TREATMENT OF DISEASES CAUSED BY WORMS 37
judgment if he is to be trusted with the more or less poisonous drugs
which constitute our present armamentarium of anthelmintics. He
can be taught, or could be if we had suitable teachers, a sound know-
ledge of the other factors involved in anthelmintic medication. He
cannot be taught to be a person of sound judgment, if he is intrinsically
a person of unsound judgment ; the poor thinker will continue to be
a dangerous performer with potent drugs, and will continue to dis-
credit excellent drugs by obtaining bad results as a result of bad
judgment.
(2) The patient must always be considered as to status praesens in connection
with the other factors, and especially in regard to conditions constitut-
ing contraindications for treatment. Failure to consider contraindica-
tions is altogether too common, and is a prolific source of fatalities.
(3) The parasite must be known definitely and its habits, location, and life
history taken into consideration. A knowledge of these facts leads to
sound procedures, and affords an intelligent explanation for certain
failures.
(4) The parasiticide (the anthelmintic) must be selected not only with reference
to its known action on the worms to be removed, but also with
reference to its effects on the patient. These drugs are potent and
poisonous, they exert a certain amount of unfavourable effect on the
patient and the practitioner must select his drug and his dosage with
reference to both of these things.
(5) The purgative is usually the most important factor in connection with the
procedure of safety: It must be selected with reference to its known
action in connection with any anthelmintic, since some purgatives are
unsuitable with certain anthelmintics, and either afford inadequate
protection to the patient or diminish the efficacy of the anthelmintic.
Purgatives should be given in adequate amounts, as small amounts
are as bad as, or worse than, none. The time and mode of adminis-
tering the purgative are also important.
(6) Prophylaxis rounds out the job of treatment. The practitioner has not
fulfilled his duty to his client until he has not only aided him in his
trouble, but also told him why he was in trouble, and how to avoid
similar trouble in the future if the state of our knowledge affords such
information. The veterinarian who treats a herd of swine in a hot
lot, and leaves the swine to pick up millions of ascarid eggs from the
ascarids removed and left there, has an inadequate idea as to his duty
to his client.