74 DISEASES OF CHILDREN. 



winter or early spring, or the eastern coast in summer, is strongly to be recom- 

 mended. For children living in cities, the mere removal for a time to any healthy 

 country district is often sufficient to completely re-establish the health. 



Worms. Children are mainly affected by two varieties of intestinal worms. 

 These are known as thread worms and round worms. Thread worms, of which the 

 scientific name is ascaris vermicularis, and which are commonly spoken of as 

 ascarides, inhabit the lowest part of the bowel, and live just within the lower orifice 

 or arms, and indeed crawl in and out. They resemble pieces of white thread, hence 

 their name. They are innumerable in quantity, and are about a quarter of an inch 

 in length. They cause an intolerable itching, and often provoke painful contractions 

 of the bowel (tenesmus). The bowel generally gets into a semi-inflamed condition, 

 and slimy mucus is often discharged from it. The irritation may set up that most 

 troublesome condition known as falling down of the bowel (prolapsus ani). The 

 irritation in the rectum is occasionally the cause of fits, and it often sets up 

 a sympathetic irritation in the genito-urinary organs which is very undesirable. 

 Now it must be borne in mind that a healthy child hardly ever has thread worms, 

 but a sickly child is hardly ever without them. They are always an indication 

 of ill-health, and the ill-health is the cause of the worms. 



Treatment. Injudicious feeding often occasions irritation of the rectum and the 

 secretion of mucus, in which mucus the worms live and nourish. Look first of all,, 

 therefore, to the child's diet, and correct whatever is amiss, and take particular care 

 that the child has no access to trash. It may be necessary to give a mild purgative, 

 in fact, this course is generally to be advised. Next we may treat the worms locally, 

 and the best method is usually by throwing injections into the bowel. Several 

 injections have been recommended. Salt and water is very effectual. So also is 

 infusion of quassia. Half a drachm of the tincture of the perchloride of iron in 

 four ounces of rose water or lime water is very valuable also. The injection should 

 not be too large, and it is not necessary to inject it with great force, as the worms 

 inhabit the lower part of the bowel. The injections act, no doubt, in a large degree 

 mechanically, and it is quite sufficient in most cases merely to keep the bowel clean. 



The most important part of the treatment is the constitutional treatment. 

 The child in these cases almost invariably needs tonics. Cod liver oil and iron, 

 or a dose of steel wine alone after meals, must be given in almost every case. 

 These measures are usually successful, and it is not necessary as a rule to have 

 recourse to those drugs which are recognised as worm medicines. If it be requisite, 

 however, the best of these is santonin, which should be given at bedtime in doses 

 varying from two to six grains, according to the age of the child. This should be 

 followed in the morning by a brisk purgative, such as senna tea. 



Round woi-ms. This worm is technically known as the ascaris lumbrico'ides, 

 and it is usually spoken of as the lumbricus. It usually inhabits the small 

 intestine, but it may be found in any part of the intestinal canal between the 

 stomach and the anus. They closely resemble the ordinary earth worm, and vaiy 

 in length from two to sixteen inches. The child may void them by vomiting, 

 but they are usually passed frcm the bowel. The worm being a creature of some 



