Medical journals do not often publish articles by undergraduates these days, but an 1847 edition of the Southern Medical and Surgical Journal included a short paper by one John D. Twiggs, described simply as a ‘student of medicine’. Mr Twiggs (we cannot call him ‘Dr’) betrays his inexperience in a certain lack of professional scepticism; but he certainly had an interesting case to report:
The mother of this child, a negro on a neighboring plantation, had noticed his vitiated and irregular appetite, and gradual emaciation for some weeks, when a dose of a domestic remedy for worms, the decoction of the China (Smilax China) root was given, and revealed the cause. This medicine was continued for five weeks, during which time he passed several portions of tape-worm, measuring from six inches to three feet.
That sounds quite a lot; but he was just warming up for the main event.
His appetite at times it would seem impossible to satisfy, and his whole desire was for more food. His medicine was now changed, and a dose of oil and turpentine substituted in its place. In a few hours he passed, at one evacuation, thirty-three feet of tape-worm, besides several smaller pieces. Since then his appetite has not been so great, and his hunger easily appeased. Now, if we consider the length of time the child had been passing pieces of worm, though in smaller quantities than at the last stool, the entire length must have been very great, if the Taenia solium is always solitary as its name indicates, and no more than one worm existed in the intestines of this child.
Observing the proprieties of writing for a serious journal, Mr Twiggs then surveys the literature for similar examples.
Dr. Tyson, in the Philosophical Transactions, No. 146, remarks that the Taenia is always single, being sometimes as long, and sometimes exceeding the length of all the intestines. But this is contradicted by Dr. Good, who says, the records of medicine prove that the several varieties of worms have been voided simultaneously by the same patient.
Dr Tyson’s article on parasitic roundworms, published in the Philosophical Transactions in 1683, is an impressively thorough anatomical description which includees the striking observation that the penis of one species ‘seemed to be able to exert itself almost the length of a Barley Corn.’ Tyson also disproved an earlier theory by demonstrating that worms are oviparous (egg-laying) rather than reproducing by giving birth to their young.
So far, so rigorous. But now Mr Twiggs makes the mistake of taking at face value a number of reports which a more experienced practitioner would surely have read with an arched eyebrow.
In the Cyclopaedia of Practical Medicine I find it stated, that the length which the Ticnia is capable of attaining, is very considerable, though quite indefinite: those passed now-a-days rarely much exceed twenty feet. A case is recorded by Olaus Borrichus, (Rees’ Cyclopaedia, vol 36,) of one eight hundred feet long, voided in a year’s time.
This would indeed be a monstrous specimen. But if you read the report alluded to, it quickly becomes clear that things are not quite as they seem. Borrichius (not ‘Borrichus’, and today usually anglicised to Ole Borch) was writing in the 17th century, at a time when physicians believed that only one tapeworm at a time could exist in the alimentary canal. In addition to which, tapeworms regularly shed part of their length which, of course, grows back over time. In any case, the length of the entire digestive tract of an adult human is only 30 feet or so, so the idea of a 800-foot parasite coiled up in this space is fairly ludicrous.
Twiggs ends the article by wondering aloud whether tapeworms used to grow to a greater length in earlier centuries, before the advent of effective anthelmintic (anti-worm) medications. It seems more likely to me that the earlier reports were simply less reliable, though it is possible that less sanitary conditions simply made infection far more likely. But it wasn’t just about length: numbers were also an issue, as this excerpt from Dr Tyson’s 1683 report shows:
Panarolus tells us he once saw the Stomack and Guts stuffed with them so that they ascended up to the Throat. Baricellus by the use of Crude Mercury brought away from a Patient above a hundred. Gabucinus saw voided by Stool 177. Benivenius saw voided by a Child 7 years old 152 Worms. And Jacob Hollerius, out of Musa, gives us an History of a man 82 years old, who voided above 500. And Petrius Paulus Pereda saw a Noble-man’s Child in a few days void almost a Thousand, and she voided 40 in 4 hours time.
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