On a new Method of removing Ascarides from the Human Body.

William Howison, M. D.,
Lecturer on Materia Medica and Pharmacy, &c. &c. &c.
December 1822
Published in the Edinburgh Medical and Surgical Journal, Vol 19, 1823

The principal cause which gives rise to ascarides, is stated by medical writers to be, unwholesome food with bad digestion. The former, however, can scarcely be said to be the cause, as ascarides are not more prevalent amongst the lower orders of society, than amongst the higher; which undoubtedly would be found to be the case, if the above remark was well founded. On the contrary, we daily meet with abundance of examples of ascarides in the higher walks of life, and amongst individuals who can command, and actually do subsist upon, the most nutritious diet.

Ascarides appear most frequently in individuals of a relaxed habit, and whose bowels contain a preternatural quantity of mucus, or slimy matter. Hence it is stated by medical writers to be a disease most common to children; but that they sometimes prevail in adults to a high degree, particularly in those who live chiefly on a vegetable diet. I know many individuals above adult age, who have been infested with ascarides for the greater part of their life; but I cannot say that it is peculiar to those living on vegetable food, having met with repeated instances of it in those subsisting upon animal diet, to which they were restricted by dyspepsia; and this disposition to ascarides evidently runs in families. I have known all the individuals of a family infected with them ; and therefore am of opinion that they may be said to be hereditary, in the same manner as phthisis pulmonalis, mania, and scrophula.

It is not my intention, in these pages, to consider the different means recommended for removing ascarides from the animal economy. We are all aware that, however actively employed, they are tedious, slow, and even uncertain in their effects; that some of them are violent; and that, when long continued, they tend to injure the organs of digestion. Of all of them, however, I may be allowed to say, that I have, in the course of my limited experience, seen most benefit from the administration of the powder of tin combined with the seeds of santonicum, followed up, at regular intervals of a few days, by doses of jalap proportioned to the age of the individual. And to this method I should always give the preference, during the period of infancy and childhood. The removal of ascarides, by means of irritating injections, and it is only such that can prove effectual, or by external applications, as tobacco, turpentine, &c. to the stomach and intestinal canal, appears to me to be inconvenient and indelicate; and the feelings of the people of this part of the world are such, that they will never submit to the use of injections, except in cases of extreme urgency. The practice of the present day confirms this remark. Dr Heberden says, a repetition of gentle purges alleviates whatever uneasiness ascarides may occasion; but no internal medicines, nor clysters, can certainly be depended upon for extirpating them. Tobacco clysters and others, made of solutions of sublimate mercury, have had little or no effect.
In suggesting the present method of removing ascarides from the human body, it is requisite to bear in mind the following circumstances. 1st, That these animals infest every period of life, from infancy to a later period than adult age ; 2dly, That they are confined to the lower extremity of the intestinal canal, occupying principally, or entirely, that part of the gut extending from the point of the finger, when introduced completely within it, down to the sphincter ani; 3dly, That when removed every twenty-four hours, their future generation will be prevented by the obstruction of their means of propagation ; 4thly, and lastly, That this method of removing ascarides is inapplicable to the age of infancy.

The method of removing ascarides already alluded to, must be performed by the patient or individual infested by these insects, in the following manner. Previous to getting into bed, and when completely undresssed tor that purpose, he is to bring his body into the semibent position, by leaning considerably forwards, supporting himself by means of his left hand resting upon his thigh, or a low table. Having previously besmeared the anus with melted candle-grease, which on such occasions is always at hand, or, what is preferable, with hogs-lard, he is to cover completely the middle finger of his right hand with the same unctuous substance, particular care being taken to have the nail of that finger cut short, so as not to scratch or irritate the internal surface of the rectum. With his body in the position above described, he is next to introduce this finger gradually and cautiously up the rectum, until the hand coming in contact with the sphincter ani, prevents its further introduction.

When the sphincter ani muscle is in a state of relaxation, which it generally is, this step of the operation will be effected with great ease, and without giving the slightest pain. When in a state of spasmodic contraction, which however seldom happens, it then becomes more difficult; and if this contraction should be present to a considerable extent, it will be proper to deter the introduction of the finger until it has completely gone off. The point of the finger within the rectum is then to be rubbed along the whole inner surface of the gut, bringing it gradually downwards, until it comes out at the anus, when the whole mass of ascarides occupying the rectum will be brought out upon the finger near to its point, rubbed into the form of a ball enveloped in mucus and unctuous matter. The first bringing out of the finger, if properly performed, will be found to have removed the ascarides completely, as, upon repeating the operation a second or a third time, nothing will be brought down but mucus, thrown out in great quantity by the increased action of the glands of the gut, irritated by the second or third introduction of the finger.

This operation is to be repeated every night, when, in a short time, the gut will be completely cleared of ascarides. Their further means of propagation being removed, the symptoms produced by them will cease, and the individual be restored to perfect health. I may also remark, that when the ascarides have been several times removed in the above-mentioned way, they are observed to diminish in size; a proof that the older or full-formed ones have disappeared, and that they are succeeded by their offspring, which have not been allowed to come to maturity.

When the rectum is loaded with fecal matter, some obstruction is offered to the introduction of the finger; and the intention of the operation, the removal of the ascarides, is considerably frustrated.

From what has now been stated it is obvious, that ascarides can be removed from the intestinal canal by a manual, or, what may be termed, a surgical operation, altogether independent of the skill of the physician; and that it presents many advantages over the methods formerly in use. The suffering individual gets rid of the noxious animals, in which his disease consisted, without swallowing unpleasant medicines, which impair the organs of digestion, without wetting his belly by fomentations or liniments, and without distending the intestinal canal by irritating injections.
9, Nicholson’s Square,
December, 1822.