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The Worm Turned—Action and Reaction*

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The Worm Turned—Action and Reaction* THE WORM TURNED—ACTION AND REACTION* I)ONALD L. AUGUSTINE Harvard School of Public Health, Boston, Mass. My reason for selecting a subject on worms “TheMuse's Looking Glass― takes cognizance for this address is that my professional career of the fact that, has been largely devoted to the study of para “Poorworms being trampled on turn tayle, sitic worms, and I have always found these As bidding battail to the feet of their opres creatures interesting and at times exciting. It is, sors.― therefore, another instance of “Doing What This observation was made in 1638. I do not Comes Naturally.― hold that it is exactly the precursor to the dis At what time man first attached any signif covery of dermal infection made 260 years later icance to the action of worms must be a matter by Professor Looss. of pure conjecture; it is quite unimportant. But Despite its great age, the phrase has never at one time, somewhere along our ancestral grown stale or hackneyed. I would remind you trail, someone possessing that rare quality, of its fresh appearance in Roger Lee's fascinating curiosity, stopped long enough to watch a autobiography, “TheHappy Life of a Doctor― crawling creature; he probably poked at it, and which was published just two years ago. also, probably to his astonishment, noted that “Theworm turned― was very much of an old the creature turned sharply against the poker. saw to me until one day it suddenly came to The observation provoked an idea: the proverb, mind and it carried new significance; in fact, it “Theworm turned.―Thus, a saying burst forth. had a very singular meaning. It occurred some It was pleasing, it spread, became commonplace time ago during one of our symposia on malaria. and, let us say with all due credit to Theodor The speaker, who was reviewing the history of Storm, the author of that delightful novelette, malaria, at the moment was dwelling on the “Immensee,―it sprouted, it dropped from a origin of Manson's mosquito-malaria theory. cloud, floated over land like gossamer and was The old saw burst upon me, for it was indeed the sung in a thousand places at the same time. It turning of a worm that prompted Manson's became a favorite epigram of poets and scribes. theory; it ushered in a new era in medicine, it You may well recall that Clifford, in Shakes was the beginning of modern tropical medicine. peare's “HenryIV,―cautions his gracious liege Reflecting for the moment, I ceased to follow that, “Thesmallest worm will turn, being trod the speaker. I sat there recalling some of the den on.― And, Cervantes, being more than a turnings of worms which had had direct and little vexed over the publication of a second “Don forceful influence on the development of tropical Quixote― while he was preparing his own second medicine and tropical public health. I assure you part for press, notes in his foreword, “Blessme, I had visions of actions and reactions. Reader, gentle or simple, or whatever you may Now, seemingly going somewhat astray, I be, how impatiently by this time must you am going to dwell briefly on a certain phase of expect this Preface, supposing it to be nothing physics, a phase of the subject which was of but revengeful Invectives against the Author of particular interest to all of us early in our scien the second Don Quixote. But I must beg your tific careers; in fact, much before we decided upon pardon—though it be universally said, that a scientific career, namely, Newton's third law even a Worm when trod upon, will turn again, of motion; “Toevery action there is an equal yet I'm resolv'd for once to cross the Proverb.― and opposite reaction.― Objects which turn are And again, Thomas Randolph in his entertaining objects in action. Although the action and the reaction are always equal, the action may be * Presidential address before the American readily perceived but the reaction may not be Society of Tropical Medicine and Hygiene at its annual meeting, November 7th, 1958 at Miami noticeable. For example, when a person pushes Beach, Florida. his stalled automobile along the street, the force 93 94 DONALD L. AUGUSTINE he applies against the automobile is equal to concerned, that bit of added equipment permit that applied against the pavement. The action ting accurate observation of action and reaction is perceptible, but the reaction is not. Let the was introduced, namely Leeuwenhoek's simple pusher put on roller skates and the reaction lens of small size and with considerable curva becomes immediately and decidedly apparent. ture for close focus. The study of intestinal In other words, the roller skates were added worms became the vocation and avocation of equipment which made visual perception of the the naturalist. It became a specialty; the reac reaction possible. Similarly, the reaction to the tion became more apparent than the action and turning of a worm was not sensed until compar a new branch of zoology, helminthology, came able added equipment was applied. In the present into existence. presentation, reaction will refer to man's under The present long list of helminthologists could standing and appreciation of the worm's action, rightly begin with Marcus Bloch, Johann August rather than to a direct reaction; namely, any Goeze, and Peter Simon Pallas, whose years were pathologic physiology. from 1723 to 1811. Whether these gentlemen In all probability our parasitic worms in would have accepted such distinction is, I believe, ancient times did as much turning as they do a bit of a question for each is well known, if today; there was the same action on the part of not better known, for contributions in other the worm but the equipment for sensing any fields; two were physicians and the third was a reaction was lacking. Essentially there was theologian. But all had a common avocation; little or no reaction. It is true that the commoner, they were naturalists in the true sense of the cosmopolitan helminths, Ascaris lumbricoides, word and probably would have preferred to Enterobius vermicularis, and the larger tapeworms remain in this category. were known. Primitive man as well as the medi Even in the present day of specialization it evalite must have been well aware of these is difficult, if not hazardous, to place a scientist creatures. They did not know how they got in any definite category. He might disagree with into the body, but they were fully cognizant of your classification. For example, some years ago the way they left the body. To some, they were at an evening seminar the then recent studies the obvious cause of their intestinal disorders, on bird malaria were to be presented. The speaker abdominal pain, while to others their presence was the late Dr. Samuel T. Darling. The chair was an indication of normal health and well man reviewed Dr. Darling's outstanding scien being. tific contributions and introduced him as a However, once it was assumed that these protozoologist. I was looking at Dr. Darling worms could cause pain, it was natural first to and noticed that he shuddered a bit; then he suspect, and later conclude, that worms caused rose to speak, beginning somewhat as follows, pain and illness elsewhere in the body, particu “Gentlemen, I have been introduced to you as larly the most violent pain, the toothache. a protozoologist. Urumph! This is indeed some The symptom was the disease, as a rule, but in thing new and strange to me. I always considered other cases the cause of the symptom was con myself a pathologist—and I hope I shall be sidered the disease. The patient had worms, remembered as such.― the worms were the disease. Thus, action was During the 18th and 19th centuries helinin observed, but the reaction was overlooked thology was in its heyday, and there were he! except by the physicians who prescribed remedies minthologists of that day: Kitchenmeister, against the worms or the disease. The naturalist, Herbst, Colbald, Steenstrup, van Beneden, and the zoologist of the day, speculated on the ques many others; and especially Leuckart, affection tion of the origin of worms. Further than this ately recognized at home as Altmeister der point, it mattered little if the worm turned, for Helminthologie and acknowledged as the great to them, it looked much the same on both sides. leader by students in all nations. The apparent This trend of thought remained unchanged force of the reaction equalled that of the action. until well into the 17th century. Thousands of animals were examined for their Then came an abrupt and glorious awakening, worm parasites and records were made. It a time of spiritual and intellectual uplift, an was discovered that a worm does not look the age of individual scientific endeavor and un same on both sides. Sex was revealed. The ex biased observations. As far as the worms were perimental method was successfully introduced THE WORM TURNED—ACTION AND REACTION 95 into research, life histories were discovered and rapidly put into action. Prior to this time the the widespread belief in the myths of necro prevalence of echinococcosis in Iceland was genesis and abigenesis became lost in oblivion. astonishingly high. Following the application I look upon the elucidation of the life-history of control measures there was a remarkable and of Triehinella spiralis as the first epochal con steady decline in the number of cases.
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