Case of A. lumbr. extracted from an Abdominal Abscess,” ‘Brit. Med. Journ.,’ 1861.—Smith, J. N., “Thirty-nine Specimens of Ascaris lumbricoides in a Child,” ‘Bost. M. and S. Journ.,’ 1856.—Spalding, P., “Case of Worms (100 Lumbrici),” ibid., 1839.—Stockbridge, T. G., “Worm-trap (hooks and eyes), a New Remedy,” ibid., vol. xxvii, p. 73, 1842–43; see also Anon., A. M.—Stockbridge, W., “Mechanical Expulsion of Worms (by metallic buttons),” ibid., vol. xxviii, p. 419, 1843.—Van Beneden, ‘Animal Parasites,’ l. c., p. 95; see also Gervais.—Villemin, “Case of Death from Worms (about 18 specimens of A. lumbr.),” from ‘L’Union Méd.,’ in the ‘Lancet,’ and rep. in ‘Dubl. Med. Press,’ vol. xxxv, p. 327, 1856.—Weinland, in his ‘Essay,’ l. c., p. 88, and in ‘Troschel’s Arch.,’ 1859, s. 283.—Welsh, T., “Curious Facts respecting (symptoms produced by) Worms (A. lumbricoides),” art. ix in the ‘Med. Papers communicated to the Massachus. Med. Soc.,’ vol. i, p. 87, 1790.—Wendelboe, “Case of discharge of Worms (Ascarides?) through the Skin,” from ‘Rep. of Roy. Soc. Copenhagen,’ in ‘Lancet,’ 1836; see also Neilson.—Williams, H. W., “Exhibition of a Lumbricus with a dress-hook attached,” ‘Rep. of Bost. Soc. for Med. Improv.,’ in ‘Bost. M. and S. Journ.,’ vol. lvi, p. 163, 1857.—Wilson, J., “On the prevalence of Lumbrici in China,” in his ‘Med. Notes on China,’ London, 1846.—Woodman, W. B., “Case of Convulsions, &c., arising from Lumbricoid Worms,” ‘Med. Times and Gaz.,’ 1863.—Young, W., “Cases in which Lumbrici were evacuated by Ulceration through the Parietes of the Abdomen,” ‘Lond. Med. Gaz.,’ from ‘Glasgow Med. Journ.,’ 1828; rep. in ‘Lond. Med. and Surg. Journ.,’ vol. i, p. 564, 1828.
SECTION IV.—Part I.—Acanthocephala (Thornheaded worms).
Echinorhynchus gigas, Goeze.—There is but one recorded instance of the occurrence of this entozoon in the human body. This is the oft-quoted case by Lambl, given in the ‘Prager Vierteljahrschrift’ for 1859. Lambl, indeed, described it as a separate species (E. hominis), but as the worm was a sexually-immature female, its identification with E. gigas, notwithstanding Schneider’s great authority, can hardly be regarded as absolutely certain. The worm was found in the small intestine of a boy of nine years, and measured only rather more than the fifth of an inch in length. As Leuckart hints, the worm may be Echinorhynchus angustatus, or possibly the E. spirula, a species found in various South American apes (Cebus and Jacchus), and also in the Barbary ape (Inuus).
In 1872, Welch, unaware of Lambl’s case, announced the discovery of “the presence of an encysted Echinorhynchus in man.” The minute parasite found by him occurred in a soldier, thirty-four years of age, who died at Netley, but who had contracted the worm in India. “It was situated in the jejunum, immediately beneath the mucous coat, and formed an oval prominence in the interior of the gut.” Speaking with great confidence, this able microscopist further remarks:—“The character and arrangement of the hooklets unequivocally shadowed forth a species of Echinorhynchus for the first time discovered as a representative of the Acanthocephala in the human body.” Along with his elaborate description Welch gives several figures; but these, so far from producing conviction as to the accuracy of his inferences, have unfortunately led me to believe that the parasite in question would be more properly referred to the Pentastomidæ. But for Heller’s acquiescence I might have more fittingly noticed this worm elsewhere. Davaine falls into the same view, and moreover accepts Lewis’s “Echinorhynque du Chien,” which I have shown to be a nematode (Cheiracanthus robustus). It is thus that serious errors creep into the literature of parasitism.