WORMS IN THE INTESTINAL CANAL HELMINTHUSIS. 627 



worms become more lively during coitus, appears to be meant as a joke. 

 To infer, from a pale, cachectic appearance, and from the nervous 

 symptoms above mentioned, that a child is suffering from round worms ; 

 is an error even more common than that of diagnosticating a tape- 

 worm in an adult who has the same symptoms. If such a child pass 

 round worms from the bowels, or vomit them, it is only too common 

 to consider the diagnosis as verified, and to neglect more careful ex- 

 amination. By and by, when too late, the discovery is made that the 

 symptoms do not depend upon worms, but upon acute hydrocephalus 

 or some other dangerous malady. The same is true of worm fever. 

 Round worms may occasionally induce intestinal catarrh, with slight 

 febrile reaction, but, in most cases, worms have nothing to do with the 

 fever ascribed to them. They may enter the stomach, exciting great 

 nausea and discomfort ; the little patient cannot describe his feelings, 

 and the doctor is perplexed, until a vomited worm solves the riddle. 

 Again, a worm in the stomach may be quite unfelt, and may even crawl, 

 unperceived, from the mouth during sleep. If it wander into the larynx, 

 there will be a spasm of the glottis. Children have even suffocated 

 as a result of this accident. If the round worm finds its way into 

 the ductus choledochus, there may be biliary obstruction, and, if it 

 pass on still farther into the gall-ducts of the liver, there may be par- 

 tial hepatitis ; but we can rarely interpret the symptoms correctly. 

 The signs usually ascribed to the presence of ascarides are so little 

 to be trusted that Bouchut advises the microscopic examination of the 

 mucus which covers the faeces, in search of the eggs. 



When the oxyuris approaches the anus, or crawls out of it, its in- 

 cessant motions cause a very troublesome itching. This usually in- 

 creases late in the evening and during the night, and interferes with 

 sleeping. Besides the itching, there is usually an incessant desire to 

 go to stool. In the evacuations, which are often mixed with mucus, 

 the worms continue their snaky movements. If they crawl over the 

 perinseum to the vulva and vagina, they cause annoying prickling and 

 itching there also. The irritation from the worms, and from the rub- 

 bing that they induce, may cause catarrh of those parts, and the 

 frightened mother brings the child to the doctor, saying " it has the 

 whites already." In such cases a careful examination quiets all fears. 

 The trichocephalus dispar causes no symptoms. 



TREATMENT. The prophylactic treatment for tsenia solium follows, 

 as a matter of course, from what has been said. No pork should be 

 eaten that has not previously been subjected to the procedures by 

 which any cysticerci in it would be killed. Cooks should be forbidden 

 to taste raw sausage, or to hold the kitchen-knife in the mouth. 

 Butchers should be instructed not to cut sausage or ham with the knife 



