§ 51. Worm fever; helminthiasis.

Worm affections, with or without fever, are evidently chronic diseases. Entozoa are no disease, but the product of disease, which may however react upon the organism as a morbific cause. We class worm fever and even the chronic condition which is termed helminthiasis, among the acute diseases for this reason, that a worm fever is very similar to gastric and pituitous fevers, and that it generally sets in only while the organism is under the influence of some other affection which makes the contents of the bowels unpleasant to the worms; when this is the case, the worms writhe and twist themselves about in the intestines, irritating the mucous membrane of these organs.

Physicians have mentioned so many symptoms as indicating the presence of worms that it is difficult to offer a well-marked image of a worm fever. Many of those symptoms are extremely changeable; they are occasioned by the temperament, sex, individuality, or mode of life of the patient, or may characterize the gastric, pituitous, or other similar affections of the patient. Nevertheless there is a sufficient number of characteristic symptoms which leave no doubt about the true nature of the affection; these are the phenomena which reveal the characteristic irritation of the mucous membrane of the intestines. But even of these symptoms, no single symptom has any decisive value as a diagnostic symptom; it is the simultaneous occurrence of a number of such symptoms which decides the character of the disease. The discharge of one or more worms or pieces of worms is no certain proof that the existing fever is occasioned by those animals, since it is a well-known fact that worms may even exist in the healthy body, and probably do exist more or less in every child. The following are the more permanent symptoms of a worm disease: pains in the abdomen, almost always proceeding from the umbilical region, and being frequently a mere sensation of pressure or constriction, which is sometimes very violent, amounting to colic; if the affection arise from asca-rides, the pain is generally local, accompanied with the following symptoms: troublesome itching of the anus, especially in the evening, dysuria, stranguria, tenesmus, apparent haemorrhoidal sufferings, discharge of mucus by the rectum, bladder, vagina; uncommon periodic sadness, gloominess, and irritability of temper; when taenia is present, the patient frequently experiences a sensation as if something were crawling or twisting itself from the left side of the abdomen towards the stomach and even the oesophagus; or a sensation as of the undulating movement of a cool ball in one or the other side, sensation as if something were sucking in the abdomen, vertigo, tingling and numb sensation in the fingers and toes, they- are disposed to go to sleep; the pain is always periodical, not continuous, it occurs principally in the morning and when fasting, and is generally relieved by eating; the quality of the food influences the pain greatly: it is increased by milk, sugar, and other sweet things, by acrid and salt food, ham, cheese, and by the so-called anthelmintica. The abdomen is not painful when pressed upon, it is soft, sometimes distended, the taste in the mouth is unpleasant, the smell from the mouth is offensive, the appetite is irregular, now canine hunger, and then again aversion to food; the tongue is frequently coated white, and the mouth is filled with water. The bowels are at times confined, at times there are loose and slimy stools. If the worms be lodged in the duodenum and stomach, there is pressure and a gnawing pain in the pit of the stomach, eructation, vomiting, sometimes even vomiting of worms. Other symptoms are: itching, tingling, and bleeding of the nose, frequent sneezing; pale countenance, sunken eyes surrounded with blue margins, squinting, dilated pupils; restless sleep, during which the patient starts frequently; ruminating, grating of the teeth, talking in sleep; indolence; emaciation of the extremities; bloatedness of the countenance. The febrile erethism is characterized by a little chilliness, a small, irregular, and even intermittent pulse, clammy sweat, turbid urine, smelling like horse urine. The febrile phenomena, as a general rule, are vague and uncertain, sometimes they are very violent, the heat being very great and accompanied with sopor, shrieking and trembling. Less permanent symptoms are: jactitation of the muscles, spasms, vertigo, fainting turns, illusions of sight and hearing, oppression of the chest, palpitation of the heart, hickup, paralysis, stupor, sopor, cerebral diseases, hemorrhage, blennorrhoea, ischury, strangury. Worm affections almost always increase and decrease with the moon; when the moon is on the decline, a quantity of worms is frequently passed.

§ 52. The formation of worms occurs most frequently in childhood. Sometimes the worms are hereditary (they have even been found in the foetus); they occur rarely in infants at the breast, most frequently in the period of dentition, very rarely in the age of adolescence (except taenia, which is most frequent at that age), and rather more frequently in the declining age; they are more apt to be found in females, and in persons of a leuco-phlegmatic constitution, with disposition to excessive formation of mucus and blennorrhoea. Exciting causes are: bad food, vegetable diet in preference to meat, uncleanliness, and a damp, tepid atmosphere, which may convert helminthiasis into an endemic or epidemic disease.

Helminthiasis may easily be confounded with hydrocephalus, especially when the so-called nervous symptoms, sopor, spasms, dilated pupils, vomiting, are present; but in helminthiasis the abdomen is soft and distended, whereas in hydrocephalus it is flat and drawn in; in hydrocephalus the head feels hot to the touch, and the symptoms occur in a certain succession, whereas in helminthiasis the symptoms are changeable, and occur at uncertain periods.