g^w t'iw~7 ARMY MEDICAL LIBRARY WASHINGTON Founded 1836 Number ...1&Q.Cf.l££.__._......... Form 113c. W. D.. 8. G. O. fO 3—10543 (Revised June 13, 1936) U)Oyu ' ft? x Id TREATISE ON VERMINOUS DISEASES, PRECEDED BY THE NATURAL HISTORY OF INTESTINAL WORMS, AND THEIR ORIGIN IN THE HUMAN BODY. BY VALERIAN LEWIS BRERA, PROFESSOR OF CLINICAL MEDICINE IN THE UNIVERSITY OF PA VIA. ORNAMENTED WITH FIVE PLATES. TRANSLATED FROM THE ITALIAN, WITH NOTES, BY MESSRS. i J. BARTOLI, M. D. rOKBESPONDING MEMBER OF THE MEDICAL SOCIETY OF EMULATION OF PARIS, ETC. ETC. ETC. AND CALVET, NEPHEW, .EX-SECRETARY OF THE MEDICAL SOCIETY OF EMULATION, MEMBER OF THE SOCIETY OF CLINICAL MEDICINE, ETC. ETC. ETC. Que de jeunes Me"decins eussent mieux servi leur Art en s'occupant & traduire, au lieu de risquer leur gloire par des productions irreflcchies et ,pr£matur£es ! J. L. Alibert, p. 4. Traduction du Traite des Pertes du sang, par Pasta. /sAjl ?' 0 £$«V""v PARIS, 1804. y ^ '"J' v'v^ TBANSLATED FROM THE FRENCH, WITH ADDITltijM^*^.^ BY JOHN G. COFFIN, M. D. V"^>-/: J{ r^ 1816. *"'*"■* '-"'^ BOSTON : PUBLISHED BY CUMMINGS AND HILLIARD, NO. 1, OORNHII.I, CAMBRIDGE.....BILLIARD AND METCALF. 1817. DISTRICT OP MASSACIIt'SET'IS, to wit. District Clerk's OJJice. Be it remembered, that on the eighteenth clay of October, A. D. 1816, and in the forty first year of the independence of the United States of Amer- ica, John- G. Coffin^ of the said district, has deposited in this office the title of a book, the right whereof he claims as proprietor, in the words following, namely— " A Treatise on Verminous Diseases, preceded by the natural history of intestinal worms, and their origin in the human body. By Valerian Lew- is Brera, Professor of Clinical Medicine in the University of Puvia. Or- namented with five plates. Translated from the Italian, with notes, by -Messrs. J. Bartoli, M. D. corresponding member of the Medical Society of Emulation of Paris, etc. etc. etc. and Calvet, nephew, Ex-secretary of the Medical Society of Emulation, member of the society of Clinical Medicine, etc. etc. etc. Que de jeunes medecins eussent mieux servi leur art en s'oc- cupant a traduire, au lieu de risquer leur gloire par des productions irrd- flechies et prtmaturees ! J. L. Alibert, p. 4. Traduction du Traite" des pertes du sang, par Pasta. Paris, 18U4. Translated from the French, with additions, by Joh\ G. Coffin, M. D. 1816." In conformity to the act of the Congress of the United States, entitled, " An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies, during the terms therein mentioned;" and also to an act, entitled, " An act sup- plemeatary to an act, entitled, an act for the encouragement of learnings by securing the copies of maps, charts, and books, to the authors and pro- prietors of such copies, during the terms therein mentioned; and extend- ing the benefits thereof to the arts of designing, engraving, and etching, historical and other prints." .,0,1* W.DATB, &£$£$? TO M. ANTHELME BICHEIIAND, Professor of Anatomy and Physiology, Ad- junct Surgeon in Chief of the Hospital Saint Lewis, Surgeon Major in the Guard of Paris, Memher of the Medical Society of Emula- tion, of that of the School of Medicine of Pa- ris, etc. THE GRATEFUL TRANSLATORS* MP TO THE STUDENTS OF MEDICINE OF HARVARD UNIVERSITY. GENTLEMEN, When you come to be engaged in the res- ponsible duty of conducting the sick to health, or of alleviating their descent to the grave, it will then appear to you how impor- tant it is that you should well understand the profession you embrace. To know less than can be known, where knowledge is power, and where power can never equal the impulse of benevolence, is to be unjust both to ourselves and our pa- tients. When you shall have obtained this information and faithfully applied it, you will then feel that consolation which alone re- mains in those cases where the healing art, with all its improvements, still falls so far be- low our wishes and efforts. To decide the uncertainty where worms are suspected, and effectually to expel them \i AMERICAN TRANSLATOR'S where they are known to exist in the human body, is not the least embarrassment of the physician's occupation. If you shall be able in all these instances to surmount this uncertainty, or to cure the patient, you will be more fortunate than your predecessors. That this work will materially aid you in such an attempt, I cannot doubt. For twenty years I have been seeking information relative to human worms, but have never before found, in any single publi- cation, what is at all suited to satisfy a medi- cal inquirer whose purpose is to keep pace with the progression of his art. For though we have a number >of good papers and com- munications on this branch of medicine, there is no systematic treatise on this subject in the English language. In our country, this chasm has been sen- sibly felt and much regretted. I contemplate the work of Professor Bre- ra as well calculated to supply this deficien- cy, and so far as I know, it is the only one, accessible to us, that has any claim to be so considered. If it should not contain all we need, it is dedication. yii because medicine is not yet a perfect science. I have endeavoured, by some additions, to render it yet more full and instructive. Having witnessed and shared the advan- tages you now enjoy, permit met© congratu- late you on the improved state of medical education in New England. We have multiplied means, and increasing facilities for the acquisition of every species of knowledge, necessary to form intelligent and accomplished physicians and surgeons. In return for these privileges, in a great meas- ure peculiar to this period, every individual, connected with the profession, should be am- bitious to contribute something for its further advancement. Any man of common industry and capac- ity, can observe facts and record them, and in due time give them to the public. Or, if the habit of thus noticing the many phenomena and events, which are constantly presenting themselves to the attentive physician, and which without it are too often suffered to es- cape him, should not increase the number of our useful publications, it would at least improve the practice of individuals. That you may attain eminence in the science you Viil DEDICATION. N cultivate, and long and successfully apply and extend its resources, is, Gentlemen, the sin- cere wish of Your friend and servant, THE AMERICAN TRANSLATOR. ADVERTISEMENT. in the five plates of worms*, some of the figures are rep- resented as viewed with the microscope, and their increase as to the diameter, the surface, and the whole body, re lates to the glasses, that were used. The proportion not- ed below has been settled by Gdeze, in conformity to the calculations of Hoffmann, a celebrated optician of Leipsic. By the tube A they are magnified ; In diameter. In superficies. In the entire body. No. 6. — 16 times . 25 times . . . 4,09C times; 5___31 ... 961.....29,791 4___52 . . 2,734. .... 140,608 3. — 78 t . 6.084, .... 487,552 2. — 154. . 25,716 .... 3,632,254- 1. — 189 . . 35,721 .... 6,731,269 0. — 300 . . 90,000 . . . 27*000,000 [This work has already appeared in the Italian, Ger* man, and French languages. The following recommenda- tion of it is from the Medical Professors of Harvard Uni- versity. " This book appears to us highly valuable on account of the numerous facts it contains, and as comprising the information which is scattered through many voluminous works. The subject which it embraces is such as to enti- tle it to the attention of every medical practitioner. It seems to us to fill a space, which is not occupied by any single work in the English language. X ADVERTISEMENT. " The accurate plates annexed to it must be considered! as adding greatly to its value. Aaron Dexter. James Jackson. John C. Warren. John Gorham." The Notes of the French Translators are marked F. Trs. The additions to this edition of Brera will be in- cluded between [ ] brackets, and the Notes of the Ameri- can Translator will be marked A. T.J PREFACE OF THE TRENCH TRANSLATORS. Perhaps on no subject has there been so much writ- ten as on the diseases arising from worms. Block, in his treatise, which is one of the best, merely describes as a naturalist, the worms of the human body, and he has mul- tiplied their species without end. Jlndry is lost in a labyrinth of hypotheses ; and others seem to have written merely to proclaim their success, and to make known their specifics. The celebrated Brera, professor of clinical medicine in the University of Pavia, known by several excellent medical publications, which have placed him among the first physicians who have done honour to Europe, has recently analyzed the diseas- «s from worms in a work entitled, Lezioni medico practiche sopra i principali vermi del corpo umano vivente, e le cosi dclte malattie verminose. Having no good distinct treatise in our language on verminous diseases, we have thought our- selves usefully employed in translating his work into French. This treatise, to which the author gives the mod- est title of Lectures, claims the attention of physicians and naturalists. The first part contains the natural history of worms ; in the second, the author treats of their origin in the human system ; in the third, he speaks of verminous affections, both local and sympathetic. Lastly, the fourth Lecture is devoted to the different methods of cure. This, in a few words, is the plan of the author. Fur- ther, Professor Brera gives us, in his preface, an account *)f the method he has adopted : little then is left for us to XI? PREFACE OF THE FRENCH TRANSLATORS. add; we hope however to be indulged in saying a few words in order to justify an undertaking, which is perhaps beyond our ability. In translating from the Italian, we find it difficult to render the text without disfiguring the ideas of our author. This language, like all others, has peculiar turns, not ea- sily adapted to the genius of our own. We have however preferred monotony to elegance of style, where the former seemed necessary to express clear- ly the ideas of the writer. We have added some notes, which we hope will be pardoned from the interest they excite. END OF THE FRENCH TRANSLATORS^ PREFACE. THE AUTHOR'S PREFACE. Called by the government, in the years 1797 and 1798, to the honourable office of professor extraordinary of practical medicine, in the celebrated University of Pa- ▼ia, I found myself obliged to read and explain, in the short space of two scholastic years, all those theoretical and practical treatises, which furnished the best methods of treating the various diseases that afflict the human race. The doctrine of general sthenic and asthenic diseases, as well as of local morbid affections, was then expounded with all the elucidations which the short period allowed by the academic regulations would permit. As the prac- tical school established in the civil hospital of Pavia, pre- sented me an opportunity of treating and examining, I will not say all, but at least most of the principal diseases, I am to this day very happy in having been able to lead in practical medicine, by the light of experience, a great number of pupils, who under my direction, have assiduous- ly applied themselves to this useful science, and thus to have contributed to the medical education cf a multitude of young men, among whom not a few, in relieving suffering humanity, already exercise, to the satisfaction of the pub- lic, their useful but difficult profession. It is not for me to apologize in this work for the med- ical observations which were made and compiled by my pu- pils in the clinical Institute confided to my direction. They are already published, and ornamented with six beautiful plates, (dnnotaxioni Medico-practiche sulk diverse \i> THE AUTHOR'S PREFACE. malatte trattate nelle clinica medica di Pavia negl* anni 1797 e 1798,m vol.J I refer them entirely to the impartial judgment of the public. Translations of them appeared in several foreign lan- guages, and the satisfactory manner in which they have been noticed, and extracts made from them, both in the journals of medicine and of literature, as well as the hon- orary diplomas which have been awarded to me by sev- eral illustrious academies, so soon as the first volume ap- peared, encourage me to hope that the public will favour- ably receive the result of my other literary occupations. To reflections analogous to the cases observed, drawn from the study of the best works of the most esteemed writers, I was desirous of adding my clinical observations, that the pupils in surveying them, at the same time they observed the diseases I described, might perceive the sour- ces whence I derived the precepts that guided me in the practice of medicine. A young practitioner, I was also de- voting myself with ardour and confidence to the examina- tion of those works, ancient and modern, to which medicine owes so much of its present reputation, when my duty call- ed me to initiate others in the healing art. I think I have thus sufficiently justified the method I have followed in the order of my Lectures, by explaining diffi- culties as they rose, and by publishing the Jlnnotazioni medico-jwatiche, in which my pupils might find a summa- ry of the leading precepts which should confirm the argu- ments of our daily pursuits ; and as, agreeably to the im- mortal axiom of Hippocrates, art is long, life short, and practice difficult, I still approve the method adopted to con- duct the pupils to a practical acquaintance with the resour- ces which medicine offers to assist nature in triumphing over many diseases that oppress her. The Treatise on the worms which inhabit the human body, in conformity to the program of my observations on practical medicine, should form a part of this work ; but on reflection I thought it better to publish it separately, THE AUTHOR'S PREFACE. xt Because the theoretical part of it being extensive, it did not seem proper to connect it with a series of observations which so intimately relate to the practice of medicine. For though I have had occasion to notice diseases aris«- ing from worms, both in the clinical institute and in my private practice; yet perceiving no great importance in bringing together observations thus collected, I judged it proper not to communicate them to the public, nor to speak of them in this work. Many of my pupils however who recollected the Trea- tise on the principal worms of the living human body, as well as on some diseases called verminous, which I had composed for their instruction, and publicly exhibited in the scholastic year of 1798, have frequently expressed to m* the pleasure they should derive from having it in their own bands. It is not therefore an unbecoming ambition, nor the desire of useless applause, that prompts me to pub- lish the four Lectures which compose this Treatise, but merely the obligation of yielding to the solicitations of those who are to be instructed in so essential a part of practical medicine, and who have not the means of con- sulting the prodigious number of books in different lan- guages, which treat of h'uman worms, and which are not obtained without much difficulty. I now resolve the more willingly to publish these Lectures, as the late examina- tion of the works of the Italian physicians has convinced me of the deficiency of medico-praetical instruction relative to the principal human worms, and the diseases they ex- cite, and which should be directed in conformity to princi- ples which the philosophical physician knows how to ap- preciate, because th^y are solid and incontestable. Though the reader may approve my efforts, I am far from flattering myself that I have obtained the end in view. I have merely the pleasure of being able once more to make known my zeal for the good of humanity, and my desire to contribute as much as possible to the advance- ment of the healing art. Xvi THE AUTHOR'S PREFACE. I have endeavoured to arrange these Lectures with clear- ness and precision, in order to make myself intelligible, and to avoid all confusion and uncertainty. I have laboured to comprise in four Lectures, a num- ber of very extensive subjects which are connected with many branches of natural history and medicine. I have written them for practitioners and not for nat- uralists ; I have in consequence, but slightly announced the articles pertaining to the natural history of worms, and have uniformly aimed to speak only of those which are im- mediately related to practical medicine. An exact view of the internal and external parts, composing the body of worms ; the knowledge of the systematic characters in or- der to distinguish the principal worms which inhabit the liv- ing human body ; some reflectlotis on their origin, so far as they relate to medicine; the history of the morbid phenom- ena, which at once originate from their birth, as well as certain diseases which are often the cause of their devel- opment ; and lastly a careful examination of the reme- dies proper for their expulsion from the body, and suited to prevent their reproduction ; these are the subjects I have treated in these Lectures, which offer matter, for the physician who reasons, sufficiently vast to enable him to multiply their number as far as he pleases. I have not failed to avail myself of all that the most celebrated writers, naturalists and physicians, have pub- lished on human worms. To render these Lectures more instructive to my pupils, I have appropriated all the know- ledge of others, and have printed i* without alteration. I have thought proper to subjoin to each Lecture a num- ber of citations, as it will thence appear from what sources I have derived the most exact information. The reader*will then be enabled to consult the best pub- lications on the topics I have treated. I have annexed to these Lectures five superb plates,- engraved with all possible skill and exactness4 by one of the THE AUTHOR'S PREFACE. xvii most excellent artists. In this manner the reader will the more easily recognise the parts which characterize the worms here described. I can guaranty the fidelity of the plates ; they exact- ly resemble the originals, having compared them with the samples, still visible in the celebrated collection of the il- lustrious Goeze, and which is preserved in the museum of natural history of the University of Pavia. Estimating with impartiality the merit of those natur- alists and physicians who have devoted themselves to the productions of nature, I have made it a sacred duty to re- exhibit in my plates, such human worms as they have ex- amined and described with great fidelity. The plates in the works of Bonnet, Marx, Pallas, Goeze, and Werner, are the most valuable and instructive of any which have yet appeared relative to human worms. Of these plates, I have selected the most interesting, and uniting them with the engravings of other worms which I have found described, and which still remain in the pathological Museum of the University of Pavia, I flat- ter myself that I have presented in these five plates a rep- resentation of the principal worms of the living human body, in conformity to the Lectures, and which will be very advantageous, particularly to those physicians who do not possess the interesting works of the naturalists and phy- sicians already cited. EVD OF THE AUTHOR'^ PRF.WCE. .1 A TREATISE ON VERMINOUS DISEASES- LECTURE FIRST. AN EXAMINATION OF THE PRINCIPAL HUMAN WORMS. § I. The subject we propose to examine is doubtless very extensive, if we would form an ex- act idea of all the worms which are occasionally found in the living human body,( 1) If we admit all that has been said by a number of distinguished and faithful observers, worms of various sizes are met with in almost every part of the human body, even the most hidden,(2) and which physicians Jjave described in a manner too satisfactory not to secure attention. If we reflect however that most of these worms do not preserve at all times the same form, that they do not always occupy the same parts of the body, and that we are not acquainted with any pe- culiar phenomena arising from their presence in any particular organ, their history seems rather interesting to the curiosity of the naturalist, than important to the physician, whose chief attention is devoted to what may be immediately useful to suf- fering humanity. (3) 1 See the Notes at the end of this Lecture. 2'0 OF THE PRINCIPAL WORMS I omit therefore what would be a useless exam- ination of those worms which may be called anom- alous, and proceed to the description of those which are constantly found in the human body, and which are sometimes the cause, and sometimes the effect of severe and long continued diseases. An acquaintance with the history of those worms which I call principal, is the more important, be- cause experience has clearly proved that each ge- nus of these worms, requires for its expulsion, some peculiar modifications of the general treatment. § II. Till the time of Linnaeus, physicians knew only three sorts of intestinal worms. (4) Naturalists since the new discoveries have increased their genera. Latterly, several well informed writers have multiplied the number of human worms, but have classed them obscurely.(5) If, admitting the conclusion of the most accu- rate observations of the best naturalists, consulting the classifications they have given of worms in gen- eral, and in particular, I compare them with the models preserved in our museums, and with those I have found in the examination of dead bodies, or have seen expelled alive by my patients, I think I have sufficient motives for presenting to physicians the principal worms of the human body reduced to a single class. For, besides their presenting a multitude of ob- jects worthy of contemplation, such as their singu- lar origin, and their prodigious multiplication, they OF THE HUMAN BODY. £1 moreover authorize the method I have adopted to separate them from other worms, and to form them into one particular class which comprehends ; 1. Taenia. 2. Vermis Vesicularis. 3. Tricocephalas. 4. The Ascaris Vermicularis. 5. The Lumbrico'ides. $ III. Our worms, like other animals, have red blood, which, according to the observations of Midler,(b) circulates in an artery, and a whitish se- rum flowing in a vein. Their external texture is admirably organized.(7) The construction of the in- terior organs is surprising to human imagination.(8) It is proper to remark in this place, that we should not trust to an examination of these worms when dead, stiff from cold, and hardened by the spirit of wine, or injured by hot water, if we would ascertain the singularity of their internal or exter- nal structure: under these circumstances the parts of the worm are changed, irregularly contracted? and of a size larger than natural. Immersed in te- pid water, they are better preserved, altered less, and are more conveniently submitted to observa- tion. FIRST GENUS. TAENIA.(9) § IV. This is a very long worm which seems to be formed by a chain of flat articulations, unit- ed together by means of a border or edge, varying 22 OF THE PRINCIPAL WORMS in breadth and thickness. The joints of the taenia when united, present at first sight, remarkable pe- culiarities both as to their width, bigness and tenui- ty, and also in regard to the perforated papillae on the lateral border of some of them, as well as the lon- gitudinal lines which traverse the centre of their bodies.(lO) I am however confideut that all these pretended peculiarities do not always exist in the same species, but that they are mere signs of the age of the worm, and of the richness and abun- dance or poorness of the nourishment which it re- ceives at the expense of the animal machine. § V. The length of the taenia is sometimes so considerable as to appear incredible. In mam- miferous animals it is ordinarily from nine to twelve Paris feet (four metres*), and in man from twenty- five to thirty (from eight to ten metres.) Rosen- 6tein(ii) once saw a taenia voided, which surpassed in length one hundred and twenty eight metres. Van-Doeveren(l%) relates the history of a peasant, who, after taking an emetic, evacuated sixty metres of taenia, and who probably would have voided more if he had not broken the worm from an apprehension that he was discharging all his intestines. IfjBaldinger&oea not exaggerate in his work,(13) he speaks of a taenia which was more than two hundred metres long. * The metre of France is equal to 39,3702 inches, or three feet and nearlyathird ofa foot, of American long measure. S.T. OF THE HUMAN BODY. 23 In the cabinet of the University, one is pre- served exceeding the length of seventy metres. $ VI. This worm is divided into head, neck, body and tail. The head is sometimes so small, that it cannot be distinguished without the microscope. It re- sembles a small tubercle,(14) which rises on the anterior extremity of its body, called neck. (15) ltis furnished with four apertures,(l6) which are eminences in some worms and depressions in oth- ers. From each of these four openings proceeds a canal for nourishment, which extends to all the ar- ticulations. Block has remarked that the head of some tae- niae is armed with a sort of tube, which it can elon- gate or re tract. (' 7) If we examine very careful- ly the head of the taenia of man and of animals, we shall see in some of them very small hooks ;(18) if these are viewed with the microscope, they are seen to be arranged in form of a double crown ;(19) while others inspected with the same instrument are found to be quite destitute of this peculiarity, and appear on the contrary to be furnished with a mouth and a number of filaments all around the neck.(*50) The neck is formed by the assemblage of small articulations which become broader, longer and larger as they approach the body of the worm. It may be said that in this way, the joints of the taenia diminish in size as they recede from the cen- tre to either extremity of the animal.(31) I regard this fact as very important information, since the Z4 OF THE PRINCIPAL WORMS neck of a very long taenia, compared with its body does not seem to pertain to the same animal ;(22) in this manner several naturalists have been deceiv- ed, and subdivided the same worm into two par- ticular species. The body of the taenia is form- ed by entire articulations, which we call perfect,(23) in which the papillae are clearly visible and open at their summit, whether they are symmetrical,(34) or irregularly situated in the lateral edges of the taenia.(25) Finally the tail terminates by a piece quite truncated, or cut off and raised on its sides in form of two hooks, rounded at their sum- mit. Both the hooks or crotchets have the same small holes or apertures, which are observed in the papillae we have mentioned. The border or edge of each, which connects the articulations, is slightly concave towards the tail, and a little convex toward the head. In this manner the diameter of the body of the taenia gradually lessens as it approximates either extremity of the worm. § VII. The bigness and external form of the taenia of the same species also vary. A patient in the Clinical Institute of Pavia, voided in several pieces, in the winter of 1797* the taenia represent- ed, PI. I. fig. 1, 2. In these pieces we discovered the head, with the fangs or hooks above named, as well as the posterior extremity of its body, which we have con- sidered as the tail. These pieces taken together were from fifteen to sixteen metres in length. OF TTTE HUMAN BODY. 25 The same patient, in the following summer, discharged a taenia represented also iu PI. 1. fig. 3. In this collection of pieces, we also found the head armed with fangs, as well as the tail: its length was about thirty eight metres. We can- not suppose two taeniae of different species to have lived together in the same individual. It is more credible that both were developed at the same time, that the former was evacuated when young, and that the second grew larger merely because it was about four months older. This admitted, we can* not doubt that if the worm had remained some months longer in the intestines, it would have be- come longer and larger, like that represented PI. II. fig. *, and that it would have acquired the form of the large Taenia cucurbitina seen in the plates of Andry,(*27) of Clerici,{28) and of Vallis- wen',(29) the joints of which exceed half an inch in width. If animals, and even vegetables iu in- fancy, at puberty, in adolescence and old age, ex- hibit great variety in their forms which are pecu- liar to these several periods of their life, how can it be pretended that taeniae must preserve the same forms at the moment of their development, and af- ter the full growth of their body ? The human taeniae do not generally remain in the intestine* a sufficient time to come to their perfection ; seeing that before this epoch they are expelled by art or are accidentally killed and evacuated. For this reason the large taenia cucurbitina is rarely obtained, such as Vullisneri{20) particular- 4 5f6 OF THE PRINCIPAL WORMS ly describes, and which, from their large size, have by some been considered as a different species. (31) The diversity of the external structure of the taenia of the same species, does not depend solely on the difference of age. The nature of the soil, climate and food, vary- ing in different countries, explains the great influ- ence which produces the changes and varieties of form of all living beings. It is thus, as I believe, that the natural consti- tution of the animal structure, which we see alter- ed in a thousand ways, contributes much more than is commonly supposed, to the variation of the exterior forms of the taeniae of the same species. In fact, the inhabitants of the north are much more subject than other people to the gray taenia ;(3S) the Swiss to the flat taenia ; the Italians and the inhabitants of Lower Saxony to the taenia cucurbi- tina, etc. The feebleness or strength of the pa- tient, the soundness or diseased state of the worm itself, are circumstances which affect the size, soft- ness or firmness of the worm, and its development. The winding of the intestinal canal, the pres- sure of the contiguous viscera, and other similar accidental causes, obviously affect the growth of some portion of the taenia. § VIII. We have no exact description of the interior organs of this worm.(33) We only know that it belongs to the class of oviparous animals, because in every joint there is an ovary of a peculiar nature, sometimes having OF THE HUMAN BODY. 2T the form of a tubercle, and sometimes that of a small cluster of grapes, or entirely dendroid or ar- borescent. If these ovaries are examined with a microscope, they are seen to contain a prodigious quantity of eggs,(34) of divers sizes and different contour or outline, and perfectly dark when near their period of maturity.(35) The articulations of the taenia, in some instan- ces, are long or narrow, in others, short and broad ; we sometimes see them almost square, slightly flat- tened,—these ovaries expel their eggs through the perforated papillae observed on the lateral parts, and which, according to Block, communicate by means of two canals with the ovaries. Certain naturalists assure us that the seminal vessels open near the ovaries, and that the worm bedews the ova with the seminal fluid the instant it deposites them. It has from this been concluded that these worms are hermaphrodite, and this idea has been the more readily adopted, because among these worms the distinction of the two sexes has never been discovered.(36) Block has often observed two of these eggs so closely united that they seemed to be but one ; he could not separate them till he had steeped them sometime in tepid water.(37) This sagacious au- thor has however remarked, that this adhesion of these eggs, might arise from an abundance of vis- cous humour. This observation is not therefore sufficient to prove the existence of two sexes in the £8 OF THE PRINCIPAL WORMS taenia, and an argument like this, not yet freed from doubt, presents to our modern naturalists a vast field for consideration. $ IX. Some learned writers have pretended that the taenia, like the Sertularia ("zoophytesJ grows longer by means of the apposition of new rings. This opinion however is proved to be unfounded, and it may be affirmed with certainty, that the tae- nia, like all other living beings, increases in length and size by the addition of a homogeneous matter received into its viceraand prepared or animalized by them. The various parts of the taenia exist- ing in miniature in the egg, begin to be developed from their leavingthe ovum and continue to grow till they acquire their natural bigness. Block having examined several small taeniae, with an excellent microscope, discovered in them a prodigious num- ber of very minute articulations, which could not be seen by the naked eye.(38) § X. The taenia is very tenacious of life. Cou- icf(39) asserts, that they can live more than twelve • hours in boiling veal broth, and come out as brisk' and active as they went in. Dr. JFaa?(40) caused a taenia to simmer over a slow fire, and observed that he died so soon as some common salt, muriate of soda, was added. In general, these worms, like others, sustain a very high degree of temperature before life is de- stroyed ;(41) this is not much in favour of that per- fection of the senses which some writers have a6? cribed to them.(43) OF THE HUMAN BODY. 89 § XI. This worm usually occupies the small intestines ; some few are occasionally found in the stomach. Most frequently the head is turned up- ward, while the posterior part of the body and tail extend along the interior portion of the intestinal tube. It is said that the head is insinuated in a sur- prising manner, into the mucous membrane of the intestines, and that the worm remains firmly attach- ed to them. Dr. Tyson relates his having seen a living tae- nia in an opened dog, who^e tail was pendent from the rectum, while the head of the worm was so deeply fixed in the small intestines, that he could scarcely detach it with his nail. (4*) We should hence conclude with Rosevsicin and all practition- ers, that no one can be freed from the taenia till its head is evacuated. § XII. The motion of this worm is singular and spiral. The posterior articulations are separat- ed from the anterior, they stretch out and contract by turns, in such a manner that the worm becomes sometimes narrow and sometimes broad : in a word, in its movement it rolls as by undulation, and from this cause it at times appears longer than it really is. This worm sometimes passes out from the rec- tum without producing any sensation ; more com- monly, the head being attached to the mucous mem- brane of the intestines, the motions of the body in different directions excite those peculiar morbid phenomena which shall be pointed out in the third 30 OF THE PRINCIPAL WORMS Lecture. It is from these irregular motions of the body of the taenia, here and there compressed by the duplicatures of the intestines, that those knots are formed in the course of its body, which are seen when the worm is voided, and which have the appearance of being artificially produced. These knots are sometimes single, sometimes dou- ble.(41) § XIII. All the taeniae found in the intestines of man, are not of the same species. I cannot however embrace the opinion of thos* physicians and naturalists, who, admitting as the distinctive character of the taenia, several vague and uncertain marks, have multiplied their species without end, and thus exceeded the bounds of pro- vident nature. Hippocrates speaks of one sort of taenia only,(45) and assorts that I he maladies he produces are not always mortal. Physicians since his day have ad- mitted but one species, till the time of Plater, who, without distinguishing them, has announced two species. (4^) Andry, after having examined the two human taeniae, adopted as the specific character of one, the small knots fnoeudsj which traverse the whole length of its body, and which he denominated the taenia without thorns, and the other the taenia with thorns, (taenia epineux). (47) Bonnet considered this distinction as too gen- eral ; without augmenting their number, but hav- ing regard to the length and smallness of the ar- OF THE HUMAN BODY. 31 iiculations, he called one species tke taenia with long articulations, the taenia without thorns, and that with thorns, the taenia with short articula- tions.( 18) Linnaeus, presuming he saw a peculiar charac- ter in the position and number of the papillae, has described three species,(49) calling the first of them Taenia solium osculis marginalibus solita- fit*,(ftO) the second Taenia vulgaris osculis later- alibus geminis,(5t) and the third Taenia lata oscu- lis lateralibus solitariis(52) Pallas, not wishing to deviate from the charac- ters of Jlndry, of Bonnet and of Linnaeus, has adopted six species(53) of them, the two last of which, according to the celebrated Block, can by no means be included in the genus of the taenia. Goeze having ascertained the fifth and sixth spe- cies of taenia described by Pallas to be incorrect, he admits only the four first,(54) announcing at the same time some uncertainty as to the fourth species (Taenia tanella,) which he believes to be rather a variety of the flat taenia,(55) and to con- stitute the third species. Without detracting from the merit of three great naturalists, such as Linnaeus, Pallas and Goeze, in reflecting on their writings, and contemplating their figures of the taenia, we perceive that the char- acters they have drawn of the diversity of the spe- cies, are liable to weighty objections. The broad- est articulations may, in certain circumstances, con- tract, shrink, and again possess a width and size 32 OF THE PRINCIPAL WORMS which vary in the different periods of the life of the worm. The same may be said of the lateral papillae and of the borders, as well as of the knots, parts which are not seen in the joints of the young tae- nia without a good microscope ; th-y become visi- ble only as the worm grows. It is equally true that those who would establish systematic divisions, on characters not less vague and uncertain, have cast a shade over those questions which they ought to have elucidated. Thus several celebrated naturalists reposing too much confidence in certain vague characters, have confounded the species, and that they might follow the order of nature, they have been anxious to make these characters too distinct.(&6) If there are in the taenia certain fixed charac- ters, immutable in every age of the worm, visible to the naked eye, we see them in the head of some armed with fangs or crotchets, as we have noticed above* (57) On these characters, which may be called spe- cific, Block formed the division of all the intestinal taeniae, into the armed and unarmed taeniae, a di- vision still more appropriate for the human taeniae. This division, besides that it is not subject to uncer- tain changes, is much more beneficial to physicians. Practitioners are not ignorant that the armed tae- nia, by insinuating itself into the mucous membrane of the intestines, with greater force than the unarm- ed taenia, produces in parts thus sensible sharp OF THE HUMAN BODY. 33 prickings, and sometimes occasions alarming symp- toms, requiring the most efficient remedies to ex- pel the worm from the intestinal canal. I proceed therefore to the examination of those two species, which are the only ones found in the human intestines.(58) FIRST SPECIES. THE HUMAN ARMED TAENIA. § XIV. The worm known by the name of tae- nia cucurbitina, or solitary worm,(59) though de- scribed and figured in several classical works of natural history,(60) has nevertheless been the cause of much uncertainty from the writings of sev- eral men really illustrious, and which, in the opin- ion of Block, must be sufficient to humble the pride of the human understanding. This worm is com- mon with us,(6l) since the taenia m6st usually dis- charged by our patients pertains to this species. This taenia, altogether peculiar to man,(62) varies according to its age, food, length of its whole body, and the bigness and dimensions of the ar- ticulations or internodes, as Werner chooses to call them. We see that these .internodes are very slender and delicate in the neck ;(63) almost square in the body of the younger, and next below the neck in those more advanced in age ;(64) in form of a paral- lelogram in the oldest worms ;(65) of the same form and very broad in the largest taenia ;(6&) oval and oblong in some 5(67) and lastly in others 5 34 OF THE PRINCIPAL WORMS half an inch in length,(68) etc. We perceive that the external form of the young worms thus differs from that of the more aged, and that the external appearance of the latter seems quite different from that of the taenia when arrived at its full size and perfect growth. This accidental diversity has therefore been very improperly regarded as a characteristic index of particular species, as we have already remark- ed ;(69) and naturalists have fallen into a great er- ror, especially those, who, blinded by the authority of the Arabian physicians, have believed that they saw in each great articulation of this taenia, a par- ticular worm. (70) § XV. The head of this taenia has been the subject of many inquiries. WelchiusCTi) and Linnaeus(J2) have regarded this worm as being acephalous. Rhodius(7S) and Forestus(74>) are the first who mentioned, described and figured the head of this worm as altogether monstrous and remote from truth, Malpighi afterward presented it to us as having eyes, nostrils, a mouth, and teeth, as may be seen in a truly grotesque figure, cited by Le~ clerc.{75) We are indebted to Andry, Tyson, Bon- net, and to Roederer,(7o) for a more careful and elaborate description of the head of this worm, still further improved by Leske, Pallas, Midler, Block, Goeze and Werner. With the naked eye, we see this head armed with two pointed and protuberant appendages, which, by analogy, are called crotch. OP THE HUMAN BODY. ets or fangs,(77) and which constitute the specific character of this species, as the other species is without them. If the anterior part of the head of this taenia is examined with the microscope, stretch- ing it a little, the fangs, which are seen by the naked eye, are extended into a small crown perfectly cir- cular and stellated, in the centre of which is the tube.(78) §> XVI. Laterally iuto a square, open the four lateral canals(79) which traverse the whole length of the worm.(80) The centre of the taenia is also traversed by a canal called the middle canal,(81) which begins near the tube of the head and reach- es quite to the tail, sending branches to each artic- ulation very much resembling in figure the horns of the stag, and which anastomoze in a wonderful manner, as may be seen by the naked eye in fully formed articulations.(8;) It is not yet clearly decided by naturalists, whether the middle canal of a ring communicates with the other, though Winslow,(8S) Fandelio(84>) and Pallas,{85) affirm that they have injected it through the whole length of the worm.(86) We only know with certainty that the canal coutains a humour composed of a globular and albuminous substance : the former has great resemblance to the yolk,(87) and the latter to the white of an egg.(88) Goeze describes the eggs as enveloped in a yellowish substance, which, macerated in water, is separated into small grains.(89) We farther know with certainty that in the ar- 36 OF THE PRINCIPAL WORMS ticulations which contain the ovaries, full of eggs, the most mature are those which, from the middle of the body of the worm, extend toward its tail.(90) § XVII. The lateral edges or margins of each articulation of the armed taenia, are provided with a papilla at the extremity of which is observed an oblong opening,(91) which Goeze represents as se- parated by a line. (92) These papillae, with their small mouth, occu- py only one of the margins of each ring; their disposition is however such, that we sometimes see them in the right lateral part of a ring, and in the next in the left lateral part,(93) and at other times they rise in two, three, four, five, and even six rings on the same side, and immediately after in one or two articulations on the opposite side.(* 4) It is probable that the internal structure of these papillae results from a tissue of fibres, since, if we are to credit Rosenstein,(95) the living worm has the power of thrusting them forward and of retract- ing them. The small apertures of the papillae communi- cate with the ovaria, and on this account they are to be regarded as the last extremity of the egg- f ducts.(9'o) Goeze, though persuaded that the taenia sucks up its nourishment by means of the four openings situated in the head, nevertheless believes that the lateral papillae absorb the nutrition requisite to support the posterior division of this very long worm. (97) OF THE HUMAN BODY. 3f If this is true, their orifices must be double, for we have remarked that the eggs of the taenia may be pressed from them,(y8) as all naturalists a- gree.(99) § XVIII. That these worms originate directly from eggs, deposited by the same species, can no longer be doubted.(lOO) Pallas(tOi) introduced into the belly of a small dog some ova of a taenia canina ; a month after he laid open the belly of the auimal, and in his viscera found several small tae- niae, having very short rings, which were not above an inch in length. We are indebted to Werner for the discovery of the parts of generation of this taenia. He has demonstrated that the organs consti- tuting the two sexes exist in each ring,(10S) and he has thus verified the doubt of some naturalists in relation to the hermaphrodite species of this worm.(103) According to his observations, two canals open into the marginal papillae of each ring ; the supe- rior terminates in a round tubercle, which seems to be the male ; the inferior is tortuous and filled with eggs, and whose lower extremity, enlarged iu form of a cul-de-sac, seems to form the female. There is nothing therefore wonderful if the eggs of the taenia are fecundated at the instant of their be- ing deposited.(104) 3S OF THE PRINCIPAL WORMS SECOND SPECIES. THE UNARMED HUMAN TAENIA. & XIX. The greater number of physicians and naturalists have given to this worm the name of Taenia lata ;(i05) we owe to Bonnet(lOQ) the first accurate description of it. I therefore deem it pro- per to present in this place his own figure of it,(107) because I find it the best of all those which modern times have produced. It possesses also the further advantage of being true to life. $ XX. The external form of the unarmed tae- nia is flat, resembling a riband: its colour is white, which Pallas regards as one of its specific char- acters ;(108) its ordinary structure is rather coarse, dense or membranous. Its articulations are dis- posed in so peculiar a manner, that it may be clear- ly distinguished with the naked eye from the arm- ed taenia. From the neck, the body is sometimes regularly intersected by transverse margins, not differing from those which unite the joints of the taenia cucurbitina; from this cause it might at first bight be confounded with the latter, if it were not flat and slender. Such is the flat taenia describ- ed by Marx, and which on account of this sinsu- larity I submit to the examination of my rea- ders.(109) In general the joints of the neck are very thin and delicate, being almost imperceptible : those that follow approximate the figure of a square gradually increasing in width in the body, and be- OF THE HUMAN BODY. S9 coming a little longer, they thus continue to the tail, which resembles a truncated piece. The lat- eral margins become irregular and are said by nat- uralists to be closed. This worm varies in length. The longest hu- man taeniae which Pallas ever saw were from eighteen to twenty Paris feet, (from six to seven metres.) Block sent one of these worms in several pieces to Goeze, discharged by a woman of Berlin, whose entire length was eighty two metres. The big- ness, length and breadth of this worm vary with, or are in proportion to its age and nutrition, as we have said of the first species.(1 f 0) § XXI. The head of this taenia is very minute; like the other species, the head of this is also fur- nished with four lateral papillae, and with a sin- gle papilla, in the centre of which Werner ha3 likewise seen the tube.(Ill) This central papilla has not the crown of fangs which encircles the tube of the armed taenia. These four papillae are also in this taenia, the orifices of the four lateral canals which pervade the margin of all the joints of the worm to the tail. The middle canal also passes through the centre of each articulation, but it is not known to commu- nicate with that of the next rings, since neither Pallas nor Goeze was able to push an injection through its whole length, as Winslow assures us he has done.(HS) The neck is quite covered with whitish fila 40 OF THE PRINCIPAL WORMS ments,(113) which render it lanuginous, or downy. Beginning with the narrowest part of its body and proceeding to the tail, the surface of each ring is made distinct by furrowed lines(144) which, if ex- amined with the microscope, present a cord of three lines.(115.) Both lateral margins of each ring are provid- ed with a perforated papilla leading to the ovaria, inclosed within the substance of the above mention- ed rings.(il6) $ XXII. In the centre of each ring we discov- er the ovaria, uniting in a nodus of an oval fig- ure,(117) and pointed at one extremity. These ovaries, grouped together, were taken by Bonnet for so many glands, to which he gave the name of blossomed fields.(118) On the superior part of each ring opens a small round canal corresponding with the centre of the ovaries. Pallas asserts that the worm deposites its eggs through this canal.(119) It is possible that the opening of the marginal papillae may serve as the male sex of the worm, as well as to suck in nutri- ment, as we said of the armed taenia. From the great difficulty of procuring this worm among us, either living, or in a fresh state, we have not yet been able to pursue the various researches neces- sary to obtain an exact knowledge of its internal structure. OF THE HUMAN BODY. 41 SECOND GENUS. VESICULAR WORMS. § XXIII. Joseph Ricci, of Pavia, about fifty five years old, of a feeble temperament, and poor- ly fed, having been for three months subject to at- tacks of intermittent fever, and tormented by vio- lent affections of the mind, was seized in the road, on the morning of November 26, 1797? with great torpor of the lower extremities. Dragging himself along with a reeling and uncertain step, he was suddenly taken with a severe pain of the upper part of his head, and at the instant he cried for help, he fell senseless to the ground. He was im- mediately conveyed to the clinical hospital, where I found him in an apoplectic fit, of a character altogeth- er asthenic or nervous, as most physicians call it. Excitants were applied both externally and inter- ' nally without effect, as the man died the following midnight. On examining the body and finding nothing re- markable in the external substance of the brain, we attempted to open the two lateral ventricles, and found them filled with a bloody serum. Here an unexpected phenomenon presented itself; two large clusters of hydatids extended along the branch- es of the plexus choroides to which they were intimately attached, so closely that to separate them I was obliged to tear the substance of the plexus.(ISO) Each cluster of hydatids was about two inches in length, large and extended at its in- 6 4:2 OF THE PRINCIPAL WORMS ferior extremity, which floated at the bottom of the ventricles ; the summit terminated by a long cord folded in various directions,(121) and was strongly attached to the partition which separates anteriorily the two ventricles. This double collection of hydatids so regular- ly disposed, being removed from the brain and at- tentively examined, we saw that each little blad- der contained a real worm, of a structure quite sin- gular. § XXIV. It was composed of a head similar to that of the taeniae, and of a vesicle full of wa- ter, and organized in a wonderful manner.(12£) The vesicle seemed to be formed of three dif- ferent membranes ; the first external, thin, transpa- rent, and very shiny or glistening; beneath this was seen an arrangement of very slender circular fibres,—these were extended over another velvet membrane, which lined the inner surface of the vesicle or little bladder. Each small bladder was therefore one of those worms to which Block gives the name of hermits,(l£3) to distinguish them from the vesicular social worm, which is also a blad- der filled with three hundred or even four hun- dred small worms.(124) The internal part of the bladder contained nothing but some water, and not- withstanding every examination we could make, we could not discover the least sign of any organ which might serve for the natural functions of this animal. A very singular species of worm truly 1 Tha OF THE HUMAN BODY. 43 figure of the small bladder is sometimes round, sometimes oblong, sometimes angular, etc. While the worm is living, by slightly com- pressing the end of its long neck, the head seems to be furnished with fangs, and a little mouth like. that of the armed taeniae. $ XXV. Among authors we find our vesicular worm confusedly described under various names. It was called Hydatis animata by Peyer,(i%5) Ova in porcis by Bartholin,(1S6) Lumbricus kydropi- cus by Tyson,{it7) Hydra hydatula by Lin- naeus,(t28) Taenia kydato'ide by P'alias,(129) Tae- nia vesicularis by Goeze,(tSO) Taenia hidatigena by Fiscker{ 131) and by Werner.(i32) I have called it vesicular worm, because this name seems to me most appropriate and convenient.(133) §> XXVI. This worm has been several times found, not only in the brain, but also in various other parts of our body, by a number of illustrious physicians.(134) According to the observations of Koelpin(l35) and of Waltker,(136) the greater part of hydatids may be reduced to real vesicular worms.(137) Pallas is induced to believe that en- cysted dropsy may be produced by a cluster of ve- sicular worms.(138) § XXVII. It seems probable from observations already made, that this worm commonly resides in those parts of the body which abound in lymphat- ic vessels ; its head is attached to their branches, absorbs the lymph they contain, and thus fills the small bladder that coustilute* its body. Tts eleva- 1i OF THE PRINCIPAL WORMS tions resemble crotchets or fangs, like the armed taenia ; the head has these fangs imitating a coro- net of wrinkles which serves firmly to secure the papillae which opens in the centre of its head, to- ward the parts of our body, and which draws its nourishment at our expense. This worm is there- fore a very singular animal; it is only found in the most concealed parts of our body, that are en- tirely secluded from external substances. Not the slightest trace of its eggs have yet been discovered. May they not be developed in the interior of the lymphatic vessels ?(139) § XXVIII. Our vesicular worm differs from those seen in the liver of hares, of mice, and in the b? ain of sheep, though the latter resembles it very nearly. In man, a single worm is contained in each lit- tle bladder, while in the vesicular worms of other animals, there are several small worms in each vesicle. The head of the human vesicular worm is without the bladder, to which it is united by its neck ; in the vesicular worms of other animals, these small worms live within the parietes of the common bladder. Lastly, the small bladder of the human vesicu- lar worm seems to form the body of the worm, while in the vesicular worms of animals, it is merely the common recipient to contain the worms. The figures of the vesicular worms of hares and sheep, as given by Goeze, are very exact • they merit attention^ 140) in order to notice the OF THE HUMAN BODY. 45 particular diversity between the latter and the hu- man vesicular worm. Block only has been capable of distinguishing them accurately.',141) THIRD GENUS. THE TRICOCEPHALUS. § XXIX. Dr. Wagler was the first writer who described this worm ;(142) it was found by pro- fessor Roederer and himself in the intestinum coe- cum of some French soldiers, who in the year 17^0, were attacked at Gottingen with a contagious epi- demic. The celebrated Blumenback found it sev- eral times afterward in the dead bodies of some miserable and half starved subjects.(143) Among us it may be said to be very rare, since so far as my information extends, no practitioner has had occasion to notice it.(144) Wagner and Block inform us that they have uniformly seen it in the coecum : others have seen it in the course of the larye intestines, and Werner[l4s5) says he has found it in the lower portion of the ilium. § XXX. We find the tricocephalus described by various authors, under the names of Tricu- m,(146) Ascaris tricuira,(l\7) of Taenia spi- rille,(iAS) and of Fuseragnelo codi setola,(l4i9) or worm with a tail. The name of tricocephalus is the most appropriate.(150) ^ XXXI. Several naturalists, among whom we may count Linnaeus, Leslce and Werner, have improperly classed it with the genus of the asca- 43 OF THE PRINCIPAL WORMS rides, though its figure has little resemblance to them. Still less can it pertain to the class of the taeniae, among which it is ranked by Pallas. Block and Goeze afterwards formed a particular genus of these worms, immediately following that of the ascarides,(151.) § XXXII. The form of our tricocephalus is that of a spiral line, 153) and its largest part doeg not surpass half a line in diameter. The external surface presents an assemblage of small transverse lines, like rings. Its length is from an inch and a quarter to two inches. One part of the body terminates in a fila- mentous elongation, as fine as a hair, and coiled round in a very surprising manner. The other part, turning in a spiral form, most commonly ter- minates in a hook, broad and obtuse, and similar to the pistil of the liliaceous flowers. From this extremity the worm can put forth a sort of tube, en- veloped in a sheath.(1 3) Its extremity, terminating in this very fine fila- mentous elongation, and one half longer than its body, has been taken for the tail of the worm by Roederer, Wagler and Wrisberg,(l5-h) and for this cause has been called trichuris. On the oth- er hand Pallas,(155) Muller9{l56) and Goeze1157) have demonstrated that this part is the real head of the tricocephalus.(158) Werner has also con- troverted the opinion of these three naturalists, but his arguments are too weak to prove it incor- rect *,(159) and we have reason to admit the head OF THE HUMAN BODY. 47 ©f the worm to be at its anterior filamentous ex- tremity, which serves as a neck. In the opposite extremity terminates the intes- tinal tube, and for this reason, it should be regard- ed as the tail of the tricocephalus. § XXXIII. The tricocephali which are found in the intestines of men are of different sexes. The tail of the male is turned round in a spiral form ; while that of the female, on the contrary, is oblong and flat, like that of the beaver, larger than the body and bent.(l60) We discover the internal organization of the male of this worm by opening it and subjecting it to the microscope. It is provided with an alimen- tary and intestinal tube, and with spermatic ves- sels^ 161) The tube of this worm, according to nat- uralists, may* appear externally :(162) may it not constitute one of the parts of generation ? The female tricocephalus has not in fact this tube, or cylindrical invaginated body, which some authors have given it; it is the end of its tail which is quite obtuse.(l6*) Besides the intestinal canal, its ovaries, so well described by Miiller,( 161) may be easily seen ; they are filled with a great quanti- ty of eggs, which Wagler has observed(l65) to be deposited by means of a particular canal. These eggs, deposited by the female,(l66) are of an oval figure, and pointed at both extremities. In the male not the least trace of them is seen. § XXXIV. Pallas has described a tricocepha- lus which he found in the intestines of the Lacerti 48 OF THE PRINCIPAL WORMS apoda.(L67) It has been pretended that this was the same worm as that found in men by Wagler and by Roederer; but the last examination has evinced that the head of the tricocephalus of the lacerta apoda was crowned with small fangs, be- sides other peculiarities of structure,(468) never ob- served in the human tricocephalus. On this subject Goeze says that the tricocepha- lus of Pallas should be regarded as a link, which, in the series of intestinal worms, unites the trico- ccphali with the Gratteurs,(L69) or Echinorynchi. FOURTH GENUS. THE ASCARIS VERMICULARIS. § XXXV. This worm, like the lumbricoides, of which we shall presently speak, belongs, accord- ing to naturalists, to the same genus ; they ought consequently to be described under the same arti- cle. If we however inspect these two worms, when brought together, we shall perceive material differ- ences between the size and length of the body of the ascaris vermicularis and of the lumbricoides, and in the place these worms occupy in the intestines, which is not common to both, as well as in relation to the symptoms which they severally produce ;(170) it seems to me that physicians should examine them separately, as has been done by most practi- tioners who have spoken of worms. (171) § XXXVI. The ascaris vermicularis, which has received divers names by authors,(±72) is a OF THE HUMAN BODY. 49 round, filiform worm, fine and slender at both ends, from four r ;ive lines to an inch in length. The vivacity wil"-» wliic's it moves, skips and bounds, is singular. If touched with a finger, or brought near the flame of a candle, its body contracts some lines in a surprising manner. It i« perhaps to this contractility that we are to attribute those enormous irritations of the intestines, and particularly of the anus, which torment the sick, especially children, who are most subject to them. The surface of this worm is full of wrinkles, which seem to be formed by a multitude of rings. Its anterior extremity is obtuse, its posterior end, or tail, is shiny and slender. $ XXX VII. This worm resides in the large intestines, commonly in the cavernous cells of the colon and rectum. Wulf discovered an infinite number of them in a small sack between the coats of the stomach.(173) I remember to have found several masses of ascarides vermiculares in the oesophagus of a woman, who died of a slow nervous fever. This worm is often found in the vagina of women. It is remarkable that the ascaris vermicularis is never found alone, but in conglobate masses of other worms of the same genus. It may be said that they love to dwell in groups. $ XXXVIII. This worm lives longer than any other in the human body; it can exist an al- most incredible space of time. Fabricius re- 7 50 OF THE PRINCIPAL WORMS lates(l7I) the case of a man who was tormented for ten years by the ascnrides vermiculares. § XXXIX. The nature of the aliment which supports this worm has been the subject of vari- ous opinions.(175) But it has at length been observed, that the mucous matter which lubricatei the intestines and the vagina of women, is the sub- stance for which it has the strongest predilection. Agreeably to this, it is not wonderful that we find the ascaris vermicularis in other parts of the body, in which the mucous fluid abounds, as those of the bladder, stomach, oesophagus, «tc. § XL. Though Van-Phelsum(176) has treat- ed at large of this worm, but Goeze has all the merit of teaching us its internal structure.(177) This animal is very small;(178) seen through the microscope, it clearly appears that its obtuse ex- tremity is its real head. It is furnished with two lateral oval protube- rances, and divided in the middle, which is the mouth.(179) Its body gradually enlarges one third of its length from the heajl, and proceeding toward the tail, it becomes more slender and deli- cate, till it terminates in a cetaceous point. A small canal opens into the mouth, which by dilating and contracting is connected with the stom- ach and intestinal tube. The opening of this canal is seen at that part of the body where it be- gins to diminish, in order to terminate in a very fine point, forming the tail. This point is considerable in the female ascaris OF THE HUMAN BODY. 31 vermicularis ; it is'considered by some naturalists as a characteristic sign of the female sex.(180) § XLI. In the male ascaris vermicularis we observe under the intestinal tube, a very small and very white canal, which extends quite to the end of the tail.(181) There is no doubt that the or- gans of generation, which characterize the male are situated in this part, and that it passes out in common with the posterior extremity of the in- testinal tube.(182) Van-Phelsivn found it filled with a whitish albuminous substance. He is how- ever deceived when he pretended to have observ ed that the course of this canal was spiral, aud that the tail of this worm terminated in a broad sack, distended with eggs. Werner has also fallen into the same error,(183) for confiding in the remark of Van-Phelsum, he has given the figure of it without subjecting this worm to that rigorous examination, which he has bestowed on all the other worms, which he has drawn and described with exactness. The figure of the male and female vermicu- lar worms, given by Goeze, is the most perfect, and on this figure rests our description of them. § XLII. The intestinal tube of the female as- caris vermicularis is surrounded by a membranous canal containing nothing but fetuses, and which by pressure merely, can in great part be expelled through au aperture situated at about one third of the length of the body.(184) If a small portion of this membranous canal is subjected to the micro- d2 OF THE PRINCIPAL WORMS scope, we see it filled with innumerable embrios distended iu various forms.(185) The figure of these embrios seems to be oval.(tSP) The extraordinary quantity of fetuses in the fe- male ascaris vermicularis need not be at all sur- prising, since these worms, according to the obser- vations of Goeze, are viviparous ;(187) the fe- male expelling very small ascarides in a living state, after which she dies.(188) Thus the opinion of Kratzenstein is equally re- futed, .189) who pretended that the flies, habituat- ed to draw food from excrements, deposited their eggs in the anus of children, and in this manner gave rise to these worms. FIFTH GENUS. LUMBRICOIDES. § XLIII. Naturalists are no where so much divided in their opinions as on this worm. Linnaeus(l$Q) reduced to the same species the lumbricus terrestris with that which inhabits our intestines, and for this reason Vallisneri called this worm lumbricus kumanus, and we more convenient- ly have called it lumbricoides.(191) It has been sufficiently demonstrated that these two worms are strikingly different, in regard to the external structure of their bodies,(<9&) as well as iu rela- tion-to their internal organs. (193) The opinion of Linnaeus and of the writers who have copied him is greatly erroneous, as is that OF THE HUMAN BODY. 53 of those who pretend that the human lumbricoides is different from the lumbricus that inhabits the in- testines of other animals, notably those of the horse and dog.(191) The length and the extraordinary size of this worm are regarded by some as an essen- tial mark of different species ; but this may depend on its different nourishment. And have we not ev- ery day examples of animals, which, abundantly fed on highly nutritious substances, become inor- dinately large above their natural state ? Vallisneri found a very large one in the intes- tines of a calf ;(l9-">) Baglivi describes another of these worms, thirty feet long, vomited up by one of his patients by smelling garlic ;(H-6) and Rosen- stein, in the space of eight days, expelled nearly ninety of them, quarter of an arm (bras*J long, from a little girl of eight years. This question does not therefore seem to be solved, since analogy and observation can furnish several arguments sufficiently satisfactory, which- ever of these opinions we embrace. § XL1V. The lumbricoides is perfectly round, commonly about the size of a writing quill: most frequently it is from six, seven and eight to ten fin- gers' breadth in length.(197) In each individ- * The French word bras is probably here a translation of the Italian braccio both from the Latin brachium arm ; but in neither of these languages any more than in our own, does the word seem to import a definite measure length. The French translators sometimes use it for one and a half metre precisely. and sometimes for rather less. *8. T. 54 OF THE PRINCIPAL WORMS ual the sex is distinct: the male is smaller and shorter than the female. Its colour is white, sometimes resembling flesh colour. The canal, which passes through the ab- domen of the worm, is yellow and transparent. Goeze(L98) regards this as a characteristic sign of this species. But this circumstance can be nothing more than accidental, because this canal being the alimentary tube, its colour must change with that of the substances it contains. Hence its appear- ance is sometimes white, black, yellow, ect.# The whole surface of the body is wrinkled and annular, and tapers to both extremities. Most naturalists have supposed that the circular fibres embraced the whole circumference of the body. Werner has however demonstrated that the four longitudinal fibres are the only ones which per- vade the whole superficies of the worm, and that those reputed circular are mere fragments of trans- verse fibres, which inclose the longitudinal fi- bres.(199) This arrangement of fibres in the lumbricoides is precisely like that of the human intestine colon: for this reason, Werner considers all the fibres which form the surface of this worm, as true lon- gitudinal and lateral muscles ;(S00) and, in this way, he very well explains the serpentine motions of its body. * In some lately examined, the colour of this tube was pur- plish. These were expelled without life, and exhibited this ap- pearance twelve hours after being discharged. Ji. T. OF THE HUMAN BODY. 55 The transverse fibres are connected together by means of an abundant cellular tissue, which being moistened is greatly relaxed, and lengthens the body very considerably. Goeze asserts, that a piece of this worm one line long, after being mace- rated, acquired the length of an arm. What an extraordinary length may not this worm attain in the living human body ! § XLV. It is to be remarked, that the external structure of the head and tail of the lumbricoides, is peculiar. If we observe the heid with the naked eye, we see three beautiful hemispherical eminen- .ces,(20t) which insensibly terminate in a very sharp point. Under the microscope we perceive that these three eminences are perfectly hemispherical, 20$) and that Vallisneri described them with accuracy, when he compared them to three small hills.(203) To a triangular aperture in the centre of these eminences, Pallas has given the name of a mouth with three lips, trilabiata. We cannot perceive all these appearances in the dead worm, because every part of the body is then relaxed. In the living lumbricoides, these three hemispherical eminences change their aspect, as Goeze informs us,(204) who had the good for- tuue to see one of these worms at the instant it was sucking. In the living worm, on the contrary, we see that these three hemispherical protuberances are pyramidal, with a convex base truncated exte- 56 OF THE PRINCIPAL WORMS riorly with a very sharp piercing point, in such fishion as to be compared to the divisions or claws of common pincers. With these protube. ranees the lumbricoides attaches itself to the mem- brane of the intestines, and even penetrates it, and when sucking up the mucous secretions, it moves these eminences alternately like three jaws ; thus the worm opens and shuts its triangular mouth, furnished with a tube which it can put out or draw in.. A mechanism so well understood proves that these protuberances are tissues or textures of mus- cular fibres. When the mouth of the worm is closed, these eminences approximate and form together a cone hard and firm at its summit, terminating in a sharp nipping point, and with this instrument it can even perforate the intestines, and make its way to oth- er parts of the body, as into the gall-bladder,(205) into the cavity of the abdomen.(206) into the kid- neys, the urinary bladder,(207) the brain,(208) as well as into other viscera.(209) § XLVI. This worm lives in the intestines, with other worms. Rosenstein mentions(glO) an infant of four years, feeble and emaciated, who voided several ascarides vermiculares, four arms of a taenia, and ten lumbricoides. A similar case is related by Montin,'2il) and practioners have frequent opportunities of noticing the lumbricoides associated with other worms. fc XLVII. Children are much disposed to this worm, and adults are not always free from them. OF THE HUMAN BODY. of In general they prevail most in persons poorly nourished and full'of viscous humours, or attacked by some severe asthenic disease. It has been observed that the more numerous these worms are, the smaller is their body. These worms are generally found collected to- gether in great numbers; some sick persons have dis- charged a hundred and fifty of them at once,(212) a hundred and seventy,(S13) and a thousand in the space of some days.(214) §> XLVIII. Tyson, Redi, and Vallisneri have been distinguished by their description of the or- ganization of the lumbricoides. Werner has latterly given us a more exact de- scription of this worm, ornamented writh excellent and perfect plates of it. The reader may consult them in plate V, here subjoined, and thus ascertain the organs serving for nourishment, and those des, tined to the propagation of the species. § XLIX. On opening the body of the female lumbrico'ides,(213) we immediately discover the in- testinal tube, commencing at the head, and envel- oped with other parts by cellular tissue. It is thin and slender at its origin ; afterward it gradually increases in order to contract and dilate into a sack, which may be called stomach ; this ter- minates in an intes'ine, which adheres, like the oesophagus and stomach, to the abdominal line, extending quite to the tail, where is seen a very small aperture, which forms the^ anus of the worm.(2l6) Its colour is ordinarily dark and yel- 58 OF THE PRINCIPAL WORMS lowish, and in some places greenish. It is form- ed of wrinkles and valves similar to those of the human intestines. The white line, reaching fi'om the head to the tail, along the direction of the intestinal tube which is situated above it, is, according to Werner, the great artery, which he has observed,(217) as well as Willis,{2i8) to be full of red blood in the lumbricus terrestris. § L. About two inches from the head, in the abdominal line, is a small hole which is the aper- ture of the vagina, or egg-duct.(2l9) This hole opens into a canal (the vagina) nearly at a right an- gle, which, bending in form of an arch, dilates into two small sacks, forming the two horns of the ute- rus, the structure of which is truly wonderful,(2£0) with regard to the extremely delicate slender pro- ductions, turned and folded in various ways, in which each horn of the uterus terminates. Here a wrhite tenacious fluid is contained, simi- lar to human semen, in which are suspended many granulated particles. Werner imagines (231) that the uterine process- es of the female lumbricoides communicate with the small vessels filled with a whitish fluid sur- rounding the intestinal tube, as has been observed in frogs by Swammerdam,(%22) and by Gam- per.{223) $ LI. The quantity of eggs enclosed in the horns of theruterus is immense. Their external surface seems to be bristly and OF THE HUMAN BODY. 59 villous : very shining on their inner part, they pre- sent to the eye of the observer a spiral circumflex line in the centre of them.(224) Werner calls this line spiral, and regards it as the germ of the future worm.(225) The existence of real eggs in the female lumbricoides being prov- ed, is no equivocal refutation of the opiuion of Frisch, who, supposing fthat these worms were transformed like insects, considered them as so many larvae of the taenia.(326) § LII. The internal structure of the male lum- bricoides, differs only from that of the female in the sexual organs.(227) At the distance of some lines from the tip of the tail, commences a small canal of a conical fig- ure, named penis by Tyson, which, tortuous and large, reaches a third way up the length of the worm, where, contracting and dilating, it forms a vesicle, (compared by Werner to the seminal vesi- cle,) and again narrowing like the horns of the uterus of the female, and tapering like a hair, in- terlaces with the intestinal tube, folded in a surpris- ing manner, and terminates in several loose and floating filaments.(228) The fluid, which fills this system of spermatic vessels, is not so glistening as the fluid of the ute- rus, nor, as in the latter, do we see any granu- lated particles swimming in it. §. LI II. Several distinguished naturalists have maintained, by observations altogether illusory, that the lumbricoides was viviparous.(2S9) Perebaom 60 OF THE PRINCIPAL WORMS. even believed that he saw a small lumbricoides come forth from the body of the female already dead. (230) Tyson, Vallisneri, Van-Swieten, Van-den- Bosch, Goeze, and several other naturalists of mer- it, have proved that this opinion was without foun- dation, and they have demonstrated that the visce- ra, and particularly the very slender spermatic ves- sels, having passed out by some accident from the belly of the female lumbricoides, and turned in form of an arch, in consequence of the natural elas- ticity of these parts, have been erroneously taken for fetuses of the same species. APPENDIX PRINCIPAL HUMAN WORMS. $ L1V. Several eminent naturalists(231) have spoken, in their writings, of some other worms which are rarely found in the human body, and they have described them as particular species. Though the history of these worms does not per- tain directly to medicine, yet J deem it very impor- tant that physicians should know all the varieties ot the worms of the human body, besides those which are peculiar to it, and may prove hurtful, agreea- bly to the observations which have been already collected. In my opinion all these worms may be consid- ered as varieties of those we have described, or as accessory worms,(232) which are not indigenous to the human system, but which sometimes introduced there, occasion peculiar and severe diseases. § LV. We should regard as varieties of the worms indigenous and peculiar to the human body, the membranous taenia,(23S) the ascarides vermic- ulares, discovered by Brugnatelli{%Z-^) in the va- gina of a woman, the ascaris lumbricoides of Ro- senstein,(%35) the stomach worm of Pereboom/236) etc. &2 APPENDIX TO THE § LVI. Among the accessory worms, or those not native to the human body, but which are sometimes found in it, we may reckon as chief the Hoiive of the intestines ffasciola intestinalisJ',(237) the ascarides of the stomach,'238) the ascaris of the nipple, the biting or pricking ascaris,(239) the Gordius or Cri- nu,(2i:0) the vena medinensis, dracunculus, or Gui- nea-worm,*(,C41) the exatiridion of XreittZer,(242) * M. Larrey has had occasion several times to observe, in Egypt, inflammatory tumors, which are generally attributed in Africa to the presence of a worm which had penetrated the skin, the ulceration of which cannot be cured till the extrac- tion of this pretended worm is completely effected. Accordingly the mode of curing this singular malady con- sists in twisting about a small piece of wood a tender whu- ish filament, which is regarded as the body of the worm. The greatest precaution is always taken not to break this thread or worm, for if unfortunately it should break, it is believ- ed to produce such distressing symptoms, by penetrating deep- er, as to require the amputation of the limb to save the life of the patient. M. Larrey supposes that the morbid symptoms which attend these tumors, which he considers as mere furuncles (biles) or mild enthraces, arise in fact from the operation of extracting the Guinea-worm (dragoneauj, and that these symptoms are aggravated when the operation fails. He has very attentively examined this whitish filament, but did not find in it the smallest resemblance of a worm. fie was convinced, by dissection, that this thread is dead cellular substance, which they succeed to spin, as it were, through a hole in the skin, when a small portion of it is taken hold of and rolled round a piece of wood. M. Larrev believes that it is by this ill-judged manoeuvre that certain cylindrical portions of the cellular tissue are obtained, long enough to be confounded with a real worm. PRINCIPAL HUMAN WORMS. C3 and also the insect scolopendra, scolopendre.(^^) It should be remarked that men, by swallowing the eggs of worms, which inhabit the viscera of animals, are exposed, in certain circumstances, to have these eggs developed in their own intestines. In this way we are liable to be preyed on by worms, which are not proper to our species. Afterward he had an opportunity of convincing himself of the truth of this persuasion by pinching the cellular scar of sim- ple biles, as he thereby obtained the same result. M. Larrey has acknowledged that without knowing it at the time, he found himself in opinion with Dr. Laborde, who being at Cayenne, had expressed the same sentiment, after a great number of observations. See Le Bulletin des sciences de la Societe Philomatique de Paris, pluviose an 12. F. Irs. END OF THE FIRST LECTURE. NOTES TO THE FIRST LECTURE. (1) Among the great number of publications of naturalists and physicians of all periods and na- tions, on human worms, the following deserve to be consulted, and it may be added that they are truly classical. 1 Salandi, Ferdin. Trattato sopra li vermi; Verona, 1607, 4°. 2 Redi, Franc. Osservazioni intorno agli an- imali viventi eke si trovano negli animali viventi ,* Firenze, lo8£, fol. 3. Vallisneri, Ant. Opere jisico-mediche ; Ve- nezia, 1733, fol. torn. 1, p. 113. 4. Leclerc, Dan. Historia naturalis et medica latoram lumbricorum intra kominem, et alia anima- lia nascentium, ex variis auctoribus, et propriis oh servationibus, etc.; Genevae, 1715, 4°. 5. Andry. He la Generation des vers dans le corps de Vkomme, ect.; third edition, Paris; 1741, torn. 11, 8°. 6. Van Doeveren. Hissert. de vermibus intes- tinalihus kominum; Lugduni-Batavoram, 1753, 4°. 7. Pallas. Hessert. de insectis viventibus intra viventia; LugdunuBatavorum, 1760,4°. FIRST LECTURE. 6j- 8. Bloch. Traite de la Generation des vers des intestins, et des vermifuges ; Strasbourg, 1788, 8°. 9. Werner, D. E. F. Vermium intestinalium, praesertim Taeniae kumanae brevis expositio.; Leipsiae, 1782, 8°. Continuatio prima, secunda, et tertia, curante, J. L. Fischer; Leipsiae, 1782, 1786, 1788, 8°. 10. Goeze, J. A. E. Versuckeiner JVaturges- chickte der Eingeweidewurmer thieriscker Koer- per ; Leipzig, 1787? 4°. 11. lletzius, And. Jo. Lectiones publicae de vermibus intestinalibus, imprimis kumanis ; Sto- Icolmiae, 1788, 8°. 42. Zeder, J. G. K. Erster Nacktragzur Naturgeschichte der Eingeweidewurmer von J. A. E. Goeze ; Leipzig, 1800, 4°. 13. Joerdens, J. H. Entomologie und Hel- minthogogie des menscklicken Koerpers ; in torn.; Hof, 1801, 180<5, fol. This magnificent and expensive work, which comprehends the description of all the human worms, I have not yet been able to obtain, though I have desired it, that I might make, it known to my rea- ders. [To this catalogue may be added the following work in 3 vols. 8vo. 14. Eutozoorum, sive Vermium Intestinalium Historia naturalis; Auctore Cakolo Asmundo Ru- dolphi, Philos. et Med. Doct. Hujus in Universitate Litt. Gryphiswald, &c. &c. &c. Cum Tabb. iEneis. Parisiis et Argentorati, et Amstelodami, 1810.] 9 GG NOTES TO THE (2) In looking over the observations of physi- cians, we see that worms have sometimes been found in the ventricles of the brain (see p. 41, vesicular worms J, and even in the substance of the brain, Bartholinus, Histor. anatom. rar. cent. i. Histor. 64; in the tissue of the conjunctiva of the eye, Mongin; dans la Journal de Medicine, T. xxxn ; in the angle of the eye, acta natur. curiosor. V. n. observ. 116 ; in the nostrils, Angelini, de verme ad' mirando per nares egresso; Ravenn. 1670, 4°; in the sinuses of the jaw-bone, Bordenave, dans les memoires de PAc, de Chirurgie, torn, v; in the ears, Morgagni, de sedibus et causis morborum, etc. E- pist. xiv. art. 7 j iu the breasts, Baldinger, JVeves magazin fiir practische Aertze, Leipzig ; V. B; in the cavity of the thorax, Burserius, Instit. Med- icin. practic. vol. iv. p. 421; in the lungs, Redi, observazioni intorno agli animali viventi, etc. ; in the heart, Senac, Traite de la structure du coeur, de son action, et de ses maladies, Paris, 1774, torn. 11. p. 437 ; in the glands of the trachea, Treutler, Observationes patologico-anatomicae, etc. in the tunics of the intestines, Stoerck, Annus medicus, 11, p. 228 ; in the epiploon, Wegelin, Observa- tiones circa vermes; Argentorati, 1779, 8°; in the liver, Acta naturae curiosorum, vol. v. obs. 112'; vol. vin. obs. 10 ; in the panereas, Mauchart, Lum- brici teretis in ductu pancreatics reperti historia et examen; Tubingae, 1738; in the kidneys, Schacher, Pr. de Lumbricis in renibus repertis; Leipsiae, 1719.—Blasii, observat. medicae, rarior. FIRST LECTURE. GT Observ. xxn; in the urinary bladder, Brera, SyL loge opusculorum selectorum, etc.; Ticini, 1799, vol. iv. p. 1. Comm. Auct. Kiihn ; in the uterus, Mercurialis, de morbis mulierum lib. iv. cap. 2. ; in the vagina, Brugnatelli, Giornale Fisico-med- ico, Pavia, \7$5,tome iv. p. 71; in abscesses of the abdominal muscles, Acta Helvetica, vol. i. p. 73 ; in those of the arms and other parts, Bartkolinus, Histor. anatom. cent. v. Hist. 43; and even in the marrow of the bones, Commercium Litterarivm, Norimbergense, ann. 17^i,p. 71 • (3) Some writers have made mention of sever- al worms peculiar to the human body, of an exter- nal structure so extravagant, that they have been questioned by other observers. Such for example are the rough bristly macrocephalous worm of Bo- rel, Observationummedico-physicarum, cent. n. obsi 70; the worm (Gammarus*J of Fabricius Hilda- nus, opera omnia, cent. in. obs. 53 ; the villous and cruciform worms of Pare, (Euvres, lib. xxiv. cap. 19 ; the shaggy worm of Gallo, BelV use del latte, tome n. p. 133 ; the worm with feet, of Rol- ens, Adfectuum totius corporis humani praecipu- orum Tkeoria et Praxis, Francofurti, 1664, 4°, p. 219; the worm of several feet, of Heister, Medi- cinische undckirurgischeundanatomische Wahrne- hmungen; Rostock, 1753, 4°, n, B; the serpents * It is doubtless by mistake that Dr. Brera makes this ci- tation here; for in the observation of Fabricius Hihlanus he alludes o !y to the fatal symptoms occasioned by swallowing a living lobster. F. Trs. tf3 NOTES TO THE and lizards of Gesner, Historia animal., de quadru- ped, ovipar. p. 41; the horned worm of Salmutk, observat. medic, cent. n. obs. 7 ; and many others like them too numerous to relate in this place. (4) Before the time of Linnaeus, physicians were only acquainted with the lumbricus longus, lumbricus latus, and ascaris vermicularis. (5) In the classification of the human worms, we should include those only which constantly in- habit the human system, the varieties of the spe- cies, such as tbose of the taenia, of the lumbri- coides, as well as the worms which, by some acci- dent, have found their way into the human body, such as the viviparous gordius, or crino, the insect known to naturalists under the name of scolopon- dre, the fasciola intestinalis fdouvej, the gordius medinensis (la veine de medinej the ascarus pso- ricus, (see the appendix of the principal human worms,) and other similar worms cannot be said to be peculiar to the human species, and therefore cannot make a part of the order of real human worms. (6) Vermium terrestrium et fiuviatilium His- toria, vol. n. p. 23. (7) Cast your eye over the collection of the principal worms in the annexed plates, and ob- serve their external structure which is truly admi- rable in each species. (8) There have been many disputes among natu- ralists respecting the existence of the brain of worms; but they have established nothing with certainty on FIRST LECTURE. 69 this subject, unless we consider as a brain, that protuberant mass analogous to the substance of the spinal marrow, which is seen on the head of some worms. It is nevertheless certain that these ani- mals are endowed with sense or feeling, and there is sufficient reason to believe that they have nerves, especially since Professor Mangili has proved the existence of a nervous system in the Leech, in the Lumbricus terrestris, and in other worms of a na- ture like that of the human worms. See Brugnatelli, Gior'nale fisico-medico, anno 1795; torn. n. p. 249 : " He systemate nerveo hi- rudinis, Lumbrici terrestris, aliorumque vermium ; celeberr. viro A. Scarpa, Joseph Mangili.7' (9) The word Taenia signifies a band; this worm is also thus named because of its flatness, length and breadth. Latterly Zeder has changed the name of Taenia to that of Alyselmentkus. See Zeder, Erster Nacktrag zur JVaturges- ckichte der Eingeweidew firmer, von Goeze, p. 221. (Alyselmentkus, id est Taenia auctorum.J (10) Those naturalists, who have admitted these accidental signs as characteristic marks, and have founded on them their systematic division of the species of the taenia, have fallen into an error. See sections vi and vn. (11) Traite des Maladies des enfans. It is probable that this worm may acquire such a size as not to be contained in the intestines, and may thus in part be expelled from the body. It dies, or some portion of it putrefies, and is evacu- ?0 NOTES TO THE ated with the excrements. This is the real cause of the expulsion of certain pieces of the taenia, without the use of any remedy. (12) Hissert. de vermibus intestinalibus hoinin- um ; etc. (13) Arzneyen, n. B., Langensalza, i7&7- (14) See pi. I, fig. 1, v. vi. (15) See pi. I. fig. 1, a c c d. fig. v. AB, fig. vi. a b. (16) See pi. I. fig. viii. (17) Traite de la generation des vers des in- testins, etc. p. 15. 18) See pi. I. fig. i. ab. (19) See pi. I. fig. vii, f e. (20) See pi. 1. fig. vii. ix. (21) See pi. I. fig. i. a c c d. fig. iv. a b. fig. v. AB. (23) Let us consider for example the taenia which Baldinger says he saw, seven hundred feet in length(§ V). Admitting the neck to be fifty feet long, its head being cut off, and the rest of the bo- dy observed apart, it would have been taken for the entire body of a taenia by every observer. The same uncertainty would arise from the other part of the body separated from the neck. The length might lead one into a mistake; and the same worm examined superficially, would be described as two different species. We find this conjecture realized in a number of naturalists who have divid- ed the same species into several. FIRST LECTURE. 71 (23) See pi. I. fig. iii. fig. iv. c e. fig. v. C D. and pi. II. fig. i. (24) See pi. I. fig. iii. fig. x. (25) See pi. I. fig. xi. and pi. II. fig. i. (26) See pi. I. fig. v. (27) De la generation des vers dans le corps de Vhomme, etc. T.i.p. 198, 268. (28) Historia naturalis et medica latorum lum- bricorum intra kominem, etc. tab. prima, A, B. (29) Opere jisico-medicke T. i. tav. 18. (30) The work cited, pi. XIX. (31) We are accustomed to attach to things un- common an idea of singularity which does not ex- ist ; we even forget all delicacy in order to induce belief. It has accordingly been imagined that each joint of a large taenia could live when separated from its contiguous joint. From this idea has orig- inated the name of taenia cucurbitina, by which some have chosen to distinguish one species of the taenia, since it has been thought that this worm was formed by the union of a number of vermes cucurbitinae, or worms resembling gourd seeds. This error, which for a long time prevailed in the classification of worms, is now acknowledged to be incorrect, though it has been countenanced by some excellent naturalists. If we consider that taeniae, like other animals, must gradually obtain their full size, it necessarily follows that their external form must vary with their age : thus a young taenia must differ from a middle aged taenia, and from one of full age or of rs NOTES TO THE the largest size, though all pertain to the same spe- cies. (32) The Swiss, as has been said, are princi- pally subject to this taenia, which has been describ- ed as composed of a delicate, lax, and membranous substance. Linne, Amoenitates acedemicae, vol. ii. p. 7, tab. 1, fig. ii.; and Pallas, Elenckus Zoophy- torum, p. 408, no. 3, call this taenia vulgaris. The same Pallas in another of his writings, Neve Mrdische Beytrag. IB, IS, p. 54, calls it taenia grysea. Goeze, Versucheiner JSTaturgeschichte, etc. p. 296, gives to it the name of taenia membranacea. The head of this taenia has not yet been de- scribed, because it has not been seen. Its length does not exceed eight arms. Its body is narrower than that of the flat taenia (unarmed taenia). Each of the rings has marginal papillae at the sides, en- closing an ovary in the centre. These are the prin- cipal characters of this pretended new species of taenia. I think however with Werner, Vermium intestinalium, pr aesertim taeniae humaniae brevis expositio, etc. p. 49, that it should be regarded as fallacious, or as described from badly preserved sub- jects. Or may we not again suppose that it was a flat taenia, young or poorly nourished, or not yet de- veloped ? (33) Authors in their turns have frequently contradicted themselves while describing its inter- nal parts. FIRST LECTURE. Iii truth, the generative organs are but very lit- tle known. The others have not been clearly ex- hibited, and are in fact but very imperfectly under- stood. (34) The time requisite for the fecundation of the eggs has never yet been determined. Block, Traite de la generation des vers etc. p. 17, assures us that taeniae have eggs before they are four months old. (35) See pi. II. fig. iv, v, vi, vii. Bonnet views them as particles of fat. Andry was the first who recognised them as genuine eggs. (36) § XVIII. " (37) The work cited, p. 17- (38) The work cited, idem. (89) He Ascaride et Lumbrico lato ; Lugduni- Batavorum, 1729, 8°. (40) Osservazioni de9 medici provinciali di Svezia, p. 283. (41) They bear also cold with indifference. Rosenstein, Maladies des enfans, etc. p. 301, after having left a taenia in a plate for twenty four hours, put it into a vessel, pouring hot water upon it. The taenia began to move and to wind about; he then bathed it with fresh water; the worm seemed to die. In this manner he saw it die and revive alternately. (42) Besides the sense of taste, of touch, and of sight, which have been attributed to these worms by various writers, Konig,Acta Helvetica, T. 1, is led to believe that taeniae possess also the sens* of smell. 10 T4 NOTES TO THE (43) Pliylosopkical Trans, of the Royal Socie- ty of London, anno 1683, no. 146. (44) See pi, I. fig. iii, c c, iv, c d d, XVI. (45) See Haller, Artis medecae principes to- mus in, Hippocrutis de morbis, lib. iv, cap. 16; " He Lumbricis latis ac teretibus, Lumbricos tere- tes parere, latos non parere, sed abrumpi; Lum- bricorum latorum ortus, species et signa diagnos- tica, et prognostica." (46) Observationum, lib. in, Basil, 1641,^7.883. (47) He la generation des vers, etc. tome i, p. 195. (48) Bonnet also called that taenia with later- al marks or points, which had long joints, and tae- nia with umbilical marks, that which had short joints. See his Traite d7 insectologie, as well as his Memoire sur le ver soletaire insire a la page, 478 des Memoires Mathematiques et Physiques presen- ts a Vacadamie royale, des sciences par divers sa- vans, et lus dans ses assemblees, tome i, Paris, 1750, 4°. (49) Linnaeus admits four species of them; but one does not belong to man, and this we have not mentioned, in order not to confound human worms with those of other animals. (50) Systema Naturae, edit, xii, p. 1323, spec. 1.; " Articuli huic speciei longissimi." Amoenitat. academicae, vol. ii. p. 7, tab. 1, fig. i. (51) Systema nalur., p. 1323 ; " Articuli huic speciei, ex oblongo quadrate :" Amoen. academ. vol. ii, p. 7, tab. l,fig. ii. FIRST LECTURE. T5 (52) Systema nat.,p. 3321, " Articuli huic spe- ceiei brevissimi sextuplo;" Amoen. acad. vol. ii. p. 81, tab. 1, fig. iii. (53) Elenckus Zoophytor., etc. The three first species are the same as those described by Linnae- us; his fourth species is the taenia tenella; the fifth and sixth species by no means belong to the genus taenia. (54) Versuckiner Naturgescliieke der Einge- weidewiirmer. The taeniae constitute the tenth genus of the worms of the viscera. The species of human taeniae, which he has admitted are four; 1. Taenia cucurbitina ; 2. Taenia vulgaris, grysea Auctorum ; 3. T. lata ; and 4. T. tenella, Pallas. (55) Goeze, the work cited, p. 302, thus ex- presses himself: fi The taenia tenella, which Pal- las saw discharged from several sick persons at Petersburgb, has great resemblance to the flat tae- nia, except that it is more slender, and in some of its parts more transparent; 1 therefore regard it as a variety of the broad taenia, or as a small flat taenia, not yet fully developed, or arrived at its natural size and growth." (56) Other writers, for example, consider the long rings as characteristic of the broad taenia. Vogid admits them in the taenia solium. No nat- uralist has yet found the head of the taenia vulga- ris. We cannot think with those who have believ- ed that provident nature has refused to this taenia ,-0 NOTES TO THE a part so essential as the head; this is repugnant to good sense. Vogel notwithstanding regarded this privation of the head as the distinct and specific character of the taenia vulgaris. The existence of the head was on the contrary, according to him, the characteristic mark of the broad taenia. For this reason, Roederer felt himself compel- led very publicly to remark, that the taenia soli- um had a head. Certainly Vogel was not a fool; but sometimes the errors of great men seem to rise in proportion to their celebrity ! (57) See § VI. (58) Plater, Andry, and Bonnet were assured- ly not deceived in admitting but two species of in- testinal taenae. As to the taenia, called common by Linnaeus, gray by Pallas, and membranous by Goeze, we must agree with Werner, p. 49 of the work cited, that it is also a variety of the flat taenia, or a taenia described from subjects badly preserved. The fol- lowing reflections of this distinguished observer are worthy of notice; I here use his own words: "Quae enim illi (taeniae vulgari) optimi Auctores duplicia in alterutra superficiei orificia tribuunt, ex quodam errore hue coavenisse videntur, si quidem ego gemina fcubercula quidem, ad latera posita, nun- quam vero in superficie, deprehendi. Quamvis ego autem is nullo modo sim, qui meas observationes horum optimorum virorum auctoritati opponere au- FIRST LECTURE. 77 derem, potui tamen ea propter cum iis non consen- tire, quoniam uti in multis veris opinionibus, ita etiam in erroneis Linnaeum nimis presso pede se- qui videbantur, quapropter exinde illos optimos viros, Linnaei auctoritatem etiam in hoc propriae experientiae anteposuisse verebar. Non nego duo- bus tuberculis instructas Taeniarum species, quae tamen non ita, uti Linnaeus posuit, mediam super- ficiem occupant, verum potius ad latera, in utroque nimirum unum, collocata sunt. " Possit ne igitur quadam observantis festina- tione factum esse, ut ex aliquo exemplo, qui vel casu unius lateris tuberculorum series abrupta erat, illud solitarium tuberculum, quod in aliis duplex et oppositum observaverat, in mediam superficiem collocaret, novamque speciem latam, videlicet oscu- lis solitariis, inde conderet ? Quae mea qualis cum* que conjectura effecit ut latam cum vulgari con- jungens, banc tantum ceu unicam veram speci- em describendam esse existimarem."' The same Goeze, Versucheiner Naturgeschichte der Ein- geweidewiirmer, etc., p. 296, affrms, that he has no knowledge of this common or membranous taenia. Supported by the authority of Linnaeus and of Pallas, he admits it into the class of human taeniae published in his work. It is proved then that the taenia tenella, see § XIII, Note 35, and the taenia vulgaris pertain to the flat taenia. There are but two real species which can be regarded as distinct 78 NOTES TO THE and charaetistic among the taeniae observed in the living human body. (59) This has been described by authors under different names; they have called it, 1. Vermis cucurbitinus, Plater, Praxis medica, p. 992; Chatne de cucurbitains, Vallisneri, Opere fisico- mediche, tome i. p. 177 5 Cocchi, dei Vermi cocur- bitini dell7 uomo ; Pisa, 1758, 8°. 2. Taenia without thorns, (epinesj Andry, de la generation des vers, etc. tome i, chap. 8. 3. Taenia with long rings, Bonnet; see Jour- nal de Physique, an 1777, avril, p. 257 ; Goeze, Versuckeiner Naturgesch., etc., p. 269. 4. Taenia cucurbitina, Pallas, Elenchus Zoo- phvtor., p. 269, no. 1, Dissert, de iufestis, etc. p. 38, no. 4; Goeze, the work cited, p. 169. 5. Taenia solium. Linnaeus, Systema Natu- rae, edit, xii, p. 1323. sp. 1, Werner, Vermium intestinalium praesertim taeniae humaniae, etc. p. 18 ; Taenia solitaire, Leske, Elimenti di Sto- via Naturale, tol. n ; Milano, 1785, p. 233; sol- itary worm, Bloch, Traite de la Generation des vers, etc., p. 45. 6. Taenia articulos dimittens, Dionis, Disser- tation sur le Taenia ou le Ver plat; Paris, 1749,8'. 7. Lumbricus latus, Tyson in Philosophical Transactions, etc., no. 146 ; He Haen ratio me- dendi, p. xii., cap. 5, p. 210; Leclerc, Historia naturalis, et medica Lumbricorum latorum, etc.; Marx, observata quaedam medica; Berolini, 1772, 8°. p. 13. FIRST LECTURE. 79 (60) See Heyde, Experimenta circa sanguinis missionem; Amstelodami, 1686, 8°. p. 47? Tyson in Philos. Trans. 1663, tab. 1; Vallisneri, the work cited, tab. 18, 19 ; Leclerc, the work cited, tab. 1, a, tab. 2, 6 ,• Linnaeus, Amoenitates aca- dem. tome n, tab. l,fig. i. ; Andry, the work cited; Limburg, in Philos. Transactions, I766, p. 128, tab. 6 / Marx, the work cited, fig. A. (61) See § VII, p. 9. (62) TAnnaeus, Amoen. Academ*, etc.; and Dr. JJnzer; see Tentamen kerpetulogie, auctore, J. T. Klein, accessit J. A. Unzeri Observatio de Taeniis; Leidae et Gottinguae, 1755, 4°., p. 67, declare that they have found this same species out of the human body. These observations excited animated debates among the naturalists, to decide whether human worms were innate in man, or whether their eggs were introduced into the human system with our food. See the second Lecture. The taeniae Which are nourished in the human body acquire so great a size, that they are never seen of like magnitude in other animals; it is for this reason that the human taeniae are peculiar to our race. (63) The articulations or internodes of the neck of this taenia have great resemblance to very small folds. See PI. I, fig. i. (64) Plate I, fig. ii, xvi. (65) Plate I, fig. iii. The largest articulations have this peculiarity, that their figure no longer presents a paralcllogram. but rather a trapezium 80 NOTES TO THE with a truncated extremity in the lateral part to- ward the head. (66) PI. I, fig. xi. (67) PI. I, fig- x. (68) As they are seen in aged taeniae. See Vallisneri, Opere Fisico-mediche, T. 1, tav. 19, p. 177. (69) See % IV, Goeze, Versuckeiner Natur. der Eingeweid^wurmer, etc., p. 278, remains in some measure in doubt on the vague and incon- stant appearances of the articulations of this taenia, as he has subdivided his taenia cucurbitina into two species ; he called the first taenia cucurbitina grandis saginata; and the second, taenia cucur- bitina, plana, pellucida. After a deliberate examination of these two taeniae, for they are preserved in the museum of natural history of the university of Pavia, with the collection of other worms made by this illustrious naturalist; I believe the first species to be a tae- nia cucurbitina more advanced in age and better fed than the second. (70) See § VIII. The articulations of the wi- dest extremity of these taeniae may be easily sepa- rated from each other. It was from this circumstance that Hionis nain- ed them taeniae articulos demittentes. According to Bloch, this separation has been the source of numberless errors. The Arabian physicians, and after them several moderns, among whom we find Vallisneri and Rosenstein, recog- FIRST LECTURE. 81 nised in the articulations a particular life, and af- terward distinguished by the name of Vermes Cu- curbitinae, on account of their resemblance to the set ds of the cucumber. (71) Devenamedinensi; Augusta Vindel. 1674, p. 230. (72) Amoenitates academ.,vol. u,p. 85. (73) Observat. medic, cent. 1, observ. 59. (74) Observat. lib. xxvi, cap. 32. (75) The work cited, pi. III. fig. iv. (76) Program, de Taenia, Goettingae, 17&0; 4°. (77) See pi. I. fig. i. a, b. It is preserved in the Museum of the University of Pavia, where the two appendages of the head, in form of fangs or crotchets, are still clearly visible with the naked eye. I notice these appendages, because Werner, Vermium intestinalium praesertim Taeniae huma- nae, etc. p. 25 asserts, that these crotchets are real blisters (ampoulesJ situated laterally on the cen- tral papilla, still called the middle canal of the head. (78) We follow the central papilla within which the tube is concealed. See pi. I. fig. viii, c, f; See Werner in the work cited, p. 26—31. (79) See pi. I. fig. viii, abed. (80) These canals are not interrupted at each ring, as has been believed. If a taenia is macerat- ed in a coloured fluid, the whole extent of the ca- nals is coloured in proportion as the fluid has filled t be in. 11/ 852 NOTES TO THE (81) See pi. I. fig. xi, d e. (82) See pi. I, fig. iii, xi. (83) Epistola ad Andryum: in the Journal des Savans, an. 1781, p> 446. (84) Hissert. de Taenia canis, Patavii, 175&? 8°. (85) Nordische Beytrage, 1 Band, p. 52. (86) Werner supposes the contrary, the work cited, p. S3. (87) These parts are, according to Goeze, so many ovaries full of eggs. See pi. II, fig. vii. (88) We may view, says Bloch, Traite de la generation des vers, etc., p. 46, as a peculiarity of this species, the ovaries resembling the form of a trunk, from whose sides issue branches, which are the more visible, as the skin is white, thin and transparent. The same observer is convinced that these ram- ifications are real ovaries, because if we compare them, the eggs advance toward the marginal pa- pillae. These observations, related by Werner in hit work which we have quoted, are worthy of atten- tion. See p. 34 and following. (89) Versucheiner Naturgeschickte der Ein- geweid., etc., p. 279. (90) The articulations of about half the body jise toward the head ; and besides that they have no visible marginal papillae in their internal sub- stance, they present an immensity of very small atoms, which are, according to the conjectures of FIRST LECTURE. 85 Pallas, Noriiscke Beytrage, 3 Band. p. 77, must probably be so many of the future embrios of the ovaries. (91) See pi. II, fig. ii, a b. (92) See pi. II, fig. iii. (93) Alternate papillae. See pi. I. fig. iii. (94) Irregular papillae. See pi. II, fig. i. (95) Maladies des enfans, etc. p. 600. (96) See note 88. (97) Versucheiner Naturgeschickte, etc.p. 274. This celebrated observer affirms, that he found a taenia sucking, and was thus assured that the lat- teral papillae of this worm serve also for nutrition. Hosenstein, Traite des maladies des enfans, p. 302, had already remarked, that this taenia attach- es itself firmly to the parietes of the intestines with its papillae, which he considered as absorbing ves- sels. (Q*) See note 88. (9-0 Except Vallisneri and Linnaeus, they took the ovaries of the taeniae for so many chy- lous vessels, their eggs for large and small glo- bules of fat. (100) See § VIII. (101) Neve Nordische Beytrage, 1 Band, §1, p. 58. (102) Vermium intestinalium, etc. p. 123, tab. ^ fig. 37. (103) See § VIII, Bianchi, de generatione vermium, p. 858, was one of the first to assert, that each articulation of the taenia was hermaphrodite. 84 NOTES TO THR (104) This manner of fecundating the eggs, though it seems extravagant, is not beyond nature, since we know, from the beautiful experiments of Spallanzani, that frogs are thus fecundated, etc. (105) Linnaeus, System, natur. edit, xii, p. 33?4, spec. 4; Pallas, Elenchus Zoopkytor., p. 450; Hissertatio de inftstis viventibus, etc. p. 85, no. 4; Bloch, Traite de la generation, etc., xvi. sjtecies de Vordr. l,p. 38; Goeze, Versucheiner Naturgeschickte, etc. no. 3, p. £9S. Plater, Prax- is medica, cap. 14, names it Taenia prima. Andry, de la generation des vers, T. 1, chap. iii. art. 2, called it Taenia with thorns, (Taenia a epines.J Bonnet in the Memoires de Mathematiques et de Physique presentes a Vaccadimie royale des sci- ences, etc., T. 1, p. 418, gave it the name of Tae* nia wi'h short articulations. Hionis, Hissert. de Taenia, called it, Taenia articulos demittens. Leske, Elementi di Storia naturale, etc. vol. n, p. 233, Werner, Vermium intestinalium, etc. p. 49, have described it under the name of Taenia vulsaris. Bonnet, in another memoir inserted in the Jour- nal de Physique, anno 1777? p. 262, again gave it the name of common taenia. (106) Memoires Mathematiques, etc., torn. i. p. 478. (107) See pi. I, fig. v, vii, ix, xii, xiii, xiv, xv. (108) " Taenia lata, Candida, articulis brevissi- mis, medio-nodosis, uniosculatis. Corpus longis- FIRST LECTURE. 85 simura. Articuli multoties breviores latitudine cor- poris transversim striati, medio glandula tumidi. Oscula ab altero latere corporis, in ni^dia glandu- la in idem latUs tumidiore, solitaria." See Pal- las, the work cited. (109. See pi. I. fig. iv. The rings seem to be circumscribed and long, as in the taenia cucurbiti- na. We cauuot deny this even with the naked eye, but if one of these articulations is subjected to the microscope, as Marx did, Observata quaedam medica, etc., fig. D. we shall perceive that it re- sults from other short rings, not differing from those of the true flat taenia. It is possible that this tae- nia is very young, badly nourished, or not yet de- veloped. " I must remark," says Bloch, Traite de la generation, p. 39, " that the articulations of this taenia sometimes acquired the length of an inch, etc." (110) See § VII. (Ill) Vermium intestinalium, tab. 3, fig. 47, p. 125. (112) Epistola ad Andryum jam c\t. (113) See pi. I. fig. ix. (114) See pi. I. fig. v. c c c c c. (115) See pi. I. fig. xii. (116) The difference of the taenia cucurbitina is, in some papillae, situated on one side only of the rings. (117) See pi. II. fig. iv. f 118) Memoir, de Mathemat. etc. T. 1. 8o NOTES TO THE (119) Neve Nordische Beytrag., 1 Band. 1 st p. 64, no. 4. (140) See pi. III. (121) See pi. II. fig. viii. (122) See pi. I'.fig. ix. (123) Traite de la generation des vers des in- teslins, etc, 2 species, p. 52. (1 'Zh) Block, the work cited, p. 56. (12"j) Miscellan. natur. curiosor., dec. I, ann. vii. observ. 206. (126) Histor. anatom. rarior., cent, n, observ. 87, i?. *93. (127) Philos. Trans, of the Royal Society of London, S. V. XVII. no. 193, p. 06. (128) Systema naturae, edit. xii. p. 1320, no. 5. (1x9) Elenchus Zoophytor., etc., no. 413. (130) Versucheiner Naturg. etc. p. 248. (131) Taeniae hydatigenae inplexu choroides inventae historia, etc. ; Lipsiae, 1780, 8°. (132) Vermium intestinalium, etc., p. 66. (133) This being the only worm found in the human body, (at least we know no other at pres- ent,) I leave it the name of hermit, given by Bloch, Traite de la generation, etc. p. 52, merely to dis- tinguish it from the other vesicular worms which are noticed in the body of animals. I have not adopted the name of taenia hydatis, given to it by Pallas, nor those of taenia hydatige- na and taenia vesicularis, used by Werner, Fis- eker and Goeze, because all these are more pro- per to designate the vesicular worm, resembling FIRST LECTURE. 87 the taenia which is sometimes found in the liver of field mice, and the domestic mouse. See Bloch, the work cited, p. 51, the first species, the taenia- form vesicular worm, the name of cysticerci, late- ly given by Zeder, Erster nachtrag zur naturg. der eingeweidewurmer, etc. p. 303, is equivalent to that 1 have retained. (134) In the brain, Ludwig de hydrope cerebri puerorum, Lipsiae, 177^« Hufeland ueberdie na- tur, erkenntrissmittel und Heilart der skrofelkran- theil, Jena, 1795, p. 339. Weikard Vermisckte med. eke Schrvfften v st., p. 7% 76. Medical facts and observations, London, 1792, vol. iii. In the liver, Baillie7s Morbid Anatomy, London, 1793, no. 9. Under the pectoral muscles, Werner, Ver- mium intestin. brevis expositionis cuntinuatio se~ cunda, curante Fischer, p. 7. In suppurated ab- scesses, Hunter, in the Transaction of a Society for the improvement of Medicine and Ckirurgical knowledge, London, 1793. (135) Melanges, par le societe des Curieux de la nature, a Berlin, vol. i. j?. 350. (136) Bloch, Traite de la generation des vers, p. 54. Zeder, the work cited p. 310, Professor Wal- ter assured Block, the work cited, p. 54, that in ex- amining some dead bodies, he saw a number of hy- datids and vesicular worms pass out of them. Werner, however, in the work cited, p. 68, hav- ing examined the membrane of the hvdatids, did 88 NOTES TO THE not find it organized, as I found it iu the vesicular worm which I had occasion to observe. (138) Nordische B ytrage, 1 band, p. 84, de Haen ratio medendi. p. tf, vol. ii. cap. 16, $ II; Mo- raud, in the Memoires de Vacademie de Paris, 1722, p. 158 ; Wagler, lib. de Morbo mucoso, Got- tingae, 17«>2, p. 190. (139) Sometimes hydatids are true varices of the lymphatic vessels. Sommering de morbis va- sorum absorbentium corporis humani. Trajecti ad Moenum, 1795, $ XXII. (140) It is well to have them before our eyes to form exact ideas of the structure of the vesicular human worm. See pi. II, fig. x, xi, xii, xiii, xiv, xv, xvi, xvii. (141) See § XXIV. (14*2) Hissert. de morbo mucoso praesidae, 1 g. Roederero, Goettingae, 1762, 4°. (143) Handbuck der Naturg., etc., p. 410. (144) It has been pretended that Aldrovando had given the description of this worm under the name of small lumbricus. A minute examination of his figure of this worm, clearly proves that he did not intend to speak of the tricocephalus, but of the ascaris vermicularis. (115) Vermium intestin. etc. p. 84; ascaris trickuira. (146) Wagler, Hissert. de morbo mucoso, etc. (147) Linnaei,Mantiss.p.54i3. Werner9 ver- mium intestinal, etc. p. 84. FIRST LECTURE. 89 (148) Pallas,Neue nordische, Beytrage 1, Band 1, sruck,p. 3, no. 21. (149) Leske, Elementi di storia not. parte pri- ma, vol. ii. p. 231, no. 3. (150) Tricocephalos or capillary head. (151) This worm constitutes the seventh ge- nus of Bloch, Traite de la gen. etc. p. 72, and the second genus of Goeze, in the work cited, p. 112. The former speaks of one species only, that is—of the human; the second describes a tricocephalus with the simple head (others reckon three species of them besides the human,) and one other having the head with fangs, see § XXXIV. (152) I say more frequently, because Bloch has sometimes found it extended in a spiral line in the human coecum, as may be seen in his work al- ready quoted, pi. IX, fig. viii. The form of this worm is very clearly represented in pi. IV. fig. i, ii. (153) See pi. IV, fig. iii. 1 m. (154) Satura observationum de animalculis in- fusoriis, Gottingue, 1765, 8°, p. 6. (155) Commentaria Petropolit. etc. vol. xix, p. 4/19. (156) In the 12th part of his Natur forscher, p. 182. (157) Versuck. Naturg. etc. p. 115. (158) See pi. IV. fig. iii, a. (159) Vermium intestin. etc. p. 85. (160) See pi. IV, and compare it with fis;. i. and ii. 12 ' 90' NOTES TO THE (161) See pi. IV, fig. iii. (152) See pi. IV, fig. iii, 1 m. (163) See pi. IV, fig. iv. (164) "Ovarium magnum, elongatum, globulis5 minimis (ova enim exprimere haud potui,) perfu- sum, tubo ab utraque extremitate instructum est. Anterior varie flexa, et inter intestina contorsta: posterior vero spiralis sub initium partis filiformis perditur." See Goeze, Versuch. etc. p. 115. (165) See Goeze, the work cited, p. 116. " Fragment of a letter of Dr. Wagler to Counsel- lor Wickmann, de Hannover.77 (166) See pi. IV, fig. v. (167) Comment. Petropolit. vol. xix. tab. 10, fig. vi. (168) See pi. IV, fig. vi. (169) Versuck. etc. p. 123. (170) Werner, Vermium intestinalium, etc. p. 72, says that the symptoms produced, whether by the ascaris vermicularis or lumbricoides, are near- ly the same. I pray the reader however to bear in mind all that has been said in the third Lecture on the varie- ty of the symptoms occasioned by these different worms. (171) It is however to be observed, that the as- carides vermiculares being viviperous, and the lum- bricoides oviparous, have by naturalists been im- properly ranked under the same genus. (172) Ascaris vermicularis, Linnaeus, System. Natur. p. 107*5; Bloch, Traite de la generation FIRST LECTURE. 93 des vers, etc, p. 69, 3d espece. Werner, Vermi- um intestinal, etc. p. 72; Ascaris pollicaris, Lin- naeus, Fauna suecica, no. 1269; Ascaride, Vallis- neri, opere Fisico-medicke, etc. torn, i, tav. 20, p. 178 ; Vermis Ascaris, Clerici historia Lumbrico- rum latorum, etc. fig. x.; Ascaris graecorum, Pal- las, Dissert, de infectis viventibus, etc. ; xiv, p. 12; Ascaris cauda selacea, Midler, historia verm, flu- viatil., etc. no. 165 ; Ascaris vermic. cauda subu- lata, Goeze ; Versucheiner, Naturges., etc., p. 97* Fuseragnolo vermicolare. Lecke, Elimenti de Sto- ria naturale, etc. parte prima, vol. ii. p. 230. (173) Observationes chirurgico-medicae Qued- limburg, 17^4, 4°. lib. 2, 06s. iv. (174) Hinsert. de Ascaridibus et Lumbricis la- tis, etc. (175) Vandoeveren, Hissert. de vermibus in- testinalibus, etc., is desirous of proving that the as- caris vermicularis is nourished by the chyle which is not absorbed by the lymphatic vessels, but blend- ed with the excremeuts. But as this worm is found in the vagina of wo- men, and in other parts moistened by the mucous fluids, we must rather believe that our worm is more closely connected with the mucus, etc. (176) Historia pliysiologica Ascaridum, Leo- wardini, 1762, 8'. c. tab. (177) Versucheiner Naturges. etc. p. 102; (178) See pi. IV, fig. vii. (179) See pi. IV, fig. viii. ix. (180) See pi. IV, fig. ix. i. 9x> NOTES TO THE (181) See pi. IV, fig. viii, k 1. (182) See pi. IV, fig- viii, hi. (183) Vermium intestinal, etc. p. 7% tao' 5> fig. 136. (184) See pi. IV, fig. ix, k. (185) See pi. IV, fig. x. (186) See pi. IV, fig. xi. (187) Versuckeiner Naturges. etc. p. 105,108. (1S8) Goeze, the work cited, p. 109, Funste anmerkung. (189) Abkand lung nouder Erzung, der War- mer in mensckilcken Carper, Halle, 1748, 8n. p. 28. (190) Systema Naturae, edit, xii, p. 1076. (191) In order to possess a figure of the lum- biico'ides similar to the lumbricus terrestris, see Tyson in tke Philos. Trans, vol. xiii, anno 1683, no. 147, this worm has been called ascaris lum- bricoides, Linnaeus, the work cited ; Bloch, Traite de la generation, etc. p. 63. Midler vermium terres- trium et fiuviatilium historia, etc. p. 35, no. 166 ; Werner, vermium intest. etc. p. 75. Lumbricus intestinalis ; Pallas, Hissert. de insutis viven- tibus, p. 15, no. 4; Lumbricus teres, Clereci, kistoria mat. et medica latorum lumbricorum, etc. p. 224; Lumbricus intestinalis kumanus teres, Klein, tentamen kerpetologiae, etc. p 62. Ascaris gigas hominum ; Goeze, Versuch. Naturges. etc. p. 65. Fuseragnolo I*ombricoide, Leske, Elimen- ii di storia nat. parte prima, vol. ii. p. 230; Pu- saria Lumbricoides hominum; Zeder, Erster FIRST LECTURE. 93 nachtrag zur Naturges. der eingeweidewurmer, etc. p. 26. (192) Tyson, in Philos. Transactions, etc.; Pallas, Hissert. cit. p. 13, no. 4. (193) Willis, Exercitatlones de anima bruto- rum, p. 201, edit. gen. Redi, osservazioni intor- no agli animali viventi, etc. p. 132. Those writers who have mantained that the hu- man lumbricoides was exactly like the lumbricus terrestris, have certainly been inattentive to the species of the former, which are male and female, while in the latter the worm is hermaphrodite. (194) Zeder, Erster nachtrag., p. 26, has sat- isfactorily made it appear that all the signs detailed by writers iu order to settle the points of distinction between the human lumbricus and that of horses and hogs, are equivocal. (195) Opere fisico-medicke, tome i, p. 281. (196) Epistola cit. ad Andryum, etc. (197) See pi. V, fig. M (198) Versuck. Naturgeschickte, etc. p. 67. (199) Vermium intestinalium, etc. p. 76; see pi. V, fig. v. (200) See pi. V, fig. i. One of these fibres is longitudinal and dorsal, the other abdominal, and the two others may be called lateral. Each fibre is composed of smaller filaments. Vallisneri thought he discovered several dark points in these, which he called spiral. Van-Phelsum has fully demonstrated the fal- lacy of this observation. 94 NOTES TO THE (20!) See pi. V, fig. i. a. (*0,e) See pi. V, fig. iv. (203) Opere fisico-mediche, tome i, tav. 34. (204) Ver such, naturges. etc, p. 67. (205 This lumbricoides was five iuches long. The observation is from Dr. Maecker ; see Block, Traite de la gen. des vers, p. 66. (206) Ludwig, Programma de Lumbricis in- testina perforantibus, Lipsiae, 1762, 4°. (207) Blasii, Observationes medicae rariores, Amstaelodami, 1677* IS, p. 79, observat. 10, p. 80, obs. 12. (208) In the brain of a sea calf; see Block, Traite, etc. p. 6-3. (09) Schultz, Hissert. de Lumbricis effractor- ibus, Halae, 174v>, 4°. (210; Traite des maladies des enfans, etc. p. 306. (211) Vel. Acad. Handl. 1763, p. 113. (212) Benivenius de abditis, etc. cap. 86. (213) Mouteti, Theatrum insec.p. 299. (214) Peredia de curandis morbis, etc. lib. 1, eap. v. (215) See pi. V, fig. viii. (216) See pi. V, fig. ii, iii. (217) Tractatus de anima brutorum, etc. lib. 1, cap. iv. (218) Werner, Vermium intestinalium, etc. ?. 79. (219) See pi. V, fig. ix. (220) See pi. V, fig. ix. 221) Vermium intest. p. 80. FIRST LECTURE. 95 (222) Biblia naturae, p. 796, 802. (223) Opuscula minora, Lipsiae, 1782, p. 131. (224) See pi. V, fig. xi. (225) Vermium intestinalium, etc. p. 82. (226) Miscell. Berolin, torn, in, p. 47, torn. Vi, p. 129. (227) See pi. V, fig. vi. (228) See pi. V, fig. vii. (229) Amatus Lusitanus, Curation ; med.cent. 9, no. 46, p. 513, relates the observation of anoth- er physician, his cotemporary, who, by means of a suitable remedy, succeeded in expelling from the body of a patient, a very long lumbricoid worm. Its head was crushed to pieces and other worms came out of it. Borel, Observationum medico-pkysicarum, cent. 1, obs. 89, speaks of another lumbricoides which he observed to be full of an immense quantity of small worms. A similar observation has been sent to us by Plater, Observationum, lib. 3, p. 6^7, and by Panarolo, lntrologismorum pentecostae quinque, Romae, 1652, 4°. obs. 15. Thus has the imagination of several observers been sometimes surprised, though they have been enlightened men. (230) Descriptio et iconica delineatio novi gen- eris vermium stomuchidae dictis in corpore huina- no hospitantium; Accidit observatio medico-prac- tica de Lumbrico per urethram excreto, nee non de Lumbrico alvino-ut utmortuo parturients : Amstelo- dami. 1780, 8°. 96 NOTES TO THE (231) We must except the Ascarus scabiei, since this, being the special cause of a peculiar dis- ease of the skin, should be particularly considered ; see Bonomo, Observazioni intorno ai pelli celli del corpo umano. Florenza, 1683 ; Linnaei, Amae- nit. acad., vol. v. no. 82; Morgagni de sedibus et causis morborum, etc. epist. L. v, art. 4; Wick. mann Aetiologie vonder Kraze, Hanover, 1786; Hartmann, Hissert. sistens quaestiones super Wichmanni aetiologiam scabiei, etc. Francofurti, 1789, 4°. (232) Happii, vermium intestinal, hominiskis- toria, p. 7> § IV. (233) See the note, no. 32. (234) Giornale Fisico-medico, Pavia, 1795, tome iv, p. 71. (235) Traite des Maladies des enfans, etc. p. 304. (236) Goeze, Versuck. Naturges. etc. p. 71', Werner, vermium intestinalium, etc. p. 87; doc- tor Pereboom, a physician of Amsterdam, pretend- ed that he had discovered a new kind of human worms, Bescriptio et iconica delineatio novi gene- ris vermium stomachidae dicti, etc., which accord- ing to him inhabits the stomach ; this worm is of a darkish colour, and seems to possess a more com- pact texture than that of the lumbricoides. Goeze and Werner have however made it ap- pear that this stomachic worm is a real lumbricoi- des, which may be a little different in some of its parts. FIRST LECTURE. 97 (237) Fasciola intestinalis Linnaei,'Systema na- turae, edit, xii, p. 1078; Dr. Montin expelled this worm from the body of a woman, and gave a description of it in the Memoires de VAcadamie Royale des sciences de Suede, in 1763,2?. 113, etc. This worm is found in the human body, and Sme- zio had already spoken of it, Miscellan., p. 563. See Goeze, Versuch. naturges. etc. p. 186. (238) Werner, Vermium intestinal, brevis ex- posit. Contin. etc. p. 19. (239) Block, Traite de la generation des vers, etc. p. 68, 71. (240) We have in the Traite des Maladies des enfans, of Rosenstein, an excellent description of this worm : see also Bloch, Traite de la gen. etc. p. 73 ; Goeze, Versuch, naturg. etc. p. 123 ; Wer- ner, Vermium intest. brevis exposit. Contin. etc. p. 5. When this worm insinuates itself into the stomach it is very dangerous. (241) Brera, Sylloge Opusculorum, etc. vol. iii. Ticini, 1799, p. 254 ; opuscul. 5, de morbo Yaws dicto et de vena medinensi, etc. (242) Auct. ad Helminthologiam corporis hu. mani, Lipsiae, 1793, p. 19, 22, tab. 59 ; Zeder calls it " Polystoma sphincteribus sex, pinguicola, depressum, postice acuminatum sphincteribus sub margine antico retractili lunatira positis, cauda enr- vata ; habitat in adipe pone ovarium humauum ;'* Erster, Nachtrag, etc. p. 203. 13 98 NOTES. (243) Goeze saw two of them expelled from an infant who died of atrophy; Versucheiner Natur- geschickte, etc. p. 102. END OF THE NOTES OF THE FIRST LECTURE. SECOND LECTURE. THE ORIGIN OF HUMAN WORMS. § LVII. The philosopher, surrounded by a multitude of immense objects, has always sought to raise that mysterious veil, which conceals the cause of the most surprising phenomena of nature. It is thus that the first useful discoveries have aris- en ; these have opened the way to researches still more wonderful, by the aid of which the fact has been established, that natural things have between them an affinity more or less remote or immediate, direct or indirect. The continued examination and assiduous study of the great book of nature, have enabled us to es- tablish several primitive laws, and led us to adopt a number of immoveable principles, of which the man of genius avails himself in order to elucidate various phenomena peculiar to living beings. Guided by this method entirely analytical, and conducted by experiment, we arrive atjust relations, unequivocal analogies, and solid points of union. In conformity to these philosophical principles. I have laboured to investigate the prime origin of those worms which inhabit the human body. 100 THE ORIGIN OF This subject, divested of the hypotheses of nat- uralists, and treated with the evidence of facts, merits the full atteution of physicians, since it di- rectly influences the diagnosis and cure of vermin- ous and other severe asthenic diseases. § LVI1I. The origin of worms, not only in man, but also in other animals, has been the theme of profound meditations among the greatest natur- alists and most eminent physicians. On this subject there have been many disputes, and much writing, and some have imagined that much had been observed; but little however has been determined, while it has, in fine, been judi- ciously concluded to hold as doubtful all opinions. hitherto adopted( l) by the most fortunate observ- ers, since they rest on suppositions which, though ingenious, are rather slippery than solid. § L1X. Excepting only the vesicular worms, the structure of all the other human worms has not yet been sufficiently studied. Hence we have seen some of them furnished with the parts which constitute both sexes ; others having both individ- uals united in one, as the taeniae ;'2) while some exhibit these parts distinct in the different individ- uals, as in the tricocephalus,(3) the ascaris vermic- ularis.(4) and the lumbricoides.(5) This would be saying that our worms, like all other living be- ings less imperfect than they, proceed from eggs peculiar to the analogous species.(6) In effect, some multiply by depositing their eggs, to be afterward fecundated by the passing of HUMAN WORMS. lul the male without any preceding copulation ; others propagate by the union of the two sexes ;(7) while a third kind fecundate themselves like the tae- niae.^) See the first Lecture. These observations which have been many times repeated and verified by approved writers, leave no doubt of their correctness ; they are di- rectly opposed to the equivocal generation admit- ted by various naturalists as a cause of the origin of our worms.(9) We readily agree that the simplicity of the structure of worms should exempt them from the ordinary laws, relative to the functions of their life. It would however be improper to attribute their binh to some more simple combinations, which some persons have supposed they have seen by means of the microscope,(lO) in comparison of oth- er more perfect beings, while the organs which serve for their reproduction are visible. Neither the sex, coition, nor the eggs, nor gen- eration were known to Aristotle and the ancient philosophers, as they are known in our time. In those remote ages, no other generation for imper- fect beings was acknowledged, than the corruption of substances.(ll) Putrefaction must then have been considered as the cause of the existence of these individuals. At this period there was nothing more ingeni- ous than the doctrine of equivocal generation, in- 108 THE ORIGIN OF vented for the purpose of finding a cause for the creation of animals ! Nevertheless this sublime hypothesis, to which some have pretended to give weight in our day, af- ter the surprising observations of Needham,(12) and the metaphysical reasonings of the very ingenious Red,fl3) seems by no means applicable here, since, I repeat it, the generative organs of worms, are very evident, as well as in the more perfect animals. $ LX. The quantity of eggs which worms de- posit in our bodies, being prodigious, it must fol- low, add the anti-ovarists and the partisans of pu- trefaction, that in every man an immense number of worms must be developed, which is contrary to experience. This sage reflection, far from overthrowing the system already confirmed respecting the origin of worms, favours it in all its extension ; and, in my opiniou, it proves nothing, unless it be that certain determinate circumstances are necessary to facili- tate the development of the eggs and the rise of worms. Rosenstein has pointed out these circum- stances so well that it is proper to give them in his own words :(14) "The eggs which are deposited by human worms in our intestines arc developed, 1. when there is a moderate heat; 2. when they are not carried out of the body, which is often pre- vented by the agglutinating mucus of the stomach and intestines, especially when they are situated in the folds of this canal, and when they are not dis- placed by the peristaltic or antiperistaltic motions of HUMAN WORMS, 103 these viscera, nor by the pulsations of the arteries which pervade their texture; 3. when they are not injured by the vapour which is continually diffus- ed through the stomach and intestines by theexha- lant vessels. In like manner sown wheat does not vegetate if it is inundated by incessant rains." § LXI. Children, women, and persons of soft and weak fibres, are more subject than others, to worms. In asthenic diseases, according to practi- tioners, worms are frequently voided with the fe- ces, or discharged through the mouth.(15) Children who have suffered the operation of cutting for the stone, are often tormented with worms, which are developed in great numbers in a a few days after the operation. The fear, occasioned by the sight of the appa- ratus, seems greatly to favour the increase of these animals, because it contributes to weaken the body. From these practical observations, we may with certainty infer, that the debility or consumption of the parts of the human body in which the eggs of worms are situated, is an essential condition of their unfolding. This circumstance was fully un- derstood by the estimable Redi, who was notwith- standing much embarrassed, when, in order to ex- plain the formation of worms, he had recourse to his famous hypothesis of the sensitive soul, inher- ent in those parts of the human fabrick, from which the worm was to originate. This learned opponent of equivocal generation, propagated an hypothesis still more metaphysical; 104 THE ORIGIN OF be has at least the merit of having apprised us that the addition of certain human animal particles, is indispensable to the development of the verminous germ, and for the nourishment of the hatched worm. It is thus that human worms, supported by human nutrition, acquire those differences of structure, which are not noticed in the worms of other ani- mals, though of the same species. In this manner may be explained those epidem- ics of verminous complaints, which being ordinarily the effect of uncommon scarcity of food, or of some putrid alteration of the atmosphere, commence with a set of symptoms quite peculiar to a general asthc nic affection of the highest degree, and of a local consumption of certain parts of the body attacked with it. In fine, it is thus that certain individuals who are well nourished, are exempt from these at- tacks, and in whom the blood consequently circu- lates with force, whose secretions go on with har- mony and regularity, the parts of whose bodies are maintained in a state of perfect cohesion ; in this respect it may be said that health is general and lo- cal. The worms which live at the expense of the human body, though of the same species, reproduc- ing themselves elsewhere, will they not be indige- nous to it?(l6) Do the latter deserve to form a pe- culiar and separate class(17) in the general histo- ry of the worms which the naturalist meets, wheth- er within or without the body of other animals? § LXII. The Taenia canina solium,(18) ac- cording to Werner, has great resemblance to the HUMAN WORMS. 105 human Taenia cucurbitina ; differing from it only in some singularities, by no means characteristic. The same may be said of the short tailed tae- nia, found in cats. Its articulations, according to Bloch7s figure,(20) in the middle of the body, can hardly be distinguished from those of a human tae- nia cucurbitina, somewhat advanced in age.(21) In fact, Pallas(22) considers both as belong- ing to the same species, and he attributes to the diversity of food merely, the difference noticeable in their articulations. In the anitra clangula and the anitra fuligola, we observe a taenia, which Block calls taenia artic- ulis cono'ideis,(%3) whose external form, excepting the tail, differs in nothing from the young human taenia cucurbitina, particularly from that represent- ed in plate I, figure ii. Sheep are very subject to worms, because of their feeble and lax fibre, and have a constitution- al tendency to diseases of debility; they are often tormented by a sort of taenia, which has been de- nominated Taenia vasis nutriciis distincta.(2$) Its exterior form has great resemblance to the broad human taenia. § LXIII. We have already remarked that men and other animals are likewise exposed to vesic- ular worms.(25) The difference however which exists between the human vesicular worms and those of animals, seems to be essential ;(26) it must however be acknowledged that the history of these 14 106 THE ORIGIN OF worms is not yet well understood, since their or- gans of generation have not yet been discovered. It cannot therefore be ascertained at present, whether the hermit vesicular worm belongs exclu- sively to man, or whether the social vesicular worm pertains exclusively to other animals.(27) § LXIV. The tricocephalus which Block(%&) says he has found only in the human coecum, has been discovered by Goeze,(2Q) in the intestines of the male mouse; by Wagler in the horse,(30) and by Ruysch in the wild boar.(31) Another trico- cephalus, having fangs at the head in form of a crown, has been found by Pallas, in the Lacer- ta apoda, as we have already said elsewhere.(32) § LXV. In passing from the tricocephalus to the ascaris vermicularis, we must recollect that this worm is found in the intestines of the Rana temporaria. Its resemblance to the human ascaris is such that Goeze pretends that our worms are innate in us. He could not perceive the least difference be- tween them, and, as an exact and impartial obser- ver, was obliged, perhaps against his opinion, to reduce them to the same species, and to give a de- scription of them together.(33) This excellent and illustrious naturalist sawi on another occasion, the ascaris vermicularis, in tne intestines of the pike and of the aquatic sala- mander.(34) All the ascarides vermiculares are viviparous like the human. HUMAN WORMS. 107 § LXVI. The human lumbricoides is not at all distinguishable from that of the horse or hog ; and the distinctive characters which have been adopted by writers, even the most modern,(35) are very faint. If the lumbricoides are of but one species, there is certainly no good reason for sepa- rating them into three particular species.(36) § LXVII. If worms of the same species have been found in the human system and in the body of animals ; if the difference between them, though slight, arises from the difference of their food; why resort to hypotheses to explain the origin peculiar to the worms of the human body ? If we also ad- mit that Linnaeus was deceived, it is by no means surprising that the bishop Menander, cited by Ros- enstein, that Unzer and Tissot declare they have found in water the same species that are seen in man; may they not also be found in fishes and other an- imals ? Our researches respecting this genus, are very limited. Perhaps in time some more fortu- nate observers may discover the eggs of the prin- cipal human worms in those animals which supply our daily food, perhaps it may yet be agreed that there are worms which are peculiar to animals; but we cannot admit that they are peculiar to each species, as Bloch(37) pretended; they will form a separate class whenever the effects, produced by the quality of the nutriment that is assimilated to their parts shall be duly considered. § LXV1II. That a taenia and some lumbri- coides have been found in infants, not yet come to 108 THE ORIGIN OF full birth, by Hippocrates, Brendel(28) and by Selle;{9 that a fasciola hepatica has existed in a lamb still in utero ;(40) that worms have been found in infants who have died immediately after they were born,(41) and in sucking animals ;(42) it seems that all these favourable arguments come in support of the opinion of those who believe that worms are innate in man and in other animals. If we consider however that the eggs of worms are so small that they are imperceptible even under the tube B, no. 1, of Hoffman's microscope(43) (these eggs are real ovaries or masses of small eggs 0 44) nothing is more probable than that these eggs are absorbed by the lymphatic vessels, that they pass into the circulation, pervade the system with the blood, and are deposited in different parts of the body. W e meet in fact with these worms in the deep- est and most hidden parts of man and other ani- mals, though they ordinarily inhabit only the in- testinal tube. (45) I think we may conclude with Dr. Panzani,^) that the worms of fetuses are engendered in the womb of the mother by the development of their germs, provided the necessary circumstances which we have pointed out, there concur.(47) Convey- ed with the maternal blood(48) into the humors of the fetus, and accidentally deposited in the intesti- nal cavity abounding in mucus, they are here un- folded, favoured by their position and the viscosity of the meconium. These verminous germs are more HUMAN WORMS. iuj. prone to expand and grow (49) in the fetal and in- fant body, than in older and firmer subjects, on ac- count of their feebler organization. Hence the reason why worms are more frequent in infancy and weak persons, while they are comparatively rare at adult age, and still more so in robust and vigorous constitutions. § LXIX. Human worms, accustomed from their origin to live in our viscera, resist their ordi- nary motions, and grow there in an astonishiug manner; and when expelled, they easily die like fishes and other aquatic animals when taken from their native element. It should be remarked that these intestinal worms, if removed from their usual place of resi- dence, either perish or are evacuated. Taeniae and lumbricoides, having once entered into the stomach, are soon vomited up alive, or kill- ed by the action of the digestive powers. The lumbricoides, once passed beyond the valve of Baukin, we may consider as destroyed, and they are evacuated.(50) § LXX. We now see how the eggs of the prin- cipal worms are introduced into the human body ; since when once transported and absorbed into the mass of fluids, ihey are diffused through and depos- ited in the most concealed parts of the body, and there enlarge and unfold when circumstances favour their development. Vallisneri sought for the origin of all worms in the first man.(51) 110 THE ORIGIN OF This opinion well considered, though after- ward adopted by Van-Pkelsum(52) and by An- dry,{53) is subject to all the objections advanced by the physiologists and naturalists, who have proved by facts, how destitute of reason is it, par- ticularly when applied to the universal generation of oviparous and viviparous animals. The worms found in fetuses and infants not yet come to the full term of gestation(54) leave no doubt that the seed of the worm is communicated to the fetus from the mother, whether she may have contracted it from her parents, or swallowed it accidentally with the substances taken for her daily food. If, by means of the placenta, the mother transmits to her offspring the matter which nourishes it and causes its growth, why may she not also transmit to it the seeds of the worms which are [included in very small germs(55) and which circulate in her fluids? Are not the personal qualities of the mind, and the peculiarities of the features, or those of her family, in like manner transmitted ?(56) Besides, the worms observed in the umbilical cord of the fetus,(57) in the uterus(58) and even in the placenta,(59) as well as the disposition to worms in the sons, mother and grandmother, re- marked by Rosenstein,(60) evidently prove that the seeds of worms may be transmitted, not only from the mother to the fetus, but also developed iu the parts contiguous to the route of commu- uication. HUMAN WORMS. Ill § LXXI. The oviparous animals, particularly birds, are very subject to worms ; these increase or grow insulated from all communication with their mother. It consequently seems ttiat worms in them are in- nate, and that for this reason, they may likewise be so in man, since nature is uniform in her great ope- rations. This objection would certainly have great weight if all that Block affirms were true, that is to sny,(6l) that in most animals, there are worms peculiar to them. We have already observed that we cannot strictly admit that there are worms peculiar to each class of animals ;(62) but that there are merely some varieties of them. On the other hand it may be said that in ovipa- rous animals, birds for instance and fishes, we meet with worms proper to each species. In truth, the fasciola, or small band (ligulaj is common to fish- es and birds ;(63) we find in these animals indif- ferently the gordius,(64<) the capuckon,(65) the eckinorinckus,(6&) the planaria cilindrica,(67) the taeniae(&8) and the worm named ckaos infusori- us mucosus.(v9) It is natural therefore that the eggs of these worms should, without distinction, be introduced into the animal body with its food, and that in man they should particularly be insinu- ated with the mother's milk. (70) Rosenstein says,(71) that with impure water we swallow an immense quantity of very small worms, and that it may be from this cause that many miserable peo- 1IC THE ORIGIN OF pie are so frequently tormented with them.(72) In Sweden the third part of the sick poor, who are badly fed, and who use the waters of the Soetra, are very often attacked with verminous diseases. $ LXXII. Faithful to the maxims established in the beginning of this second Lecture, 73) and remote from all the charms of hypothesis, I have only been solicitous to present such observation! as relate to the generation of worms in the living human body, which, if not entirely satisfactory, when philosophically analysed, throw some light on a subject which has always been the object of the most assiduous researches of physicians and naturalists.(74) If we unite all that has been hitherto said, it seems that we may with reason establish six funda- mental principles relating to the origin of human worms ; if they should not satisfy naturalists, they at least merit all the regard of practitioners, for whom this work is intended. We shall conclude, 1. That no worm can strict- ly be said to be innate in the human body; because the verminous seed or germ is received into our sys- tem, either from the mother while the fetus is in utero, or from sucking mercenary iiurses,(75) or from the saliva of the nurse by the infant,(76) or finally it may be insinuated into us with our food and drink. In these ways, the eggs of worms are dis- seminated through our bodies. 2. That these seeds, in whatever manner they may get into the human body, are not developed unless deposited in parts HUMAN WORMS. 113 abounding in mucosity; in fact these worms are found in those parts of the body which are most liberally supplied with mucus ; 77) besides, infants who have worms, commonly evacuate them with thick, whitish mucus in form of small globules. The taeniae are also most frequently discharged in a mucilaginous canal, improperly regarded by Lancici as an excrescence of the intestines/78) and which Bianchini, with more reason, has called the verminous receptacle or nidus,(79) made up of a great quantity of mucous matter, tenacious and gbiy- Nature therefore is not so remote from the law common to all oviparous insects, great and small. These eggs do not become worms except in suit- able places. 3. Besides the circumstance pointed out in no. 2, worms do not multiply except when the body is weak, which is particularly manifest in those parts where the worms are situated. The debility of the heart and arteries, and the extreme vessels, the wasting of the body, the torpor of the muscular and vascular systems, the excess of mucus, putre- faction, weakness of the organs of digestion, and diminished cohesion of the parts of the system, are all effects of a prevailing asthenic diathesis. The abundance of mucus being favourable to the devel- opment and nutrition of worms, they necessarily increase more rapidly in debilitated systems.(80) In fact, children are more subject to worms than adults, and women than men :(81) in fevers and 15 114 THE ORIGIN OF other asthenic diseases, the patient is exempt from them after the recovery of his health. The mucosities and lymph which abound in weak bodies favour the development of worms by serving to nourish them. These humours do not possess life, as Hunter supposed, and which the illustrious Blumenbach has so well refuted.(82) 4. Worms once developed in the human body, increase and multiply in the ordinary manner of the other more perfect animals, because they possess the genital organs of the two sexes; and as in each body and at all times, the circumstances which fa- vour their development do not always take place; a great number of eggs are evacuated before they are unfolded ; hence it was requisite that the num- ber of female worms of the intestines should ex- ceed the males, and that the quantity of eggs should supply the number lost, otherwise their species might become extinct. The pike, carp, tench, and other fishes which we daily eat, deposite great numbers of eggs in fresh water ; all these eggs do not hatch ; many are de- stroyed by other fishes, and fail from circumstances unfavourable to their multiplication ; these species are nevertheless perpetuated, because in the great quantity of eggs deposited, several are developed and grow. Nature is therefore uniform in her operations, with regard to animals subjected to similar vicissi- tudes. HUMAN WORMS. 115 5. When worms have once been developed in the human body, they take effect and increase, and are nourished by the elements of our system, (doubt- less by the most appropriate,) and they acquire a larger size than those of the same species which remain in the body of other animals, notwithstand- ing the diversity of figure, since naturalists have not yet been able to affirm a characteristic differ- ence between them.(83) It seems to be already proved, by an attentive examiuation of the rudiments, or first forms, of worms, whether human, or those of other animals, and perhaps also those of the earth, that they are formed and organized from the same matter, and that they exhibit a structure more or less uni- form.(84) It is therefore natural that if these worms have acquired life in the human body, that they should grow there, and perish when discharg- ed from it; but they can live in places where oth- er beings would be destroyed or digested. It is however demonstrated that the worms of other animals, introduced into our bodies,(85) if they do not multiply, like those proper to the hu- man system, certainly live there and increase in size. 6. Finally, worms, being foreign to the human body, do not multiply or generate in it, except when it is predisposed to the asthenic diathesis, or when asthenia actually exists. It appears that Block has advanced a proposition too general in wishing to prove that worms are not always the 116 ORIGIN OF HUMAN WORMS. cause of disease in the human body;(S6) the pres- ence of worms is at least a certain index of asthe- nia, which is a state contrary to that of perfect health.(H7) Furthermore, the very extraordinary diseases occasioned by worms are either idiopath- ic or sympathetic, and they clearly admonish us that worms cannot remain with impunity in the hu- man system. END OF THE SECOND LECTURE. NOTES TO THE SECOND LECTURE. (1) "Ingenue fateor unam hypothesim non mi- nus obscuram esse quam alteram; fateor etiam me nescire, quae vera sit harum, nee opinari me au- dere, ob difficultates ab utraque parte mihi impen- etrabiles. Dies forte docebit." Thus wrote Retz, an excellent Swedish natu- ralist, after having examined the different hypo- theses published by several illustrious authors on the generation of worms in the human body. See Lectiones publicae de vermibus intestinalibus, im- primis hamanis, etc. p. 55. (2) See § XVIII. (3) See $ XXXIII. (4) See $ XLI, XLIII. (r) See § XLIV. (6) "From the egg of a fly proceeds a fly; from the egg of a hen, a pullet, and not a serpent; from the egg of a goose, a goose, and not a fish. Thus from one worm is produced another worm, and nothing else.7' Rosenstein, Traite des malar dies des enfans, etc. : ckap. xxii, p. 293. 118 NOTES TO THE (7) In this manner must the ascarides vermic- ulares be fecundated, since, as we have remarked, these worms are oviparous. See sect. XLII. (8) See $ VIII and XVIII. (9) We ascribe to Aristotle the origin of equiv- ocal generation. But before him, some ancient philosophers, particularly Pythagoras and Anax- agoras, counting as nothing the male, female, coi- tion, the eggs, and generation of beings, had al- ready imagined a certain order of nature, by which shapeless matter variously combined, tended to produce an organized being. According to Aris- totle, there were three worms in the intestines, the broad worm, the earth worm, and the ascaris ; all of them, agreably to this philosopher, derived their origin from the excrements contained in the human body. The theory of Hippocrates, on the origin of in- testiual worms, seems to reduce itself to equivocal generation; this great man supposed that worms were developed in the fetus only, having remark- ed that in aduts the excrements do not remain so long in the intestines, as the meconium does in the bowels of the fetus. The system of generation, imagined by the celebrated Buffon, does not differ much from that of the ancient philosophers. This eminent writer pretended that the primitive molecules of animals, instead of being inert or dead, were deposited in the bosom of nature, already organized and living, and consequently more disposed to the generation SECOND LECTURE. 119 of different animated beings. The system of the infusory animals, to which some naturalists have had recourse in order to explain the origin of worms in the human body, is essentially contrary to the nature of those animalcules. In fine the crystallization of salts, another ar- gument of the partizans of equivocal generation, is, in my estimation, something too gross and insignifi- cant to occupy my time in refuting it. For this inor- ganic production, the concourse of homogeneous par- ticles is indispensable: before this is applied to animals, it ought at least to be shown how the com- bination of heterogeneous particles can take place. (10) The microscopical observations, on which the moderns rest their arguments in favour of the equivocal generation of some less perfect living creatures, ought not, in my opinion, to be regarded as certain proofs, because a subsequent examina- tion has proved them to be false. For example, the infusory worms of Bonnet: Considerations sur les corps organises ; Amsterdam, 1762, tome i,p. 3, and. of Wrisberg, Satura observationum de ani- malculis infusoriis, p. 95, strictly compared with polypes, and which it has been thought are repro- duced like them, have been found of a different sex by Goeze, Bonnet, Und an deverer naturfors- cker ab kandlung aus der Imektologie herausgege- ben, von Goeze ; Halle, 177^? V- ^7> who has ob- served that all the uteri of the females were filled with living fetuses. 130 NOTES TO THE (11) "Alia animalia sponte procreantur, alia in excrementis, aut jam in excretis, aut adhuc intra animantem contentis ut quae Taeniae, sive Lum- brici appellantur, quorum tria genera sunt, latum, teres, et quod Ascarida apellatum est, ex quo nihil procreari aliud potest." Aristoteles, Historia an- imalium, lib. 5, cap. 19 ; see Ar., Opera Graec. et Lat.; ed. Gulielm. du, Vail., Lutet. Paris, 1729, in fol. p. 849. Sic ubi deseruit madidos scptemfluus agros Nilus, et antiquo sua flumina reddidit alvco, Aethereoque recens ex arsit sidere limus ; Plurima cultores versis animalia glebis Inveniunt; et in his quaedam modo coepta sub ipsuni Nascendi spatium; quaedam impersecta ; suisque Trunca vident numeris: et eodem corpore soepe, Altera pars vivit: rudis est pars altera tellus. Quippe ubi temperiem sumpsere, humorquc, calorque, Concipiunt: et ab his oriuntur cuncta duobus. Cumque sit ignis aquae pugnax,vapor huinidus omnes Res cieat, discors concoidia faetibus apta est." Ovid. Met am. lib. 1, v. 422. [The American Translator is neither prepared nor disposed to enter at any length into the merits or demerits of an hypothesis, which has already occupied more time than it has rewarded with any advantage. So far as he has examined the sub- ject, or can conceive of it, he fiuds no reason to adopt the opinion of the equivocal generation of insects or of any other animals. But he would be less wise than presumptuous to imagine that he had any thing to offer which is likely to weaken the SECOND LECTURE. J21 faith of those who can believe without reason. This ever baseless and now declining supposition still enlists on its side, or holds in suspense, some en- lightened minds, whose talents and industry he respects,* and this is the only circumstance which leads him to bestow a moment's consideration on the subject. If these friends of the doctrine did not hesitate to follow him, he would consider the production of any animal, however simple or mi- nute, without the aid of animal life, organization, and action, as wholly incredible. The equivocal hypothesis is neither specious nor probable; it de- rives no support from aualogy, no aid from reason, no countenance from facts. All these have anoth- er aspect and another tendency. The whole fab- rick we renounce seems to be nothing better than an unsuccessful effort to conceal that ignorance which its framers wanted magnanimity to acknow- ledge. In its operation it has been worse than useless, tending to obscure truth by substituting for its light a senseless conjecture. It ascribes to chem- istry, or to "creative warmth," what pertains alone to animal life. In the natural sciences it has been thought a defect sufficiently great to confound the animal with the vegetable kingdom, which do indeed ap- proximate and sometimes seem to run into each * Among these are several of the water's medical acquaint- ance. See Rudolphi, Cap. xviii, De generatione Eutnzoorum spontanea: vol.i. published iu 1810. 16 122 NOTES TO THE other. But this error is still more enormous ; with gross blindness, or the most vague and licentious imagination, it disregards the boundaries which nature has set between the animal and mineral divisions of her works. Till this hypothesis arose, these sacred land- marks had remained inviolate ; but now inert, life- less matter, mere earth, is at once to be endowed with all the properties and attributes of living, animal bodies,—and all this without an agent or a cause ! Whenever a disciple of the equivocal expedient will show us an ascaris or an elephant, (for though the examples differ, the labour will be the same,) bred without parents, we will hold ourselves bound to receive whatever he may choose to advance on the spontaneous production of animals. Till this exhibition is made, those who reject the idea of an effect without an adequate cause, as absurd and unfounded, must be permitted to believe that the generative system of insects and worms is des- tined to perform the same office which is assigned to it in other living beings. It is true that every class of animals have their peculiarities, insects certainly have many, especially in their sexual organs and manner of propagation. The two sexes of the same species are so extreme- ly unlike each other that they would rather be ta- ken for completely different species than for ani- mals that could pair together. SECOND LECTURE. 126 Among the bees and neighbouring species the greater number of individuals have no sex; they are conceived and born, without being destined, as in the ordinary course, to conceive or produce im- pregnation. Their copulation is performed in a very extraordinary manner in many instances. The act is performed on the wing, and some are winged only during the short period of copulation. Some copulate only once, and the act is very soon followed by death ; in which cases the life of the animal may be prolonged by deferring the copula- tion. It is said the hydatis, or vesicular worm, re- ceives nourishment, like vegetables, from its exter- nal surface, having no mouth. The polypus has no organs of generation, as every part of its sto- mach, or body, is endowed with the generative power; &c. &c. But these facts, singular as they are, give no weight to the feeble hypothesis in question ; for here, as every where else, so far as we are ac- quainted with the natural history of animals, every one, it is immaterial however much the mode may vary, is produced and continued in its successive generations by the properties and actions of animal life. "When the great Creator first gave being to the natural world, every part of the vegetable and animal systems was brought into existence by an extraordinary exertion of productive power; they were not moulded and matured by the slow opera- 124 NOTES TO THE tion of time, and the cooperation of physical and mechanical forces, but < He spake, and it was done.' " But since that first act of creating power, we see that these creatures are propagated and perfect- ed by processes more gradual, successive, and ope- rose, many of which can be successfully traced by human wisdom, and admit of being regulated, fur- thered and controlled by the interference of human culture and ability." Christian Observer, vol. xiv. p. 574. But it is said there are hard cases in the natural history of worms and insects ; it is true there are, but none of these are so hard as the de- fence of the device which is set up for their solution. These cases are already greatly diminished in number, and the remaining difficulties are vanishing exactly in proportion to our increasing acquaintance with the forms, laws and operations of animated nature; and our progress in these sciences will at all times be accelerated by acknowledging the exti isting limits of our information, rather than by as- signing false causes for known phenomena. It is more fair and promising to admonish the student of nature of his descent into the twilight of doubt, or the darkness of ignorance, than to pre- tend to direct him- where he cannot be guided in safety. Thus placed on his guard, if he cannot open a clear path for others, he will at least be more likely so to feel his way as to able to retrace his steps to the point whence he started, and thus avoid the risk of being lost himself, as well as the hazard of misleading his followers. SECOND LECTURE. 125 On the whole, there is every reason to believe that the origin of all animals has been the same, and that the laws and conditions which prevail in the economy of other animals, take place also in the reproduction of insects and worms; the only di- versity in "elation to these animals is, that in these classes of !ier productions, nature accomplishes her purposes by some peculiarities of structure, and mode of action. I submitted this note to the criti- cism of a friend, who favoured me with the fol- lowing observations. (4) among infants nursed and detained in or- phan houses, who have been attacked with typhus accompanied with petechiae.(55) This worm com- U2 VERMINOUS DISEASES, monly passes from the large(56) to the small intes. tines. (57) § LXXXIX. In mucous diseases which are manifestly asthenic, arising from a defect of nutri- ment, and which I think might properly be called, general consumption, when symptoms of worms are subjoined,—they are most frequently produced by the tricocephali and lumbricoides which live to- gether. SYMPTOMS OF THE ASCARIS VERMICULARIS. § XC. Commonly this worm resides in parts abounding with mucosity,(5*>) such as the large in- testines, the vagina, etc.; they generally inhabit the lower portion of the rectum.(59) By contract- ing and extending themselves they excite in the large intestines, particularly in the rectum, a dull feeling of irritation, or a tedious and unsupporta- ble itching, and sometimes very acute and cutting pains.(60) It is probable this worm insinuates its mouth into the folds of the intestines, and thus re- sists the peristaltic motion of these organs. They are united into conglobate masses with other worms of the same family; the inner surface of the intestines is entirely altered by the irritation produced by thousands of these worms, and the want of mucus, which their eating this fluid oc- casions, renders these parts more sensible and irritable. § XCI. In children and weak persons, the mu- cous substance is ordinarily more abundant than in VERMINOUS DISEASES. 15$ adults and robust constitutions ; hence these worms prevail more in the former than in the latter, be- cause in the first, circumstances favour their growth and reproduction. Infants and enfeebled persons being already irritable, it follows that the ascarides vermiculares must produce in these individuals more serious inconveniences than in adults and firm subjects. § XCII. The symptoms derived from these worms are extremely violent in the inflammation of the intestines, principally in the colon and rectum. Though these worms exist here in small quantity, the effects of their presence are very severe. The dificiency of the mucous secretion, and the increase of heat are so many predominant causes of the phlogistic diathesis, which renders these inflamed parts more susceptible of morbid irritation. §> XCIII. Frequently these worms, situated in the wriukles of the end of the rectum, are the cause of tenesmus, hemorrhoides, and of swelling and in- flammation of the anus. Those portions of the intestinal canal which are supplied with nerves from the branches of the intercostal nerve being irritated by worms, the ef- fects which hence result and which have often been observed, are convulsive cough, grinding of the teeth, itching of the nose, aud various other vermi* nous affections, from sympathy. 20 154 VERMINOUS DISEASES. SYMPTOMS OF LUMBRICOIDES. § XCIV. The head of this worm terminates in a cutting sharp point ;(6l) it insinuates itself into the mucous membrane of the intestines, causing pungent and rending pains, of which those complain who have these worms, particularly in the umbilical region. Colic, and a rumbling in the belly, are signs peculiar to this kind of worms. Sometimes the patients experience the same phenomena as those occasioned by the application of'leeches. § XCV. This worm, according to observa- tions already collected, makes itself a passage through the walls of the intestines,(62) and alone produces the complaints above mentioned wherever they are ;(63) these symptoms are more or less se- vere, according to the greater or less irritability of the affected part. § XCVI. This worm possesses great sensi- bility, which is very fortunate for the human ma- chine ; air, and cold water, throw them into a state of asphyxia, and the pcristalic motion of the intes- tines when quickened, or the use of a drastiapurge, is often sufficient to expel them from the body. For this reason, when these worms have once descended into the large intestines, they are easily evacuated. VERMINOUS DISEASES. 155 II. SYMPATHETIC AFFECTIONS FROM WORMS. § XCVII. In all anomalous and rare diseases,, every intelligent physician begins his investigation of the causes, by inquiring whether the patient has ever noticed any sign of worms. Experience has often demonstrated that a great number of severe and obstinate diseases may arise from worms, especially when they are lodged in the stomach and bowels. § XCVIII. The doctrine of the sympathy be- tween the abdomen and other parts of the body, was known to Hippocrates ;(64) it has been eluci- dated since by the most esteemed practitioners,(65) and they assign sufficient reason for the manner in which the irritation, produced by worms in the sto- mach and intestines, may derange the whole animal economy, and prove the cause of the most violent spasmodic affections, even in parts of the body most remote from the abdomen, and particularly in the skin. When the skin contracts, says Rosenstein,(66) shivering succeeds, and if this is communicated to the throat, deglutition is impeded ;(67) from this spasmodic contraction arise all the other symptoms which have been observed by physicians in persons troubled with worms, as the intermission of the pulse, palpitation of the heart, syncope, vertigo, loss of speech, blindness, buzzing in the ears, de- jection of the mind, stupidity, delirium, contractions in sleep, disturbed thoughts, inquietude, anxiety, 156 VERMINOUS DISEASES. hiccough, convulsions, epilepsy, apoplexy, and an infinite number of other diseases, which we have mentioned only in part.(68)* * The Journal general de Medicine, edited by the learned Sedillot, for the month of floreal year 12, contains observa- tions communicated by M. Houzelot, surgeon in chief of the ci- vil and military hospitals of Meaux, among which is a case too interesting to be omitted in this place. Pierre *¥....., born of sound parents twelve years old, ten of which he had passed in perfect health, which was not at all impaired by the eruption of the small-pox or measles, when in June, 1799, the following symptoms appeared; a continual spitting, whiteness of "the tongue, countenance alternately pale and flushed, mouth often full of water, a moving of the alae nasi, contraction of the muscles of the face and eyes, stricture of the chest; constant agitation of the arms and head, and slight convulsions. November 1, a sudden loss of sense; limbs flexible, mouth somewhat frothy ; in the evening at supper, a momentary blindness, though he was perfectly sensible. A physician who was consulted, did not perceive any thing more than a simple nervous disease which he called epilepsy, the consequence of a slight fright which the patient experienced six months be- fore. He prescribed antispasmodics, which produced no effect. A violent anthelmintic purge removed all the symptoms, which returned the following June; then he had a momentary loss of sight, of hearing, and of speech; a sense of oppression of the chest; and at la3t the strongest nervous symptoms. Some pur- gatives being administered, they produced the discharge of an enormous quantity of black and very fetid fecal substances. The symptoms subsided in part till the first of ventose vear 9. At this period, M. Houzelot was called in ; he made the following notes on the state of the patient; a changing colour of the face, a dark semicircle under the eyes, itching of the nose, pains about the epigastrium, general emaciation, an undulatin"- motion of the stomach, mobility of the wings of the nose, of the mus- VERMINOUS DESEASES. 157 $ XCIX. In the year 1543, an epidemic ce- phalalgia made its appearance in some provinces of cles of the face and eyes ; white tongue, painful stools. The same evening he lost his speech, respiration short and very pain- ful ; the patient intimated by signs that a great weight impeded his speaking and breathing. The symptoms disappeared for a moment to be followed by violent convulsions in the muscles of the arm. After the fit, the lad said that before the attack he felt something move in his stomach, and that a second after he lost his speech. Some calming medicine procured a pretty good night; there was no other crisis. February 21, in the evening, M. . . . , though perfectly tranquil, lost his sight, which soon returned, and then he be- came deaf. This deafness declined, and was succeeded by aphonia and difficulty of breathing. The patient was successively for au instant blind, deaf, and dumb, and terrible convulsions followed all these singular symptoms. The muscles of the spine were so contracted as to bend the body backward. These muscles re- laxed to obev the contractile force of their antagonists, which in their turn bent the trunk forward. The tongue passed out ol the mouth, the eyes were turned up and the arms were stiff', the nates touched the feet; the pulse was small and frequent j and respiration very short; the severity of these symptoms put his life in danger. As this lad threw up every thing he took, M. Houzelot caused him to inhale ammonia,—all the symptoms immediately ceased as if by enchantment. A strong opiate procured repose during the next night. The remission of these complaints after the use of anthelmintics, led M. II. to believe that they arose from worms; this opinion however was not well received. In the morning of Feb. 22, the symptoms returned with extreme violence, the head being most affected. His.eyes were rolled up, he understood nothing, his ideas disconnected, and his obstinacy in speaking of nothing but re^ ligion, all resembled a fit of mania. The cerebral affection often abated to be transferred to the muscles of the tongue, which was thrust out of the mouth. This 158 VERMINOUS DISEASES. France which was found to have been occasioned by worms.(69) They are sometimes the cause of ma- paroxysm had lasted three hours, when he was made to respire ammonia, which afforded relief; the patient said that before this attack, he felt a pricking and something move in his stomach. Notwithstanding the entreaties of M. Houzelot, he could not induce the family of the patient to follow the use of antispas- modics, on which the first physicians insisted, with anthelmin- tics. February 23, the boy's life was in imminent danger; the symptoms were so much aggravated, the blindness, deafness, aphonia, temporary mania, protrusion of the tongue, and the general convulsions, were not the most alarming of them. The contraction of the muscles of the spine continued three hours: the mouth was closely shut, and the masticating muscles were so contracted that it was necessary to use a tube to get down a few spoonfuls of a composing draught. The volatile alkali was now used without success; the sufferer had taken nothing for four days, and was ready to expire. On the 24th, a consultation was agreed on; that the disease arose from worms, appeared so evidently that a strong decoc- tion of artemisia semen contra, of the fucus helminthocorton, Linn, and of absynthium, with the addition of orange flower water, an infusion of the flowers oftiliaor linden tree, and pills made of submuriate of mercury and semen-contra, were imme- diately prescribed. No remission of symptoms on the 25th; 26th, symptoms less violent; two stools, with two lumbrici— general and partial convulsions. On the 27th, fifteen very large living lumbrici were discharg- ed. There is a marked diminution of the symptoms, and an ob- vious improvement; in seven days, fifty-five living and twenty- eight dead worms were voided. On the 7th of March, a new order of symptoms took place. The belly became the seat of the disease, the muscles of the abdomen were so violently convulsed that they rose and fell alternately at least six inches. This state continued three hours. On feeling the abdomen, a pretty large tumour, hard and moveable, was discovered in the left iliac VERMINOUS DISEASES. 159 nia,*(70) ol dysentery,(71) of St. Vitus's dance,(7S) of catalepsy,(73) of tetanus,(74) of epilepsy,(75) region. A cataplasm of garlic, wormwood and tansy was applied over all the abdomen. These symptoms reappeared for three hours in the night of the 8th and 9th. The patient evacuated with his feces fifteen lumbrici, and a considerable quantity of blackish matters. A brisk cathartic, procured the next day, copious dark, fetid evacuations, loaded with an enormous quantity of putrid worms, among which forty lumbrici were counted.f FronrTthis epoch to April 11th, the anthelmintics were continued ; the patient was six times purged, and again discharged fifteen worms, and a quantity of matter containing the fragments of many more. From the last date M. seemed radically well, till the begin- ning of August, when he experienced some slight indications of worms. On the 13th and 14th, convulsions, itching of the nose, and spasmodic twitchings of the abdominal muscles, took place. The 23d and 24th, he had loss of sight, hearing, and speech; a ptisan and anthelmintic pills were administered. The presence of taenia was suspected, and M. de JVouffer's rem- edy was prescribed. Pronounced better from the first dose; the symptoms abated almost instantly. This remedy taken three times more, produced the discharge of thirty lumbrici. The patient has been six times purged; he continued the anthel- mintics, and the treatment was terminated by the use of cincho- na and preparations of iron, with so much success that on the 22d of October, 1804, the patient had complained no more after the month of August, 1803. Vermifuges however, com- bined with purgatives, were still occasionally administered. * Our colleague Esquirol, physician of the Lunatic Hospi- tal opposite la Salpetriere, has just published in the Recueil f Of this number, one was found ten inches long, as large as the ring finger of an adult person, covered witk very short hairs, visible, wifli the glass, and appearing black. 160 VERMINOUS DISEASES. convulsive asthma,(76) amaurosis,(77) pleurisy,(78) as well as other convulsive affections,(79) and in women the suppression of the menses.(80) pereodique de la Societe de Medicine de Paris, edited by Dr. Sedillot, a case which deserves a place in this work. A young man of 18 years, of middle size, frizzled hair, large and black eyes, devoted to the study of surgery, led a very retired life. During the heats of last summer this young man went often to bathe in the Seine, in the warmth of mid-day. In the begin- ning of June, he gave signs of alienation, to which phrenzy was soon added. Two copious bleedings restored him to tran- quillity ; some days after the delirium reappeared with the same fury; two new .bleedings gave no relief; purgatives did no good; at length the patient was conveyed to the hospital August 10, 1803. His face was pale, his eyes fried, the features of his coun- tenance were sunk, and his memory weakened. He was calm at the moment, and dined with a good appetite; immediately he tears and breaks every thing in his way, he sings, dances, hollows, and threatens with a strong and hoarse voice ; he ut- ters the most obscene language. With the most dissimilar ideas and disconnected phrases, he blends the names of his relations, his friends, his professors, and the officers of government: He -peaks of love, infidelity, courtship, etc. His countenance is by turns, red or yellow ; his tongue thick, dry, and covered with a yellow coat; his breath is fetid, and his skin burning; in the evening he ate and drank voraciously. During the night he con- verses quietly, or flies into a passion with those he believes to be near him : he swears and runs about his chamber to extract the nails, with which, he imagines the pavement of his chamber is studded. His cries are horribly painful; if one approaches him, he loads him with abuse, he spits in las face; if any one re- proves him, he threatens, or remains motionless, his eves shut, leaving his head and limbs to their own weight, or as they are placed, provided the position is that of easy flexion; copious, fttid, brown urine, belly constituted. VERMINOUS DISEASES. 161 These disease did not cease till the worms were evacuated, or the physicians were deceived in the indication of cure, when the patient became the vic- tim of the mistake. August 12. Beside the symptoms of the preceding even- ing, a syncope came on and lasted two hours. He refers his pains to the larynx and epigastric region. Frontal cephalal- gia, voracious appetite. Frightful shrieks at intervals; he seems suddenly to fall into syncope; he dreams in the night, dreams of snakes and of contending with them. 13. He sleeps six hours in the day ; an hour alter he is fu- rious. 14. An enema procures a copious discharge, at first hard, then liquid and yellow. Abundant brown urine. 15. A return of reason, he is however dejected, has some sleep; he always has acidulated, nitrated drink. 16. Delirium returns in the night; he breaks every thing; the strait jacket is put on him, which occasions much sweating, but has no moral influence over him, nor has entreaty any effect. 17. A tepid bath for an hour, followed by the shower bath; the patient at first braves the shower bath, but soon falls into a syncope, though he had taken no food. 18. Tepid bath during two hours, laxative drink. Fre- quent nasal hemorrhagy; more calm, but incoherent in his ideas. 20. Bath; another shower bath suspended after two minutes, for fear of syncope, though the diameter of the column of water was but five millimetres.* Bleeding from the nose. No delirium in the evening; but his eyes were wild, his speech short, and his motions quick and rough. 21. Bath, lotion of oxycrate over the head, less agitation, sleep. 22. After coming from the bath, a profound sleep of some hours. In the evening a clyster, followed by liquid yellow de- jections. * The French millimetre is the thousandth part of a metre, or '03937 part of an English inch. JL T. SI 162 VERMINOUS AFFECTIONS. III. VERMINOUS AFFECTIONS OF THE WHOLE SYSTEM. § C. We find in the writings of physicians, various asthenic diseases, both acute and chronic, 23. Agitated in the «lay, sleep at night; bath, acidulated, nitrated drinks. 24. Delirium'and raving return; wakefulness, abundant liquid stools* 26. Face much flushed ; abdominal pains, particularly of the epigastrium; frequent stools; syncope with a sense of tightness in the throat. The patient rubs his nose much, and desires his servant to rub it. 28. A bolus of jalap and submuriate of mercury. Infusion of male fern (Polypodium filix mas, Linn. ;) several liquid dis- charges mixed with mucus, and a large quantity of lumbricoides and ascarides. 29. The same medicines the same effects; calm in the even- ing. 30. Idem. In the evening a return of reason. Since, sev- eral discharges every day, mixed with yellow mucous substan- ces and sometimes worms. 31. Infusion of Roman chamomile; a progressive return to reason ; sleeps more, sometimes interrupted by dreams, but of- tener by outcries, appetite without voracity; the eyes more closed, complexion less yellow. September 22. Momentary explosions of fury, slight de- lirium ; tears, followed by immoderate laughter. He recognis- es every person in the house, speaks of his family, and promises to follow my advice for the complete reestablishment of his health. Visage pale, pulse weak, eyes dejected, slow answers, and en- feebled recollection; boluses of cinchona and canella; infu- sion of orange tree, more wine with his meals. Oct. 1. In the night he sends forth frightful shrieks and leaps in his chamber to avoid points in the floor; he dares not rest against VERMINOUS AFFECTIONS. 165. occasioned by worms, and which have thence been called gastric verminous fevers, muscous diseases, and glandular diseases. the wall for fear of being pressed; he jumps on his bed and then off again, always because he thinks some one is driving points into every part of his body, especially into the soles of the feet and palms of the hands. For an instant he feels as if strangling, with pains of the epigastrium. 2. Idem. The next day he took boluses of jalap and sub- muriate of mercury. Several liquid stools, the following days, infusion of rhubarb. It was not ascertained that worms had re- cently passed the bowels. From this time his countenance was less dejected, there was no incoherence of ideas, nor raging; his memory revhed and his strength improved. The patient inquired for some books, attended to his dress, and desired to see his parents. He was rather sad, and walked by himself. There was no vestige of his malady, excepting great debility; a heaviness and confusion of his head : he was restored to his family. 22. In the night he screamed out and had a syncope for two hours; he took a purgative draught which procured a very black discharge; no sign of delirium, some dejection of his spirits re- mained, with an obscure pain of the liver. A blister was ap- plied to the pained part. The healthy complexion of youth, plumpness, habitual gaiety, the free exercise of all the intellec- tual faculties, all announce a perfect convalescence, and this young man has since enjoyed very good health. Our colleague Qiraudy, who is also successfully occupied in treating mental alienation, informs us he has observed several cases of sympa- thetic mania, caused by worms. We cannot too strongly in- vite him to enrich the medical art by his observations on the treatment of the diseases of the mind. Dr. Bosquillon also speaks of an instance of lunacy produced by an insect lodged in the frontal sinuses. F. Trs. 164 VERMINOUS AFFECTIONS. § CI. Persons inhabiting cold, wet, and un- healthful climates, whose food consists of viscous rather than uutricious substances, who drink im- pure water, who are daily fatigued by their labour, who have little rest, and are a prey to those pas- sions of the soul which break down the mind, and weaken the body, these persons are found to be sub- ject to those general affections which arise from worms. To the assemblage of these causes more or less active and more or less permanent, are to be attributed the origin of the most famous vermin- ous epidemics described by authors, and particu- larly those of Bailou,(Sl) Van Swieten,(82) Hux- ham,(8S) and Van-den Bosch,(8^) as well as the fevers reputed to be of this kind by a number of celebrated practitioners. We must ascribe to these causes the intermit- tent and remittent fevers, named verminous by Bekaen,(85) and by other writers of merit. But how can we consider worms alone as the primitive cause of those diseases which have been so mortal? I do not deny that the morbid irritation they pro- duce, since we see it to be the cause of a number of sympathetic verminous affections, may also con- tribute to increase these asthenic disorders of the whole system. Still however no one can convince me that the mere irritation from worms can be suf- ficient to produce a fever of the typhous character. We often see in smallpox and measles symp- toms of worms; it would nevertheless be errone- VERMINOUS AFFECTIONS 165 ous to derive these highly asthenic diseases Irom worms. § CTI. We have already shown(86) that the asthenic state of the human body is favourable to the development of the germs of worms, provided there exists in some part a decomposition iu the continuity of the organs. Worms, escaped from the egg, find in the de- composed matter, an aliment which serves to nour- ish them. In severe diseases, mucus abounds more in the degestive organs than in other parts ; it thence fol- lows that the development of worms must be more frequent in the intestinal tube than in other parts of the body. § CIII. From all that has been hitherto said, we clearly comprehend that verminous fevers, like gastric fevers, so called,(87) are really nervous fe- vers, during which worms multiply and grow in those parts of the body that are most enfeebled. The same m:»y be said of mucous(88) and of grand u- lar(89) diseases; they are all the effects of a slow and universal consumption of the body. In these diseases worms are evacuated, and no more are de- veloped ; and under the influence of a stimulating and appropriate regimen, the body begins to re- gain its lost strength, and to maintain the contin- uity of the organs, particularly in those destined for the natural functions. I do not therefore speak of the symptoms of these maladies, because those of nervous fever are slow or acute, and accompa- 166 VERMINOUS AFFECTIONS. nied by partial weakness of the stomach and intes- tines. We have spoken particularly of those dis- eases,(90) and of the association of symptoms pro. per to the worms already mentioned.(91) The physician may infer from them the existence of worms, since those that live at the expense of the human body render its diseases more severe and complicated, as they always tend to increase the debility and the solution of the parts of the body. BND OF THE THIRD LECTURE. NOTES TO THE THIRD LECTURE. (1) As Block has affirmed that worms are not always the cause of diseases in the animal machine, Traite de la gen. des vers, p. 59, douzieme preuve, he must have said it to prove, as a naturalist, that worms are natural to every animal. But that a physician of great repute, like the American Rush, should maintain that worms are necessary to preserve the health of children, is what every practitioner will oppose : see Weikard, Maladies locales, classe premiere, etc. Natural- ists have not omitted to notice the complaints, sometimes even fatal, occasioned by worms in ani- mals. Goeze, an exact narrater of every thing he had occasion to observe, Versucheiner, Naturg. etc. p. 98, says he once took a temporary living frog which could not move, and seemed to be almost dead : this frog, put in a basin of water, immediately sunk to the bottom, and in a few minutes died. In its viscera two Cucullani were found and several as- carides vermiculares which were swarming in the 168 NOTES TO THE whole substance of the lungs. Several observa. tions similar to these, and worthy of attention have been collected and published by Vallisneri, Op. ii. p. 1. (2) Collectio Societatis medicae hauniensiae, p. SI. (3) Baglivi, Praxis medica, lib. i. (4) We read in the Ephemerides des Curieux Uie la Nature, dec. ii, an vi. obs. xxxiii, the history of a case of insatiable hunger occasioned by lumbri- coides. The patient, who was incessantly ill, found no relief except in taking food. (5) Sauvages speaks, Nosologia method cl. vii. gen. xx, spec, x, obs. cxviii, of acardialgia, which in a certain part of the country occasioned the death of several persons. On opening the dead bodies, lumbricoides were found so closely attach- ed to the coats of the stomach, that they were even perforated. From the same cause arose the volvulus of the young woman who vomited up every thing; see Sauvages. (6) See Van Swieten, He Morbis infantum, etc. (7) Traite des maladies des enfans, etc. p. 318. (8) A young woman feeble and emaciated came to the Clinical Hospital of Pavia, in the winter of 1797 ; she had been tormented for more than twen-' ty days with pains of the joints, which rendered her stiff and immoveable. There was not any swelling of the articulations; both pupils were largely dilated, the mouth inun- THIRD LECTURE. 169 dated with a very viscid mucus ; these symptoms made me suspect that the disease might originate from worms, and be kept up by them. On administering suitable remedies, she evac- uated nine large lumbricoides, and immediately the appearance of arthritis disappeared. We meet also in Rosenstein with two cases very similar to the observation I have just given. Dr. Lindestolpte was called to a girl of ten years, who complained of a pain in her left side, with a dry cough, slight heat, strong pulse, great thirst, and sometimes a biting or pricking in the stomach ; she often lost her speech, and had spasmodic contractions. He thought these symptoms arose from worms, and prescribed some anthelmintic powders. After taking them twice, she was attacked about midday with so violent contractions, that her feet were turned toward her back. The convulsions ceased ; she had no more pain, and fell asleep. Her mother, wishing to raise her from the bed, saw a round living worm fall on the floor, half a metre and three decimetres* long, which turned it- self about like a serpent. This worm passed from the body during the convulsive struggles. After evacuating several pieces of worms, the girl was cured. The other case is one of Dr. Harelius, of a young man who suffered a very sharp pain of the * The decimetre is the tenth part of a metre, or S,93710 in- ches. The close of the note p. 161, on the word -millimetre, should be thus—or ,03937 of an English inch, which the reader is desired to correct. .9. T. 22 170 NOTES TO THE thigh, and in the.right lumbar region, which oblig- ed him to carry the right foot bent forward. His father feared a luxation ; but the physician observ- ing that the son had a tension in the epigastric re- gion and frequent pains of the stomach, and also that his mouth was full of saliva, and that he had an itching of the nose, and serous or watery urine, imagined that worms were the sole cause of these symptoms. In fine, he procured their evacuation, and the patient was very soon restored to health. (9) See § and note II, of the first Lecture. (10) The organs of the animal body are so con- nected together, that they cannot continue to act without the concurrence of each other, and the pres- ervation of one depends on the reciprocal influence of others. We cannot however conclude that the proximate cause of the action of an organ exists without itself; in truth, we see its dependence on others, by virtue of the common tie, and of mu- tual relations. The parts of the human fabrick are thus reciprocally united, and severally concur to the support of the body. For this reason when one part is hurt, others, the most intimately related to it, must consequently partake of the injury.- (11) The observation is from Weikard, in his Traite des maladies locales, where he speaks of worms. (12) Ekardt, Hissertatio sistens observationum hydatidum in hepate inventarum una cum prae* missis ad hanc materiam spectantibus. See Bre- ra, Sjlloge opusculorum selectorum ad praxim me- THIRD LECTURE. 171 dicam spectantium, vol. ix, p. 137. That these hydatids were social vesicular worms, is suspected with reason from the author's recital. Take his own words : " Hydatidum majoribus ilia ovi gallinacei. mi- noribus vero ilia pisi magnitudo inerat. Fluido in iisdem coraprehenso, non prorsus fuerunt diduc- tae, atque dilatatae. Majores ovali, minores autem magis circulari forma erant instructae, tarn vesicae earundem, quam fluidum, valde clara erant et pel- lucida. Hydatides scctae et fluidum in poculum vitreura receptum, innumerabilem punctorum minu- tissimorum in eo circumnatantium, fuscorum speci- em rcferentium copiam ostenderunt, qui humore aeri exposito dein evaporato, et parietibus et pocu- li vitrei fundo adhaeserunt. "Quod fluidum neque omnino serosae, neque omnino lymphaticae, fuit indolis, et colore distinato carens." (13) See § XXIII. (14) The observation is reported by Dr. Here- ' boom,'m his little work entitled, Descriptio et iconica delineatio novi generis vermium stomachidae dicti, etc. p. 24. I shall transcribe it in his own words, because I deem it worthy of the greatest attention of practitioners. " Olitor, quinquaginta fere aetatis, ante aliquot tempus nephritide laborabat, ita ut periti judicarent calculo vesicara occupatam esse, turn ex mictu do- loroso, difficili, impedito, et quocunque modo tur- bato ; turn ex sensatione oneris in abdomine, titilla- 172 NOTES TO THE tione vergae et caeteris hoc symptoma comitantibm; turn ex gressu varicato et dolore spatico cruris sinis- tri; turn ex urina cruenta, purulenta, aeque gru- mosa, turbida, mucosa, foetida, vel et crassissima: sed praecipue catheterismo repetito. Ideo vaiiis remediis usus fuit, ut aqua calcis, millefolio, bal- samo sulphuris, atque elexirio vitrioli Mynsichti, pro parte proprio motu, pro parte et consilio peri- tiorum. Tandem et horum usus pertaesus, post Ion- gum sat intervallum,iterum meae curae sese commit- tebat. Debilis erat, vehementibus doloribus afllic. tus noctu dieque, sed praecipue duin mejebat. Uri- na jam adeo erat purulenta, ut plus puris ac urinae emitteret; vitra euim, lotio caute recipiendo usitata, dimidium, et quod excedit sedimenti purulenti ple- na erant, intermixtis frustulis quasi carnis recens mactati. Praeter emollentia precedentur adhuc lau- danum in usum vocabam cum levamine adjuncto re- gimine. Urina vero post aliquot dies, loco sedi- menti purulenti, brunneum deponebat, insimul cras- sior et stercoreum foetorem prodens dum laboriosius faciebatur. " Accedebat emissioflatuum sat fortium, ex ure- thra. Sedimentum dictum accuratius examinatum, inter caetera in eo oryzae granuluin intermixtum erat ex reliquiis ciborum hesterna die ingestorum; et passim varia talia quotidie detegebam, praecipue panis secalinae non bene commanducata. Per quinque fere dies insolita haec secretio miserrime continuabat, alvo penitus obstructa, licet earn man- natis et prunis debita in quantitate reserare cona* THIRD LECTURE. 173 bar, donee tandem diarrhaea insequabatur. Faeces sensim sensimque liquidiores, tandem cum foetore urinoso, ipsius stercoris praedominante, prodibant, ac tandem sinceram urinam alvus deponebat, per decern fere dies haec diarrhaea duodecies quando- que vicesies de die, patiens conflictabatur, ut tu- bus intestinalis inde penitus quidem exoneraretur. Interea dum absolute nihil urinae per urethram emit- teret, aliquateuus inde sensit levaminis ; et reno- vatioue quasi virium gaudebat, cibi avidus, bene quoque digerens. Licet nee adstringentibus, ne ipso quidem laudano, diarrhaeam compescere po- tuerim, sensim tamen sponte cessabat, ut in laxita- tem alvi degeneraret, faecibus nihilominus adhuc urina facientibus. Tamen ut prius vehemtissimo cum cruciatu ibat lotium, cujus sedimentum sterco- reum duas partes totius excedebat, continens quae- cumque alvus indigesta ex hesternis rejecerat, ut ficuum semina, pomorum volvas, cicerum siliquas, olerum frustulas, et singula ne referam, poni chi- nensis granum compressum medulla jam semidiges- ta continebat. Quis hujus scenae non misertus es- set, exitum acerbum minitantis? Praedictis solum modo remediis adhibitis, cum animadverti febrem fere abesse, et animo forti dolores subire patient- em, ita admonui, ut talia alimenta caperet, quae in faeces pulposas concoqui possent, ut farinacea, lac- tem, ova, jus carnium, etc., turn et ut ipsi bis de die clysma injeceretur ex terebinthina mediant vitello ovorura aquae immixta. Primi enematis portion- em una cum urina patiens mejabat, post secundum 174 NOTES TO THE non tautam, post tertium quartumve clysma, solum. modo odore tercbinthinae urina erat praegnans. Ita injectis plus minus decern clysteribus, urinam iterum cum sedimento purulento albo minime vero stercoreo, vel tale peregrinum olente, secernebat. Nee minus dejectio regularis erat absque urinae putore. Quidquid agerem, clysteres amplius re- cipere recusabat, derclictus ab omni spe, et cogita- tionem suscipiens, praeter terrae japonicae solution- em, ab aliorum remediorum usu desistere, observa- tion! solummodo animum submittens. Ita procc- dens interea sensim ut cumque vires recuperavit, domum egressus, publicos agens conventus, olitoris functiones exercens, licet magno cum dolore urinam mittens, adeo ut languidam duceret vitam. " Post novcm mensis ad me retulit, se hucus- que cum praedictis remediis continuasse : addebat vero mictionem lancinantem minime sopitam esse, utpote cum urina purulenta passim magnas frustu- las quasi sanguinis grumosi ejiciens, sinceri san- guinis, particulam monstrans mane mictara, cujus longitudo fere sesqui pollicis erat, crassities vero semi pollicis, adhuc renunciabat similia quotidie accidere. Die tertio Novembris, 1771, mane, per urethram lumbricum teretem expulit, quem mihi vivum videre contigit, prout ex virga egressum, patiens ipsum extrahebat et vitro injiciebat. Hie colore gaudet albo et in naturali magnitudine, repre- sentatur figura quinta, spiritu juniperi conservatus. " Posthac membris labefactis, vermem equidem socium nequaquam, sed ingentia frustula, gelatinae THIRD LECTURE. 175 instar sanguinolentae, urinae sedimento intermixta largiter exonerare miser continuavit, febre, praete- rea hectica et hujus cohorte vexatus et ad ultimum vitae halitum usque dolore exquisito mactatus,quam aliquantulum quidem compescere laudano potui, ipsemet vero strenue religiosa patientia et pia de- ditione sui voluntati divinae sustentare valuit, men- te adhuc dum constante ischuria tandem vitae filum abrupit, die S3 Augusti, 1772. " Aperto cadaveris abdomine, prout mihi hu- manissime ante aliquot tempus tentamento aegrotus legaverat, invenimus una cum Candida peritia CI. chirurgo Jano Ruurhof, aliisque amicis anatomicis ; " 1°. Intestinum colon cum peritonaeo arete concretum. (i2°. Laborasse defunctum hernia epiplocele, omnino in tunica vaginali procidente cum processu valde attenuato, filiformi, intestina vero baud sub- secuta fuisse, quoniam inter se validissime et ubivis fere erant concreta. " 3°. Fundum vesicae externe totum cartilagine- um, contrahi ineptum, induratum et cum intestino co- in, caeco et recto, ligamentis cartilagineis, nee minus latissime cum osse pubis, concretum quae ligamen- ta incisa vel disrupta, pus fundebat, quare et tuni- ca vaginalis dextra puris plena erat. "4°. Catherem vesica recipere renuebat. "5°. Glandulae mesenterii, quotquot offendi- mus, substantiae ex albo cartilaginae erant, magni- tudine fere juglandura. ,(fi°. Plnrima ulcera fistulosa ex vesica in an- 176 NOTES TO THK ncxa monstrosa intestina, vel et in peritonaei ca- vum exibant. "7°. Vesica interne omnino infarcta erat ma- terie gelatinosa ejus parieti affixa, pus mentiente ingrassatum, dura, tenaci, glutinosa, parum olente, in aqua valde subsidcnte, nullum vacuum pro urina recipienda relinquente, nisi quod rivulus serpen. tinus crassities ureteris urinae transcursum formabat per substantiam dictam, tandem quoque adeo op- pletum et deletum, ut sensim sensimque ischuria inde nata vitae filum abruperit. Calculus in ve- sica baud detectus fuit. Intestinum rectum vix distingui posset, ita cum vesica erat coalitum, quare nee locus suppurationis praecedentis quae commu- nicationi vesicae cum intestino recto ansam praebu* erat, ad votum indicari licuit. Erant interea ure- theres naturales, nee minus renes, papillis solito minoribus ut cunque donati. Hepar satis sanum apparebat, et quod notabile, cadaver minime adipe destitutum erat." (15) See § VI. (16) Goeze, Versucheiner, Naturges. der Ein- geweid., etc. p. 278. (17) Goeze, the work cited. (18) See $ XV. (19) See % XIII, p. 20. (20) Syllogen, Observationum varii argumenti: Hauniae, 1782, 8°. p. 45. (21) See § XI. (22) The patient was attended by the learned THfRD LECTURE. 177 professor Borda, of Pavia, who was pleased to communicate to me the accident mentioned. (28) See * XXVII. (24) Be morbis vasorum absorbentium corporis humani pars pathologica ; Trajecti ad Moenum, 1795, 8°. (2 ) Arzney kundige abhandlung ueber den JVutzen der Wasser, oder lymphen Gesasse ; Lin- gen, 1795, 8°. (26) See Soemmering, the work cited. (87) Leske, Abhandlung vom drehen, etc.; Leipzig, 1780,8°. * . (28) See § XXIII. (29) Weikard, Vermisckte medizinische Schrif- ten, 4°. stuck, p. 102. (30) Ludwig, He hydrope cerebri puerorum ; Lipsiae, 1774. Ved. Baldinger, Sylloge select. Opusc. argumenti medico-practici, etc. (31) Nordische Beytrage, 1 Band, p. 84, (32) Medical Transactions, vol. ii. p. 486, Phi- losophical Transactions, etc. vol. xxii, p. 197? vol. xxv, p. 234. Memoirs of the Tendon Medical Society, vol. ii, art. ii. (33) Haller, He corporis humani fabrica, vol. vi, p. 480, not. 6. (34) Soemmering, Baillie anatomie des Krank haften baues von eiuigen der wichtigsten Theile im menschlichen Korper, ucbersetz. Und mit Zusat- zen von Soemmering ; Berlin, 1794, p. 184. (35) Baillie, the work cited, p. 116. (36) Eckardt, Hissert. sistens obs. kydatidum in 23 178 NOTES TO THE hepate invent, etc. Soemmering, Baillie, the work cited. (37) Acta Natur. curiosor. Berolini, v. i. p. 848. (38) Walther, Annotationes Academ., etc. p. 84, no. 6. (39) Medical Communications, etc. U. i. p. 10. (40) Sandifort, Obs. anatomico-patholog. lib. ii. (41) Soemmering, the work cited, p. 222. (42) Ruyschius, observ. xiv, p. 15. (43) Morgagni, He Sed. et causis morb. etc. Epist. iv, art. xxx. (44) Eckardt, Hissert. cit. (45 Werner, Vermium intest. brevis expos. continuatio secunda,p, 7- (46) Morgagni, He Sedibus et causis morb. etc. Epist. xxxviii. (47) See $ XXVI. (48) Verm, intestinalium, Taeniae praesertim humanae, etc. p. 68. (49) He Morbis Vas, absorb, corporis hum. etc. $XXII. (50) See §$ XXIV, XXVIII. (51) See § XLIII, and the annexed note, no. 27. (52) Margraff, He morbis a vermibus intestim- libus oriundis ; Vittebergae, 1799, p. 8. (53) Wagler, Hissert. de morbo mucoso, Prae- side, 1. G. Roederero, etc. See § XXIX. (54) Blumenbach, Handbuch der Naturges. etc. p. 410. THIRD LECTURE. 179 (55) Stoll, Parsseptima ratio, medendi;' View nae, 1790, p. 116. (51) See § XXIX. (57) Werner, Verm, intest. etc. p. 84, Stoll, Op. et loco cit. (58) See §* XXXVII, XXXVIII, XXXIX. (59) See $ XXXVI. (60) Van Phelsum, Hist. Ascarid. pathologica, etc. cap. iv, v, vi, vii. (61) See^XLV. (62) See the end of § XLV. (63) See the end of § LXXIX. (64) " In corpore kumano conjluxus unus, con* spiratio, una, et omnia consentientia." Hippo- crates, de aliment is, etc. (65) See my Notes medico-practiques, sur les differentes Maladies traitees dans la Clinique med- icale de Pavia pendant les annees 1797? 1798, pre- miere parties § XL1I. (66) Traite des Maladies des enfans etc. p. 310. (67) I have lately seen a young man, otherwise very robust, who was suddenly attacked with a violent convulsion of the throat and chest, which threatened suffocation, and obliged him to cry out with a loud voice. This convulsion lasted three or four hours ; it subsided and afterward returned, in such a manner that in twenty four hours three paroxysms had taken place. Iu the intervals the patient complained of a sense of cold in the xiphoid cartilage, and was de- jected. After minute examination no assurance 180 NOTES TO THE of worms could be found, thougb he bad several symptoms of them, such as dilitation of the pupil, salivation, itching of the nose, pains of the joints, as well as the anamalous character of the disease, which strengthened the suspicion of them. The convulsion commenced, according to the patient, at the region of the stomach, like a flame rising and fixing with violence in the larynx. The stomach being strengthened by an electu- ary of cinchona, valerian and opium, and continu- ing for some days, the convulsive access gradual- ly lessened in force and frequency, and finally dis- appeared. (6s) See $ LXXVI and the following. (69) Sauvages; Nosol. method, etc. cL iii, gen. xxiii, sp. vii. (70) Ephemerides naturae curios, dec. iii, ob- serv. cxxxv. A few days since I was called to visit a girl of nine years, who after surmounting a scarlet fever, exhibited all the signs of an effusion of water in the ventricles of the brain, as they are pointed out by Ludwig, in his excellent Hissertation de kydwpe cerebri puerorum. The disease which had pre- ceded, the certainty that the child had never been affected by worms, the deficiency of urine, the swell- ing of the abdomen, as well as the oedema of the infe- rior extremities, all contributed to the belief that thia disease was hydrocephalus internus. Theivretch- ed sufferer, reduced almost to the grave, presented no hope of recovery, yet being unwilling to leave THIRD LECTURE. 131 her without any resourse, I prescribed some diuret ic and tonic medicine, which possessed anthelmin- tic properties, as the sudden appearance of the dis- ease made me suspect it might arise from worms. Submuriate of mercury in powder, and a saturated infusion of valerian, made stronger by the addition of a good dose of camphor, were the remedies I chose to produce these effects. I obtained no success during the two first days of this treatment; the disease on the contrary was worse, but on the third day she vomited a living lumbricoides, and some mucous and bilious matter. The next day she voided four lumbricoides; and in a short time she was fully restored to health. (71) Sauvages, Nbsol. Method, class, xi, gen. ix, spec, xv, speaks of a verminous dysentery, which, from August to November, attacked a fourth part of the inhabitants of the country, and destroy- ed a number of them. The pains of the abdomen were sudden and severe; a sense of heat became violent in the vis- cera, and a vomiting of mucous matter, resembling the spawn of a frog, aggravated this complaint. It gave way to the use of anthelmintic remedies, after the worms were expelled from the body. (72) In the Ephemerides nat. curiosor, ann. iv, observ. clxxxvii, we meet with a case of St. Vitus's dance, occasioned by worms. A sim- ilar case is reported by Siblot in the Journal de Medicine de juillet ann. 1783, torn, ii, p. 22. A 1$£ NOTES TO THE taenia and several lumbricoides were the cause of this malady. While practising medicine in the hospital of Berliu, in the autumn of 1795, under the direction of the illustrious Selle, I saw a child about twelve years old, affected with St. Vitus's dance, which had been produced by worms, though the patient did not exhibit the least sign of any verminous af. fection. (73) Sauvages, Nosol. Method, etc. cl. ix, gen. xxiv, species ii. (74) Commercium litterarium Norimbergense, torn, i, p. 385; torn, xv, p. 124. Sauvages, No. solog. method, torn, ii, tit. tetanus. Heister, Medi- ciniscke chirurg., und anatom. warnehmurgen, 1. Band, p. 170. Brera, Sylloge, oprtscul. selector, vol. iv. p. 18. (75) Acta naturae curiosor. vol. vii. observ. exxvii, vol. vii, observ. xix. Van den Bosch, Histo- ria constitutionis epidemica verminosae, etc. p. 132. Ackerman, Hissert. de epilepsiae motuumque convulsivorum infantum causis praecepuis ; Gry- phiae, 1765. Medical Observations and Enqui- ries by a Society of physicians in London, vol. vi. observ. of Fothergill. Gordak geschichte derfrau- en Zimmers; Eonigsburg. 1770,8°. Journal de Medecine, torn. xxx,p. 51. (76) Ephemerides Naturae curiosorura, dec. iii, an. iv, observ. xix, an. vii, viii, obs. clxxxxiii, Acta Helvetica, vol. vi, p. 216. THIRD LFCTURE. 183 (77) Ephem. Nat. curiosor. dec. ii, an. v. obs. clxx. Journal de Medicine, tome xxxiv, p. 135. Richter, Elementidi Chirurgia,tom. iii, cap. amau- rosi. (78) Bonnet, Sepulcretum, lib. ii, sect. 4, ob- serv. xxxviii. Riverius, Observat. cent, i, no. 75. Epkemerid. nat. curiosor. dec. ii, an. 5, Append. p. 80. (79) Selecta Medica Francofurtensia, Franc ad Viadr. 1739, torn. i. p. 110. Henneberg, His- sert sistens historiam morbi convulsivi infantis, ejusdemque sanandi methodum; Erford, 1791. Abrege des Transactions philosophiques de la socie- te royale de Londres, tome xiv, Venise, 1796, p. 219, 279. (80y Spigel mentions a young woman, of a dis- tinguished family, who had an aversion to food, like a pregnant woman ; there was tumefaction of the abdomen, with a total suppression of menstru- ation. The parents consulted a number of physi- cians, who said she was with child, and all medi- cines were abandoned. In the mean time the dis- ease increased, and she died a victim to ignorance and inattention. On opening the body, her inno- cence was apparent, there was no embrio in the uterus, but a mass of water and mucus was found in the intestines, and a taenia as long as the bow- els. See Rosenstein, Traite des maladies des eih- fan$, etc. p. 311. (81) Opera omnia genera, 1562,4°. opp. I,p. 25. (82) Commentaria in Hermanni Boerhaava 148 NOTES TO THE aphorismos de cognoscendis et curandis morbis, etc. torn. iv. p. 720. (83) Opere fisico-mediche, tome i, p. 284. (84) Constitutions epidemiae verminosae, quae, ann. 1760—63 grassata fuit, etc. Norimbergae, 1779,8°. (85) Ratio medendi in Nosocomio practico, Vindobonensis, torn, xiv, p. 142. (86) See %% LV, LVl. (87) See my Notes de Medecine pratique sur les diverses maladies traitees & la Clinique medi- cale de Pavie dans les annees 179® and 1798, pre- miere partie, §> 44. If worms in the stomach and intestines, sometimes become the cause of disease, as of fever for instance, it cannot on this account be called a general disorder, since the cause of it is entirely local. The blli jus, gastric, pituitous, and verminous fevers so much in vogue during the last century, ought to be considered as simple local af- fections, or as complaints wholly chimerical; as accurate and observing physicians have agreed.* If we are to understand by verminous disease, the verminous affection general in appearence, which is occasioned by the accidental presence of worms in the stomach, disturbing the functions of the system, because they derange the functions of the stomach which is in other respects healthy; we cannot deny this, provided we view it as depend- ing on a local injury, and differing from a general * Professor Find doos not even mention any febrile ver- mhiOJs :liaordfc'.-P in hi- .'Yoyi^.-rtph'u- philosophiqne. F. Trs. THIRD LECTURE. 185 disease. In fact, a disease of this kind is never preceded by predisposition ; it does not originate from increased or diminished general excitement, but from a body which may be regarded as alto- gether foreign, and which may be either in the sto- mach or intestinal tube. Brown, in his medical writings, says nothing of the gastric affections, nor does he name verminous fevers, though several physicians of the first rank have written of them. If, however, what we have said of fevers called verminous, be compared with the principles of Brown's doctrine, it will be seen that this philo- sophical physician, when speaking of diseases aris- ing from poisons, (Elements of Medicine, vol. i. § LXXVII,^ he informs us that these diseases should often be regarded as local, because the poi- son (and we will say a worm,) by mechanically at- tacking the stomach and intestines, organs endow- ed with great excitability, may produce from sym- pathy, an irritation through tlje whole system; but as neither the sthenic nor asthenic diathesis is there- by produced, it cannot be considered any thing else than a local malady ; this view of the case is con- firmed by the treatment, which consists merely in expelling the poison, or the worm, from the body. If, on the contrary, worms in the first passages are preceded or accompanied by febrile commo- tion, originating in reality from the irregular ex- citement of the system, and is evidently occasioned by a power directly or indirectly debilitating, no physician can deny that the development of worms 24 m NOTES. would be favoured by these circumstances, which, as we have repeatedly observed, appear precisely in this state of the body, and rather from the effect than as the cause of the febrile disease. All the accompanying symptoms indicate a general ner- vous affection predominating in the organs destin- ed to perform the animal functions. An inclination then, to found on this basis the chimerical existence of a worm fever, is, in my opinion, a dangerous error in practice. (88) Wagler, Hiss, de morbo mucoso ; Gottin- gae, 1762,4°. (89) Werner, Verm, intest. brevis exposit. con- tin. secunda, etc. p. 4. (90) See my Notes medico-pratiques, etc. sec. partie, cap. i, class, ii and iii. (91) See ** LXXVI, LXXVII, LXXVHI, LXXIX, LXXX. END OF THE NOTES TO THE THIRD LECTURE. FOURTH LECTURE. THE TREATMENT OF VERMINOUS DISEASES. $ CIV. The asthenic diathesis of the human body, especially when it prevails in the gastric sys- tem, is one of the chief circumstances which favours the development of the verminous germs,(l) which circulate in the mass of fluids in the form of very small molecules,(2) or remain at rest in different parts, where accident may deposite them.(3) The effects produced by the use of emetics and cathartics, which many physicians still prescribe and administer to dissolve and expel the mucous substance which we have already considered as the aliment of worms, and which in the opinion of some persons, favours also their adhesion to differ- ent parts of the body, must npt only be useless, but even dangerous. If Monro and Rosenstein($) have sometimes used emetics with some success, it is to be attribut- ed rather to the general efforts and concussion of the frame, particularly of the stomach and intes- tines, produced by the sudden and violent action 188 TREATMENT i)t of this remedy, which detaches and expels them from the stomach.(5) Purgatives act in the same manner, by increasing the peristaltic motion of the intestinal tube ; worms are by this means often se- parated from the intestines and evacuated with the feces. It may soon be seen however that both these remedies must debilitate the system, and con- sequently predispose it to verminous affections. § C V. Worms are common and familiar in those constitutions, in which the lymphatic system pre- dominates.^) We further know that sheep are subject to the social vesicular worms, when they feed on wet low pastures, especially during autumn and in rainy years. All the debilitating causes which are favourable to the development of the seeds of worms, examined with care, will persuade the philosophical observer, that the multiplication of worms can be easily prevented by means of a tonic and nourishing regimen, such as we shall point out in speaking of the prophylactic method. No one can be said to be completely cured of worms, if after their expulsion, the predisposition to ver- minous complaints be not also removed. § CVl. Guided by these principles, we may with ease and certainty perceive the true indica- tion by which the physician should regulate his plan of treatment in curing the disease occasioned by worms, whether local or sympathetic,(7) slight or severe. This mode of proceeding is more or less con- stantly crowned with success, and contributes to VERMINOUS DISEASES, 189 render observations philosophical, as it evinces the extravagance of those remedies which have been invented by superstitious men for the cure of worms, and which have been adopted even by phy- sicians of merit,(8) who have too blindly subscrib- ed to the opinion of the former. § CVII. Jn the treatment of worms and the effects they produce, the physicians ought, in the first place, to be assured of their existence, of their seat, of their quantity and quality, because nature has organized them differently, and experience proves that they do not all yield equally to the same remedies.(9) The medicines which destroy ascarides are sometimes inert with regard to the lumbricoides and taenia. On the contrary, the remedies which are high- ly recommended against the taenia, administered to patients not having this worm, may occasion very severe derangements of the animal economy. For this cause, before we commence the treat- ment of worms, it is incumbent on us to ascertain their species, in order to direct the method of cure. § CV111. In the treatment of verminous com- plaints in general, such remedies as strengthen the body, at the same time that they diminish the mor- bid secretion of mucus, and resist the decay and con- sumption of all the parts, give action to the organs destined to the natural functions, annoy the worms, destroy them, and excite throughout the system that energy which is so necessary to expel them, and to prevent their further increase : the remedies that 190 TREATMENT OF produce all these effects, accomplish the necessary indications. We are chiefly to regard as such the articles taken from the class of stimulants, which, possessing a bitter and an astringent principle, are well suit- ed to invigorate the nervous power, and augment the cohesion of the solids.(lO) Besides, experience every day proves that these worms are expelled from our bodies by the use of these medicines when administered in quantities adapted to the degree and character of the asthenic diathesis, whether this action takes place in con- sequence of the subtle and penetrating odour of these substances, or their mechanical agency on these vermin ; the former is more probable, by ex- citing the system, and particularly the parts affect- ed. The verminous nidus is formed by the mu- cous substance constantly enclosing the worms,(ll) which remaining like any foreign matter, are set in motion and expelled by the increased action of the organs.(12) § CIX. By reasoning accurately, we easily perceive that the specific property of destroying and expelling worms from the body has been false- ly attributed to a certain class of remedies. Be- fore this can be true, anthelmintics must be endow- ed with the power ascribed to them, and they should constantly produce the desired effect. This can- not be affirmed except by persons who are influ- enced rather by superstition, than exact and phi- losophical observation. VERMINOUS DISEASES. 191 The mere catalogue of remedies vaunted against worms would fill whole pages, but it could only serve to open the way to pyrrhonism. I am not disposed to say much of them, because an analytical exposition of their history would be foreign from my subject. I shall therefore gener- ally confine myself to an enumeration of all those remedies only, which in the opinion of every prac- titioner, are acknowledged to be the most active and efficient in fulfilling the above indications. I shall then describe those remedies, which experiment and observation have recognized, as well suited to expel from the human body the different species of worms. It is necessary to observe that several medicines are endowed with a drastic power, though stimulant, and that others possess a corroborant power. The physician should convince himself of the species of verminous affection, whether it is local, sympathetic, or general, before he decides on the remedy which is to be employed. Drastic purgatives may be proper for robust persons, in whom worms produce local symptoms, though they would occasion serious mischief if giv- en to feeble subjects, especially when the asthenic diathesis greatly prevails in the stomach and bow- els. In these cases we should effect the desired end by employing remedies which excite and strengthen the animal frame, without altering the natural secretion of the fluids. 192 TREATMENT OF $ CX. Physicians have been in the habit of prescribing their remedies for verminous complaints, both externally and internally. The internal administration is preferable to the external, because the former is more effectual than the latter; it is followed by more prompt and sure success. A number of patients however, and particular ly children, dislike to swallow the necessary medi- cines, because they are ordinarily very disagree- able. Other patients, harrassed by sympathetic ver- minous affections, can swallow nothing. Others, with great weakness of the stomach, throw up eve- ry thing given them. Lastly others, tormented by the hemorrhoids, or some other local disease of the anus, canuot receive enemas, by means of which might be introduced into the body whatever could not be swallowed, or retained on the stomach. In all these cases, the mere application of tht remedies appropriated to the. exterior, particularly over the surface corresponding to the part affected, as the region of the stomach, of the small intes- tines, and all the abdomen, is the only means of conquering or diminishing the disease. Epithems compounded of the remedies which *are directed to be taken internally in similar cases, applied to the region of the stomach, have been re- garded as excellent to drive worms from the intes- tinal tube by Boy, Frank and Weikard. These remedies dissolved in the gastric juice of ani- VERMINOUS DISEASES. 193 mals,* and then applied over the skin, are capa- ble of producing effects scarcely inferior to those obtained, when they are administered internal- ly (14) For this reason, when I have wished to apply medicines to the surface of the body for the expul- sion of all the worms which torment the inner parts of the body, and at the same time to strengthen the solids, I have advised them to be prepared accord- ing to the rules laid down in the anatripsologia.(l5) § CXI. I ought to remark, that in the sympa- thetic affections from worms, the nervous system being strongly excited, the most suitable remedies and such as should be preferred in these cases, are those endowed with a diffusively stimulant proper- ty, that is, calculated to sooth and calm the de- rangement and disturbance of the living solids. The class of medicines called antispasmodic, ex- hibits a long series of them. Valerian, opium, and assafoetida are the most frequently used. But let us pass to the examination of the principal reme- dies which have been extolled, either against worms in general, or some particular species of them. * Dr. Alihert is convinced by a multitude of experiments, of the nullity of tbe gastric juice, and the medicines he has ap- plied by friction, without having recourse to this vehicle, have been attended with the same success. See Memoires de la SocietS M6dicale dJ emulation, 1st year, second edition; Bul- letin des sciences de la Societe Philomatique de Paris, nivose year 6. F. Trs. 25 194 TREATMENT OF FIRST SERIES OF VERMIFUGE MEDICINES. $ CXI I. The vegetable and mineral kingdoms furnish most of the remedies which have been pre- scribed in verminous affections, and which physi- cians have called vermifuge or anthelmintic. 1 shall point out the vegetables under the Lin- naean name, and the minerals by the new nomen- clature introduced by the French chemists. VEGETABLE VERMIFUGES. § CXIII. Allium cepa.(l6) Onion. The fresh roots, or the expressed juice which has a peculiar ve- ry volatile odour and an acrid taste, are frequently used ; this is however less efficacious than the com- mon garlick. $ CXIV. Allium sativum.(17) Garlick. Its recent bulb contains an oily volatile principle, which is suited, like assafoetida, camphor, and sub- limed sulphur, to strengthen the stomach and bow- els, and thence to expel worms. The observations of Rosenstein,(18] and of Tissot,(19) leave no doubt of its possessing this property, since these two phy- sicians, having continued its use a long time, suc- ceeded in discharging entire taeniae. We also have examples of sympathetic convulsions, occasion- ed by worms, and cured by garlick.(20) These are prescribed under different forms, and they are com- bined with other remedies in their exhibition.*(21) * Our colleague M. O.uld, author of the exc ellent Diction- nttire de Chimie. has extracted an essential oil from garlick, VERMINOUS DISEASES. 195 § CXV. Artemisia santonica.'22) Santoni- cum. The seeds of this vegetable, which is well known to apothecaries by the name of wormseed, of semen contra, and of zedoary, (Kaempkeria rotun- da, Livn.J are very efficacious in expelling worms, particularly the lumbricoides. They have a bit- ter and subacrid taste aud smell ; all their activity depends on a volatile oil that is easily extracted. They are ordered iu substance, in infusion, in decoction, and in form of electuary, combined with other remedies.(23) The confections and pastils made of them(24) answer best for those who are nauseated by the odour of medicines. The dose for children is two grains, and for adults a drachm, in powder or electuary. The infusion is made with milk, and for this, two or three drachms of the pul- verized semen-contra is requisite. $ CXVI. Chenopodium anthelminticum.(25) Jerusalem oak. The seeds of this vegetable, which grows iu Pennsylvania, have an agreeable, pretty strong odour, and an aromatic taste ; it is said to be much used in America against worms, especially against the lumbricoides. Chalmers, who gives the description of it,(26) affirms that with the powder of these seeds only is composed that anthelmintic electuary, so famous in North America. which, applied to the skin, excites an almost insupportable paiu and irritation. He thinks it may be used as a vesicatory, and perhaps with the advantage of'not affecting the bladder like cantharides. F. Trs. 196 TREATMENT OF § CXVII. Convolvulus Jalappa.(27) Jalap. The resinous acrid principle of this root, which has a disagreeble smell and nauseous taste, is proba- bly the cause of its anthelmintic virtue. Wep- fer,(2S) after having employed without success the remedies most celebrated against the taenia, suc- cessfully prescribed to one of his patients half a drachm of this root in powder. It is commonly di- rected in combination with other remedies.^ 9) § CXV11I. Angelicae cortex.(30) Angelica, the bark. Dr. Grieve(31) was the first who gave this article as an anthelmintic, particularly against the lumbricoides. An ounce of this bark is boiled in three pounds of water, to one pound ; of which decoction the patient takes every morning, one or two ounces. This remedy lias sometimes occasioned griping pains; it has however occasionally expelled an ex- traordinary quantity of worms. § CX1X. Ferula Assafoetida.(S2) The gum- mi-resinous juice, obtained from incisions of the root of this plant, is what is used in medicine for the cure of several diseases, and particularly for the purpose of relieving the human body from worms, and those spasmodic affections from sym- pathy, which result from them. The virtues of this substauce reside in the volatile oil and resi- nous principle which it contains. Its taste is somewhat sharp, aromatic, and nau* seous ; it diffuses a smell of garlick. VERMINOUS DESEASES. £97 It is given in pills, or in some other manner, in doses from two to ten grains, several times a day; it is sometimes combined with other medi cines, as myrrh, the black oxide of Ton, subinu- riate of mercury, etc.(33, Enemas of as*afoetida, and cataplasms, in which this article enters,(34) seem to me better, on account of the repugnance of many sick people to swallow this medicine, whose odour is so disgusting. Frictions of assafoetida dis- solved in the gastric juice,(35) are preferable. § CXX. Geoffroya surinamensis.(S6) Cab- bage-bark tree, or worrubark tree. The bark of this plant has latterly been recommended against worms. I have many times used, and witnessed its efficacy against lumbricoides and the ascarides vermiculares. I have given it in powder and in extract; I think the decoction however prefera- ble.^) § CXXI. Juglans regia.(&8) The valnut tree. With the green bark of the nut I have made a de- coction, an infusion, an extract, and a rob,(39) which all possess a corroborant, astringent, and a vermifuge property, as the observations of An- dry,(4&) and of Fisher^hi) evince. It has long been observed that oil was injurious to insects; those even, which heat revives after submersion in water, die if immerged in oil, or covered with it. Redi and Malpighi have made many experiments on this subject; the result is that the oil closes all the air vessels, which in these small animals are very numerous, and distributed almost over every 193 TREATMENT OF part of the body. Agreeably to these views, oily substances have been recommended as vermifuges, and the oil of walnuts has been particularly extol- led by Andry,(4:2) and by other French physi- cians ;(43) they mix it with wine,(44) and believe the compound to be the more active and efficacious. § CXXII. Lauras cumphora.'4*5) Camphor. The volatile principle of this substance is a diffu- sive stimulus proper to strengthen the nerves and calm spasms, which renders it very efficacious in ver- minous affections, as Pringle has demonstrated.(46) The celebrated Moscati generally prefers cam- phor to other vermifuges, for the expulsion of lum- bricoides. Half a drachm is dissolved in a pound of water, to which a drachm of gum arabic is add- ed, and this mixture is given in small spoonfuls. Sometimes a larger quantity of camphor is dissolv- ed in an equal quantity of water, and with some ounces of this solution, and a quantity of tepid milk, injections are prepared, which are equally. efficacious with children. As it is to be apprehend. ed, says the illustrious Palleta,(\7) when campho- rated enemas arc used alone, that the lumbricoides may retire to the upper portions of the small intes- tines, or the stomach, these clysters should only be administered where children have great reluc- tance to take medicines by the mouth, because the camphor, being highly volatile, soon penetrates to the stomach, and all the viscera are impregnated with its subtle odour. It is also communicated to VERMINOUS DISEASES. 199 the month and respiration, so that the lumbricoides are nearly asphyxied and intoxicated with it. The employment of camphor is also attended with this precious advantage, that it counteracts the predisposition to the further development of ver- minous seeds. I have always used it with the greatest success : and I cannot too strongly recommend its use to phy- sicians in worm complaints, 48) whether given in the mode already mentioned, or some other, or com- bined with other remedies.(49) § CXXIII. Polypodium Filix mas.(50) Male polypody, or fern. The anthelmintic virtue of this plant has at all times been celebrated ; its taste is disagreeable, mucilagiuous, soft, styptic and bitter. It is recommended against worms, particular- ly against taeniae and lumbricoides. Tkeophrastus, Eresius,(51) Galen,(52) Pliny,(53) have prescrib- ed its use in doses of a drachm, and even to two or three drachms, in powder, or dissolved in wa- ter, as Windt(5$) advises. The powder of the root of the filix mas being the principal remedy of the specific of Nonffer, proposed as infallible against the taenia ;f55) it is necessary to know that this root, kept for a long time, loses its virtue. $ CXXIV. Spigelia anthelmi'a.(56) Worm- grass, or Indian pink. The herb and root of this plant indigenous iu the West Iudies, of which Lin- naeus has left us a very exact description,*; 57) pos- sess, like opium, a narcotic quality. 200 TREATMENT OF Among the Indians it is celebrated as a vermi- fuge, and Brown was the first to make known its utility iu Europe ;(58) afterward Rosenstein, Ber- gius, and Hahlberg brought it into fashion in Rus- sia and Sweden. 1 have also frequently ordered it with the greatest success. From ten to twelve grains, in powder, are given to children, morning and evening, and from half a drtchm to a drachm, to adults. An infusion or decoction is made of the herb ;C59) the extract has not yet been made use of. Lining, a celebrated physician of Charleston, S. C. in place of the above, substituted tbe spigilia marilandica,(60) or Carolina pink, another plant which grows in South Carolina,(61) which, ac- cording to B&rgius, is more efficacious than the preceding species. Arnemann attributes the vermi- fuge property solely to tbe root ;(62) and this re- duced to powder is prescribed in milk, beginning, for children, with a dose of half a scruple. The use of all these powders generally renders the body costive ; practitioners therefore advise to keep the bowels open, by administering, every third day, one or two grains of sub muriate of mercury, mixed with a suitable quantity of rhubarb. § CXXV. Tanacetum vulgare.(G8) Common tansy. Hoffman employed the seeds of tansy against worms with gotd effect. Several other physicians have said much in their favour, and par- ticularly Rosenstein,^) who was in the habit of combining them with other anthelmintics.^) One, VERMINOUS DISEASES. 201 two, or three drachms as a dose, are prescribed in a pound of water, in infusion. § CXXVI. Valeriana qfficinalis(66). The volatile oil, contained in the root of this plant, has a smell of the goat, and a bitter aromatic taste; this article is one of the best stimulants, of which medi- cine can boast. In all nervous asthenic affections, it produces unequivocal effects, and most generally it acts more powerfully than a number of medicines, which are highly commended in these complaints. Practitioners have esteemed it as equally beneficial in worm complaints, and particularly in sympa- thetic affections depending on them, such as epilep- sy, St. Vitus's dance, etc. In the famous electu- ary of Storck,(67) the powdered root of the offici- nal valerian, called Valeriana sylvestris, or wild va- lerian in books of pharmacy, is the most active in- gredient ;(68) the dose should be proportioned to the age, temperament, and degree of weakness of the patient. It is prescribed under different forms, and ordinarily combined with other remedies. § CXXVII. Veratrum Sabadilla.(6Q) Ceva- dilla. Indian caustic barley. This plant grows in Mexico. The seeds and capsules, pulverised to- gether, have been used, time immemorial, among the poor, for the destruction of those insects, which want of cleanliness has permitted to multiply on different exterior parts of their bodies. Loeser(70) first admitted this plant into the class of anthel- mintics ; it was employed with success by Sckmuc- ker.(7i) in epidemic verminous dysenteries, and in 26 202 TREATMENT OF cases of taenia, where Nouffer's remedy had failed. These trials, variously multiplied, lead us to con- clude, that the seeds of the cevadilla produce the desired effects, and that their use is not followed by any bad consequence. Schmucker prescribed them in powder, in the dose of half a scruple, blended with a little sugar and a few drops of oil of fennel, taken for four days, directing the patient to drink some decoction of chamomile flowers after it; on the fifteenth day he augmented the dose to fifteen grains, forming it in- to pills with honey : every five days he subjoined the use of a purgative. Thus he administered the remedy to adults. He followed the same method with children, ex- cepting that the dose of the powdered seeds was but two, four, or at most six grains, mixed with syrup of rhubard. In cases of vermicular ascarides, he rendered this treatment more active by means of enemas of the decoction of the cevadilla seeds, adding to it an equal portion of milk. Herz(72) has repeated the experiments of Schmucker, with equal success. It however appears from the observations of Odhelius,{~3) that the virtue of Schmucker's ver- mifuges is rather to be attributed to the combined use of jalap and submuriate of mercury, given to- gether as a cathartic. In whatever mode this remedy may act, it is well to know that the seeds of the cevadilla con* VERMINOUS DISEASES. -263 taining a poisonous caustic principle, and having an excessively acrid and burning taste, ought to be exhibited internally with great circumspection, be- cause it may readily produce deleterious effects, and even death.(74) § CXXVUI. Aloes, rhubarb, the gratiola offi- cinalis, gamboge, chamomile, and particularly sul- phureted scammony, (diagrede sulphure.J and oth- er similar articles, are also remedies commonly us- ed for the expulsion of worms. I have not spoken of these substances singly, because these drastics being usually combined with vermifuge remedies, vegetable or mineral, cannot in strict reasoning be directly classed with those medicines, which we use to expel worms from the body, and to prevent the development of verminous seeds.* * We are indebted to M. Charpentier Cossigni, member of the Academical Societyjof Sciences of Paris, for some very inter- esting details on the juice of the papaya, (Curica papaya,) em- ployed by him with the greatest success in tbe verminous dis- eases of the isle of France and Reunion. This tree is very common in most hot countries. It springs up without care or cultivation, and grows spontaneously ; it is unisexual. Certain nude trees are however occasionally seen to bear hermaphrodite flowers and fruit not so large, and less round- ed or filled up, and shorter than that of tbe female tree, equal- ly good however, and affording prolific seeds. In order to extract the milk from the fruit, this must be green and fresh gathered; they are pricked with a pin or cut longitu- dinally ; it yields a milk which is collected and given while new to the patient fasting. This is the most powerful of all the an- thelmintics. It is said even to kill tbe taenia cucurbitina, which is common in the island. It is thought by some to be corrosive, 204 TREATMENT OF MINERAL VERMIFUGES. § CXXIX. Sal Ammoniac. Muriate of ammo- nia. Among the most efficacious remedies for the ex- because when first taken it occasions colic, followed by erysi- pelas ; but in these cases it was acknowledged that the dose was too large. Its activity and danger have been diminished by mixing with it boiling water, three or four times as much water as of the juice, and giving this to the patient after stirring it with a spoon; administered in this way 1 have not heard of its pro- ducing any accident. Some of the planters say this remedy may be given, without addition or inconvenience, to persons of every age; they have however remarked, that when taken in great quantities, it may excite a slight inflammation of the anus; but they add that this is removed in one or two days bj means of lotions of emollient herbs. Some have attempted to mix it with sugar or honey; it is pretended however that this addition very much lessens its effi- cacy. M. Cossigni adds, that the proofs of the powerful property of this remedy are already very numerous, without reference to any unpleasant consequence from its abundant or excessive ex- hibition. What renders this medicine very important is, that a single dose of it is commonly sufficient to kill all the worms of the patient, however numerous they may be. To an infant ol from six to eight months, and even a year, is given a tea spoonful of the milk of papaya, mixed and bea- ten with three spoonfuls of boiling water or of boiling milk: this has the property of moderating the action of the remedy. A table spoonful of the milk of the papaya is given to children of five, six, or seven years of age, with three times as much boil- ing water; and to those of twelve or fourteen years, two ta- ble spoonfuls of this milk, mixed with six of boiling water. Three hours after this medicine is swallowed, the patient is to take a quantity of pure oil of Palraa Christi, suited to the age, VERMINOUS DISEASES. 205 pulsion of intestinal worms, Bloch(75) admits the mu- riate of ammonia, combined with rhubarb or jalap.* sex, and strength of the patient, in order to discharge the dead worms, whose continuance in the intestines might prove injuri- ous, etc. The seeds of the papaya dried and pulverized, and given in substance, are anthelmintic; the decoction of these with the roots neither occasions nausea, sickness of the stomach, nor colic ; they are rather insipid, but not purgative. Our colleague Cossigni has further remarked, that the mdk of papaya, grown on dry ground, and in a warm situation, is more active than that of the papaya, produced in opposite circumstances, and that the milk of the former dries more readi- ly and perfectly, than that from wet and cooler lands. For more ample details, see the work of M. Cossigni, entitled, Moyens d' Amelioration et de Restuuration proposes au Gouvernement et aux habitans des colonies, chez Delaplace, libraire, etc. We ought however further to inform our readers that the trials made in France of the juice of the papaya by professors Corvisart and Leroux, conjointly with Dr. Graperon, had no success. These experiments have been repeated by Dr. Alibert and M. Calvet, tbe nephew, at the hospital of Saint Lewis. Five children, from five to six years old, troubled with worms, took, for four sucpessive days, the concrete juice of the papaya in two drachm doses, and in the manner directed above, with >ut producing the expected effect. Dr. Alibert gave, on the fifth day, three grains of the oxide of tin, combined with a sufficient quantity of extract of juniper berries, and three of the young patients voided a number of lumbricoides. To render the history of the papaya complete, we want an exact analysis of these different preparations. M. Cadet Gassi- court, an eminent chemist, has done us this interesting service. * Our fellow member Duval, equally commendable for his learning and morality, has employed this remedy, against lum- bricoides, in his practice, with complete success. F. Trs. 206 TREATMENT OF He advises a scruple of the former with half ascru- pie of either of the roots every half hour. A like " M. Vauquelin, who has already made this analysis, has found, between the concrete juice and certain animal substances, some very curious analogies. He has not only observed a pretty large quantity of phosphate of lime, but he has separated from it a white substance, quite similar to animal oil, or fat Mr. Rock, a surgeon in the isle of France, has sent me several samples of the evaporated juice, and a bottle of liquid papaya. " As M. Vauquelin has operated only on the concrite juice, I thought it would be interesting to examine this material in its liquid state. " The bottle containing it was well closed and sealed, but on opening it, it was not full; the stopple was forcibly withdrawn. I examined the gas, which was disengaged from it, which was carbonic acid. The liquid, white and opaque like milk, exhaled an insupportable odour, resembling assafoetida, but more active and nauseous. This smell became gradually weaker. This milk strongly reddened the tincture of turnsole, which the aqueous solution of the concrete juice did not. Its flavour was sickish and acrid, leaving in the mouth a taste of sugar. The concrete juice had not the same sharpness, or acrimony." "The milk of the papaya filtrated, passes transparent and greenish like clarified whey; it leaves on the filtre a white mat- ter, curdled, of a suety insipidness, insoluble in cold or hot wa» ter, swelling in the air, and puffing up on the coals like case- ous matter." " The concrete juice, distilled over an open fire in a glass ves- sel, has given a great quantity of carbonate of crystalized am- monia, a fetid oil, and disengaged much carbonic acid gas and earboneted hydrogen. There remained in the vessel a volu- minous mass of coal, shining like that of some animal substance." " This coal, reduced to ashes, gave a quantity of lime and phosphate of lime." " I have distilled in a sand bath, and over a gentle fire some liquid juice of the papaya; the liquor coagulated ; it passed in- VERMINOUS DISEASES. 207 dose should be suited to the age, strength, and state of the stomach of the patient. to an insipid phlegm, having no acid property. I have stopped the distillation, and filtrated the liquor from the matrass to sep- arate the concrete matter. " The liquor was much more acid than before. I saturated one portion with potass 5 I evaporated it; and poured on alko- hol, which dissolved a small part of the extractive and saccha- rine matter, without touching the salt which had formed. The salt exhibited all the characters of malate of potass. Exposed to the air^ it readily absorbed moisture, and equally precipitat- ed the nitrate of mercury, from lead and silver. Another portion of the acid liquor from the same distillation, was treat- ed with alkohol, which separated a white substance, entirely so- luble in water, precipitating by the acetite, and by the nitrates of lead and of mercury, making a sort of dry and brilliant var- nish, when applied to the surface of bodies, acquiring by de- siccation, the transparence, aspect and taste of the gums. Treated with the nitric acid, this material gives nothing of ox- alic acid; it is malate of lime perfectly similar to that obtained from pouring alkohol on the clarified juice of houseleek. Final- ly, I have precipitated a third portion of the acid liquor by the acetite of lead ; 1 treated the precipitate with the sulphuric acid, diluted with water, and from this I obtained malic acid. Alkohol poured on the filtrated solution of the concrete juice ef- fects the same precipitation of malate of lime. I confess that I suspected at first that the malic acid, which existed in so great quantity in the milk of papaya, might arise from the beginning of the fermentation which the juice had undergone; but after find- ing in the concrete juice the same acid united to the lime, I have considered it as one of the constituent principles of this vegeta- ble matter. The white, concrete matter which gives to the juice of the papaya the appearance of milk, has not, as has been supposed, the characters of pure albumen, or fibrine, but those of curd or cheese." 208 TREATMENT OF Hirschel(76) affirms that he thus succeeded in curing a sufferer who had been for a very long time incommoded with a taenia, and who, to obtain re- lief, had taken, without advantage, several highly extolled remedies. I have employed, with the greatest success, in cases of lumbricoides, particu. larly in children, the anthelmintic drops of Dr. Hart- mann,'m which the liquid aniseted {"anise J carbonate of ammonia is combined with assafoetida and a bit- ter essence.(77) § CXXX. Barytes. The muriate of barytes, prepared with all the precautions of modern chem- ists, is a remedy endowed with great exciting pow- er, extending its effects chiefly over the system of lymphatic vessels. For this reason, this salt has been employed, with the best effects, by Crawford(78) and Clark 79) in scrophulous diseases, and in chronic elastic tu- mors ; by Altholf'(80) in scirrhosities, and obstruc- " It is affected like cheese, by the acids, alkalis, and distil- lation ; the presence of caseous matter in a vegetable is not surprising. Proust has already found it in the emulsion of almonds. This concrete matter furnishes by analysis the phosphate of lime and carbonate of ammonia, which brings them very near to animal substances." % " In like manner the liquid juice of the papaya, or the concrete juice when dissolved, presents also two remarkable substances." " The first retained on the filtfe is the caseous matter, mix- ed without doubt with a small portion of albumen; the second is a solution of the malate of lime with excess of malic acid in the natural liquid juice; without excess of acid in the concrete juice." F. Trs. VERMINOUS DISEASES. 209 tions of the mensenteric. glands, in tubercles of the lungs, in pituitous asthma, and in dropsies ; in oth- er kindred diseases, by the celebrated Hufe- land,(81) and by myself. The illustrious Hufeland, Westrumb,f82) Ber- nigau,(8S) and Kloths have used the muriate of ba- rytes in verminous complaints with so great bene- fit, that, according to them, there is no more pow- erful remedy than this, to expel from the intestines the vermicular ascarides. This medicine* however does not suit in cases where the lymphatic system is irritated, especially if disposed to inflame, as is often noticed even in diseases of the asthenic dia- theses, as may be seen in the judicious reflections of Harwin.(85) The muriate of barytes is-most commonly given dissolved in water; it is also di- rected in pills and powder. § CXXXI. Ferrum. This metal, prepared according to pharmaceutical processes, is one of the best tonics for the stomach. It is on account of this property, that physi- cians have attributed to the filings of iron, an an. thelmintic virtue, and not for the asperity of its par- ticles, as some have pretended. In the works of Wedel,(87) of Welthoff.(88) and of Van-Hoeve- rcw,(89) we read of many cases of worms expelled from the stomach and intestines, by means of eight * Dr. Elzear Roux cured two soldiers of taenia, with pills of muriate of barytes. We ngret that we cannot subjoin the two cases which this excellent physician has just communicat- ed to us. /''. Trs. 27 210 TREATMENT OF or ten grains of limatura ferri, mixed with an equal part of rhubarb, taken two or three times a day. Harluc{90) succeeded even in expelling a taenia with iron filings ; he recommends it still more for cases of colic produced by worms. The filings of iron, mixed with cinnamon and magnesia, prevents those belchings and flatulences, which sometimes incommode particular persons, who have taken this preparation of iron. It seems probable that some of the particles of iron, not yet dissolved in the first passages, pass into the vascular system, which they strongly ex- cite.* It is probably from this cause that the im- proved complexion of those who take iron but a short time, is derived. This medicine therefore is equally well suited to prevent the morbid diathesis which favours the development of worms. The sulphate of iron is ranked among the pre- parations, which, according to Rosenstein,(9l) are best suited to relieve verminous affections. It possesses a greater astringent force than iron ; it is also more useful in moderating excessive excre- tions of mucus from the intestines, and to give tone to parts relaxed. It is prescribed for children in doses of two, four, or to ten grains, and to adults from half a drachm to a drachm, and better still, if combined with cinchona, valerian, jalap, male fern, * Is it not owing to the great tendency of iron to unite with oxygen, that we are to attribute its tonic and exciting quali- ties ? F. Trs. VERMINOUS DESEASES 211 semen-contra, assafoetida, or rob of walnuts, etc.(9S) To a child seized with spasmodic convulsions oc- casioned by worms, I prescribed a mass of pills,(93) in a manner analogous to that of Fuller: the worms were promptly expelled from the intestinal tube, the convulsions subsided almost immediately, and the patient was well. Water acidulated with iron,(94) and what are better the martial waters,(95) so much commended by practitioners, as a means of curing verminous complaints, possess this medicinal quality by rea- son of the iron they hold in solution, and united with other astringent substances which strengthen and invigorate the stomach, the intestines, and the whole animal machine.* §> CXXXII. Mercury. A number of eminent physicians(9'>) have ascribed to mercury the prop- erty of dissolving and attenuating the mucus of the intestines, and of destroying the worms which in- habit them. Conformably to this idea, they have recom- mended, without limitation, the decoction of mer- cury, as a very active remedy in verminous com- plaints. A similar practice has given rise to dis- cussions, of which it is useless to speak here. I shall merely remark that nonoxidized mercury has no irritating power on our bodies, except what comes from its weight and continual motion, and * See in the work of Dr. Marie de Saint- Ursin, entitled the Ami des Femmes, page 238, the ma.ner of using the artificial mineral waters. F. Trs. 212 TREATMENT OF the facility with which it is oxidized when intro- duced into the stomach and bowels; this last pro- perty tends rather to weaken, than to strengen and excite the human frame.(97) This being admitted, it clearly appears that the decoction of mercury, and even mercury itself introduced into our body, are of no importance against verminous complaints, though thVir use has been highly celebrated ;v98) still less can they be adopted in the treatment of worms. The people who work in the mercury mines of Almada,in Spain, are more subject to worms andvenerial complaints, ihan to any other; though these individuals, and particularly those who melt the mercury, absorb so enormous a quantity of it> that small globules of this metal are evacuated with the excrements.(99) The same thing happens to persons employed in the mines of Lydria, and in the laboratories of Chemnitz, in Hungary, and of Freyburg, in Saxony, where the amalgamation with mercury is practised, to purify gold and sil- ver. In these places, I have seen, as it were, ver- minous complaints to be epidemic. The labourers are constantly enveloped in humid- ity, badly fed and poorly clothed ; they live indeed in a situation suited to produce asthenic diseases, and consequently conducive to the development of verminous germs. But let us proceed to positive facts. Mo7ick has performed a series of experiments to determine the quautity of the mercury which was dissolved in the water in which it had been VERMINOUS DISEASES. 213 boiled to make a decoction of it; and in conformi- ty to the results obtained, he asserts with certain- ty that the water holds in solution only the small* est possible portion of mercury; that the largest portion of the solution is charged with particles of lead and foreign substances usually found in union with mercury. In addition to this, Rosenstein has administered mercury in several cases, even to salivation, with- out being able to expel a single worm.* Instruct- ed by these observations, and by some of my own, I conclude that nonoxidized mercury is not to be regarded as vermifuge, except when it ha9 been triturated with other appropriate medicines. It is administered to patients tormented with worms un- der the form of electuary or pills.(lOO) Mercury, given in the state of oxide, acts on the solids as a powerful stimulant, since by its use, the pulse acquires great force, and the secretions and excretions are augmented. In this way sever- al of the oxides of mercury have been very efficient in expelling worms, and in curing verminous affec- tions. Among these the submuriate of mercury is to be preferred, then the ammoniacal muriate of mercury; and the sulphate of mercury administer- ed in powders, boluses, or pills(lOl) etc. Sul- * Our school-fellow, Dr. Cushet, has assured us that he em- ployed the decoction of mercury with two children, troubled with lumbricoides, with the greatest success. Professor Four- rroy also recommends the use of it in his Cours de Chimie, at the school of medicine of Paris. F. Trs. 214 TREATMENT OF phur blended with mercury, and triturated together, has also been found useful in the cases abovemen- tioned : the black sulphureted mercury fie mercu- re sulfure noirj has been given from a grain, to ten grains, twice a day. (102) In the administration of the mercurial preparations, it is necessary to take care that th.ey do not readily provoke salivation, which by debilitating the stomach and bowels, might produce effects contrary to those intended. The dose should be insensibly augmented, and the mercurial preparation suspended so soon as the patient feels a heat in his gums, as I am accustom- ed to do in the treatment of general venereal dis- eases.(103) §> CXXXIII. Petroleum. At Montpellicr, petroleum is famous against worms ; it is common- ly called rock oil, red petroleum, and naphto-pe- troleum. Dr. Hasselquist affirms also that in E- gypt* the taenia being common, the inhabitants re- lieve themselves by means of petroleum taken in water in the dose of twenty or thirty drops each lime.(104) A physician having for a long time prescribed various medicines without success, to a man suffering with taenia, at length ordered him half a drachm of petroleum mixed with an equal quantity of oil of turpentine, to be divided into three doses; the patient, already fatigued with remedies, * Dr. Larrey, who has so well described the diseases of E- gypt, assures us that the taenia:is rarely seen there: and that the inhabitants and physicians do not know the petroleum. F. Trs. VERMINOUS DISEASES. 215 did not take them without the greatest reluctance, aud to get rid of the business at once, swallowed the whole quantity as a single dose. He was im- mediately delivered of the entire taenia. Some time after the same physician prescribed for a woman, thirty drops of this oil to be taken in the morning, and forty more of them in the after- noon ;- she was soon delivered of a worm twelve metres long.(105) The petroleum is a very stimulating and heat- ing remedy: it is given in combination with some syrup, or with other remedies possessing a stimu- lant antispasmodic power,(106) in the dose of ten, twenty, or thirty drops. Vicat has advanced by little and little to the dose of one hundred drops ; many practitioners advise the external use of it in cases of pains of the abdomen occasioned by worms. For this purpose the whole region of the abdomen is rubbed with the petroleum alone or mixed with ox's gall, as Mellin advises : in this way it is more penetrating and at the same time more active. § CXXXIV. Muriate of Soda. The stimu-' lating effect of this salt facilitates the digestion of food, dissolves and attenuates the mucus of the stomach and intestines, excites the bowels to dis- charge their contents, opposes the putrefaction of the animal parts, and gives tone to the cohesion of the fibres. These properties have not only rendered this salt necessary for the seasoning of our daily food, but also very useful in many asthenic diseases, and 216 TREATMENT OF especially in those which attack the system of lymphatic vessels, such as scurvy,(108) costive- ness,(109) obstructions of the viscera and glands of the abdomen,(110) scrophula,(lll) etc. The muriate of soda must also be injurious to worms, as in fact it has been observed to be by Heber- den,(H2) and by Rush,(113) who have administered it on these occasions with success, both by adding it in larger quantity to our daily meals, and by taking it alone, in large doses, fasting. § CXXXV. Stannum. Ever since the days of Paracelsus, the power of expelling worms from the intestines, has been attributed to tin. In the last century, Alston(ll^) of Scotland, began to make use of tin with the greatest success, not only against lumbricoides, but also against taeniae. Oth- er physicians of great name(115) recommended it also as one of the strongest and most powerful an- thelmintics, as we shall notice in the sequel.*(ll6) § CXXXVI. Zincum. In convulsive, epileptic, and hysteric complaints, the sublimed oxide of zinc, has been directed to advantage, as may be seen in the cases and observations of physicians, particu- larly in the work of Hart.(lt7) This remedy has * Dr. J. L. Alibert, in his excellent cours de MatiereMedi- cale, says that the oxide of tin is one of the most potent reme- dies against the taenia. He gives it to children in doses of three grains, in a convenient quantity of extract of juniper. For adults, he makes use of the muriate of tin in clysters: the latter should not be given without great caution, as it is a vio- lent poison. F. Trs. verminous diseases. 21? also been used in convulsive affections arising from worms, and with some success, according to the experiments of Dr. Martini,(H8) of Monck,(llQ) and of Storke.(120) It is ordered for children in doses of half a grain, to one or two grains, in a little sugar, two or three times a day. For adults the dose is increased in proportion to the age and irritability of the individual. It is very useful in the treatment of the ascarides ver- miculares^ 121) § CXXXVII. Sulphur. The property of sul- phur is to destroy the insects which infest different parts of our body. It has been remarked that the combination of sulphur and mercury, is an excel- lent remedy against worms.(122) We derive the same advantage from the use of sublimed sulphur, administered in doses of ten, twenty, or even thirty grains, etc. It is also united with camphor, or assafoetida, to form pills. Tis- sot, Van-Swieten, and Van-Hoeveren employed it against worms with the most perfect success. Persons predisposed to worms find themselves well after the use of the cold sulphureted wa- ters^ 123) and by this means are secured against the evils which worms produce. II. TREATMENT OF TAENIAE. § CXXXVIII. Thedifficultyofexpellingthese worms from the intestinal tube is often very great. The enormous length of these worms,^124) and 28 218 TREATMENT OF particularly their various convolutions in the small intestines, render it impossible to expel them with- out incommoding the patient. A specific is still wanting to kill them without disordering the stomach and bowels; if such a rem- edy should ever be found, they might be easily dissolved and discharged w th the fecal matter, be- cause once dead, they no longer adhere to the mu- cous membrane which lines the alimentary canal. The armed human taeniae, by insinuating them- selves with greater force into the substance of the intestines, are more difficult to expel, than the tae- nia without arms.(125) Thus the morbid symptoms they occasion, be- ing consequently more intolerable,^ 126) demand more prompt and efficient relief. § CXXXIX. The principal remedies used by practitioners to expel the taenia are taken from the class of the most powerful evacuants, and from the most active stimulants ; the number of these reme- dies is great because several of them are inefficient. On this point it is necessary to remark, that the administration of these remedies should be adapt- ed to the age, constitution and morbid predisposi- tion to which the individual tends who is troubled ' with the taenia; in a word, to the excitement of his system. In an individual of middling strength, affected with this worm, and who has a tendency to asthenia, we can easily expel the worm that tor- ments him by a simple evacuant, or a compound drastic cathartic. VERMINOUS DISEASES. 219 On the contrary, an individual attacked with taenia, of a cachectic constitution, in whom the as- thenic diathesis prevails, will be with certainty cured, by means of a stimulant treatment propor- tioned to his state of weakness. This being grant- ed, we clearly comprehend how some persons have been cured by taking tartrite of antimony,(127) sul- phate of soda,( 128) nitrate of potass,(129) gambo- gia,(130)or jalap,(13l) and other similar remedies ; while these same medicinal substances administer- ed to other patients, also affected with taenia, have been unsuccessful, or even injurious. This also explains why recourse must some- times be had to opium,'v 132) to electricity,'133) and to a stimulant regimen. Besides the variety of constitutions, the different species of taeniae oc* casion, as we have said, a noteable difference in the success of the treatment undertaken with these med- icines. A gentle evacuant or a bracer, though light, are ordinarily sufficient to drive out the unarm- ed taenia ; tbe armed taeniae, on the contrary, are not commonly detached from the walls of the in- testines, till after the exhibition of a drastic pur. gative, which, by irritating the intestinal tube, oc- casions a violent and rapid peristaltic motion, which obliges it to give up its hold, or by another remedy which acts on the worm with a force altogether me- chanical, for example, like the oxide of tin.(134) It is from a profound examination of these prac- tical results, that we arrive at the knowledge of 220 TREATMENT OF the true cause which frequently renders inert the treatment of taeniae, by those compounds and meth- ods which are so highly commended in the publica- tions of authors, illustrious however, and which have been spread through all the courts of Europe, sometimes as infallible specifics, sometimes as mar- vellous secrets. From this philosophical source, we can comprehend how it is, that in many cases of taenia, which have been almost without hope, the desired success has been obtained by medicines quite simple and common, such as garlic,(135) the seeds of cevadilla,(136) muriate of ammonia,(137) filings of iron,(^8) the oxides of mercury/139) petroleum,(140) etc. It is, in fine, in this manner, that we shall be able to determine the true value of the different methods vv hich have at various pe- riods been adopted for the expulsion of taeniae from the human bodv. I shall mention such of these methods as have been deemed most successful, in order to give a general representation of the means that medicine can employ in triumphing over an enemy so injuri- ous to health, aud sometimes so difficult to be driv- en from his strong holds. §> CXL. But befure we enter on the details of the remedies, employed at different times, by dif- ferent physicians, and with various success, I should offer some practical precepts, with the view of reg- ulating and favouring the discharge of the worm from the patient under treatment. So soon as a part of the taenia appears from the anus, it seems, VERMINOUS DISEASES. 221 at first, very easy to extract the entire worm. Ob- servers however agree that this is impossible, and I have been several times convinced, when desirous of doing it, that by pulling, even with caution, the portion evacuated, that the patient begins to feel iu his belly a twisting and drawing, such as would throw him into convulsions, if the pulling were continued, or the worm not cut off. When, in place of cutting off the worm, a thread of silk is tied round the portion passed out of the anus, it retires into the body about three metres eighteen centimetres; but soon after it is again detached from the intes- tines, and passes out of the anus. So soon as the patient begins to find the worm to be passing out, he should immediately repair to the close-stoool and remain patiently seated till the whole worm is voided. The taenia, rolled into a knot, is ordinarily ex- pelled with the feces; but it is discharaged with difficulty, either because its head is buried in the mucous membrane or valves of the intestines, or because a mass of mucous matter impedes its ex- it ; then the patient, tranquil on his pierced chair, should drink, in repeated and frequent doses, an infusion of chamomile flowers, or what is better, he should take an ounce of sulphate of magnesia to quicken the peristaltic movement of the intestinal tube. If after taking proper medicines, the worm is not evacuated, or but partially, it is obvious that suitable remedies must be repeated next day, or 22£ TREATMENT OF eveu more active remedies, if the first have been insufficient. It sometimes happens that the patient, ready to expel the worm, after an abundant alvine evacua- tion, experiences a strong sensation of heat and anx- iety at the praecordia, which ends in vomiting. In this case we need not be uneasy, because this ac- cident soon passes away; the patient has only to snuff up some radical vinegar (acetic acid), to he almost instantly restored. METHOD OF ROSENSTEIN. (Cold water, and mineral waters.J § CXLI. We have elsewhere noticed,(141) that taeniae, plunged into hot water, move with vivac- ity, and plunged into cold water, that they are al- most asphixied. Rosenstein, supported by this observation, judged that these worms could be ea- sily detached, by causing the patient to drink a large quantity of cold water, after taking a purga- tive, because the cold water depriving them of the power of moving the neck and fixing the head into the folds of the intestines, they would be thurst from the body by the violence of the peristaltic motion, increased by the action of the purga- tive^ 142) He communicated his thoughts on this subject to Dr. Harelius, who some weeks after, sent him a taenia expelled in this way; this worm was seventeen metres ninety nine centime- VERMINOUS DISEASES. 223 tres* long, the neck entire, at the end of which was the head with its tube and four lateral holes. The same Dr. Harelius cured several other pa- tients in this manner. Lindhult and Sidren have, in like manner, had the same success. Rosenstein then remarks, that if water could remain cold half an hour, or an hour in the stomach and intestines, or if taken every moment, it could pass without delay into the stomach and into the bowels, this means would never fail to succeed. But as we cannot always find these circumstances, we should frequently repeat the potions of cold water so as to obtain its effect with certainty.(143) § CXLII. We have noticed from the results communicated by Dr. Soa, that the muriate of soda kills taeniae with promptitude ;(144) besides the vermifuge property of this salt which is confirmed by practitioners,(14.>) I would advise a strong solu- tion of it in cold water, instead of water simply, to give more efficiency to Rosenstein's method ; sea water cooled might answer this purpose very well: the same may be said of mineral waters, which hold muriate or sulphate of soda in solu- tion.(146) * The centimetre is the hundredth part of a metre, or near- ly four tenths of an inch. A. T. 224 TREATMENT OF METHOD OF MEIER. (Carbonic acid gas.J § CXLIII. A young girl, seized first with epileptic attacks, and by fits of violent colic, ex- hibited unequivocal signs of the existence of a tae- nia iu the intestinal tube. Some slight remedies were prescribed, without effect; but after eating freely of strawberries just gathered, and drinking a cup of warm milk, she had four copious alvine evacuations accompanied with pain, and in the last of which she passed a fragment of tape worm three metres eighteen cen- timetres in length.(147) Dr. Meier of Erfurt, after being informed of the treatment, attributed tthis effect to the considerable quantity of carbonic acid gas, which is disengaged from fresh strawberries so soon as they are taken into the stomach, since this fruit contains no oth- er material capable of expelling a taenia. To ver- ify bis hypothesis, he ordered a patient, having taenia, to take every hour a teaspoonful of carbon- ate of magnesia, and immediately after, another spoonful of the acidulous tartrite of potass. The patient having continued this treatment two days, evacuated the third day several pieces of taenia. It was observed on this occasion, that by abandon- ing the remedies mentioned, he voided no more of the taenia, and that so soon as he took them anew VERMINOUS DISEASES. 225 he discharged several more pieces of the worm with the feces. § CXLIV. The vermifuge property of carbon- ic acid gas has already been announced by Tar- gioni.(i48) by Hulme,(iW) by Hartmann,(150) by Suenscke/151) and lastly determined by a beau- tiful series of experiments made by the celebrated Ingenhouz. 152) The credit however of reduc- ing to practice the trials of physicians, cannot be refused to Dr. Meier, to whom we are under great obligations. This method is mild and agreeable, and at the same time seems calculated somewhat to strengthen the system. This method ought not to be abandoned, aud I should prefer the use of the carbonate of magne- sia and the acidulous tartrite of potass, as directed by Meier. The cold mineral waters charged with carbon- ic acid gas,(153 and in want of these, the a'erofo- rous powder of Wagler( 154) or the water of Splt- %er artificially imitated, 155) may render this meth- od nlore efficacious than that of Rosenstein. METHOD OF CHABERT. Essential oil of turpentine and liquid carbonate of ammonia. § CXLV. The essential oil of turpentine, com- bined with petroleum, has already been noticed, as well suited to expel taeniae.(156) The remedy of Chabert consists in the distilled oil of turpen- 29 226 TREATMENT OF tine with the liquid carbonate of ammonia; this mixture he assures us(157) is a very powerful and infallible means of expelling the taenia from do- mestic animals.(158) Repeated observations prove, that though this remedy acts with activity and energy against taeniae, it produces not the least dis- order in the system. It is also to be desired that it should be adopted by physicians to expel taeniae from the human body, since we have seen that the essential oil of turpentine, muriate of ammonia, and carbonate of liquid ammonia, are also remedies,. which have been advantageously employed both against taeniae and lumbricoides. METHOD OF NOUFFEK. The root of polypodium filix mas. § CXLVI. Toward the middle of the last cen- tury a great number of persons, troubled with tae- niae, went to Morat in Switzerland, where madam Nouffer, after the death of her husband, continu- ed to cure them with promptitude and success, by means of a secret which she held from her husband. The king of France gave a considerable sum to ob- tain the formula of this celebrated remedy, and charged the physicians Lassone, Macquer, Lamothe, de Jussieu and Carbuvi, to examine it, and make such trials with it as they might think proper. This committee made their report, July 13, 1765, whence it appeared that the remedy of Nouffer answered very well in practice, and that it merited VERMINOUS DISEASES. 22/ the celebrity it had acquired. The king ordered the publication of it for the benefit of suffering hu- manity, in the following terms.(159) Preparation of the patients. " This treatment requires no preparation, unless it be to take for supper, seven hours after a com- mon dinner, a soup-panada, made in the following manner: take a pound and a half Of water, from two to three ounces of fresh butter, and two ounces of bread cut into small pieces; add a sufficient quantity of salt to season it, boil the whole over a good fire, stirring it frequently till it is well mixed and reduced to a panada. Fifteen minutes after, give the patient two middling sized biscuits, and a glass of white wine, or pure water, if he does not commonly drink wine. " If the patient be costive, give him the follow- ing clyster fifteen or thirty minutes after supper : take a good pinch of mallows and of marshmallows, boil them a little in half a pint of water, add to it a little muriate of soda, strain it, and mix with it two ounces of olive oil. Treatment of the patients. u The next morning, eight or nine hours after supper, the following specific is administered: take three drachms of the root of the filix mas,(l60) re- duced to a very fine power, mixed with four or six ounces of the distilled water of the male fern or of the flowers of the tilden or lime tree (tilleul,) 228 TREATMENT OF the whole to be swallowed by the patient, rins. ing tbe tumbler two or three times with the saaie water, that none of the powder may remain in the glass or mouth. " For children, the dose of this powder is lessen- ed to one drachm. If the patient, after taking the powder, siiould be incommoded vvith nausea, be must inhale the odour of strong vinegar; if, not- withstanding this, the powder rises and seems rea- dy to be discharged from the mouth, he must swal- low and do every thing in his power to keep it down ; but if obliged to reject it in whole or in part, he must continue to take it till the nausea ceases, and till what equals the first dose is retained* " Two hours after the powder is taken, the pa- tient is to swallow the following bolus : take sub- muriate of mercury, and dry resin of scammony of Aleppo, of each twelve grains, of gamboge five grains ; reduce these three articles to a very fine powder, and with a sufficient quantity of hyacinth confection ft»rm the whole into a bolus of middling consistence; this is the purgative dose usually giv- en ; that of the confection I 61) is from two scruples to two scruples and a half for persons of robust con- stitution, or difficult to purge, or who have previous- ly taken strong purgatives. A bolus compounded of eight and a half grains of submuriate of mercury, and the same quantity of the resin of scammony, is given to weak persons who are sensible to the ac- tion of purgatives, and for children the dose should be diminished agreebly to the prudence of the phy- VERMINOUS DESEASE 2£9 »ician. In a case where all circumstances unite, seven grains of submuriate of mercury and as much of the resin of scammony with a sufficient quanti- ty of hyacinth confection, are sufficient, without the gamboge. " This bolus has also been given at two times, that is, one half of it two hours after the powder, and the other part three hours after the first, be- cause the first had operated but slightly. Immedi- ately after the bolus, one or two small cups of green tea; and from the beginning of the evacuations, a cup should be given from time to time till the worm is discharged. After the bowels are opened, but not before, the patient is to take some good broth, aud some time after, a second broth or light soup. " The patient may afterward dine temperately, but through the day he is to be cautious and rather abstemious; if however the bolus has been partly ejected from the stomach, or if retained, it has not purged sufficiently in four hours, he must then take from two to eight grains of sulphate of magnesia, dissolved in a convenient quantity of boiling wa- ter." § CXLVII. The powder of the male fern has been employed with success, as we have elsewhere remarked,(l62) for the expulsion of worms from the intestines, and particularly taeniae and lum- bricoides. Even before madam Nouffer had un- veiled her secret, Dr. Herrenschwand had used this remedy in cases of taeniae, pursuing nearly the same treatment.(163) 2iO TREATMENT OF The French commissioners however, who were chosen to examine the remedy of Nouffer, and oth- er physicians who have often tried the method ot Harrenschwand and that of Nouffer, certify, that this remedy is fatal to the human unarmed taenia, but that it produces no effect against the armed human taenia.(l64.) The Russians, the French, and the Swiss have chiefly contributed to the ce- lebrity of these two methods ;(165) in fact, the in- habitants of these countries are more subject to the unarmed taenia than to the other species.(166) It follows that in Russia, in Switzerland, and in France, one of these methods must be more effi- cient, than in Lower Saxony,(l67) and in Italy, where the inhabitants are tormented by the armed human taenia,(l68) more than by the unarmed 9pecies. § CXLVIII. In 9pite of the fine observations of some celebrated individuals, who testify to the suc- cess of Nouffer's method in the treatment of tae- niae, I must however say, that the maxim of be- lieving it efficacious only against unarmed taeniae is subject to some restrictions. The celebrated Palletta relates, that the'Miianese physician, Gal- laroli, drove both species of this worm from the human body with Nouffer7s remedy.(l69) I have also had several patients attacked by the armed taenia, who were happily cured by the same regimen.(170) Though these observations seem to contradict the maxim announced by the French physicians and other practitioners, I ought VERMINOUS DISEASES. 123 nevertheless to notice the exception to which it is subject; 1 am led to this by a practical case truly singular. 1 report it because it seems well calcu- lated to reconcile the two opinions given on the method of Nouffer, and to settle with precision the cases in which it may be crowned with success. Case. Anthony Arcova, of Pavia, of a tolerably robust constitution, had no particular disease before the age of 2z years, if we except some attacks of an autumnal intermittent fever, epidemic in this city, and from which his health was soon reestablished; he was badly nourished, labouring more than usu- al, preserving no proportion between his fatigue and repose. On the 9th of February, 1797? be- ing occupied about his domestic affairs, before breakfast, he was suddenly attacked with violent pains in the abdomen, which soon subsided, but afterward returned, accompanied with extraordina- ry appetite, and an undulation of the belly. Small pieces of the armed taenia were observ- ed in his excrements. At length, on the 17th of February, toward night, such violent cutting pains took place, that he was obliged to keep his bed, and to have recourse to some bitter spirit of wine and good rum to repair his strength. The pains abated, and the patient had a tranquil night. The following day, he rose with an unusual appetite: during the day he had three discharges, and with each voided a piece of taenia three metres eighteen 2$2 TREATMENT OF centimetres long. Three days after, having again suffered pain, he decided to repair to the Clinical Hospital of Pavia, then under my care. Besides the symptoms already mentioned, I found his pulse very small and feeble. February 22d, I direct- ed him the soup-panada, prescribed by Nouffer, and the day following, gave him in the evening a drachm of the pulverized root of the filix mas, and then his purgative agreeably to the precepts of Nouffer. The patient followed this regimen ex- actly, and was again seized with griping pains, dur- ing which he discharged, in several pieces, the armed taenia, represented Plate I, fig. i, ii. The same eveniug he took again the soup-panada, and on the 23d he took, early in the morning, the fern powder, and soon after the usual purgative. The patient had no pain; the remedy produced reach- ing to vomit, which gave way on sucking a lemon. He voided, without having pain, in his fecal dis- charges, a lumbricoides, and two pieces more of tae- nia, which, with the preceding, measured ten me- tres sixty decimetres. The head (PI. 1, fig. i,) and the tail were among these pieces. The same treat- ment was continued three days longer, but dis- charging no more taeniae, and the patient being in other respects restored, he returned to his house. Near the end of August of the same year, he came to consult me, because he again felt the pains of the abdomen, and again discharged pieces of tae- nia, which according to him were larger, broader, and longer than the other pieces. I advised him VERMINOUS DISEASES. a$3 to enter the hospital where he arrived August 29th. I treated him for seven days agreeably to the plan of Nouffer; as had been done in the month of Feb- ruary ; but no effect was produced, as he discharg- ed merely some small fragments of taenia, as hap- pened before he entered on this course of treat- ment, and the symptoms increasing for two days, I subjected him to the trial of the root of the male fern, according to the mode of Herrensckwand,(171) in lieu of that of Nouffer; but all was useless. The griping pains returned with augmented vio- lence ; the alvine evacuations were more frequent, the patient very weak; frequent fainting fits ren- dered the disease more severe, and the taenia seem- ed more and more difficult to be expelled. In a case to me so singular, I determined to try Alston's plan; and accordingly, September 8th, I prescribed for him, to be taken in the morning, a bolus, compounded often grains of filings of tin, with a sufficient quantity of conserve of roses, to be re- peated every two hours. After the third dose he voided, in several pieces, a very large armed taenia, in length twenty five metres one hundred and fifty decimetres ;(172) he recovered his health perfectly, aud was no more troubled with taeniae. § CXLIX. If we attentively consider this case, it will teach us that the method of Nouffer may be successfully adopted even in cases of armed taeniae, if they are small or young, because this worm, before his size and strength are completed, js not yet firmly attached by the fangs of bis head, 30 234 TREATMENT OF to the mucous membrane of the intestines. This case also instructs us, that the same method will certainly fail when the armed taenia, at full growth, is strongly fixed to the membranes of the intestines, and consequently occasions more severe symptoms. I have had occasion to prescribe for these tae- niae, when the age of the armed taenia was differ- ent from that just mentioned. This difference has however required an oppo- site mode of treatment; if the instance is not rare, it is certainly instructive. § CL. Further, the root of the polypodium filix mas, even before the method of Herrenschwand was known, and before the secret of Nouffer was revealed, had been employed by different physi- cians in cases of taeniae and other worms, as we have already announced.(174) Renard,(i75) in these cases, used to prescribe, in the evening, an enema of soap dissolved in water, and during the five following days administered, fasting, a drachm of the pulvis radicis filicis maris, dissolved in some purslain, and soon after a bolus, compounded of submuriate of mercury, of jalap, rhubarb and honey; and for common drink a decoction of the male fern root. Vogel affirms,(176) that nothing is more ef- fectual in expelling taeniae than half a scruple of this root, and three grains of gamboge, taken morn- ing and evening, for several days : the same thing has been observed by Alix,(L77) by Huncan,{178) eic. VERMINOUS DISEASE*. 235 METHOD OF ODIER. Oleum Ricini. § OLI. The celebrated physician Odier, of Geneva, first administered this oil for the purpose of expelling worms from the human body, and par- ticularly taeniae.(179) The experiments of Redi, of Malpigki, already mentioned,(180) as well as the practice of Andry and other French physicians, have confirmed the vermifuge property of oily sub- stances ; and among these the fresh oil of the com- mon ricinus(181) has been found the most proper, because from its mildness, the sick take it with ease and without dislike. This oil both kills the worms and purges the patient. Adults take three ounces for a dose, and children a teaspoonful several times a day. It pro- duces no pain in the abdomen, as is the case with most other purgatives ; this oil may also be given without fear, even to ruptured persons. Goexe re- lates^ 82) the case of a feeble and very irritable old man, who had a double hernia, who soon re- lieved himself of a taenia, by means of this salu- tary oil. (1*3) § CLII. The use of the oleum ricini has been confined to cases of the unarmed taenia, because Odier and his colleague Hunant, have never de- stroyed the other species, with this remedy. I can however say, that it sometimes serves wonderfully well to expel also the armed taenia. 236 TREATMENT OF In my journal, I have two cases of armed tae- niae expelled by three ounces of this oil, taken by a patient during three successive days, and by an- other taken twice a day for a week. § CLIII. Some practitioners have calculated to render the root of the polypodium filix mas more active, when administered in doses of two or three drachms, by prescribing, two hours after, an ounce and a half of oleum ricini, instead of the purgative commonly given by Nouffer, which is attended with some inconveniences, as vomiting, colicy pains, abundant evacuations, prostration of strength, and other similar symptoms. After this oil has been taken, the patient drinks some broth, and the dose is repeated the second or third time, if the suffer- er can bear it, in order to drive the taenia from the intestinal tube. Selle advises,(184) on tbe contrary, to take the oleum ricini in the evening, and the next morning ten grains of gamboge, and to repeat it twice more, drinking afterward some broth, provided no un- pleasant irritation exists. METHOD OF DESAULT. Mercurials. § CLIV. Dr. Hesault, an eminent physician of Bordeaux, having observed that taeniae (principaJU ly the armed) sometimes attach themselves to the intestines in such a manner, that it is difficult to separate and expel them, proposed for this purpose VERMINOUS DISEASES. 227 an ingenious and bold expedient, that of adminis-, teriog alternately a mercurial friction and a purga- tive of calomel in a large dose ;(185) it cannot be denied that wornvs have often been expelled by the oxides of mercury.(186) The method proposed however may readily oc- casion diseases more intolerable and dangerous than that of the worms. Besides, very few persons would willingly sub- mit to a treatment altogether mercurial. In using mercurials therefore, and especially the oxides, which are useful only in certain cases, the practice of Rathier,(187) who assures us he prescribed the following remedy with the best success, is prefer- able: take twenty grains of savine (sabinej in powder, fifteen grains of the seeds of rue, ten grains of submuriate of mercury, twelve drops of the oil of tansy, and of syrup of peach flowers sufficient to form the whole into a bolus. The patient should take half of it in the morning and the remainder after dinner, drinking each time a glass of good wine, in which some peach kernels have been macc- ' rated. METHOD OF ALSTON. Tin. § CLV. Tin was regarded, even anciently, as a very efficient remedy for the expulsion of intestinal worms ;(188) it was afterward proposed by Dr. Al- ston to expel taeniae. Several physicians have( 189) 238 TREATMENT OF obtained from it great success, especially against the armed taenia. I have already remarked that in cases of old, large armed taeniae, the method of Nouffer was insufficient, and that on the contrary, with the filings of tin, regularly administered, the desired effect is promptly and certainly obtained.(190) § CLVI. To comprehend clsarly the manner in which tin produces these salutary effects, we must reflect on an observation of Bloch, relative to tbe lanciolate taeniae, which are found in great numbers in the intestines of lean geese ; in small numbers in fat geese.(191) In the latter, he sev- eral times found some of these taeniae included int the rectum and enveloped in the excrements, with which they are commonly expelled. The reason why the lanciolate taeniae leave the small intestines in fat geese, (the common abode of worms,) is certainly not to be attributed to their fat, but to the change of their nourishment. In villages, geese commonly feed on the simple pasture of barren places, and consequently the lanciolate taeniae accumulate in the small intestines, to be nourished by the juice of the grass they eat. Whereas geese sold in the city are commonly fed on barley and oats to fatten them. The goose di- gests meal very well, but the capsules of the grain, separated only by the stomach, pass into the intes- tines. Hence it follows, that these small irregular substances prick the worms and oblige them to de- scend to the lower portion of the intestines, where, VERMINOUS DISEASES. 239 not being able to support themselves long, they are soon expelled with the feces. From this observa- tion Dr. Bloch concludes that it is. certainly proba- ble that the filings of tin act on worms by reason of the sharpness and asperity of their particles ; and it has been remarked, in fact, that the coarsely filed tin is more efficacious than that which is very tine, because the particles of the former are better suited to irritate the taeniae, and consequently to expel them from the intestines. & C LVII. The tin of Malacca, or very pure tin, called in England grain-tin,(19%) is preferable to any other, because it is more free from heteroge- neous poisonous particles, which are usually com- bined with this metal.(193) Margraff however prudently admonishes us, that sometimes even in the tin of Malacca and England, we meet with a small quantity of arsenic, which may produce fatal accidents.(194) Unfortunately, the tin sold with us, is more or less blended with lead, and the latter is very fre- quently combined with arsenical pyrites; physi- cians should be very careful of its quality, when they employ tin internally, for I can assert from my own experience, that if the tin be not pure, the sa- turnine or lead colic, and palsy of the inferior ex- tremeties, will be the deplorable consequences of its exhibition.(195). § CLVIII. Tin, coarsely rasped, is, as we have said,(196) to be preferred to tin in fine grains, as used by the English, according to the observations 240 TREATMENT OF of -BZoc/i,(197) of Goeze,(198) and of Fotiier- giU,(L99) to which I can subjoin my own.(200) It is administered in doses from half a scruple to an ounce, according to the constitution of the pa- tient, and the certainty of the purity of the tin. It is ordinarily gi\en in form of bolus, or electuary, using theriaca, the conserve of roses, erf absinthium, honey, etc. By adding some vermifuge, it has been thought that its operation would be more effectual, and with this view, the union of jalap has been recom- mended,(201) the root of the male fern,(202) the sul. phate of iron,(203) semen-contra and sugar,(204) etc* I have constantly used, with the greatest advan- tage, when well prepared, Guy's powder of Ethio- pia.(205) In general, the use of tin should be con- tinued for several days in succession, if one would realize the desired effect; it should be suspended every fourth, fifth, or sixth day, to interpose a pur- gative for the expulsion of the worms.(206) * METHOD OF MATHIEU. Tin, fern, semen santonicae, and drastic purgatives. § CLIX. We now come to the last of the va- rious methods, which have been vaunted for the expulsion of taeniae. M. Mathieu, an apothecary of Berlin, for some years employed, with astonishing success, a med- VERMINOUS DISEASES. 241 icine, which was remarkable for curing those per- sons who had either species of the taenia. His method, which begins to prevail, consists in the administration of two electuaries, compound- ed of the filings of English tin, the powdered root of male fern, semen-contra, scammonia of Aleppo, gamboge and sulphate of potass. The simultaneous exhibition of so many reme- dies, which we have noticed as suited to expel both species of taenia, must certainly produce effects, if not constant, at least superiour to what may be hoped from other methods. Aliz had already com- bined, with great advantage, the use of tin filings and the pulverized root of male fern.(207) The remedy proposed by Mathieu will, of consequence, be still more active; and physicians may try it with confidence of success.(208)* * Dr. Bourdier, professor of the Special School of Medi- cine of Paris, used the following remedy with the greatest suc- cess, against both species of taenia : Pour a drachm of sul- phuric ether into a glass of the decoction of male fern, which the patient is to take fasting; four or five minutes after, an in- jection of this same decoction, with two drachms of ether, is to be thrown up. One hour after, give two ounces of oleum ricini, aud one ounce of the syrup of peaoh blossoms. This treatment is to be continued lor three days. The worm is commonly dis- charged but half organized. When the worm is in the stomach, success i3 certain ; whqa in the intestines, the treatment, after some time, is repeated; then Dr. Bourdier prescribes an enema of decoction of fern and two drachms of sulphuric etlier, immediately after the patient has swallowed the etherated potion. F. Trs. 31 242 TREATMENT OF [Since the French edition of Brera, several ar- ticles have been used as remedies against the tae- nia, and with so much success, that they are like- ly to supersede the further employment of some substances, which formerly acquired, for a time, a reputation, which they have not been able to sus- tain. The most valuable of the new remedies is spirit of turpentine, whose origin, as a vermifuge in England, is given in the following paper from the second volume of the Medico-Ckirurgical Transactions for 18il. e{ On the use of oil of turpentine in taeniae, com- municated in a letter from John Ralph Fen- wick, M. H. of Hurham, to Matthew Bailie, M. H. F. R. S. Read January 2, 1810. " Sir, Hurham, Hec. 19,1809. " Having been informed that you are desirous of a fuller account of the efficacy of oleum terebin- thini in expelling the tape-worm, and knowing no one, who, by his influence in the medical world, and his zeal for the improvement of medicine, is more likely to diffuse a knowledge of that remedy, I shall now lay before you a detail of all the infor- mation I have received, and of all that my own experience has taught me on the subject. " You will make what use you please of the communication, as my only wish is to make the remedy generally known. " In the month of August last, I was told that Mr. John Hall, of this city, had been cured of the VERMINOUS DISEASES. 245 tape-worm by the use of oleum terebinthini, and had since administered it with success, in several other cases ; and lost no time to procure a confer- ence with him, when I received the following in- formation. " He stated that about five years ago, when suf- fering severely from the tape-worm, he had met with a seafaring man, who said he had cured him- self of the complaint by taking oleum terebinthini. He was induced, as he informed Mr. Hall, to try it, by observing that whenever he drank rather free- ly of gin, he always passed portions of the worm, and experienced relief; which led him to hope, that if he could find some substance of the same na- ture as gin, but stronger, it might effectually cure him. " Under this impression, he took, (his ship be- ing at that time in the Baltick,) a wine glass full of oleum terebinthini. The consequence was, that about two hours afterwards he passed, with a pur- gative stool, an entire tape-worm; from which time the complaint had not returned. " Disappointed in all the remedies employed in regular practices, and encouraged by this state- ment, Mr. Hall took two or three ounces (for he was not at the trouble to measure it) of undiluted oil of turpentine in the morning, fasting ; and as it did not operate in two hours, he had recourse to a second dose, amounting, as near as he could guess, to three fourths of the first. In about an hour af- ter, he had r. purgative stool, and with it passed a 244 TREATMENT OF « tape-worm, apparently not quite dead. The med- icine produced giddiness, like that which follows the use of ardent spirits, a slight headache, and a tendency to sickness, but he felt no other incon- venience, and he has since continued well. Though I had no reason, from Mr. Hall's character, to doubt the truth of his account, yet the extraordina- ry dose, in which the medicine was said to have been taken, determined me, before 1 ventured to employ it, to examine carefully, and apart, those inhabitants of this city, to whom he told me it had been successfully administered. As their account entirely confirmed his, I shall now give the out* line of their cases. "1. Greathead, aged 70, had been afflicted with the tape-worm above twenty years, during which time he had taken many remedies; and among others Madam Nouffer's, with temporary relief, but with no permanent advantage. He took olei terebinthini two ounces undiluted, fasting ; and in two hours after one ounce more. A tipe-worm came away soon after iu a dead state, and he has since experienced no return. " This took place near three years ago. The medicine acted as a brisk purgative, and produced considerable sickuess, but no other inconvenience. "2. Edward Dodd, Sergeant, Major to the Durham volunteers, also took the oleum terebinthi- ni rather more than two years ago. He had had the disease about fifteen years, and had tried Madam Nouffer's and other remedies in vain. VERMINOUS DISEASES. 245 In this case also, a second dose of one ounce was given two hours after the first, as that did not affect the bowels. This, in less than an hour, was followed by the expulsion of a dead tape-worm, fifteen feet long, which he had preserved and showed me. He has had no return. Edward Dodd stated, that he had given it to a young girl 10 years of age, in the dose of one ounce with complete success. " 3. Robson, shoemaker, aged 45, took the ole- um terebinthini two years ago, after breakfast, with considerable relief; but his complaint return- ing in about six weeks, he took it in the usual dose, and fasting. He did not attend to the nature of what passed, except so far as to observe that there were numerous portions of worm ; but he has since been free from all complaint. " This patient having drunk some malt liquor in the evening, before the action of the medicine had ceased, was seized with such violent vomiting and diarrhoea as greatly alarmed his family. He did not remark that the liquor was hard, stale, or otherwise bad in its quality. " Besides these, five other cases were mention- ed to me, by Mr. Hall; but as I had not an oppor- tunity to examine the patients, I do not notice them here. " Conceiving myself now fully justified in try- ing the remedy, I recommended it to Francis How- ard of this city, butcher. He had laboured under the disease for several years, and was much craa- 24G TREATMENT OF ciated. The medicine was administered by Mr. Clifton, surgeon, on the morning of August 8th. The first dose of two ounces not affecting the bow- els, in two hours one ounce more was given, and in about half an hour after, an entire tape-worm, measuring fourteen feet and a half, came away dead. Soon after taking the first dose, when I saw him, he complained of giddiness and tenden- cy to sickness. Neither his pulse nor the heat of his skin was affected by it. It operated briskly after the second dose, and produced great sick- ness in the evening ; but he bad no strangury or heat in passing urine, or other inconvenience, and was cheerful and at work early the next day. Dr. Southey saw this patient as well as Mr. Clifton and myself. Within the last three weeks the dis- ease has returned, and he will shortly again take the remedy. The second patient, to whom I re- commended the oleum' terebinthini, was Anne Lunsden, aged twenty. She took two ounces un- diluted on the 23d of August, and that dose not operating in two hours, she had one ounce more. Nearly another hour passed before she had a mo- tion, and the first being scanty and nearly natural, and without any portion of worm, she took a third dose, of the same strength as the second. The medicine then operated briskly, bringing away a large quautity of worms, broken into small por- tions, with what had the appearauce of skins and much mucus. VERMINOUS DISEASES. 247 "I saw her on the 13th instant, and she had not since felt any symptom of the disease. The patient was seen by Mr. Clifton also. The third (fourth?) case was that of Welford, shoemaker, aged nineteen. He had before twice taken the oleum terebinthini. After the first trial, he remain- ed free from all complaint for nearly six months ; after tbe second, not quite so long; with both, a great quantity of worm had been passed. He took the medicine August 25th, and passed several por- tions of worm, the operation of the turpentine be- ing that of a severe purgative, producing consider- able sickness ; but as he felt quite well the next day, and the effect had not been quite satisfactory, I advised Mr. Clifton again to give it to him on the 27th of August. He accordingly did so ; with this dose however no tape-worm passed, but only a very large lumbricus. During the month of No- vember, he again had evidence of the presence of tape-worm, on which he once more had recourse to the oleum terebinthini, which brought away an eutire tape-worm, which was dead when it passed. I saw it in Mr. Clifton's possession. I shall now offer a few observations. " From the general failure of purgative medi- cines in this disease, and from the circumstance of all tbe worms being dead, when passed (except perhaps in Mr. Hall's case,) we may safely con- clude, that besides its purgative quality, the oleum terebinthini is really poisonous to the taenia. B»t though destructive to the worms present, w« 248 TREATMENT OF have evidence in the cases of Welford and Cow- ard, that it does not remove the tendency to gene- rate these animals. This is yet a desideratum. From Welford's case, there seems reason to hope, that the oleum terebinthini will be fouud useful against the lumbricus, and I am disposed to try it in the form of injection, against ascarides also. " After the evidence adduced, it is unnecessary to dwell on the safety of these large doses of ole. um tirebinthini; I will therefore only observe that, when exhibited, its quick action on the bowels pre. vents its being absorbed, and accordingly we find in these cases, no complaint of those affections of the urinary passages which have arisen from much smaller doses. As to the mode of exhibition, my directions have been, to take either no supper, or a very light one the night before; to abstain from all food or liquid till the medicine has operated twice or thrice, or a worm has passed ; then to di- lute freely^ and through the day to avoid spirituous or fermented liquors. " I have the honour to be " Your obedient servant, "J. R. Fenwick." We have seen that the spirit of turpentine had been used, in combination with some other article, on the continent of Europe, before it was employed as an anthelmintic in England. From Eugland a knowledge of this valuable remedy has extended to North America, where it is frequently and euc- VERMINOUS DISEASES. 249 •essfully administered for the destruction and ex- pulsion of taeniae. It will, we think, be found equally effectual in killing all the species of this worm, and the lumbricoides. Further experience of its anthelmintic properties, either when taken in- to the stomach, or thrown into the rectum, may prove its sufficiency to destroy all the intestinal worms. In two cases, where it was given to expel tae- nae, I have seen a large lumbricoides discharged, dead and entire. A year ago, a child six years old, having most of the symptoms of Inmbrico'ides, took six drachms of the spirit of turpentine, without the least inconvenience. No worms were voided; the signs of them how- ever soon completely disappeared, and the little pa- tient has since enjoyed uninterrupted, and unusual- ly good health. Some years ago a woman took, by direction of her physician, an insufficient dose of this remedy for taenia. Becoming impatient, two days after, she took, without advice, six or seven ounces of it; this proved an effectual remedy, but was attended by a severe inflammation of the rectum; this was soon relieved by a few injections of flax-seed tea, to which a small quantity of tincture of opium was added. The best mode of giving it seems not yet to hare been fully ascertained. 32 i50 TREATMENT OF From what I have witnessed of its effects, I should deem it important, before its exhibition, freely to evacuate the alimentary canal. This ena- bles the. remedy to act both with more certainty and expedition. Whatever quantity it may be thought proper to give at one trial of the remedy, should usually be given in one dose. Three ounces of the spirit of turpentine taken at once will be more like- ly to destroy the worm or worms, than the same quantity taken one third at once and repeated after an interval of one, two, or three hours, and will be much less tedious to the patient. In some cases where the stomach or intestines, or both, are dis- eased, and their sensibility and irritability are great- ly increased, the requisite quantity of the remedy may perhaps be better borne, if given in two or three doses, one or two hours apart. If this idea should be confirmed by a more per- fect knowledge of the effects of the turpentine, when variously administered, we think these cases will be found to be rare exceptions to the best mode of giving it in a great majority of cases. The greatest inconvenience I have noticed from taking this medicine has arisen from the prohibition of drinking—or in other words, the inconvenience has been such as mild, mucilaginous drinks would have relieved. Now if the stomach and bowels be freely evacuated before the spirit of turpentine is directed, and this be taken in sufficient quantity; it will commonly pass through the body in an hour and a half, or in less time than this ; and so soon VERMINOUS DISEASES. 251 as this effect has been produced—so soon ag any portion of the turpentine has been discharged per anum, whether the worm appear or not, the patient should be permitted to drink freely of any bland, suitable liquid. I have known the patient to be restrained from drinking for six or nine hours, and to suffer much in consequence of this useless restriction. The larger the dose is, the sooner it passes through the body, and the less is the chance of its being absorbed, and of thus incommoding the urina- ry organs. This last effect I have never seen but once; that was not severe, and I believe it very rarely occurs. In one instance we are credibly informed that the turpentine operated on the bowels, bringing por- tions of a worm with it, in fifteen minutes ; in anoth- er instance the remedy was discharged, with an en- tire taenia, in twenty minutes. When one dose, properly administered, does not prove curative, it is better to suspend its further use for one or two days, or till the patient has re- covered from any inconvenience attending its exhi- bition, than to give a second or third quantity in the same day.* Fowler's mineral solution of arsenic. This medicine I have known to destroy the taenia in several cases. * If the turpentine should not move the bowels in three hours, it should then be followed by a liberal dose of castor oil. 252 TREATMENT OF Dr. Fisher* says of it, " The taenia may be des- troyed by Fowler's mineral solution ; for this pur- pose the patient should take it, two or three times every day, in as large doses as the stomach will bear; and continue the use of it till the worms are destroyed. Hitherto this remedy has not disap- pointed me in a single instance." Medical com- munications of the Mass. Med. Society, vol. i, Boston, 1808. The following case is taken from the Edinburgh Medical and Surgical Journal, vol. x, p. 419. A case of taenia in an infant, cured by decoction of pomegranate. By W. Pollock, M. H. Com- municated by Adam Burt, M. H. Superintend- ing Surgeon, Bengal. "1 would have done myself the pleasure of tran- scribing for you the case of taenia in an infant, the moment I received your kind letter, but my jour- nal for 1811 had been mislaid, and I have only this morning discovered it. " I formerly communicated to you some cases of taenia, cured by the pomegranate decoction, which were inserted by Dr. Fleming in his catalogue of Indian Medicinal Plants and Drugs, printed in 1810, and, since that period, 1 have found the rem- edy invariably successful, in a very great number of instances. In some of these the taenia had ac- quired an enormous length, and in some of them * Joshua Fisher, M. D. President of the Mass. Med, So- ciety. VERMINOUS DISEASES. 233 it was received in tepid water, and lived for sev- eral hours after it was passed. The following case occuring in an infant, not two months weaned, ap- peared to me to be very remarkable, in consequence of which 1 reported it to you, and also sent a copy of it to Dr. Fleming at the time it happened. That it is a very uncommon occurrence, may be inferred from an observation of Dr. Hamilton, in his most valuable work on purgative medicines, where he says, that the taenia is altogether unknown in in- fancy and childhood. Peter Daly, aged 14 months, 27th August, 1811, was weaned about two months ago, and has since been gradually drooping, in consequence, as was supposed, of dentition. He is now excessively reduced, refuses all food, and is harassed with a constant diarrhoea. His skin is loose, dry, and shriveled, and he has the whin- ing, fretful cry of a child who has been long sick. " Different medicines have been prescribed for this diarrhoea without relief, and for several days his stools have contained small fleshy shreds, some of which considerably resemble half dissolved por- tions of the tape-worm. Two ounces of water were added to six of a decoction of the pomegran- ate root, (prepared by boiling two ounces of its fresh bark in a pound of water to nine ounces,) and a table spoonful was ordered to be given the child every half hour, unless sickness and vomiting inter- vened. i( 28th. He took the whole of his medicine yes- terday, without either sickness or vomiting, and in 254 TREATMENT OF the eveniughe passed a portion of tape-worm alive, upwards of six feet long. The medicine purged him briskly, and today he has vomited almost ev- ery thing he has taken. Appearing much exhaust- ed, an anodyne carminative mixture was ordered to be given at intervals, to relieve the sickness. "29th. Appears more lively ; has had no vom- iting since yesterday, and the diarrhoea has been much restrained by the anodyne. Quiescat. " September 1st. Is manifestly better in every respect, but his stools still contain portions of the tape-worm. Eight ounces of the above decoction, without dilution, were ordered to be given in the same manner as before. " 2d. He took the whole of his medicine yes- terday, without either sickness or vomiting, and with but little effect on his bowels, till this morn- ing, when it began to purge him briskly, and he passed another portion of the worm, nearly eight feet long. He has been very hungry and has eat- en a hearty breakfast. "25th. No portions of the tape-worm have been observed since the last report, and the diarrhoea gradually left him, without the use of any other medicine. His bowels have become regular, his appetite keen, and he has filled up apace. He has the appearance of a healthy, thriving child, and his strength has improved so rapidly, that he has now begun to walk. From the above period he continued to thrive till August 1812, when he again began to pass pieces of the tape-worm. The VERMINOUS DISEASES. 255 pomegranate decoction was repeated, and he pass- ed an entire taenia alive, fifteen feet long, since which he has been in perfect health, and is at this moment a very fine boy. He is a son of Edward Da- ly, a private soldier in his majesty's 53d regiment. Merat, 7th January, 1814.] TREATMENT OF THE VESICULAR WORMS. §. CLX. I doubt very much whether the mate- ria medica can furnish any good remedy for the expulsion of vesicular worms, especially those in the substance of the brain. Sheep recover from these worms when they feed on elevated mountains, and in a pure and dry atmosphere. This rural observation teaches us that an invig- orating regimen is the only means of destroying and disorganizing these worms. All those remedies which exercise and excite the solids, and at the same time invigorate the lymphatic system, and di- minish its mobility, should, in my opinion, be pre- ferred, because by confirming the course of the lymph, and the cohesion of the solids, and by ex- citing the irritability of the lymphatic vessels, the vesicular worms, which we have said are always attached to this system of vessels,(209) will be de- prived of their necessary nourishment, and thus cease to live. § CLXI. It would be fortunate if we could set- tle the diagnosis of those complaints which arise .256 OF HYDATIDS. from vesicular worms; but if this is not impossible, it is doubtless very difficult to determine.(210) The best method of cure, in my opinion, is to use stimulating diuretics, and diaphoretics, com- bined with the most permanent and efficient stim- ulants. Squills, digitalis, purporea,(211) colchi- cum autumnale, black hellebore, gratiola officina- lis, opium, toxicodendrum,(212) muriate ef barytes, muriate of soda, the preparations of iron, canthari- des, sublimed sulphur, liquid carbonate of ammonia, and other similar remedies, are those from which we may hope, if not the annihilation of vesicular worms, at least for some relief from the diseases they produce. As conducive to the success of these remedies, a nourishing regimen of easy degestion should he adopted, with good wine, cinchona, moderate ex- ercise of body, an elevated, dry habitation, situated in a temperate, mild and healthful climate. The treatment, in fact, should be that which is practised in dropsy. [The following account of hydatids, or vesicular worms, though long, is too valuable to be omitted in a treatise on the entozoa, or intestinal worms. It is from Monro'3 Morbid Anatomy, Edinburgh, 1811, 8vo. " OF HYDATIDS. ? (262) The helminthochorton is administered in powder, in the dose of a scruple or half a drachm, combined with the root of the polypodium filix mas, or in decoction,—with any other vermifuge. (263) See §§ C, CI, CIII. (264) See § CII. (263) Hist. Constitutions epidemicae vermi- nosae, etc. p. 57. (266) See § CIV. (267) Such are assafoetida § CXIX; cam- phor, § CXXII; Valeriana offic. § CXXIV ; mu- riate of ammonia, § CXX1X ; muriate of barytes §CXXX; the preparations of iron, § CXXXI; pe- troleum, § CXXXIII; muriate of soda, §CXXX1V: sublimed zinc, § CXXXVI. FOURTH LECTURE. 353 (268) See ^ LX, LXI, CIV. (269) See §C VIII. (270) Which is obtained from the use of the cinchona offic, cascarilla, the preparations of iron and other similar articles, and by nourishing diet; in fine, by a treatment truly tonic in its full extent. [A few words to the general reader shall close the book. If any one, not having a medical education, should think of prescribing anthelmintic medicines, he is desired to reflect, that this cannot be done ei- ther with safety or any prospect of advantage, till he shall acquire the following information,—a knowledge 1. of the structure of the human body; 2. of the vital properties and functions of the vari- ous organs of this complex system, in a sound state; 3. of the deviations from this state, which occur in the many diseases to which the body is subject; and 4. of the medicinal virtues of the several arti- cles called anthelmintic, both as they affect the in- testinal worms, and the living body they inhabit. The injunction, rightly to exercise the facul- ties we possess, is so obviously reasonable, and of so high authority, that it could not receive any new force or extent of application from any thing which could be here said, even if it were proper to dwell on the subject in this place. It is sufficient to re- mark, that this improvement implies a knowledge of our talents, a cultivation, and a proper direction of them. 45 354 NOTES. Faculties, not understood, cannot be trusted; such as are neglected will not become better, and an effort, not well directed, is more likely to do harm than otherwise. If we could suppose that the several individuals of a society were to relin- quish their ordinary and well known occupations, and each to assume a new pursuit with which he had no acquaintance,—we should find that the con- fusion and wretchedness of this perverted and un- happy community would be in exact proportion to the zeal and activity of its members.] END OF THE NOTES TO THE FOURTH LECTURE* rt Fl.l. Fiff.L Fi 215 Tin........- 216 Amalgam of tin ------ 502 Zinc........" 2l6 Sulphur........217 Fowler's mineral solution - 251 CONTENTS. 367 II. Treatment of Taenia.....217 Cold water and mineral waters - 222 Carbonic acid gas ... - - 224 Spirit of turpentine and of ammonia - 225 Polypodium filix mas ----- 226 Preparation and treatment of the patients - - 227 Oleum ricini ------- 235 Mercurials . - - - - - - - " 236 Tin.......m- 237 Tin, fern, semen santonicum and drastic purgatives 240 Spirit of turpentine - - - - - 242 Fowler's mineral solution - - - " 251 Pomegranate ------- 252 III. Treatment of vesicular worms - - - - 25i5 IV. " of the tricocephalus - - - - 291 V. " of the ascaris vermicularis - - - 292 VI. " of lumbricoides - 296 Guinea worm.....' s05 Worms &c. from the urethra - s°7 Larvae of different insects.....5*5 VII. Treatment of general verminous affections - 319 VIII. Preservative treatment.....321 Notes to the Fourth Lecture - 322 Explanation of the plates.....' S5!* END OF THE CONTENTS. The reader is desired to correct the following ERRATA. Page 26, line 1, for their—have, read its—has. 27, " 2, " deudroYd, read dendroid. 42, " 5, " anteriority, read anteriorly. 44, " 4, " papillae, read papilla. " " 4, 5, " toward, r.ead to. 48, " 3, " last, read fullest. 50, " 14, dele but. 68, " 15, for scolopondre, read scolopendre. 92, " 23, " insutis, read insectis. 128, " 5, " lumbrici'des, read lumbricoides. 156, " 31, " first of ventose year 9, read Feb. 19, 1801. 160, last line, for constituted, read constipated. 212, line 12, for venerial, read venereal. 256, " 6, dele comma after digitalis. 283, " 4, for placcid, read flaccid. 298, " 13, " vermins, read vermin. 312, after * relieved', second line, insert " to close the quotation. 313, line 1,/or voracity, read veracity. 328, last line," uniformibus, read reniformibus. ! i XI0