46 



men, especially if very busy, can take the trouble to make 

 sure whether they are present or not, they are only too often 

 neglected. Even the characteristic itching about the anus 

 and neighbouring parts, which is strong presumptive evidence i , 

 especially if it comes on at night, is sometimes passed over 

 as irrelevant. And there are a number of other symptoms 

 which should arouse suspicion, and which the sufferer's puzzled 

 medical attendant ascribes to any cause except the right one 2 . 



Diagnosis in Children. 



This applies, chiefly, when the sufferer is a child, and unable- 

 to supply the physician with suggestive information about its 

 sensations. Practically, one may say that whenever a child 

 is in any way abnormal in growth or development, either 

 physical or mental, the possibility of the presence of thread- 

 worms should be suspected. Picking and scratching at the- 

 nose, though popularly regarded as strong evidence of 

 " worms/' is probably of little diagnostic value, when not 

 accompanied by other symptoms ; and the same remark 

 applies to nocturnal enuresis. But restlessness, and grinding 

 of the teeth during sleep are very suspicious ; and so, also, 

 is frequent diarrhoea ; while " worms " should always be 

 looked for in cases of infantile convulsions, or fits, unless there 

 is some other perfectly obvious cause. 



Diagnosis Simplified. 



The drastic and dangerous nature of the remedies commonly 

 used justified the demand that absolute certainty of diagnosis 

 should be established, before having recourse to such danger- 

 ous drugs as, for instance, santonin or mercury ; and hence, 

 no pains have been spared by authors in their effort to inculcate 

 the highest degree of diagnostic accuracy. But it is obvious 

 that, if a drug can be employed, which is perfectly harmless if 

 no worms are present, and may at the same time be absolutely 

 relied upon to destroy and expel the parasite if it should have 



1 " Sed Ascaris vermicularis certa dilatation des pupilles, la teinte 

 diagnostica signa expromit; in recto bleuatre des conjonctives et 1'aspect 

 et ad anum pruritum molestum picote de la langue, sont ceux que 

 excitat." (SCHUEMMEK, C., op. cit., j'ai le plus souvent remarques dans 

 pp. 23, 24.) les observations que j'ai par- 



2 " Parmi les symptomes, la courues." (FiD^LiN, P., op. cit., p. 36.) 



