OF THE WORM-FEVER.

THE Worm-Fever, as it is called, being a diſorder to which Children are pretty gene⯑rally liable, and frequently eluding the ſkill of the phyſician; it will not, I preſume, be unacceptable to the Public, if I lay before them a method of treating that diſorder, which, in ſeveral inſtances of my own practice, has been attended with ſuc⯑ceſs, and which, from the immedi⯑ate relief it gives the patients, I con⯑clude to be ſpecifically adapted to the cure of it, and not ſucceſsful by accident only.

The difficulty of curing what is called a Worm-Fever, ariſes in my opinion from its being frequently at⯑tributed to Worms, when the cauſe of the diſorder is of a quite different nature. I do not mean to deny that Worms do ſometimes abound in the human body, nor that the irritation cauſed by them does ſometimes pro⯑duce a Fever; but I apprehend theſe caſes to be much more uncommon than it is generally imagined, and that great miſchief is done by treat⯑ing ſome of the diſorders of children as Worm-caſes, which really are not ſo.

That Practitioners are frequently deceived in this reſpect, is ſufficiently aſcertained by the teſtimony of Dr. Hunter, who aſſures me that he has diſſected great numbers of children, [5]who have been ſuppoſed to die of Worm-Fevers, and whoſe com⯑plaints were of courſe treated as proceeding from Worms, in whom, however, there appeared upon diſ⯑ſection to be not only no Worms, but evident proofs of the diſorder hav⯑ing been of a very different nature. A ſingle caſe of this kind was pub⯑liſhed long ago in the Edinburgh Medical Eſſays by Profeſſor Sinclair, who, after informing us, that upon opening the body, no Worms were found, goes on to obſerve, that ‘"A diſappointment of this kind is no new thing; for all experien⯑ced Phyſicians know, that every ſymptom commonly produced by Worms, (except voiding them) ſometimes ariſes from other cauſes."’ If this be the caſe, if it be no new thing for Phyſicians to [6]preſcribe medicines againſt Worms to patients who have none, I am afraid it is no new thing alſo, un⯑der this miſapprehenſion, to do a great deal of miſchief.

The cauſe of theſe miſtakes is plainly this, that people not only conclude too haſtily from the exiſt⯑ence of a ſingle Worm, that there are many more behind; but they often (as Dr. Sinclair alſo intimates) infer the exiſtence of Worms from ſigns that are very equivocal and uncertain; ſuch as the ſtools con⯑taining ſometimes a curdly mat⯑ter, like the curd of milk, and ſometimes a dark green ſubſtance, apparently full of filaments, like the conferva upon ſtanding waters, the urine, at the ſame time, having a mixture of ſomething creamy. With evacuations of this kind, if [7]the patient is fluſhed in the face, ſtarts frequently from his ſleep, and is much diſpoſed to rub his noſe, it is concluded, that though there be no Worms completely formed, there is yet a conſiderable quantity of the minera verminoſa, or ſemini⯑um verminoſum, which muſt be carried off by repeated purges.

It is obſerved, however, by Prac⯑titioners, that the diſorder is much leſs obſtinate and dangerous when the Worms appear to be completely formed, even though their number ſhould be conſiderable, than when there is no evacuation of complete Worms, but only a large quantity of what is called the ſeminium ver⯑minoſum: and yet in this laſt ſtate, the animal being by ſuppoſition as yet in embryo, and quite inviſible, [8]cannot give ſo much irritation to the bowels, nor abſorb ſo much of the chyle, as when it is perfectly form⯑ed and active; and therefore ought not, upon this principle, to give ſo much diſturbance to the body that it inhabits.

But further, it is remarked, that the ſuppoſed Worm-Caſes do every now and then cauſe a ſoreneſs, pro⯑minency and inflammation of the navel, which, if it comes to ſuppu⯑rate, the diſorder ſpeedily gives way; whereas, if there is no ſuch tendency to inflammation, it fre⯑quently proves fatal, and is at beſt very tedious and difficult of cure. Now, what connection can there be between a ſuppuration of the navel, diſcharging nothing but pus, and a real Worm-Caſe? How comes [9]it to paſs that all the bad ſymptoms ſhall vaniſh, as I have ſeen them do, upon the coming on of the ſuppu⯑ration, if they had been produced by Worms lodged in the inteſtine, and ſtill continuing to lodge there?

Wherever this has been the caſe, it ſeems clear that the diſorder muſt have been only an irritation or morbid affection of the bowel, from the uſe of ſome improper food, which the ſtrength of the conſtitution after a time throws out upon the external ſurface of the body, producing at the ſame time a proportionable relief of the in⯑ternal and vital part. Now if this be the nature of the diſorder in ſome few caſes, it may not im⯑probably have been ſo in many more, in which the efforts of Na⯑ture [10]have been checked; or, to ſpeak leſs metaphorically, in which the power of Nature has been too much weakened by injudicious and repeated purges.

That purges are often found in⯑effectual to diſlodge the Worms in children, is a fact acknowledged by thoſe who moſt frequently uſe them in the ſuppoſed Worm-Caſes. In⯑deed the difficulty of thoſe caſes evidently ſhews it, the general me⯑thod of cure being by repeated purges. If this, however, was the only inconvenience, if all that pur⯑ges did was to produce a little un⯑neceſſary nauſea and griping, the practice might be borne with; but unfortunately, what upon the com⯑mon ſuppoſition is only uſeleſs, up⯑on the contrary and more probable [11]ſuppoſition is pernicious and de⯑ſtructive. Where the irritation of the bowels is diſpoſed to affect the brain, the proper indication, after carrying off the original offending matter, is to comfort and ſtrength⯑en the bowels, inſtead of weaken⯑ing them by frequent purges, which effectually prevent the irri⯑tating cauſe from diſcharging itſelf upon the ſurface. In children, par⯑ticularly, whoſe nerves are tender, and in whom all irritations are rea⯑dily tranſmitted from the inteſtines and other remote parts of the body to the brain, the effects of too fre⯑quently repeating them are greatly to be dreaded. I have myſelf ſeen more than one inſtance, where the evacuations intended to carry off Worms from the bowels, though [12]not immoderate in quantity, have been ſoon after followed by ſlight convulſions, and other very threa⯑tening nervous ſymptoms.

For this reaſon, unleſs we could be certain a priori, that the child we preſcribe for has Worms, and Worms too in a conſiderable num⯑ber, I muſt think it highly impru⯑dent and unſafe to teaze and weaken him by purging, which, if there be really no Worms, muſt certainly do conſiderable harm. To thoſe Worm-medicines that are not pur⯑gative, there is not the ſame ob⯑jection, though ſtill there is little or no benefit to be expected from them in the ſpurious Worm-Fever, which, as I obſerved before, is much the moſt common of the two.

The ſpurious Worm-Fever, of which I come now to give an ac⯑count, has, in all the inſtances I have ſeen, ariſen evidently from the children having been indulged with too great quantities of fruit; though a poor cold diet of any kind may, for aught I know, oc⯑caſionally give birth to it. Every ſort of fruit eaten in exceſs, will probably produce it; and of courſe, that which is to be had in the greateſt plenty, will, from its plenty, be the occaſion of moſt miſchief. I am convinced, how⯑ever, as well from my own expe⯑rience, as by the obſervations of my medical friends, that a great pro⯑portion of theſe diſorders is pro⯑duced by the immoderate uſe of cherries, which may in part be [14]owing to a prevailing opinion of their innocence; ſo that children are ſuffered even by their parents to eat freely of them, without any ſuſpicion or apprehenſion of dan⯑ger, which they are very ſeldom ſuffered to do of pears, plumbs, or apples.

There is no part of Nature ſo open to doubt and ſcepticiſm as me⯑dical ſubjects; and therefore it is not to be wondered that many people ſhould entertain a notion of the innocence of fruit to children. Fruit, like moſt other ſubſtances that we know, has a variety of effects upon the human body: To ſome it is ſalutary and medicinal, to others innocent, and to a third ſort prejudicial. Where it is even prejudicial, the harm it does de⯑pends [15]in a great meaſure upon the quantity; and the preciſe quantity that will be prejudicial, it is, from the great varieties of conſtitution, impoſſible to define. People not aware of this intricacy, can hardly be ſaid to reaſon ill, when they in⯑fer, that what a great number eat with impunity is innocent to all. Yet further reflection would ſuggeſt to them, that things the moſt con⯑feſſedly noxious do not in every conſtitution produce the ſame ef⯑fects. The effluvia of the ſmall⯑pox, for inſtance, will affect one man, while another, equally ex⯑poſed to them, ſhall eſcape. It would, therefore, be a very com⯑mendable piece of diſcretion, to pay a little more regard, upon this occa⯑ſion, to the judgment of our fore⯑fathers, [16]who are known to have been particularly cautious in the article of fruit, and attributed many of the diſorders of children to a too frequent or exceſſive uſe of it. And that this apprehenſion was not wholly unreaſonable, will appear, I think, from the follow⯑ing reflection. We have all fre⯑quent opportunities of obſerving, and moſt of us have experienced, that fruit in no very large quan⯑tity will produce the colic; which it could not do, without being occaſionally offenſive and hoſtile to the body. Now, whatever is of⯑fenſive and capable of creating pain, will, by change of circum⯑ſtances, be capable of creating a diſorder of a different kind; that [17]is, a fever, a diarrhoea, or a ſtu⯑por, and oppreſſion of the brain.

The approach of this diſorder has a different appearance, accord⯑ing as it ariſes from a habit of eating fruit in rather too large quan⯑tities, or from an exceſſive quan⯑tity eaten at one time. In the former caſe, the patient gradually grows weak and languid; his co⯑lour becomes pale and livid; his belly ſwells and grows hard; his appetite and digeſtion are deſtroyed; his nights grow reſtleſs, or at leaſt his ſleep is much diſturbed with ſtartings, and then the fever ſoon follows: in the progreſs of which the patient grows comatoſe, and at times convulſed; in which ſtate, when the event is fatal, he dies. The pulſe at the wriſt, though [18]quick, is never ſtrong or hard, as indeed it very ſeldom is in any of the diſorders of children. The carotids, however, beat with great violence, and elevate the ſkin, ſo as to be diſtinctly ſeen at a diſtance. The heat is at times conſiderable, eſpecially in the trunk; though at other times, when the brain is much oppreſſed, it is little more than natural. It is ſometimes ac⯑companied by a violent pain of the epigaſtric region, though more commonly the pain is ſlight, and terminates in a coma; ſome de⯑gree of pain, however, ſeems to be inſeparable from it, ſo as clear⯑ly to diſtinguiſh this diſorder from other comatoſe affections.

Where a large quantity of fruit has been eaten at once, the at⯑tack [19]of the diſorder is inſtantane⯑ous, and its progreſs rapid; the patient often paſſing, in the ſpace of a few hours, from apparently perfect health, to a ſtupid, coma⯑toſe, and almoſt dying ſtate. The ſymptoms of the fever, when form⯑ed, are in both caſes nearly the ſame, except that in this latter ſort I have now and then ſeen a little purulent matter diſcharged by vomit and ſtool from the very firſt day. The ſtools in both ſorts are ſuch as I have already deſcrib⯑ed; that is, they exhibit ſome⯑times a kind of curd, reſembling curdled milk, and at other times a floating ſubſtance, of the colour and appearance of conferva, ſome⯑times a number of little threads [20]and pellicles, and now and then a ſingle Worm.

If the patient, under theſe cir⯑cumſtances, is too frequently or too ſtrongly purged, the complaints, af⯑ter a ſhort interval of relief, return with great violence; the coma in⯑creaſes, or, inſtead of it, convulſions come on. Where the diſorder is not ſo ſevere, frequent purgings will bring on flatulent ſhifting pains of the ſides and breaſt, and twitchings of the lips and face. As ſoon as any thing of this kind appears, it is neceſſary to deſiſt immediately from purging. And as to bleeding, it is not to be thought of in any ſtage of the diſeaſe.

At the beginning of the illneſs, as the indigeſted matter and mucus that [21]lies in the ſtomach and bowels has a tendency to keep up the morbid ſymptoms, it may be of great uſe to give one vomit and one purge; the vomit for a child of three or four years old, to conſiſt of a few grains of Ipecacuanha, or, which is rather better, three or four tea ſpoonfuls of Ipecacuanha wine, with ten drops of the eſſence of Antimony. The purge for the ſame age may be; a powder of Jalap and Rhubarb, of each four grains, powder of Sena leaves and fine ſugar, of each ſix grains. When this has operated properly, there will very ſeldom be any occaſion for repeating it; and it will be ſufficient, if the body is coſtive, to throw up every ſecond or third day, the following cly⯑ſter: [22] ‘℞ Infus Flor. Chamaemel. unc. v. Aloes Caballin. drachm. ſs. Fiat Solutio pro Enemate.’

But the principal part of the cure depends upon external appli⯑cations to the bowels and ſtomach, which are the reſidence of the mor⯑bid cauſe, and from whence the miſchief ſpreads as from a centre to the parts above and below. I have already delivered my ſentiments with regard to external applica⯑tions, that they have a real diſtin⯑guiſhed efficacy, and that their ac⯑tion is not by abſorption and circu⯑lation, but directly upon the nerves. As the cauſe of this diſ⯑order is of a cold nature, the ap⯑plications muſt be warm, cordial, and invigorating; and their action [23]muſt be promoted by conſtant ac⯑tual heat. The following is a pre⯑ſcription I have uſed with ſuc⯑ceſs: ‘℞ Folior. Abſinth. & Rutae āā p. aeq. Aq. Pur. Q. S.’ Fiat decoctum ſaturatiſſimum, quo calidè foveatur regio ventriculi & abdomen quartâ vel quintâ quaque horâ per horae quadrantem.

Magma ex herbis coctis poſt fotûs uſum iiſdem partibus perpetuò appo⯑ſitum teneatur, & quoties refrixerit, aliud calidum apponatur. For in⯑ternal uſe, the following is all I have found neceſſary:

[24] Miſce, & tempore uſûs fortiter con⯑cutiantur in phialâ. Capiat pro ra⯑tione aetatis drachm. ij. ad drachm. vj. tertiâ quaque horâ.

If any nervous ſymptoms ſhould come on or remain after the diſ⯑order is abated, they will ſoon be removed by giving a pill of four grains of Aſa foetida once or twice a day. The benefit the children find from this, makes them, in⯑ſtead of loathing, ſoon grow fond of it, ſo as to call for it of their own accord, if it is not brought them, and ſometimes prefer it to an orange or a ſweetmeat.

It was before obſerved, that the diagnoſtics of Worms are very un⯑certain, which implies not only that they are ſometimes ſuſpected where they have no exiſtence; but on the [25]contrary alſo, that they ſometimes exiſt where they are not ſuſpected. Hence it becomes a very natural queſtion, whether, if a real Worm-Caſe ſhould be treated in the man⯑ner here deſcribed, there would be any riſque of its being increaſ⯑ed by ſuch treatment? or of its gaining ground by loſs of time? My opinion upon both theſe queſtions is clearly, No; and that in caſes, where we will ſuppoſe the bowels to be really full of Worms, this method, with ſome ſlight alte⯑rations, is greatly preferable to thoſe which are commonly uſed. As Worms either find the conſti⯑tution weakly, or very ſoon make it ſo, the frequent repetition of purges, particularly mercurials, cannot but have a pernicious effect [26]upon children. Bearsfoot is ſtill more exceptionable, being in truth to be ranked rather among poiſons than medicines. Worm-ſeed, and all kinds of bitters are too offen⯑ſive to the palate and ſtomach to be long perſiſted in. The powder of Coralline creates diſguſt by its quantity; and the infuſion of pink⯑root is well known to occaſion now and then vertiginous complaints and fits: and though ſome people aſſert, that theſe fits are owing to the contorſion of the Worms in the bowels, when the infuſion is not ſufficiently ſtrong to kill or ſtupefy them; others, and parti⯑cularly Dr. Lining, are of a con⯑trary opinion, and impute the bad effects of it to an over-doſe. In this diverſity of opinions, who will [27]poſitively undertake to ſay, that the accident ſhall not happen? It is commonly, therefore, with ſome reluctance that parents ſuffer it to be adminiſtered to their children, who have on their parts, on ac⯑count of its ſickly and earthy taſte, an equal averſion to taking it. But fomenting the belly night and morning with a ſtrong decoction of Rue and Wormwood, is a remedy very eaſy to be adminiſtered, at⯑tended with no danger, and, in⯑ſtead of weakening the bowels, has an evident tendency to corroborate them; which circumſtance alone contributes, perhaps, more than any thing elſe to the deſtruction of Worms, the vigour of the con⯑tained or paraſitical animal being overcome by the digeſtive powers [28]of the Viſcera in which it is lodged. After the fomentation, it may be of uſe to anoint the belly with a liniment compoſed of one part eſ⯑ſential oil of Rue, with two parts of a decoction of Rue in ſweet oil. Foreſtus, in his Obſervations, Lib. xxi. 33. mentions a remarkable cure effected by an ointment in which the gall of a bull [the text has it, fel Auri] was a principal ingredient. Where the decoction or eſſential oil of Rue are not rea⯑dily to be procured, an ointment ſtrongly impregnated with this or ox's gall, would, I ſuppoſe, be very efficacious. Of internal medicines, the beſt is Aſa foetida, with an aloetic pill or two at proper in⯑tervals.

The diet of children diſpoſed to Worms ſhould be warm and nou⯑riſhing, conſiſting in part at leaſt of animal food, which is not the worſe for being a little ſeaſoned. Their drink may be any kind of beer that is well hopped, with now and then a ſmall draught of porter or negus. A total abſtinence from butter is perhaps not ſo neceſſary, as the generality of the world imagine. Hungry poor cheeſe muſt by all means be avoided; but rich pun⯑gent cheeſe, in a moderate quan⯑tity, is particularly ſerviceable. In the ſpurious Worm-Fever, the pa⯑tient ſhould be ſupported occa⯑ſionally by ſmall quantities of broth; and at the cloſe of it, when the appetite returns, the firſt food given ſhould be of the kinds above [30]recommended, though in a very ſmall quantity. As the patient grows ſtronger, the quantity may be increaſed, taking care, if poſ⯑ſible, to avoid indigeſtion; or, if it ariſes, correcting it with the fol⯑lowing powder: ‘℞ Rhubarb. pulv. Magneſ. alb. āā gr. v. Spec. Aromat. gr. ij. Miſce.’

The diet here directed will, per⯑haps, be thought extraordinary, as the general idea is at preſent, that, in the management of children, nothing is ſo much to be avoided as repletion and rich food. It is, no doubt, an error to feed children too well, or to indulge them with wine and rich ſauces; but it is equally an error to confine them to too ſtrict or too poor a diet, which [31]weakens their digeſtion, and ren⯑ders them much more ſubject to diſorders of every kind; but parti⯑cularly to diſorders of the bowels. In regard to the ſpurious Worm-Fever, if it be true that acid fruits too plentifully eaten, are the gene⯑ral cauſe of it, it follows as a con⯑ſequence, that a warm nutritious diet, moderately uſed, will moſt effectually counteract the miſchief, and ſooneſt reſtore the natural powers of the ſtomach. Beſides, if the diſorder does not readily yield to the methods here directed, as there are many examples, and ſome within my own experience, of its terminating by an inflamma⯑tion and ſuppuration of the navel, it is highly adviſeable to keep this probability in view, and by a mo⯑derate [32]allowance of animal food, to ſupport thoſe powers of Nature, from which only ſuch a happy cri⯑ſis is to be expected.