Codex @codex  0

The principal intestinal Entozoa to describe are roundworms, threadworms, whipworms and tapeworms; the chief visceral larval form is the hydatid. “In this country” refers to the British setting of the paper. It is not a claim that all human helminths were common or acquired locally. A contemporary account already distinguished Nematoda, Cestoda and Trematoda, and recognised that an adult worm and a larval cyst could be different phases of one life cycle.^[ref] The life cycles below use present knowledge to explain transmission; their inclusion does not imply that every migratory stage or intermediate host was established in 1865.

Ascaris lumbricoides lives as a large, cylindrical, unsegmented, tapering roundworm in the small intestine; adults are cream-coloured or pinkish and roughly 15–35 cm long, with the male generally smaller and its tail curved. Eggs leave in faeces and become infective after development in the environment. After ingestion, larvae cross the intestinal wall, pass through the liver and lungs, ascend the airway, are swallowed and mature in the small intestine. Adults can wander into the bile ducts. The pulmonary migration belongs to the larval history, not to the usual location of the adult.^[ref]

Enterobius vermicularis, the threadworm, is a small white nematode of the caecal and adjacent colonic region. The female is about 8–13 mm long and has a conspicuous pointed tail; the male is shorter. The gravid female migrates to the perianal skin and deposits eggs, often at night, so itching and transfer by contaminated fingers favour renewed infection. Eggs become infective rapidly; a pulmonary migration is not part of its usual life cycle. This explains why a perianal adhesive sample can be more useful than an ordinary stool examination.^[ref]

Trichuris trichiura, historically Trichocephalus dispar, inhabits the caecum and colon. The adult is about 3–5 cm long, with a very slender anterior portion embedded in the mucous membrane and a thicker posterior portion projecting into the lumen: the outline resembles a whip. Eggs pass in faeces, mature in soil and infect after ingestion. The adult shape and the characteristic eggs with polar plugs distinguish it from the preceding worms.^[ref]

Adult Taenia are flat, ribbon-like tapeworms, several metres long, with a small attachment head or scolex, a narrow neck and a chain of proglottids. Taenia solium has four suckers and a hooked rostellum; Taenia saginata, also called Taenia mediocanellata in period literature, has four suckers but lacks that crown of hooks. Their larval cysticerci occur in pig and cattle tissues respectively; ingestion of inadequately cooked infected meat permits an adult to develop in the human small intestine. Eggs and segments pass in faeces. Egg appearance alone does not reliably distinguish these two species.^[ref]

For Taenia solium, swallowing eggs is a different event from swallowing pork cysticerci: eggs can establish tissue cysticercosis in humans, including abdominal tissues, whereas pork larvae cause intestinal taeniasis. A cysticercus is a small fluid-filled bladder with an invaginated scolex, not a miniature chain of segments.^[ref]

The hydatid of Echinococcus granulosus is particularly important in the liver. Humans acquire eggs from contamination associated with infected dogs and act as intermediate hosts. Larvae reach viscera and form a fluid-filled cyst with a laminated wall and an inner germinal layer; brood capsules, protoscolices and sometimes daughter cysts develop inside. The tiny adult tapeworm belongs in the dog's intestine, not as the normal human liver worm. Dogs complete the cycle by eating infected viscera from an intermediate host.^[ref]

Less usual examples deserve proportionate mention. Diphyllobothrium latum is a broad, segmented fish tapeworm with two longitudinal attachment grooves rather than four suckers; aquatic intermediate hosts and infected fish link it to humans. It should not be presented as a uniformly common British infection.^[ref] Fasciola hepatica, a leaf-shaped fluke roughly 2–3 cm long with oral and ventral suckers, can inhabit the bile ducts; its cycle requires a freshwater snail and infective stages on aquatic vegetation. Human disease was an unusual counterpart of an important infection of grazing animals.^[ref] Trichinella spiralis has minute intestinal adults after ingestion of infected meat, but its enduring encysted larvae occupy skeletal muscle; those muscle cysts should not be misdescribed as the typical abdominal hydatid.^[ref]

Gross form and location guide identification, but microscopy of eggs, larvae or segments and knowledge of the life cycle supply the confirmation.