Article IX.—Remarks on some Means employed to destroy Tænia, and expel them from the Human Body.—By Louis Frank. M. D. Privy Counsellor of her Majesty, Maria Louisa, Duchess of Parma. [Lond. Med. Rep. April 1825.]
Reading edition
The symptoms produced by the presence of tape worm in the human body, are exceedingly distressing, and the sufferings of the patient are increased, by the obstinacy, with which these animals resist the operation of the most disgusting, and even painful and dangerous remedies. Improvements in the mode of attacking and expelling them, therefore, should be gladly received, and widely made known.
The numerous reports which we have received, concerning oil of turpentine as a remedy for tænia solium, have already given to that remedy the highest character; but many cases have been only partially relieved by it. The ol. tereb. seems to be capable of causing the separation and expulsion of portions of the animal; but while the head remains unexpelled, it is supposed to be capable of reproducing the joints, to a degree not yet ascertained. If we may believe medical writers, the tænia has been observed of the enormous length of 700 feet. It is probable that the reproduction, after the loss of large numbers of joints, is often very rapidly effected; as was the case in a patient treated at the Carey Street Dispensary, mentioned in their report for Aug. 1813,[18] This person always discharged very considerable quantities of joints or fragments, after the use of oil of turpentine; after which he remained free from the complaint for a few months, until the tænia recovered a troublesome magnitude; when it was again easily reduced to less uncomfortable dimensions.
We are not able to state positively, how long the oil of turpentine has been in use as a remedy for tænia. The Carey Street Report for Feb. 1810, informs us, that a mechanic in Durham, having been very successful in the treatment of tænia by means of this article, the circumstance was communicated by Dr. Southey, of that place, to Dr. Laird of London; and it was accordingly prescribed in doses of ℥ss. to [Symbol: ounce]ij. at several of the London charities. It had been found, says the report, that ol. tereb. might be thus given, as safely as so much gin, and frequently caused the expulsion in two hours: Dr. Knox says it has been in use in Germany for fifty years for the expulsion of tænia.
The experience of Dr. Knox, concerning tænia, at the Cape of Good Hope, is the most extraordinary that we are acquainted with. Dr. Sparman, the traveller, had observed, that worms were exceedingly common in the northern parts of the colony; but Dr. Knox, who was there in 1819, did not notice any special prevalence of verminous disorders, "previous to Oct. 1819, when the tape worm became so general among the troops, as to resemble an epidemic."[19]
Most of these troops had been employed on a short campaign to the east of the great fish river. They had been compelled to live on very bad beef and mutton, driven and starved half to death; and Dr. Knox thinks he has proved, that the tænia in these cases did "arise from the use of unwholesome animal food; from the flesh of animals, which had been diseased." Two out of five of the troops, who had been thus employed and fed, were affected with worms. Of a detachment of 86 vigorous, healthy young men, 36 were found, on inquiry, to have tape worm. Those who remained in the colony did not suffer so much, as those who had been out on the campaign, the ratio being as one to four; whereas of the others, it was two to five. Dr. Knox had ample experience of the utility of turpentine during this singular prevalence of tænia. Concerning the 36 men above mentioned, he says, "the cure of all, who chose to adopt the means, was easily effected by small doses of the spts. of turpentine, after the failure of purgatives and various other remedies."
He considers ol. tereb. as the most efficacious remedy. He does not approve of large doses, because of headach, vertigo, and delirium, which have been produced by them in "many patients."
"I have generally found," says he, "that from one to two drachms of ol. tereb., given in a little water, morning and evening, for three successive days, were sufficient to destroy the tænia solium, (even in the most obstinate cases,) and cause it to leave the intestines, without the aid of any purgative medicine." He advises, however, to give a little castor oil each day about noon.
It has been a very common observation in regard to the dose of turpentine, that the patient suffers more cephalic distress when it is given in small quantity, than in a large dose. The writer of this has been obliged to desist from the exhibition of oil turpentine, in doses of ℨij twice a day, in consequence of a vertigo so considerable, as to alarm and distress his patient very much. Perhaps there might have been in this case some peculiar liability to nervous excitation, which in another patient would not have been worthy of much notice. Dr. Knox's opinion is of great weight.
The celebrated remedy of Chabert, Dr. Knox thinks, owes its efficacy to the ol. terebinth. combined with it.
Dr. Frank, whose name stands at the head of this article, was informed by the celebrated helminthologist, Dr. Bremser, at Vienna, in 1814, that he had for ten years preferred the use of Chabert's remedy, and with invariable success.
Chabert was a veterinary surgeon of Alfort, who used the animal oil of Dippel in many diseases of animals, as well as those of men. This oil he often gave for the purpose of removing tænia in his animals. He often combined it with spt. terebinth. and gave equal parts of these substances, in doses of ℨi.[20] The London Medical Repository states, that Chabert's remedy is prepared from
Ol. Corn. Cerv. Fœtid.1 part.
Ol. Terebinth,3 parts.
These are well mixed, and left at rest four days; they are then distilled in a sand bath, till three-fourths of the liquor has passed over. It must be kept tightly stopped, out of the light.[21]
The great objection to Chabert's remedy is its disgusting flavour; which is the more obnoxious, because the remedy must be continued for a length of time. Dr. Frank cured two persons affected with tænia solium, after considerable perseverance with it: he cured two other persons with a preparation as follows:
Ol. Terebinth.℥ss
Æther Sulphuric.ℨij
Pulv. G. Arab.℥ss
Aq. Flor. Chamam. distil.℥xvj m.
Two spoonfuls morning and evening.
Four of these mixtures were sufficient to cure the patients, who remained well two years afterwards.
A fifth patient, unable to take the last named medicines, was cured by the boluses subjoined:
Sem. Santonic. pulv.℥ss
Pulv. Jalap.
Ferri Sulphat. aaℨi
Ol. Corn. Cervi,gtt. viij.
Syrup.q.s.
Make 20 boluses.
One to be taken morning and evening. These 20 boluses being repeated three times, the patient found himself perfectly well. In the above 5 cases, the tænia was discharged in fragments.
Dr. Frank does not say much concerning the bark of pomegranate root, which has come into vogue lately as a remedy for tænia. He refers to the Med. Chirurg. Transact. Vol. XII. for accounts by some English physicians, and remarks, that Dr. Gomez, the Portuguese physician, had cured 14 cases with this bark.
Dr. Pollock (vide Ed. Med. and Surg. Journal, Oct. 1819) treated a child, aged 14 months, with the decoction of bark of pomegranate root, so far back as the year 1811. This infant, under the use of the medicine, discharged at several times upwards of 30 feet of tænia solium, and was cured. We learn also from the Med. Repository,[22] that MM. Deslandes, Sourya, and Bourgeoise, have employed pomegranate with great success; that the decoction generally expelled the worm in two hours; that it sometimes occasioned vomiting and griping pains; and that it has been a common remedy for tape worm, in the East Indies, and among the blacks of St. Domingo.
From the same source we are informed, that the French pharmaceutists recommend, before boiling the bark, that it should be allowed to swell (macerate) in cold water. ℥ij of bark should be boiled in lbij of water to ℥xii. Of this decoction, [Symbol: ounce]ij may be taken every half hour. The worm is here said to be passed often in twelve hours instead of two. It may be necessary to continue this plan four or five days, taking care to suspend the medicine, in case any vertigo, or intestinal disease supervenes. A dose of castor oil is recommended after the 4th bottle; even though the worm be happily for the patient expelled.
In the Revue Medicale is a case, in which pomegranate succeeded in discharging three ells of tænia; but the patient broke off the worm in attempting to extract it with too much violence. This circumstance recalls us to the consideration of Dr. Frank's communication. He recommends much caution in the extraction of those portions of tænia, which have remained partly in the intestine; and says that Dr. Cagnola proposed touching the extruded portion with prussic acid, in hopes of killing the whole animal by means of this violent poison. Dr. Garleke adopted this plan on an extruded portion of four inches in length, and in one hour afterwards the whole animal came away dead. Dr. F. suggests, that the electric shock might weaken the tænia, so as to cause it to let go its hold, and thus be unresistingly extracted. Brera recommended that the worm should be tied with a piece of silk. In this manner, it is retracted into the bowel, but begins to descend again not long afterwards. He dissuades from any attempt at forcible extraction, which excites the most distressing sensations in the bowels, and causes the risk of bringing on convulsions.
We are informed by Dr. Frank, that a surgeon of St. Petersburg succeeded by passing the worm through a canula, and the canula through the sphincter ani muscle, so as to obviate the resistance caused by its contraction. In this manner, he easily succeeded in withdrawing the tænia whole, which is always desirable.
The writer of this article succeeded in removing many pieces of tænia from a female, by means of the tincture of black hellebore, given in doses of a teaspoonful for another object. The patient has since been affected with the same symptoms, and took to-day, Oct. 19th, in doses of ℥iss, repeated every hour, sixteen ounces of a decoction of the rind of pomegranate fruit, (none of the cort. rad. being procurable); after which she took a dose of castor oil. It is said, we know not on what authority, in a French journal, that this preparation possesses the same powers as the root. It may be so; but this patient had no discharge of the tape worm, after swallowing the whole of this very astringent decoction, and following up the plan by taking [Symbol: ounce]iij of ol. ricini.
Perhaps the tænia had been effectually destroyed before. She has seen none of the joints for 18 months. The accounts, however, of the expulsion of tænia by the bark of the root, are so encouraging, that we have much pleasure in recommending it to the notice of the medical public in this country.