William Abbotts Smith.

On human entozoa: comprising the description of the different species of worms found in the intestines and other parts of the human body, and the pathology and treatment of the various affections produced by their presence online

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THE LIBRARY

OF

THE UNIVERSITY

OF CALIFORNIA



PRESENTED BY

PROF. CHARLES A. KOFOID AND

MRS. PRUDENCE W. KOFOID



ON



HUMAN ENTOZOA



COMPEISING

THE DESCRIPTION OF THE DIFFERENT SPECIES OP "WORMS

FOUND IN THE INTESTINES AND OTHER PARTS OP

THE HUMAN BODY, AND THE PATHOLOGY AND

TREATMENT OP THE VARIOUS AFFECTIONS

PRODUCED BY THEIR PRESENCE.



TO WHICH IS ADDED

A GLOSSARY OF THE PRINCIPAL TERMS EMPLOYED.



BT



WM. ABBOTTS SMITH, M.D., M.RC.P. Lond.,

SENIOR ASSISTANT-PHYSICIAN TO THE METROPOLITAN FREE HOSPITAL,
LATE SENIOR PHYSICIAN TO THE CITY DISPENSARY, ETC.



LONDON :

H. K. LEWIS, 15, GOWEE STREET NORTH,

186 3.






PREFACE.



The nature of the present work having been
sufficiently indicated on the Title Page, it is
unnecessary for me to occupy the reader's attention
with any lengthened prefatory remarks.

I feel, however, that I cannot permit its issue
without recording my deep sense of obligation to
Dr. Davaine, of Paris, the author of one of the best
modern treatises upon Entozoa,^ for the disinterested
and unconditional manner in which he gave me per-
mission to make use of any portions of his work ;
and to Messrs. Bailliere and Son, the proprietors
of the copyright, as well as the publishers, of
Dr. Davaine's treatise, for a similar privilege, of
which I have, as will be seen upon a perusal of the
following pages, largely availed myself.

It also affords me much gratification to express
here my warmest thanks to those colleagues and
friends who have kindly placed at my disposal
numerous facts and cases, having especial reference
to the subject of Entozoa.

^ Traite des Entozoaires et des Maladies Vermineuses de Vliomme
et des aniviaux domestiques. Paris : Messrs. Bailliere and Son.
1860.



IV PEEFACE.

In the general arrangement of the contents of
the book, I have followed the plan adopted by
Dr. Davaine, of dividing it into three parts, so as
to keep the description of the different species of
Entozoa distinct from the pathology and treatment
of the affections occasioned by their presence. I
have added a short Glossary of the principal terms
employed, both with the hope that it may prove
useful, and also in order to avoid the frequent
repetition of explanatory notes.

38, DOITGHTT StEEET,

Mecklenbuegh Squaee, w.c.
March, 1863.



TABLE OF CONTENTS.



PART I.

SYNOPSIS OF THE ENTOZOA WHICH ARE
FOUND IN MAN.

Chapteb 1.— PEOTOZOA, or INFUSOEIA.

Page
Yibriones. — Genus Bacterium. — Genus Vibrio. — Mo-
nades. — Genus Monas. — Genus Cercomonas. — Genus Tri-
chomonas. — Paramecia . . . . . . . . 1

Chaptee 2.— CESTOIDEA.

Sub-Clasa 1. — Taeniae. — Taeniae in tbe Larval State. — ^Al-
ternate Generation. — Hydatid. — Echinococcus. — Cysticercus.
— Cysticercus Telae Cellulose. — Other Species or Varieties
described by different Authors. — Taeniae in the Perfect
State. — Taenia Solium Armata. — Taenia Inermis. — Taenia of
the Cape of Good Hope. — Taenia of the Tropics. — Taenia
Nana.

Sub-Class 2. — Bothriocephali. — Genus Bothriocephalus.
— Bothriocephalus Latus . . . . . . , , 6

Chapteb 3.— TEEMATODA.

Polystoma. — Distoma. — Sporocysts. — Cercariae. — Genus
Monostomum. — Monostomum Lentis. — Genus Distomum. —
Distomum Hepaticum. — Distomum Lanceolatum. — Disto-
mum Heterophyes. — Distomum Haematobium. — Distomum
Ophthalmobium . . . . . . . . . . 30



VI TABLE OF CONTENTS.

Chapter 4.— NEMATOIDEA.

Page
Nematoidea iu the Larval State. — Nematoideum Tra-
cheale. — Nematoidea in the Perfect State. — Genus Oxyuris.
— Oxyuris Veruiicularis. — Genus Ascaris. — Ascaris Lumbri-
coides. — Ascaris Alata. — Genus Spiroptera. — Spiroptera Ho-
minis. — Genus Trichina.— Trichina Spiralis. — Genus Trico-
ceplialus. — Tricoceplialus Dispar. — Genus Eilaria. — Pilaria
Lentis. — Filaria of the Anterior Chamber of the Eye. — Eilaria
of the Orbit. — Eilaria Medinensis. — Filaria Hominis Bron-
chialis. — Genus Anchylostomum. — Anchylostomum Duode-
nale. — Genus Strongylus. — Strongylus Gigas. — Strongylus
Longevaginatus. — Genus Dactylius. — Dactylius Aculeatus 38

Chaptee 5.— ACANTHOTHECA.

Genus Pentastomum. — Pentastomum Constrictum. — Pen-
tastomum Denticulatum. — Pentastomum Taenioides . . 50



PAET II.

THE PATHOLOGY AND TREATMENT OF
HUMAN ENTOZOA.

Chaptee 1. — General Remarks upon Human Entozoa . . 53
Chaptee 2. — Entozoa found in the Respiratory Passages 59

Chaptee 3. — General Remarks concerning the Entozoa which

affect the Alimentary Canal . . . . 61

Chaptee 4. — Intestinal Protozoa . . . . . . 66

Chapter 5. — The Cestoid Worms found in the Human

Intestines
Chaptee 6. — The Tasnia Solium
Chaptee 7. — The Bothriocepbalus Latus
Chaptee 8. — The Anchylostomum Duodenale
Chaptee 9. — The Ascaris Lurabricoides
Chapter 10. — The Tricocejjlialus Dispnr
Chapter 11. — The Oxyuris Vermicularis



69

74
80
82



101

104



TABLE OF CONTENTS. Vll

Page
Ohapteb 12. — The Treatment of Intestinal Entozoa . . 107

Chaptee 13. — Affections produced by the presence of En-
tozoa in the Biliary Passages . . . . 113

Chapteb 14. — Affections of the Urinary Organs produced

by Entozoa . . . . . . . 115

Chapter 15. — The Entozoa found in the Sanguineous System :

— Haematozoa . . . . . . 120

Chaptee 16. — General Remarks upon the Entozoa which
exist in natural or in adventitious Serous
Canities .. .. .. ..123

Chaptee 17. — Hydatids in Man. The Anatomical and Che-
mical Constitution of Hydatid Tumours . . 125
Chaptee 18. — The usual seats of Hydatid Tumours, the
Changes produced in Neighbouring Organs,
and the Diagnosis, Prognosis, and Ordinary
Termination of Hydatid Tumours . . 133

Chaptee 19. — Hydatids which are in relation with the Cir-
culatory System . . . . . . 144

Chaptee 20. — Hydatids which are in relation with the Organs

of Eespiration . . . , . . 146

Chaptee 21. — Hydatids developed in the Abdominal Viscera 154
Chaptee 22. — Hydatids situated in the True Pelvis . . 162

Chaptee 23. — Hydatids in the Urinary Organs . . . . 165

Chaptee 24. — Hydatids situated in the Superficial Parts of

the Body and in the Bones , . . . 168

Chaptee 25. — The Medical and Surgical Treatment of Hy-
datid Tumours . . . . . . 172

Chaptee 26. — The Cysticercus Telae Cellulosge . . . . 189

Chaptee 27. — Entozoa developed in the Central Nervous

System . , . . . . . . 192

Chapter 28. — Entozoa in the Muscular System. The Tri-
china Spiralis . . . . , . 201

Chaptee 29. — Entozoa found in the Subcutaneous and Inter-
organic Areolar Tissue. The Eilaria Medi-
nensis, or Gruiuea-Worm . . . . 200

Chaptee 30. — Entozoa Situated in the Eye and in its Appen-
dages . . . . . . . . 214



VUl TABLE OF CONTENTS.

PART III.

SPECIAL THERAPEUTICS.

Page
On the Yaeious Medicinal Agents Employed in
THE Treatment of Intestinal and other Entozoa: —
Absinth. — Acids. — Aloes. — Antimonial Preparations. —
Aspidium Eilix Mas. — Assafoetida. — Camphor. — Ether. —
Greoffreya. — Kamala. — Kousso. — Mechanical Irritants. —
Morns Nigra. — Musenna. — Nitrate of Silver. — Panna. —
Papaya. — Pomegranate. — Pumpkin-Seeds. — Salt. — Santo-
nine. — Saoria. — Spigelia Marilandica. — Tatze. — Turpentine.
— Varec .. .. .. .. .. ..218



Glossary of the Principal Terms Employed in the Synopsis 241
Index .. .. .. .. .. ..247



ON HUMAN ENTOZOA.



PART L

SYNOPSIS OF THE ENTOZOA WHICH ARE
FOUND IN MAN.

Entozoa are parasitic animals which live in the organs
of other animals, and which possess neither a distinct
respiratory apparatus, nor articulated appendages
specially adapted to locomotion.

The entozoa found in man may be arranged into
five separate classes, namely, the Protozoa, the
Cestoidea, the Trematoda, the Nematoidea, and the
Acanthotheca.



Chapter I.
THE PEOTOZOA, OR INFUSOEIA.

The entozoa included in this class are very minute
animalcules, being visible only by the aid of the
microscope ; they are usually of irregiilar shape, and

B



2 ENTOZOA FOUND IN MAN.

have no complete distinction between their different
organs. In some the simple organization is reducible
to the type of a cell, whilst in others, which are more
complex, the functions are still performed by simple
organs, and not by special parts.

The integuments of the protozoa are sometimes
soft, contractile, and not distinct from the substance
of the body ; sometimes more distinct, and reti-
culated ; sometimes firm and non-contractile, or hard
and horny, and remaining after the destruction of the
animal. They are usually provided with various
appendages which serve for the purposes of taking
food, of locomotion, and possibly of respiration ;
these are the contractile expansions, sometimes short
and broad, sometimes long and filiform, which certain
protozoa have the power of frequently emitting or
retracting ; or, in others, these are the constantly
agitated vibratile cilia, and the little filaments which
appear to be under the control of the will of the
animalcule.

The body is composed of a soft, transparent,
diffluent, and contractile substance. One or more
reddish vesicles, which appear and disappear at uto-
gular intervals, represent a rudimentary system of
circulation. The digestive tube, like the other
organs, is usually altogether wanting.

No well-defined limits have, as yet, been assigned
to the class of protozoa, both because it is easy to
include within this class the larvae of other animals
which are higher in the scale of organization, and
because it is difficult to distinguish the protozoa from
plants which are endowed with motion, or even
from particles newly separated from a living structure,



PROTOZOA. 3

and still showing signs of vitality, as may happen in
the case of muscular fibre, of vibratile cilia, of
spermatozoa, or of zoospores.

The protozoa are the most widely diffused of all
animals. They exist in both running and stagnant,
and soft and hard water, in decaying substances, in
mosses and confervse, etc. They soon make their
appearance in decomposing vegetable or animal
matter ; they are found upon the integuments of
animals which live in water, and in different
organs of the cold, and even of warm-blooded
animals.

The protozoa which live in the organs of animals
are true entozoa, for they perish quickly when they
are removed from these organs ; and, on the other
hand, infusorial animalcules which are accustomed
to live in a free state, perish when they are intro-
duced into an animal structure.

The following are the various protozoa which are
known to affect the human subject :

1. Vibriones. — These are extremely minute, fili-
form protozoa, which do not possess any visible
organization, nor parts suitable for locomotion ; they
are multiplied by their transverse division, and move
by means of their general contraction. The vibriones
are the protozoa which appear first in all infusions,
and which, on account of their extreme smallness of
size and of the imperfection of our means of observa-
tion, must be considered as the most elementary
animalcules which are at present known to us. Two
genera are included under this head.

(a.) Genus Bacterium. — The protozoa belonging
to this genus are found in various animal fluids when

B 2



4 ENTOZOA FOUND IN MAN.

in a state of decomposition, in the wHte matter which
collects about the teeth,^ etc.

(6.) Genus Vibrio. — The microscopical parasites
belonging to this genus are found in the evacuations
of persons suffering from cholera and from diarrhoea,
in putrescent urine, and in the purulent discharge of
balanitis, and of leucorrhoea.

2. Monades. — Protozoa which have a fixed form,
either round or oval ; their bodies are of a homo-
geneous appearance, without any distinct integument,
and are capable of adherence to surrounding objects ;
they have no visible intestine nor mouth ; one or
more flagelliform filaments serve the purpose of
locomotory organs.

Tliree genera of the monades have been observed
in relation with the human subject.

(a.) Genus Monas. — Body naked, of a rounded or
oblong form, with variable expansions ; possesses a
single flagelhform filament. Has been observed in
the urine of persons suffering from cholera.

(6.) Genus Cercomonas. — The body is of a
roundish or oval form ; it possesses an anterior flagel-
liform filament, and also a posterior prolongation, of
variable length, which is more or less filiform, and
sometimes adheres to surrounding objects so as to
momentarily fix the position of the animal.

There are two varieties, or species, of the Cerco-
monas found in connection with the human subject.

^ Kiichenmeister doubts the existence of the animalcules said
by some writers to exist about the teeth, and he thiuks that there
is some confusion between them and the buccal Algae, or spores.
Kcinus, who gave the name of Denticola Hominis to the para-
site which is found in this locality, states that he has often met
with it, and especially in hollow molar teeth.



PROTOZOA.
Fig. 1}



The first species (marked 1 in the woodcut) some-
times exists in very considerable numbers in the
recent evacuations of persons affected with cholera ;
the second species of the animalcule (marked 2 in the
woodcut) is smaller than the preceding ; it has been
observed in the dejections of patients suffering from
typhoid fever.

(c.) Genus Trichomonas. — This very minute ani-
malcule is similar in appearance to the two genera
just described ; it differs, however, in possessing an
anterior flagelliform filament, surrounded by a group
of vibratile cilia. The Trichomonas Vaginalis has
been observed in the vaginal mucus. Trichomonad
protozoa are often united together in groups com-
posed of about five or six individuals, of which only
the moving flagelliform appendages can be distin-
guished. When the mucus becomes reduced in
temperature they quickly perish and disappear.

3. Paramecia. — Protozoa having a soft, flexible
body, of variable form, usually oblong, more or less
flattened, and provided with a reticulated integu-
ment, which is loose, and covered with numerous
vibratile cilia, arranged in a regular series ; each
Paramecium possesses a distinct intestinal tube ; the
movements of these animalcules are rapid, and some-
times gyratory.

The Paramecium Coli has been found in the
human colon, and in the evacuations.

* Explanation of Figure 1. — The Cercomonas liominis mag-
nified 850 times. The two varieties are marked respectively
1 and 2.



6 ENTOZOA FOUND IN MAN.

Chapter II.
CESTOIDEA.

The entozoa which belong to this class are composed
of a soft, and usually flattened body ; they have no
mouth nor intestinal cavity ; calcareous corpuscles,
ordinarily very numerous, are scattered about in
various parts of the body of the worm ; there is
usually a head (known as the nurse, or scolex), fur-
nished with two or four little depressions (known as
suckers), which are muscular and very contractile,
and are often armed with hooks, arranged either in
a terminal circlet around a small tube (called the
rostrwm or rostellum), or in pairs in front of each
sucker, or else in considerable number upon four
retractile tubes ; the body of the worm (called
strobile) is formed of numerous pieces, or rings ;
these either remain for a long period continuous with
each other and with the head, or are soon detached,
and live for some time in a free state, when they are
spoken of as cucurhitini or proglottides ; four rami-
fying longitudinal canals may be observed upon the
head and the rings ; — these possibly serve the purpose
of an excretory apparatus. The embryo is usually
oval-shaped, and armed with six hooks, from which
circumstance it derives the name of hexacanthus.
The larva undergoes various transformations, but is
sometimes multipUed in the same form by gemmation.
The cestoidea are the most common of all the
entozoa. They comprise a very large number of
species which, in their difierent stages, occupy all of
the viscera of vertebrated animals. The cestoid



CESTOIDEA. 7

worms in man and in the domestic animals belong
to two distinct sub-classes, the Taeniae and the
Bothriocephali.

Sub-Class I. — T^ni^.

These are cestoid worms which have a head
(scolex), furnished with four suckers, and frequently
with a rostellum, which may be either armed with
hooks, or not ; a body (strobile), in the form of a flat
band, composed of numerous pieces ; these pieces
{cucurhitini, 'proglottides) are either joined together or
free, and are provided, when they have become adult,
with male and female reproductive organs, which are
situated near the margins of the rings.

Embryonic Condition : — An oval vesicle, or hexa-
canthus.

Larval Condition : — The hydrated or acephalocyst
form ; the cystic form {echinococcus, cocnurus, and
cysticercus) ; in the greater number of species the
larval form is unknown ; the scolex.

Perfect Condition : — The cucurbitinus or pro-
glottis.

In the larval state taeniae are found exclusively
in the parenchymatous organs, or in serous cavities ;
in the perfect state they only exist in the intestiaal
cavity of vertebrated animals. They are common in
the mammiferae and in birds, but are very rare in
reptiles and in fishes.

The cestoid worms belonging to the sub-class of
Taeniae are propagated by Alternate Generation ;^ in

^ Besides the reproduction by means of the genital organs, cer-
tain animals are also reproduced by germs; in both cases it may



b ENTOZOA FOUND IN MAN.

fact, if we compare with one another the embryo, the
head, and the rings of a tape-worm, it may be readily

happen that the individual which is produced does not resemble
the individual which is the producer. It is known that in the
case of batrachian animals, and of insects, the larva which issues
from the ovum does not resemble the parent, but that sooner or
later it acquires the shape and organisation of the parent by
metamorphosis. In the case of some other animals, the indi-
vidual which issues from the ovum, difiFering also in form and
organisation from the individual which produced it, does not
become metamorphosed into an individual resembling the parent,
but perishes without ever reaching the adult state ; and there are
other individuals to which it gives birth, by means of germs, which
acquire the form of the original parent, and which, in their turn,
produce ova. The individual which has issued from the ovum,
does not resemble, either in form, or in organisation, that which
produced it, nor does it in any greater degree resemble its
progeny; this latter possesses the form of the first parent, or it
acquires it by a metamorphosis. There are consequently two
very distinct phases of generation ; but sometimes this second
generation does not arrive at the adult condition, but reproduces
a third, differing from itself and from that which preceded it, and
this third generation alone assumes the type of the primitive
parent.

By the term Alternate Generation, or Digenesis, is therefore
understood the succession of dissimilar generations, sexual and
non-sexual, after which the primitive type is resumed.

It frequently occurs that an individual belonging to one of
these phases of generation (ordinarily that in which genital organs
are not possessed) produces new individuals similar to itself, and
these, in their turn, give birth to other individuals similar to
themselves before either of them produces individuals of a dis-
similar character. These similar individuals, born of a common
stock and successively one from the other, cannot be considered
as constituting new phases of generation, for they do not form a
more advanced stage in the evolution of the animal which they
represent, and they only multiply the individual-stock ; the dis-
similar individuals, on the contrary, always form a stage in
advance towards the adult state. The larva which produces a
succession of ten or twelve individuals, born one from the other
by gemmation, and similar to each other, has not definitively ten or



CESTOIDEA. 9

seen that they constitute three distinct individua-
lities, of which one, at least, is derived from another
by gemmation.

The head, or scolex, evidently possesses a special
individuality. It is distinguished from each of the
rings by its form, by its suckers, by the constant
absence of sexual organs, and often by the presence
of hooks ; and, if in certain species, it seems to
belong to the series of rings because it is not plainly
separated from them, the separation is well-marked
in other species ; besides which, the head of certain
cestoid worms has been seen detached, and has even
been described as a distinct animal under the name
of scolex.

- The rings, or proglottides, also possess a peculiar
individuahty, which is clearly shown in a considerable
number of species, as, after they have remained for

twelve successive phases of generation, but two only, one sexual
and the other non-sexual ; the hydatids produced successively
from one another do not each represent a new phase of genera-
tion, but it is the echinococcus which represents this new phase ;
just as in plants, the succession of buds only represents the same
phase of generation.

Steenstrup, the author of the theory of Alternate Generation,
calls the non-sexual individual, which gives birth to the sexual
one, the nurse ; and lie designates as grand-nurse, the non-sexual
one, which, when there are two non-sexual phases of development,
gives birth to the nurse. Van Beneden calls the nurse scolex,
and the grand-nurse proscolex.

Amongst the entozoa, the cestoid and trematode worms are
generally propagated by alternate generation ; but the different
phases of their generation are accomplished in different situa-
tions. The animal cannot pass through the stages of larval
existence in the organ in which it becomes adult, and there is
consequently a necessity for migration into new organs and new
animals, this migration corresponding to each new phase of its
evolution.



10 ENTOZOA FOUND IN MAN.

some time continuously with each other, and with
the head or scolex, they become detached, and live
separately for a certain period. In several known
species of cestoid worms, the separation from the
scolex is ejffected before the rings have arrived at
maturity ; each ring lives, moves about, is nourished,
and increases in size in this free state, and its repro-
ductive organs complete their development in the
same condition. This detached ring, which possesses
all the characteristics of animal life, is the adult
cestoid worm, which reproduces its species by means
of ova.

Before the ovum has been expelled from the
several organs, there is developed in it an embryo
which neither resembles the proglottis from which it
proceeds, nor the scolex which has produced the pro-
glottis. It is, in fact, destitute of suckers, and armed
with six hooks which differ from those of the scolex
both in number and in form.

Here, then, are three successive and distinct
individuahties, of which one forms the perfect animal.
How is the interrupted series between the embryo
and the scolex completed 1 Does the latter come
from the former by metamorphosis, or by gemmation 1
Before proceedmg further, the phases of alternate
generation in these successive individuals may be
recapitulated ; a ring is produced from the head by
gemmation ; and a six-hooked embryo is sexually
produced from the ring. The head is consequently a
nurse, accorduig to the nomenclature of Steenstrup,
and a scolex, according to that of Van Beneden ; the
ring, or proglottis, is the adult individual.

No observer has traced in a decisive manner the



CESTOIDEA. 11

embryo during its transformation into the scolex ;
and we are therefore ignorant whether the latter is
produced by metamorphosis or by gemmation, or
whether there are not several generations interposed
between the six-hooked vesicle and the scolex.

Some, as yet incomplete, observations lead to
the idea that the embryo, when it has arrived at
its habitat, loses its hooks, and is developed into a
vesicle which produces the scolex by gemmation ; in
this case, the embryo would be a grand-nurse (Steen-
strup), or a proscolex (Van Beneden). But, if the
echinococcus be compared with the coenurus, it will
be understood that there is probably, in this respect,
no uniformity of development amongst all the


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