There are no well established contraindications for hexylre- 

 soreinol therapy. However, it is advisable for the patient to 

 abstain from alcohol immediately before and after treatment. 

 As a precautionary measure, it is probably well to avoid treat- 

 ing persons suffering from gastric or duodenal ulcer and any 

 form of gastroenteritis. 



Oil of Chenopodium. This drug has had widespread appli- 

 cation in the treatment of aseariasis and hookworm disease 

 but its margin of safety is small and it has prol>ably been re- 

 sponsible for more fatalities than any other single anthelmin- 

 tic. However, its efficacy against ascarids is very high. 



The active principle of chenopodium is ascaridol which varies 

 in content with different oils. Effort has been made to stand- 

 ardize the ascaridol content at 70 percent in order to have 

 available a uniform product but various oils on the market 

 may vary in the content of the active principle. 



In using chenopodium, the ijatient should be given a light 

 evening meal. If constipated, a saline purge is indicated fol- 

 lowed by a high soapsuds enema the next morning. These pre- 

 cautions are important in the ease of constipated individuals 

 since chenopodium itself tends to produce constipation. 



The drug is given on an empty stomach and no food should 

 lie allowed until the bowels move. The adult dose should not 

 exceed 1.5 ce. The dose for children is based on 0.0.3 ce. for 

 each year of apparent (not chronological) age. The drug may 

 be given in gelatin capsules and immediately preceded or fol- 

 lowed by adequate dose of a saline purgative. Some authorities 

 recommend dividing the dose into two jiarts and administering 

 the doses 2 hours apart, in which case the purgative is given im- 

 mediately after the last dose. If the patient shows any signs 

 of reaction, the second half of the dose should be omitted and 

 the purgative given immediately. The advisability of the split 

 dose method is problematical since increased absorption and 

 toxicity may result when the purgative is thus delayed. 



The preferred method of administering chenopodium is to 

 mix it with castor oil and give as a single dose. One to 2 ce. 

 of castor oil should be given for each year of apparent age 

 in children. The larger dose provides more adequate protection. 

 The oil not only produces adequate purgation but protects the 

 intestinal mucosa against the irritating action of the drug. 



When chenopodium is measured by the drop method, there is 

 a wide variation in dosage. Measurement should be made by 

 a standard 1 cc. pipette graduated into tenths in order to 

 avoid errors in dosage. 



Toxic symptoms manifested in chenopodium poisoning are 

 nausea, vomiting, dizziness, a tingling sensation of the ex- 

 tremities, muscular incoordination, stupor, profound collapse, 

 cyanosis and respiratory failure followed by death. Severe 

 and even permanent deafness may result. If purgation does 

 not ensue within a reasonable time, strenuous efforts should be 

 made to evacuate the bowels as promptly as possible. Any delay 

 in instituting rigorous measures maj' seriously endanger the life 

 of the patient. 



Contraindications for chenopodium therapy include gastro- 

 enteritis, chronic constipation, alcoholism, pregnancy, deljilitat- 

 ing diseases, and moderate to severe cardiovascular-renal dis- 

 ease. Very young children or aged individuals are poor risks 

 for treatment. 



S.'INTONIN'. Santonin is a time honored remedy for the re- 

 moval of large intestinal roundworms, although its efficacy in 

 single doses does not approach that of either hexylresorcinul 

 or oil of chenopodium. However, it is non-irritating and easily 

 administered and can be used to advantage when there are defi- 

 nite reasons for avoiding the two other drugs. 



The patient should be given a light evening meal and the 

 dose of santonin administered with an equal amount of calomel 

 at 10.00 p.m. The next morning before breakfast, a saline 

 purgative should be given. The dose of santonin for adults is 

 3 to 5 grains (0.2 to 0.3 gram). For children, the dose rate is 

 based on 1/6 grain (0.01 gram) for each year of apparent age. 

 Santonin is more effective when given in repeated treatments 

 over a period of time. A satisfactory routine is to give 1 to 2 

 grains (0.06 to 0.12 gram) for adults" and % to % grain (0.015 

 to 0.03 gram) for children daily over a period of 7 days. The 

 drug is given with an equal amount of calomel and no other 

 purgative employed. With continued treatment, the patient 

 should be observed carefully for any evidence of toxicity. 



Santonin is responsible in some cases for disturbances in 

 perception and there may result yellow, green, and occasion- 

 ally, blue vision. Symptoms of toxicity are evidenced by nau- 

 sea, vomiting, dizziness, diarrhea, hematuria and convulsions. 

 The drug is contraindicated in nervous disorders such as epi- 

 lepsy. Fats and oils should be avoided as they increase ab- 

 sorption. The factor of safety for santonin is considerably 

 greater than that for chenopodium but the drug is not without 

 its hazards. Some authorities recommend that a single dose of 

 3 grains for adults be not exceeded. 



TREATMENT FOR THE KE.MOVAL OF HOOKWORMS, ANCYLOSTOM.^ 

 DUODENALE AND NEGATOR AMERICANTJS 



TBTRACHLORf;THYLENE. Because of its greater safety, this 

 drug is largely replacing carbon tetrachloride and other treat- 

 ments for hookworm disease. 



The patient should be given a light evening meal and should 

 receive the drug on an empty stomach the following morning. 

 No food should be allowed until aftei- the bowels move. The 

 dose for adults is 3.0 ec. and for children 0.1 to 0.2 ec. for 

 each year of apparent (not chronological) age. Better results 

 are obtained with a dose of 4.0 cc. for adults but the larger 

 dose is apt to be followed by more severe reactions. The drug 

 may be administered in gelatin capsules followed immediately 

 by an adequate dose of magnesium or sodium sulphate. In 

 mass treatment, tetrachlorethylene is given with the purgative. 

 In such cases, the mixture should be stirred while the patient 

 is drinking it so that the tetrachlorethylene will be distributed 

 evenly throughout and not sink to the bottom of the container. 

 The purgative should lie dissolved in a liberal amount of water. 

 One of the preferred methods is to use 30 ec. of a saturated 

 solution of the saline purgative plus 60 cc. of water for an 

 adult patient. As previously noted, a solution of magnesium 

 citrate meets with less objection on the part of children and 

 apparently causes less disagreeable reactions. In constipated 

 individuals, it is best to give a saline purgative the night be- 

 fore treatment followed the next morning by a high soapsuds 

 enema. 



In the hands of various investigators, tetrachlorethylene has 

 sliown a degree of efticacy varying between 75 and 95 percent. 

 T^ike carbon tetrachloride, it is more effective against Necator 

 than against Ancylci.il oma. 



Following treatment, patients frequently complain of dizzi- 

 ness, headache, nausea, vomiting and abdominal pain. Experi- 

 ence indicates that these reactions are less severe if the pa- 

 tient remains quietly in bed and for safety's sake it is best 

 to insist on his doing so. Reactions usually disappear rapidly 

 following action of the jiurgative. If the bowels do not move 

 within the expected period of time or if minatory symptoms 

 develop, prompt measures should be taken to hasten evacuation. 



Tetrachlorethylene is contraindicated in cases of gastro- 

 enteritis, chronic constipation and concomitant infections with 

 A.tcaris himbricoidrs. Fats and oils should lie withheld from 

 the diet for 48 hours prior to the administration of the drug 

 since they increase absorption and add to the toxicity. Pa- 

 tients receiving arsenical treatments are poor risks. 



Hexyresorcinol : This drug, administered as for Ascaris, is 

 about 50 to 60 percent effective for the removal of hookworms. 

 Because of its relatively wide margin of safety, it can be 

 used to advantage in cases in which the physician might hesi- 

 tate to employ tetrachlorethylene. 



TREATENT FOR CONCOMITANT ASCARIS AN"D HOOKWORM 

 INFECTIONS 



Tb;trachlorethvi,ene and Oil of Chenopodium. A mixture 

 of these two drugs can be used in cases in which both kinds of 

 parasites are present. By itself, tetrachlorethylene should not 

 lie given when Axcaris is present because the drug tends to 

 stimulate clumping of the worms with possible intestinal ob- 

 struction. 



The dosage of the mixture for adults is 1.0 cc. of oil of 

 chenopodium plus 2.0 cc. of tetrachlorethylene. For children, 

 the dose rate is based on 0.05 ec. of chenopodium and 0.1 cc. 

 of tetrachlorethylene for each year of apparent (not chrono- 

 logical) age. The mixture is given in one dose and followed 

 immediately by a saline purgative as outlined for tetrachlor- 

 ethylene. The contraindications and precautions are those noted 

 in connection with the use of chenopodium for Ancaris. 



Hexylresorcinol. Because of its greater safety, this drug 

 is to be preferred over the above-mentioned mixture for the 

 treatment of combined hookworm and A.trarix infections. The 

 method of administration is the same as tli:it for the latter 

 ]iarasite. 



treatment for trichuris trichiura infection 



While various anthelmintics in single doses will remove a 

 small percentage of these worms, treatment is generally un- 

 satisfactory. Repeated doses of santonin, as outlined under 

 therapy for Aficaris himbricoidcf!, represent the most practical 

 treatment at the present time. Even this regimen of treatment 

 may have to be repeated on several different occasions to ap- 

 proach any considerable degree of efficacy. 



Hexylresorcinol and tetrachlorethylene each will remove small 

 numbers of worms, as will oil of chenopodium. Leche de 

 higueron, the sap of the Central and South American fig tree, 

 Ficv.i Jaiirifolia, is a fairly effective treatment when given in 

 doses of 30 to 60 ce. However, this material is not usually 



338 



