Affections due to Parasites

Round worms (ascaris lumbricodes) or eel-worms are of a grayish or pinkish color, and in form resemble earthworms. They get into the digestive tract through contaminated food or water, and live in the small intestine, but sometimes, especially in febrile conditions, migrate into the stomach, bile ducts, respiratory tract, or urinary passages, or perforate into the abdominal cavity through an intestinal ulcer.

Symptoms: Often there are none. Sometimes there are colicky pains, dyspepsia, voracious appetite, pruritis, mucous stools, anemia, and such reflex nervous phenomena as night-terrors, grinding of the teeth, disturbances of vision, chorea-like movements, and convulsions.

Technically known as oxyuris vermicularis, pin worms are small, white worms, measuring from one-eighth to one-half an inch in length. They get into the digestive tract through contaminated food in the form of eggs. They may develop at any age but are seen most frequently in children. Adult worms are most numerous in the cecum, but the females migrate to the rectum, where they deposit their eggs.

Symptoms: Intense itching at the anus, especially at night, is the most constant symptom. The symptoms described above under common round worm infection may also develop.

Two varieties of hook-worms are described: (1) Uncinaria Americana seen in the southern part of the United States, the West Indies, and South America; and (2) Uncinaria Duodenalis, seen in Europe, Asia and Africa. They live in the small intestine.
Uncinariasis or ankylostomiasis is said to be a “common disease” in subtropical countries. In temperate regions it is seen chiefly among miners. The eggs of this parasite which escape with the feces, hatch in a few days and bring forth larva through food or water. It is claimed that in the majority of cases, entrance into the intestine is by way of a more circuitous route. The larva is said to penetrate the skin, usually in the feet or legs, causing at this point an eruption known as ground, itch, from whence it gets into the blood, is carried to the heart, from the heart to the lungs, from the lungs it reaches the larynx, thence to the esophagus and stomach and intestine.

Symptoms: The chief symptom is a more or less severe anemia. Digestive disturbances and mental lassitude are said to be frequent. While the diagnosis is said to depend on finding the eggs or the adult worms in the stools, we have seen the eggs and worms found in cases that presented no symptoms at all.

Care of the Patient: Efforts to destroy intestinal worms by poisoning them succeeds in doing more damage to the patient than to the worms. It also fails to raise the general tone and resistance of the body, hence it fails to prevent re-infection.
Weger says: “Round worms can be starved out and they will not again infest the intestinal tract that is kept sanitary by right food and right living.” Tilden says all that is necessary to get rid of these worms is to correct the diet and to secure sufficient rest for recovery. He recommends a week on fruit, with no eating between meals.

Symptoms: There are no marked symptoms unless the infection is severe. In well-marked cases, digestive disturbances — colicky pains, nausea, vomiting, and much diarrhea — appear on the second or third day. These represent the body’s effort to expel the invader.
In from one to two weeks symptoms of acute inflammation of the muscles (myostitis) develop. These include severe pain and soreness in the muscles, edema, especially of the face, profuse sweating, and remittent or intermittent fever. Hoarseness from involvement of the larynx and difficult breathing from involvement of the diaphragm, are often seen. In severe infestations, delirium and stupor are common. The symptoms often resemble those of typhoid fever. Trichinous capsules, impregnated with lime, are visible to the naked eye.

Prognosis: Favorable cases recover in from two to eight weeks, depending on the number of worms ingested. Early diarrhea is favorable. The death rate ranges from 5 to 30 per cent.

Care of the Patient: Efforts to poison the worms are not effective. Opiates to relieve pain account for much of the mortality. No food should be given from the appearance of the first symptom until all acute symptoms have ended. Thereafter feed and live to build up good health.

Infection with the guinea worm (filaria or Dracunculus medinensis), a parasitic neamatode [nematode], the female of which may be three feet long, and as thick as a knitting needle, and which infests the feet and toes of residents of the East Indies and the Guinea coast of Africa, in India, Hindustan, Turkeystan, Russia and other warm countries. An abscess forms beneath the skin in which the worm is coiled up. Formerly confined to the Old World, the worm has been carried to the New.

Care of the Patient: The worm is extracted by slowly winding it upon a roll of paper, a little at a time, care being taken not to break the worm, for, if it is broken and a portion left, the young will develop and scatter under the skin. Living thereafter should be of a character to build up resistance to further invasion.

Symptoms: Sometimes no symptoms are present. Dilatation of the scrotal lymphatics (lymph scrotum), enlarged and tortuous lymphatic veins, fat in the urine and elephantiasis, are the not uncommon symptoms.

Care of the Patient: Same as for Elephantiasis.

This is a parasitic worm that is very common on the African West coast.

Symptoms: It finds a habitat in the connective tissues throughout the body and often approaches the surface near the eye, causing an edematous swelling, with itching and, at times, more or less intense conjunctivitis.

Care of the Patient: The usual treatment is to remove the parasite under local anesthesia. This does nothing to build up resistance to subsequent infection. Proper living should follow its removal.

Bothriocephalus latus (broad tapeworm) is a large tape worm that is rare in this country. The larval form is found in certain fresh-water fish. Man receives the worm by eating uncooked fish. The mature worm is one to two yards in length, yellowish-brown in color, the head is flat with hooklets, the segments are usually broader than long, the sexual opening is in the middle of the flat surface of the segment, and uterus is in the form of a rosette. It is common in Northern Europe.

Hymenolepsis Nana (Dwarf tapeworm) develops without an intermediate host. Human infection is thought to occur by eating foods contaminated with eggs derived from feces of infected rats or other human beings. The adult worm is but a few millimeters long, the head is small and provided with a single circle of hooklets. Great numbers are usually present and the geographical distribution of these worms is great.

Tenia Echinococcus is seen in man only in the larval state. The adult worm is found only in the intestine of the dog.

Tenia Solium or the pork tapeworm is six to twelve feet long with a round head smaller than that of a pin, with projecting rostellum on which is a double circle of hooklets and below which are four sucking disks. By its hooklets the worm attaches itself to the mucosa of the small intestine. Below the head is a constricted neck, which is followed by a large number of segments, which increase in size from the neck onward. Each segment contains the generative organs of both sexes. The worm attains full growth in three to three and a half months, after which, segments continually break off and pass out with the stools.

Tenia saginata, or the beef tapeworm, is the most common form in the U. S. It is larger than Tenia solium, is fifteen to twenty feet long; possesses a large head, but no hooklets. It is square and has four sucking disks. The segments are larger than those of the above worm.

Bothriocephalus latus, a still larger worm, and other species are rare in this country.

Symptoms: The only symptoms may be the passage of segments. There may be excessive appetite, nausea, vomiting, diarrhea, or abdominal pain, sometimes anemia. Vertigo, palpitation, itching of the nose and movements resembling those of chorea may sometimes be seen.

Care of the Patient: Weger says, “tapeworms can be starved out and they will not again infest an intestinal tract that is kept sanitary by right food and living.”