XXVI.

ON THE PRODUCTION OF WORMS IN THE HUMAN BODY. By J. SCOULER, M.D. &c. Professor of Natural History in the Andersonian University.

A very ingenious paper on the above intricate subject is published in the MAY number of the Glasgow Medical Journal, from which we are tempted to make an extract. The formation of worms in the human body is one of the most difficult problems in physiologyand is one of considerable interest even to the practical physician. We do not deem it necessary to go over the various hypotheses that have been framed, from that of “equivocal generation," maintained by the ancients, down to the revival of the same hypothesis by Blumenbach, Rudolphi, and other German naturalists. It is a startling doctrine! We have the authority of Holy Writ that man himself is only a worm ;-and if worms are produced by equivocal generation—or, in other words, by the "fortuitous concourse of atoms," it is needless to suppose that the act of the Deity was necessary for man's first creation from the earth on which he crawls! With the hope of releasing us from this humiliating supposition, we gladly introduce to our readers the lucubrations of Dr. Scouler. After a critical analysis of the doctrines maintained by ancients and moderns on this subject, he thus develops his own ideas. "We have now given a very brief outline of the theories by which the origin of worms has been attempted to be explained; but enough has been stated to prove that every one of them is utterly at variance with well-known facts. One theory yet remains, founded on very different principles, and which demands our most candid consideration. Do worms originate from a spontaneous generation? Generation, or the production of a living being, consists, if we separate it from all accidental circumstances, in the separation of a portion of the parent animal, which is endowed with independent, vitality. This portion is formed in the ovarium of the female before she has any inter

course with the male, and the principal effect of the spermatic fluid is to excite the dormant powers of the germ into action, and to modify its form. This is the essence of generation properly so called; but there is another way in which animals, or parts of animals, may be produced. If we cut off the leg, or extirpate the eye, of a water newt, these parts are again restored after the interval of a few months, and only differ from those which had been destroyed in being a little smaller. The claws of lobsters and the rays of star fish are reproduced in the same manner. In the lower animals, this process reaches its maximum of development, and becomes a new mode of continuing the species. If we cut a polype into two portions, and the circumstances be favourable, each section becomes a perfect animal. Many worms, if divided in this manner, grow under the knife, and, if abundance of food be supplied, the division may be continued ad infinitum. A very common fresh water worm, the Planarea of naturalists, if well supplied with food, exhibits this process spontaneously. The animal begins to swell, and several fissures appear on its surface, and it gradually separates into several distinct portions, each of them becoming a perfect animal. Hence generation, by means of sexes, is not necessary for the continuation of animals, and the law of Harvey, omne vivum ex ovo, must be changed into omne vivum e vivo. This mode of reproduction is by no means rare among the simpler animals; indeed it appears to be the only one by which the infusory animalcules are propagated.

Having proved that generation, by means of two sexes, is not essential for the propagation of many animals, we are prepared to advance a step further, and maintain that entozoa may be produced by the animal which they inhabit. When we consider the extreme complexity of the organization of the more perfect animals, and vast variety of tissues which enter into the composition of their organs, we may grant that it is not impossible that the vessels which erect such delicately constituted parts may form others of far greater

simplicity. Thus, in many diseases, tumours and tubercles are formed in the organs of animals; and these new formations possess a structure as different from any of the regular tissues of the animal which produced them, as the texture of an entozoon does from that of the creature it inhabits. These tumours may be considered as possess ing a degree of vitality peculiar to themselves, and only deriving their nourishment from the body to which they are attached. In the same manner, after rupture of the uterus, when, fortunately for the parent, she survives the accident, the fœtus becomes encysted, we have a phenomenon of the same kind, the fœtus retaining a portion of its vitality, and the requisite nourishment is derived from the vessels of the mother.

In the instance of tumours and tubercles, already alluded to, their origin is doubtless to be accounted for from a deranged action of the assimilatory arteries, which is of two kinds; in the first they produce a formation which is analogous to the regular structure of some other part of the body, as ossifications and steatomatous tumours. When nutrition is still more deranged, parts are formed which possess no analogue whatever in the healthy state.

Now, it is not improbable that many entozoa owe their origin to a process similar to that which we have described. Worms are always a consequence of a diseased state, and when they produce bad symptoms, it is from some accidental circumstance depending on their size, numbers, movements, or from the importance of the organ in which they are found. So that as there is a diathesis peculiar to most organic diseases, there is also a verminous diathesis. In support of this, it may also be added, that worms differ from all other animals in being intimately dependant on the organization which they inhabit for the continuation of their existence; and, in this respect, the parallel between encysted worms and the encysted fœtus, already mentioned, is perfect in every point of view. As the mode of nutrition in every animal is, to a cer

tain degree, sui generis, so the worms which they produce are also peculiar.

To express clearly the manner in which worms are supposed to be formed, and to prevent mistakes, we will condense what has been said in a few words. It is not maintained that entozoa are produced from the fluids found in the intestinal tube or in the tissue of organs, but that their germs are formed by some aberration of nutrition, in a manner similar to that in which other new formations originate, and that this germ becomes endowed with an independent vitality, and is evolved into a worm.

The consideration of hydatids affords us a proof of the manner in which entozoa are formed. These cysts are of two kinds, those which are mere serous vesicles, and those which are true entozoa; but the transition from the one to the other is very gradual. We first observe a serous cyst smooth, polished within, and containing a limpid fluid, and exteriorly fibrous. The next kind, the Acephalocysts of Laennec, consist of an internal fibrous capsule, containing a cyst, which is very thin and transparent, filled with a fluid, but destitute of a head or any distinct organs; these are intermediate between the cysts of the first kind and the true entozoa; so that some writers include them among the common hydatids and others among the entozoa. We have next the Echinococcus, which is included in a fibrous cyst like the preceding ones, but contains in its interior many little bodies, which are acknowledged by all writers to be true worms. From these the transition is easy to be cysticerci, with a head like that of a tape worm, attached to a transparent cyst, included, as usual, in a fibrous one. Lastly, we have often found round worms included in such cysts. These facts afford a strong support to the theory we have adopted.

There are several objections which may be urged against this theory which it is necessary to notice. As many entozoa have distinct organs of generation, and some of them have individuals of both sexes, and possess a very com

plicated organization, it has, with great propriety been urged, that there is no need for seeking any other way of accounting for their propagation than the usual one, and that it is contrary to every analogy to attribute their formation to the process we have described.

To this remark it may be replied, that it has already been demonstrated that the ova of entozoa cannot travel through the tortuous paths of the circulatory vessels; and, further, many worms, as the hydatids for example, possess no genital apparatus. Nor is it to be ascertained that, if the theory we have advanced be correct, organs of generation are of no use; for, if a worm be once formed, it then propagates its species in the usual manner. A still greater alleviation of this objection is derived from the fact, that many animals, endowed with organs of generation, are frequently propagated by a process totally distinct from it, namely, by a division of their bodies.

Another objection is that, if entozoa were produced in the manner described, we should have nothing regular and determined in their forms, but that rew animals of monstrous forms and confused organization would be daily arising.

Nature, however, leaves nothing vague and undetermined in her works; and the production of entozoa is regulated by fixed and unchanging laws. The same modification in the nutrition of an organ, which produced the first intestinal worm, still continues to operate, and consequently the same animal is formed. We might as well expect to have new diseases springing up every day, and that laws, which regulate the formation of a cancer or an exostosis, should be different in every individual. Nature is always uniform in her operations, and even her most irregular productions are governed by regular laws. Even monsters, which, for a long time, were supposed to be the production of some fortuitous concourse of circumstances, can now be classified and described, and the laws of their formation ascertained with as much precision as those which preside at the origin of a regularly organized individual.

A third objection which may be urged is, that according to this theory, if worms are produced in the manner it supposes, we should have some regular apparatus of a temporary nature, at least, set apart for their production.

We may reply to this argument, that there are many parts formed in the bodies of animals differing completely from those which are found while it is in a healthy state, and yet we see no apparatus by which they are called into being. We see no apparatus for the production of encysted tumours, or for the formation of earthy matter in the valves of the heart. In these instances, as in the origin of entozoa, we have merely to attribute all these phenomena to the aberrations of nutrition, which constitutes the essence of every disease, and the chief cause of every organic change."

We beg to return our thanks to Dr. Scouler for the pleasure which we have derived from a perusal of his interesting paper.

XXVI.

PATHOLOGY OF THE STOMACH AND INTESTINAL CANAL, &c. By J. ABERCROMBIE. M. D.*

We have already noticed two or three of the additional cases inserted by Dr. Abercrombie in the last edition of his valuable work, and we have now to throw a coup d'œil on the remainder. They are few and by no means important, being rather designed to fill up hiatus in the morbid anatomy of the organs treated of, than to afford matter for practical reflections. We will take them as they come.

CASE 1. (LV) Fatal Peritonitis after Drinking Cold Beer, during Profuse Perspiration.

A man, æt. 60, whilst perspiring profusely, on the 22d of June, 1829, drank two quarts of cold beer. During the following night he was attacked with

* Second Edition, enlarged, 1830.

severe pain and sudden distention of the abdomen, with noise in the right hypochondrium; vomiting was added on the 23d; no passage through the bowels could be procured, though eneinata brought away bloody stools; and on the 26th he was admitted into the Edinburgh Infirmary with the symptoms of peritonitis. Every thing which Dr. Duncan could do was done, but the patient sank on the following evening.

Sectio Cadaveris. "The small intestines were much distended and were filled with a fluid of a yellow colour, similar to that which had been vomited. They were externally much injected, with some adhesions. In their substance they were easily torn, giving way even when gently handled. The lower end of the ileum and the caput coli were of a deep red or port wine colour. The great intestines contained chiefly gas, and a small quantity of fluid feces, and no appearance was discovered of any contraction or obstruction, except what arose from a slight narrowing of the ileum near the ileo-colic valve. At this place there existed an ulcer, which extended quite round the circumference of its inner surface, and was about an inch in breadth. It had gangrenous edges, and the bottom of it seemed to be bounded only by the peritoneum, the mucous and muscular coats being destroyed. The man had enjoyed perfect health up to the period of this attack."

It is most probable that the inflammation of the peritoneum in this instance was consecutive to that of the mucous membrane, in the vicinity of the ileo cæcal valve. This is what we frequently observe in the progress of continued fever, and is most consistent with the nature of the exciting cause of the disease, the application of cold to the mucous surface of the stomach and intestines. Dr. Abercrombie cites it to bolster up his unfortunate theory of ileus, but we will only say that his remark, "the case can only be explained by the supposition of sudden distention and loss of muscular power," is purely hypothetical, and altogether unsupported by, indeed incapable of, proof.

CASE 2. (CXI.):-Fatal Peritonitis

from Perforation of the Intestine in Fever. A boy, aged 10, in February 1829, was affected with the mildest form of the epidemic fever at that time prevalent in Edinburgh. His pulse was scarcely 100; his bowels were easily regulated, and the motions quite healthy; and the abdomen was entirely free from pain, tension, or tenderness. In this favourable state of all the symptoms, he went on to the 12th day. He was then suddenly seized with most intense pain of the abdomen, with vomiting; the abdomen soon became tense, tender, and tympanitic; the pulse was rapid and feeble. I now saw him for the first time, along with Dr. Robert Hamilton. No relief was obtained from any kind of treatment; he continued in a state of extreme and continued suffering, and died in about 30 hours.

Inspection. The peritoneal cavity was distended with air, and contained some liquid feces. There were the usual appearances of extensive but recent peritonitis. In the lower extremity of the ileum there were five or six small but well-defined ulcers, no larger than the diameter of a split-pea, one of which had perforated the intestine by a round aperture. The seat of these ulcers appeared to be in the mucous follicles, and the disease from which they arose was distinctly traced at differeut spots, in different periods of its progress; namely, first a firm, elevated nodule or tubercle, then a pustule, and then an ulcer.

The foregoing is a good specimen of a class of cases with which the profession are now becoming conversant. To say that they are insidious would be merely to echo a truism, but the fact is, that in some cases the symptoms are more than obscure, they are absolutely incapable of being unravelled till the sudden and terrible onset of coffeeground vomit and abdominal pain proclaim that perforation of the gut has taken place, and that the patient's death warrant is sealed. In more than one instance we have seen the thoracic symptoms so prominent as almost to forbid suspicion with respect to the abdomen, and yet the foregoing train of symptoms have set in, the patient has rapidly sunk, and no more than the

usual congestion of fever has been discovered in the lungs. Practitioners will do well to bear these facts in mind, but they should also be aware that all or nearly all the symptoms of implication of the intestinal mucous membrane may exist in fever, and yet on dissection that membrane will be found to be next to healthy. We lately saw a case of this kind, in which the black tongue, stinking excretions, and other features of the case gave every reason to believe that the intestines were affected. On dissection some slight congestions and nothing more were found in the colon, but the lungs were crowded with myriads of miliary tubercles. It is curious that the lungs and the intestines should thus play into each other's hands in the progress of fever.

CASE 2. (CXXI.) :-Disease of the Omentum. "A lady, aged 60, of a full habit, had complained for some months of prominence, weight, and habitual uneasiness in the front of the abdomen. In November 1823, the complaint assumed an acute character, with severe pain, affected by respiration, and fever, but without obstruction of the bowels. The pain was increased by pressure, and a soft diffused tumour was felt to occupy the epigastric and umbilical regions, without any distention of the abdomen. The usual antiphlogistic treatment was now adopted, but with only partial and temporary benefit. After two or three weeks, the pain had become much less urgent; but she then passed into a state of low fever, with occasional delirium, and she died at the end of five weeks from the commencement of the acute attack. For the last week of her life, there was retention of urine, requiring the use of the catheter. "Inspection -The disease was found to be entirely in the omentum, which formed a thick, fleshy mass between three and four pounds in weight. It was of a dark colour and soft consistence, and no disease was detected in any other organ."

This case was communicated to our author by Dr. Storer, of Nottingham, and is an instance of what is but rarely seen, uncombined disease of the omentum. Dr. A. observes that Dr. Strambio No. XXV. FASCIC. II.

has described another form of omental disease in the Annali di Medicina. It formed an immense cerebral tumour, involving the spleen, the left kidney, the ovaria, uterus, and rectum; the symptoms were vomiting with enlargement of the abdomen and febrile paroxysms. Such cases as these are not so rare, for we have seen, and most of our brethren must have done the same, several instances of malignant disease involving the omentum with other parts. It is disease of the omentum solely which is uncommon.

CASE 4. (CXXII1.):~Very obscure and peculiar Affection, with Symptoms chiefly referable to the Bowels. This occupies a short section of our author's work, and is not undeserving of attention. Dr.Abercrombie remarks that the affection would appear to be connected with some morbid condition of the mucous membrane of the intestinal canal, the precise nature of which eludes our observation. The patient is thin, pale, weak, with a withered look, a peculiar dry state of skin, and a small weak pulse. His appetite is variable and capricious, and he feels uncomfortable after eating; the bowels are slow, though easily regulated; and the evacuations are always of a remarkably dull colour like mahogany, or almost black. The following fatal case will illustrate the foregoing description.

"A lady, aged about 30, had been in bad health for four or five months; and when I saw her, was wasted like a person in an advanced stage of phthisis. She had a small frequent pulse and bad appetite, but complained of nothing except some undefined uneasiness in the abdomen. The bowels were slow, requiring the constant use of medicine; the motions were consistent and formed, but always of the deep brown colour of dark mahogany or rose wood, and no treatment had any effect in correcting that colour. The abdomen was collapsed, and nothing could be discovered by examination. Sometime after I saw her, she began to have uneasiness in her chest, with slight cough; she then became liable to fits of coma, in which she lay with her eyes open, but unconscious of any thing; at length she had

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