Volume 1

An American text-book of the diseases of children ... / edited by Louis Starr ; assisted by Thompson S. Westcott.

Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of the diseases of children ... / edited by Louis Starr ; assisted by Thompson S. Westcott. Source: Wellcome Collection.

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    may be vomiting and disturbed sleep with grinding of the teeth. This is the common and exact picture of a child debilitated by improper feeding and an insufficiency of fresh air and exercise—a child that is cooped up with many others in close school-room air, and whose whole life is poorly managed from a hygienic point of view. That such children sometimes have ascarides is not surprising when we consider the ease of infection, but that the parasites are the cause of their condition is certainly not the case, although the nervous symp- toms may undoubtedly be aggravated by them. It is probable that these debilitated children, with plenty of mucus in their intestines, are more desir- able habitats for the round-worms, so that the parasites thrive in this class and retain their foothold, while healthier children more easily get rid of them. The symptom, picking the nose, is often spoken of by mothers as if it were pathognomonic of worms. This is not the case; it is simply a nervous trick common to debilitated children, as is often proved by the unproductive admin- istration of anthelmintics. My experience is that in the majority of cases where round-worms are found, their presence is unsuspected and their dis- covery accidental. Having once been found, it is common enough for almost any symptom to be attributed to them by the mother. Numerous cases have been reported, however, where the connection between the worms and severe nervous symptoms, such as convulsions, chorea, aphonia, etc., seemed to be very intimate, the nervous symptom being relieved on the evacuation of the parasites. One such case is recorded among those in the Boston Children’s Hospital: Kate M , four years old, had had two convulsions before she came under observa- tion. She was in good general condition, and no reflex cause could be found for the con- vulsions except round-worms, which she had passed from time to time. She was given santonin : a quantity of worms were expelled, and she remained well for six months, when she had another convulsion. Worms were again brought away, but she came back a month later, reporting occasional attacks of twitching and tremors, but no real convul- sions. Anthelmintic treatment again expelled round-worms, and she was lost sight of for three years, during which there was no history of worms or nervous phenomena. At the end of this time she again applied for treatment for attacks every two or three weeks of flushing and pallor, pain in the belly and convulsions. Santonin was again given, bringing away worms and giving relief as before. There is a certain mechanical danger from ascarides, owing to their habit of wandering. A number of cases have been recorded of these worms entering the cystic and common bile-ducts, giving rise, in the latter case, to jaundice. They have even penetrated to the hepatic ducts and caused abscesses of the liver. They have also been found in perityphlitic, hernial, and tubercular abscesses connected with the intestine, having wandered into these abscesses after their formation, and possibly in some cases contributing to the irritation and suppuration there. That they may cause perforation of the normal intestine is not the case, but when we consider their stiffness and activity during life, and their sharply-pointed extremities, it does not seem unlikely that they might break through an ulceration which needed only the last straw, so to speak, but which otherwise might have healed. Another danger from round-worms arises from the fact that they sometimes ascend—with or without the aid of vomiting—into the fauces, whence they may be drawn into the larynx and cause suffocation and death. If the worm be drawn into the trachea or a bronchus and is not expelled, death is not immediate, but ensues in three or four days from gangrene of the lung. The fact that a child is found dead with a lumbricoid in the larynx does not, however, necessarily prove that this was the cause of death, for these worms