Medical inquiries and observations. By Benjamin Rush, M.D. professor of chemistry in the University of Pennsylvania.

OBSERVATIONS UPON WORMS IN THE ALIMENTARY CANAL, AND UPON ANTHELMINTIC MEDICINES.

WITH great diffidence I venture to lay before the public my opinions upon worms: nor should I have presumed to do it, had I not enter|tained a hope of thereby exciting further inquiries upon this subject.

WHEN we consider how universally worms are found in all young animals, and how frequently they exist in the human body, without producing disease of any kind, it is natural to conclude, that they serve some useful and necessary purposes in the animal oeco|nomy. Do they consume the superfluous aliment which all young animals are disposed to take before they have been taught, by experience or reason, the bad consequences which arise from it? It is no ob|jection to this opinion, that worms are unknown in the human body in some countries. The laws of na|ture are diversified, and often suspended under pecu|liar circumstances in many cases, where the departure from uniformity is still more unaccountable, than in the present instance. Do worms produce diseases from an excess in their number, and an error in their

place, in the same manner that blood, bile and air pro|duce diseases from an error in their place, or from ex|cess in their quantities? Before these questions are de|cided, I shall mention a few facts which have been the result of my own observations upon this subject.

1. IN many instances I have seen worms discharged in the small-pox and measles, from children who were in perfect health previously to their being attack|ed by those disorders, and who never before discover|ed a single symptom of worms. I shall say nothing here of the swarms of worms which are discharged in fevers of all kinds, until I attempt to prove that an idiopathic fever is never produced by worms.

2. NINE out of ten of the cases which I have seen of worms, have been in children of the grossest ha|bits and most vigorous constitutions* 1.1. This is more especially the case where the worms are dislodged by the small-pox and measles.

3. IN weakly children, I have often known the most powerful anthelmintics given without bringing away a single worm. If these medicines have afford|ed any relief, it has been by their tonic quality. From this fact, is it not probable—The conjecture I am afraid is too bold—but I will risk it. Is it not proba|ble. I say, that children are sometimes disordered from the want of worms? Perhaps the tonic medicines

which have been mentioned, render the bowels a more quiet and comfortable asylum for them, and thereby provide the system with the means of obviating the effects of crapulas, to which all children are disposed. It is in this way that nature, in many instances, cures evil by evil. I confine the salutary office of worms only to that species of them which is known by the name of the round worm, and which occurs most frequently in children.

IS there any such disease as an idiopathic WORM-FEVER? The Indians in this country say there is not, and ascribe the discharge of worms to a fever, and not a fever to the worms* 1.2.

BY adopting this opinion, I am aware that I contra|dict the observations of many eminent and respectable physicians.

DOCTOR Huxham describes an epidemic pleurisy, in the month of March in the year 1740, which he supposes was produced by his patients feeding upon some corn that had been injured by the rain the Au|gust before† 1.3. He likewise mentions that a number of people, and these too of the elderly sort‡ 1.4, were afflicted at one time with worms in the month of April in the year 1743.

LIEUTAUD gives an account of an epidemic worm-fever from Velschius, an Italian physician‖ 1.5; and Sau|vages describes, from Vandermonde, an epidemic dysen|tery from worms, which yielded finally only to worm medicines§ 1.6. Sir John Pringle, and Doctor Monro,

likewise frequently mention worms as accompanying the dysentery and remitting fever, and recommend the use of calomel as an antidote to them.

I GRANT that worms appear more frequently in some epidemic diseases than in others, and oftener in some years than in others. But may not the same heat, moisture and diet, which produced the diseases, have produced the worms? And may not their dis|charge from the bowels have been occasioned in those epidemics, as in the small-pox and measles, by the increased heat of the body; by the want of nou|rishment; or by an anthelmintic quality being acci|dentally combined with some of the medicines that are usually given in fevers?

IN answer to this, we are told that we often see the crisis of a fever brought on by the discharge of worms from the bowels by means of a purge, or by an anthelmintic medicine. Whenever this is the case, I believe it is occasioned by offending bile being dis|lodged by means of the purge at the same time with the worms, or by the anthelmintic medicine (if not a purge) having been given on, or near one of the usual critical days of the fever. What makes the lat|ter supposition probable is, that worms are seldom su|spected in the beginning of fevers, and anthelmintic medicines seldom given, till every other remedy has failed of success; and this generally happens about the usual time in which fevers terminate in life or death.

IT is very remarkable, that since the discovery and description of the hydrocephalus internus, we hear and read much less than formerly, of worm-fevers. I suspect that disorder of the brain has laid the founda|tion for the principal part of the cases of worm-fevers

which are upon record in books of medicine. I grant that worms sometimes increase the danger from fevers, and often confound the diagnosis and prognosis of them, by a number of new and analogous symptoms. But here we see nothing more than that complication of symptoms which often occurs in diseases of a very different and opposite nature. How often are we puzzled by hysteric and hypochondriac symptoms in a fever; and yet what physician ever thought of an hy|steric or an hypochondriac fever?

HAVING rejected worms as the cause of fevers, I proceed to remark, that the diseases most commonly produced by them, belong to the class of NEUROSES. And here I might add, that there is scarcely a disease, or a symptom of a disease, belonging to this class, which is not produced by worms. It would be only publishing extracts from books, to describe them.

THE chronic and nervous diseases of children, which are so numerous, and frequently fatal, are, I believe, most commonly occasioned by worms. There is no great danger, therefore, of doing mischief by prescrib|ing anthelmintic medicines in all our first attempts to cure their chronic and nervous diseases.

I HAVE taken great pains to find out, whether the presence of the different species of worms might not be discovered by certain peculiar symptoms; but all to no purpose. I once attended a girl of twelve years of age, in a fever, who discharged four yards of a taenia, and who was so far from having discovered any peculiar symptom of this species of worms, that she had never complained of any other indisposition, than now and then a slight pain in the stomach, which often occurs in young girls from a sedentary life, or from errors in

their diet. I beg leave to add further, that there is not a symptom which has been said to indicate the pre|sence of worms of any kind, as the cause of a disease, that has not deceived me; and none oftener than the one that has been so much depended upon, viz. the picking of the nose. A discharge of worms from the bowels, is, perhaps, the only symptom that is pathog|nomonic of their presence in the intestines.

I SHALL now make a few remarks upon anthel|mintic remedies.

BUT I shall first give an account of some experi|ments which I made in the year 1771, upon the com|mon earth-worm, in order to ascertain the anthelmin|tic virtues of a variety of substances. I made choice of the earth-worm for this purpose, as it is, according to naturalists, exactly the same in its structure, man|ner of subsistence, and mode of propagating its species, with the round worm of the human body.

IN the first column I shall set down, under dis|tinct heads, the substances in which worms were placed; and in the second and third columns the time of their death, from the action of these substances upon them.

	Hours.	Minutes.
I. BITTER and ASTRINGENT SUBSTANCES.
Watery Infusion of Aloes,	2	48
—of Rhubarb,	1	30
—of Peruvian bark,	1	30
II. PURGES.
Watery Infusion of Jalap,	1
—of Bears-foot,	1	17
—of Gamboge,	1
III. SALTS.
1. Acids.
Vinegar,		1½ convulsed.
Lime Juice,		1
Diluted nitrous Acid,		1½

2. Alkali.
A watery Solution of Salt of Tartar,		2 convulsed, throwing up a mucus on the surface of the water.
3. Neutral Salts.
In a watery Solution of com|mon Salt,		1 convulsed.
—of Nitre,		ditto.
—of Sal Diuretic,		ditto.
—of Sal Ammoniac,		1½
—of common Salt & Sugar,		4
4. Earthy and Metallic Salts.
In a watery Solution of Epsom Salt,		15½
—of Rock Alum,		10
—of Corrosive Sublimate,		1½ convulsed.
—of Calomel,		49
—of Turpeth Mineral,		1 convulsed.
—of Sugar of Lead,		3
—of green Vitriol,		1
—of blue Vitriol,		10
—of white Vitriol,		30
IV. METALS.
Filings of Steel,		25½
Filings of Tin,	1
V. CALCAREOUS EARTH.
Chalk,	2
VI. SEDATIVE SUBSTANCES.
Watery Infusion of Opium,		11½ convulsed.
—of Carolina Pink-root,		3••
—of Tobacco,		14
VII. ESSENTIAL OILS.
Oil of Wormwood,		3 convulsed.
—of Mint,		3
—of Caraway Seed,		3
—of Amber,		1½
—of Aniseed,		4½
—of Turpentine,		6
VIII. ARSENIC.
A watery Solution of white Arsenic,	near 2
IX. FERMENTED LIQUORS.
In Madeira Wine,		3 convulsed.
—Claret,		10
X. DISTILLED SPIRIT.
Common Rum,		1 convulsed.

XI. THE FRESH JUICES OF RIPE FRUITS.
The Juice of red Cherries,		5½
—of black ditto,		5
—of red Currants,		2½
—of Gooseberries,		3½
—of Whortleberries,		12
—of Blackberries,		7
—of Rasberries,		5½
—of Plumbs,		13
—of Peaches,		25
—of Water melons, no effect,
XII. SACCHARINE SUBSTAN|CES.
Honey,		7
Melasses,		7
Brown Sugar,		30
Manna,		2½
XIII. IN AROMATIC SUBSTAN|CES.
Camphor,		5
Pimento,		3½
Black Pepper,		45
XIV. FOETID SUBSTANCES.
Juice of Onions,		3½
Watery Infusion of Assafoetida,		27
—Santonicum, or Worm-Seed,	1
XV. MISCELLANEOUS SUB|STANCES.
Sulphur mixed with Oil,	2
AEthiops Mineral,	2
Sulphur,	2
Solution of Gunpowder,		1½
—of Soap,		19
Oxymel of Squills,		3½
Sweet Oil,	2	30

IN the application of these experiments to the hu|man body, an allowance must always be made for the alteration which the several anthelmintic substances that have been mentioned, may undergo from mixture and diffusion in the stomach and bowels.

IN order to derive any benefit from these experi|ments, as well as from the observations that have been

made upon anthelmintic medicines, it will be neces|sary to divide them into such as act,

• 1. MECHANICALLY,
• 2. CHEMICALLY upon worms; and,
• 3. INTO those which possess a power composed of chemical and mechanical qualities.

1. THE mechanical medicines act indirectly and directly upon the worms.

THOSE which act indirectly are, vomits, purges, bitter and astringent substances, particularly aloes, rhubarb, bark, bears-foot, and worm-seed. Sweet oil acts indirectly and very feebly upon worms. It was introduced into medicine from its efficacy in destroy|ing the botts in horses; but the worms which infest the human bowels, are of a different nature, and pos|sess very different organs of life from those which are found in the stomach of an horse.

THOSE mechanical medicines which act directly upon the worms, are, cowhage* 1.7 and powder of tin. The last of these medicines has been supposed to act chemically upon the worms, from the arsenic which adheres to it in its purest state; but from the length of time a worm lived in a solution of white arsenic, it is probable the tin acts altogether mechanically upon them.

2. THE medicines which act chemically upon worms, appear, from our experiments, to be very numerous.

NATURE has wisely guarded children against the morbid effects of worms, by implanting in them an early appetite for common salt, ripe fruits and saccha|rine substances; all which appear to be among the most speedy and effectual poisons for worms.

LET it not be said, that nature here counteracts her own purposes. Her conduct in this business is con|formable to many of her operations in the human body, as well as throughout all her works. The bile is a necessary part of the animal fluids, and yet an ap|petite for ripe fruits seems to be implanted chiefly to obviate the consequences of its excess, or acrimony, in the summer and autumnal months.

THE use of common salt as an anthelmintic medi|cine, is both ancient and universal. Celsus recom|mends it. In Ireland it is a common practice to feed children, who are afflicted by worms, for a week or two upon a salt sea-weed, and when the bowels are well charged with it, to give a purge of wort in order to carry off the worms, after they are killed by the salt diet.

I HAVE administered many pounds of common salt coloured with cochineal, in doses of half a drachm, upon an empty stomach in the morning, with great success in destroying worms.

EVER since I observed the effects of sugar and other sweet substances upon worms, I have recom|mended the liberal use of all of them in the diet of children, with the happiest effects. The sweet sub|stances probably act in preventing the diseases from worms in the stomach only, into which they often in|sinuate

themselves, especially in the morning. When we wish to dislodge worms from the bowels by sugar or melasses, we must give these substances in large quantities, so that they may escape in part the action of the stomach upon them.

I CAN say nothing from my own experience of the efficacy of the mineral salts, composed of copper, iron and zinc, combined with vitriolic acid, in destroying worms in the bowels. Nor have I ever used the corrosive sublimate in small doses as an anthelmintic.

I HAVE heard well-attested cases of the efficacy of the oil of turpentine in destroying worms.

THE expressed juices of onions and of garlic are very common remedies for worms. From one of the experiments it appears that the onion juice possesses strong anthelmintic virtues.

I HAVE often prescribed a tea-spoonful of gunpow|der in the morning upon an empty stomach, with ob|vious advantage. The active medicine here is proba|bly the nitre.

I HAVE found a syrup made of the bark of the Ja|maica cabbage tree* 1.8, to be a powerful as well as a most agreeable anthelmintic medicine. It sometimes purges and vomits, but its good effects may be obtain|ed without giving it in such doses as to produce these evacuations.

THERE is not a more certain anthelmintic than Ca|rolina pink-root† 1.9. But as there have been instances

of death having followed excessive doses of it, impru|dently administered; and as children are often affected by giddiness, stupor, and a redness and pain in the eyes, after taking it, I acknowledge that I have ge|nerally preferred to it, less certain, but more safe me|dicines for destroying worms.

3. OF the medicines whose action is compounded of mechanical and chemical qualities, calomel, jalap, and the powder of steel, are the principal.

CALOMEL, in order to be effectual, must be given in large doses. It is a safe and powerful anthelmin|tic. Combined with jalap, it often brings away worms when given for other purposes.

OF all the medicines that I have administered, I know of none more safe and certain than the simple preparations of iron, whether they be given in the form of steel-filings or of the rust of iron. If ever they fail of success, it is because they are given in too small doses. I generally prescribe from five, to thirty grains every morning, to children between one year, and ten years old; and I have been taught by an old sea-captain, who was cured of a taenia by this medicine, to give from two drachms to half an ounce of it, every morning, for three or four days, not only with safety, but with success.

I SHALL conclude this essay with the following remarks.

1. WHERE the action of medicines upon worms in the bowels, does not agree exactly with their action up|on the earth-worms in the experiments that have been

related, it must be ascribed to the medicines being more or less altered by the action of the stomach upon them. I conceive that the superior anthelmintic qua|lities of pink-root, steel-filings, and calomel (all of which acted but slowly upon the earth-worms compa|red with many other substances) are wholly occasioned by their escaping the digestive powers unchanged, and acting in a concentrated state upon the worms.

2. IN fevers attended with anomalous symptoms, which are supposed to arise from worms, I have con|stantly refused to yield to the solicitations of my pa|tients, to abandon the indications of cure in the fe|ver, and to pursue worms as the principal cause of the disease. While I have adhered steadily to the usual remedies for the different genera and species of fever, in all their stages, I have at the same time blended those remedies occasionally with anthelmentic medicines. In this I have imitated the practice of physicians in many other diseases; in which troublesome and dan|gerous symptoms are pursued, without seducing the attention from the original disorder.

Notes

• * 1.1

  Since the above observations upon worms were committed to paper, I have met with the following facts, in a letter from Doctor Capelle of Wil|mington, which has been read in the College of Physicians of Philadelphia. In the livers of sixteen, out of eighteen rats which he dissected, he informed me that he found a number of the taenia worms. The rats were fat, and ap|peared in other respects to have been in perfect health. The two rats in which he found no worms, he says,

  were very lean, and their livers small|er in proportion than the others.
• * 1.2

  See the inquiry into the diseases of the Indians, pag. 22.
• † 1.3

  Vol. II. of this Epidemics, p. 56.
• ‡ 1.4

  p. 136.
• ‖ 1.5

  Vol. I. p. 76.
• § 1.6

  Vol. II. p. 329.
• * 1.7

  Dolichos Pruriens, of Linnaeus.
• * 1.8

  Geoffrea, of Linnaeus.
• † 1.9

  Spigella Marylandica, of Linnaeus.