This is the explanation of the vast difference between the opinions of Rudolphi, of Brera, of Bremser,* and the opinions of the greater part of the medical men of Paris. The former have observed them in the localities where the verminous affections are endemic and truly formidable; whilst they are more rare, almost accidental, and of little danger where the latter have established their field of observation. Three kinds of intestinal worms are met with among children; the ascaris lumbricoides, the ascaris vermicularis, and tænia. This last rare; the two others, on the contrary, are common enough. is THE ASCARIS LUMBRICOIDES. Lumbrici usually develop themselves in the small intestine. Their body is cylindrical, pinkish, gradually diminishing towards the two extremities. On each side a very evident furrow is observed. The head is distinguished by a small circular depression, above which are observed three small tubercles, or small valves, which can open and close; when they open, the aperture of the mouth is perceived in the midst. The inferior aperture presents, a little before its termination, a transverse aperture or anus. The length of the body is from six to eight and even fifteen inches, the breadth about two or three lines. let The two sexes are separate; the male is smaller and shorter than the female. Stueller Although lumbrici are usually met with in the small intestine, they are sometimes found in the stomach, oesophagus, and large intestine. And alien They are common in infants, and especially so in childhood. The use of fruits and vegetables, milk and its preparations, favour their development, which rarely coincides with an animal regimen. They ha are more frequent in summer and in autumn. Scrofulous children, and those of a lymphatic temperament, are more disposed to them than Male others. They are met with in the course of diseases of the alimentary canal, and especially in children attacked with typhoid fever. They are then the consequence of this disease, and they do not give rise to any phenomenon different from the symptoms of the principal disease. It is impossible to suspect their existence, unless several of them have been expelled by stools. It is a matter of regret that no work on medical geography has appeared to indicate in a precise manner the influence of localities and latitudes on the manifestation of the diseases to which human flesh is heir. Undoubtedly the topography of the verminous affection would there find a place; it would then be truly known what countries are ravaged by this disease. At present the only districts noticed are * Traité des vers intestinaux de l'homme, traduit de l'Allemand, avec des notes; par D. de Blainville. Paris, 1837; in 8; avec atlas. Holland, Germany, Switzerland, some provinces in the west of France and the departments which surround Montpellier. There this disease presents all those singular and sympathetic phenomena which we have so rarely the opportunity of observing at Paris. The symptoms of lumbrici are connected with the local irritation th which they occasion in the place of their abode and with the irritation which they determine in other organs, the brain for example. eal The local symptoms of lumbrici consist of dull or acute colic of more or less frequency, dejection of glairy or sanguinolent matters, vomitings, and lastly, the expulsion of these animals by stool or by vomiting. al This last symptom is the only one to which any importance can be attached. The general symptoms are-loss of appetite, a whitish state of the tongue, sourness of the breath, &c. The face is pale, of a leaden Beck, tint, the eyes surrounded by a bluish circle, and the pupils much dilated. There is frequent itching of the nostrils. Sometimes temporary blindness and deafness are observed, partial or general convulsions, delirium, 7111 agitation during sleep, and lastly, a continuous pining away. Con vulsions are especially pointed out as being the usual consequence of the verminous affection. However, one who has had the greatest experience in diseases of children, M. Guersant, states that he has only met with a single case in which fatal convulsions were occasioned by the simple presence of the ascarides lumbricoïdes. He relates the case, and he adds, that in a considerable number of analogous circumstances, he might have been mistaken, and attributed to worms nervous symptoms, independent of the influence exercised by these animals, and brought on by a central, pulmonary, or gastro-intestinal disease.* [Dr. Schreber states that great dilatation of the pupils, with bluish rings beneath the eyelids, constitute a common symptom of the presence of intestinal worms. It is a decided fact that largely dilated pupils with bluish areola are frequent in fair scrofulous children, and that in them these intestinal parasites are very common, but it does not follow that the former statement should be applied generally and purely to verminous diseases. An interesting case is recorded by Dr. Reicke, in which a little girl, four years of age, suddenly died on the night stool, after having complained of abdominal pain, colic, diarrhoea, &c. On examination of the body, seven balls, formed of intertwisted lumbrici, were found in the jejunum, each ball containing from eight to thirteen worms, the total number being eighty-eight. Two worms were also found in the stomach. The mucous membrane appeared reddened at the spots where the " worm balls" were situated.-P.H.B.] Once more, and we are glad to repeat it, we are in an unfavourable locality to investigate the symptoms of worms. We do not remark them like our brethren who practice in other localities. Did we not give them the benefit of the reserve imposed by this circumstance, we should feel disposed to accuse their recitals of exaggeration. Lumbrici, in fact, determine few serious symptoms. Most children pass them, without suffering and without the health being affected. When their number is very considerable, they become the source of more or less serious intestinal lesions. When they exist at the same time as typhoid fever, or any other disease, they in no way alter the progress of the disease, the symptomatic expression of which is the same. Amongst children who are subject to pass lumbrici, the circumstances which favour the generation of these animals should be carefully avoided. A suitable regimen, a mixed animal and vegetable diet, from which green fruits and the too great quantity of milk are excluded; arrech a prolonged residence in a salubrious situation facing the south, suit these patients. If symptoms are observed which do not refer to an affection of the ALG! alimentary canal or any other organic lesion, and if, moreover, the expulsion of lumbrici has demonstrated their existence, the employment aled. of anthelmintics should be had recourse to. We should first seek to Mix, and divide into four powders-one to be taken every twenty-four hours. This substance has been sometimes associated with Corsican moss: Divide in four powders-one to be taken twice a day in preserves. The following is the formula of a syrup which M. Cruveilhier praises RAT very much. After its use children have passed sixty lumbrici in one morning: Senna leaves, rhubarb, worm-seed, sothern wood (Artemisia Abrotamun), Camphor has been advantageously used by Rosen, who gave it in a draught, to which a small quantity of generous wine was added. The decoction of garlic, fern, assafoetida, the oil of Dippel, of Chabert, &c., have been also recommended; but these medicines are little used on account of their very disagreeable taste. It is proper to combine with the employment of these means which kill the worms, the action of purgatives which expel them. Thus a short time after having given the anthelmintic remedy, eight or twelve hours afterwards, castor oil, jalap powder, or still better, calomel should be administered. Most physicians also recommend the use of tonics in order to effect a slight change in the constitution of the children. The antiscorbutic syrup or the syrup of bark, 3 ss to 3j a day; and it is to conduce to the same result that cod-liver oil is also given, in the dose of 3 ss to 3j, mixed with an equal quantity of simple syrup. [MM. Beauclair and Viginer (Med. Gazette; No. 30), in the course of a paper having for its object to demonstrate that the production of worms must be regarded as a diathesis, and that in treating those suffering from the disease, we must aim st the correction of the vitiation of the humours, testify to the great benefit they have derived from the administration of cod-liver oil. They recommend the following formula: five drachms of the oil are to be mixed with six of powdered sugar, fifteen grains of bicarbonate of soda, six drops of essence of mint, and one drop of the essence of bitter almonds. This is to be given fasting, divided into two doses, In the case of adults, the entire quantity is to be given, substituting carbonate of potash for soda. They at the same time recommend tepid alkaline baths for half or three-quarters of an hour, and when the functions of the skin are slow in reestablishing themselves, warm air baths, or baths giving off ammoniacal fumes, are useful. Good diet and all hygienic means calculated to fortify the cutaneous, respiratory, and digestive functions, are also indicated.-P.H.B.] ON THE ASCARIS VERMICUlaris. This ascaris is of a filiform shape, one line and a half in length; the head obtuse, the tail terminating in a very slender extremity; its seat is nearly always in the large intestine and especially the rectum. In little girls it sometimes occupies the genital parts. These worms occasion very severe itchings and sometimes considerable pains. The child incessantly carries the hand to the painful parts and scratches furiously. It is a serious inconvenience when the ascarides occupy the vulva. They cause a more or less decided vaginal discharge. The habit of masturbation has sometimes no other origin. These worms are difficult to get rid of; they multiply with an astonishing rapidity. In order to destroy them, the following means must be employed: Enemata should be administered composed of: 1st. The decoction of two cloves of garlic in milk. 2nd. The decoction of about 3 viij of soot in 3 iv of water. 4th. Three to four scruples of mercurial ointment mixed up with oil or melted butter. 5th. The solution of the arsenite of soda, which I have seen employed at the Necker Hospital by M. Trousseau : Book IX, Chap. IX.] Arsenite of soda Distilled water . INVAGINATION OF INTESTINES. For six enemata- -one or two a day. This remedy often occasions rather violent colic. 1 grain. 3 xij. 489 6th. An enema of simple cold water, as recommended by Van Swieten. 7th. The enema of absinth, two to four drachms in infusion, &c. Without there is a special indication, it is not necessary in this disease to administer medicines internally. ΟΝ ΤΑΝΙΑ. dupretion calcis. Tænia is observed in children with the same characters as those Sauce which it presents in the adult. The symptoms are the same; but these are not to be depended upon. The expulsion of the fragments Eules as of the worm establishes the diagnosis. In the treatment, the same agents which are used in the adult should be administered. It is therefore useless to specify them here. blain in adulis. CHAPTER IX. ON THE INVAGINATION OF THE INTESTINES. Intestinal invagination also bears the names of intussception, volvulus, and ileus. It is characterized by the spontaneous introduction of a part of the intestine into the continuous adjacent and inferior portion. It is a penetration similar to that which is produced when a finger of a glove is drawn back on itself. This lesion is very frequently observed in the newly-born and in children at the breast. Hévin relates, in his memoir on gastrotomy, that he has seen more than three hundred examples of it at the ute p Salpêtrière, in children who have died during teething or in consequence of verminous affections. In these cases invagination takes place during the extreme pain, under the influence of the peristaltic movements of the intestine, and does not give rise to symptoms sufficient to ensure its diagnosis. In other cases, the invagination occurs almost suddenly in a child attacked with diarrhoea or acute enteritis, and of this there is already a tolerably large number of cases reported. I would here refer to those of Monro, Cayol, Billard, Gorham, Mitchell, Clarke, Cunningham, Markwick, Marage, Rilliet, &c., which are highly interesting to consult. In children the invagination presents itself with anatomical characters similar to those which are observed in the adult, the symptoms alone Enteritis み |