An extraordinary quantity of worms

In 1801 a contingent of 20,000 soldiers commanded by General Charles Leclerc, the  brother-in-law of Napoleon Bonaparte, set sail for the Caribbean island of Hispaniola. Their mission was to recapture the former French colony of Saint-Domingue, now under the control of the former slave Toussaint Louverture.  Known as the Saint-Domingue expedition, the two-year campaign was a disaster for all involved, characterised by appalling bloodshed and barbarity.  Leclerc’s atrocities included the execution of a thousand colonial officers – not for crimes actually committed, but because their loyalty was doubted.

The French eventually admitted defeat in 1803, and their withdrawal led to the declaration of Haitian independence. But the rebel armies were not their only enemy. Thousands of French soldiers, including General Leclerc, succumbed to yellow fever – and other tropical diseases cut a swathe through the heart of Napoleon’s revolutionary forces. One example of the exotic perils of the tropics was documented a few years later in the pages of the Medical Repository:

Extraordinary quantity of worms removed from the nasal passages

Francis Guilain, officer in the third brigade of General Le Clerc, in Hispaniola, had reached the thirty-sixth year of his age, with a good constitution, but lately enfeebled by seven months’ residence in the island, and by ordinary attacks of illness. In the beginning of February he often experienced much irritation in the nasal cavities, and very troublesome prickings; they were felt principally at the upper part, and under the frontal sinuses; they were renewed at the interval of four or five days.

Mere discomfort soon turned to something much worse.

His face became turgid, his complexion discoloured, his voice hoarse, his respiration difficult, was all over uneasy, much deprived of sleep, and lost his appetite; his nose swelled, and, in the upper part, was red and inflamed; a thick and fetid mucus lined the nostrils, and issued from them, carrying with it a great many small worms.

Maggots, you may be thinking. Apparently not:

These might be from one half to one sixth of an inch in length, and somewhat less than a tenth in thickness; they were conical, with an obtuse and enlarged posterior extremity, which presented an orifice that could admit the head of a pin, and to which two dark lines, from the middle and under the body, were extended. The exterior extremity was terminated like a sharp pointed sucker. With a magnifying glass no legs nor rings could be perceived. The colour was greyish white; but some were reddish, and with this colour they were endued with less life and motion.

The surgeon prescribed fumigation with camphorated vinegar, and aromatic injections of various kinds including olive oil and aloes.

On the third day of the admission of this gentleman into the hospital, his bodily uneasiness and restlessness were inexpressible; for he dared not to rest or sleep, as he fancied the worms were falling from the back nostrils into the throat, and that he might be choked. He never sat on the fourth day, but to take his injections and fumigations, and twenty worms were discharged.

The patient’s hunch that the worms would fall from his airways into his oesophagus may have been accurate – although it is unlikely that this would have threatened his life. The lifecycle of some parasitic worms do involve reproduction in the lungs, followed by migration to the stomach, via the trachea and oesophagus.

On the fifth day the nose was ‘of a shining red inflamed colour’, and the worms had apparently created a new aperture at the side of the nose.

Six or eight of them issued from it, while more than forty actually fell, by the posterior mares, into the pharynx, and the patient could hardly speak.

You have to admit, this does sound mighty unpleasant.

Shortly after the aperture showed a disposition to heal, forming a depression on the spot, and a small ulcer was observed on the left side of the gullet. He complained, also of a constriction of the throat, as if worms were accumulating there. He soon conceived that they were descending into the stomach, where he felt them pricking and gnawing.

The doctors soon found that their patient could no longer swallow or even sneeze. Since he was now incapable of taking food or drink they (quite sensibly) opted to administer his nutrition by enema. They also gave him an emetic, a rather toxic preparation of antimony and cream of tartar. This had its desired effect:

Many worms were discharged; the patient was better, and could, at last, obtain some rest. On the ninth day it was hoped no more worms would appear. M. Guilain had recovered both the power and appetite for eating, which was indulged in, with the addition of some wine.

The tenth day showed a depression in the middle of the nose, through which blowing and respiring were easily effected. The voice remained a little impaired, with a nasal sound; in other respects his deglutition [swallowing] was perfectly free. The cure was completed by the continuation of some astringent injections, after having discharged one hundred and fifty worms.

That is a lot of worms. A few basic experiments were performed in an attempt to identify them; but without reaching any definite conclusions.

The worms did not seem to adhere to, nor feed on fresh or putrid meat exposed to heat.

So what were they? We can pretty much rule out maggots, since they feed on dead and rotting flesh and would be unlikely to be seen in a living patient, particularly in such large numbers. Much more plausible is a helminthic infection – parasitic worms. These remain incredibly common in developing countries even today: up to a third of the world’s population is believed to be infected at any given time.

Several species of these parasites are endemic to Haiti – among them Ascaris lumbricoides, whose eggs hatch in the small intestine. The larvae travel through the blood and lymphatic system to the lungs, where they mature before migrating to the stomach via the airways and the back of the throat.  The hookworm (Necator americanus) has a similar lifecycle, except that the eggs hatch outside the body and the larvae tunnel through the skin before finding their way to the lungs.

Infections of both these species are often first detected when worms are vomited or emerge from the nose. It seems likely that the French soldier had just had his first taste (yuck!) of a common, and particularly unpleasant, tropical parasite.

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