HEAD. — This is the most formidable tape-worm of man, and measures 5 to metres in length. It is made up of from 3000 to 4000 short, broad segments. These are broadest in the middle region, and grow narrower toward the end. The length of the largest segment is 3 to 5 millimetres; width, 10 to 12 millimetres.
The head has an elongated oval or club shape. It has on each lateral border a slit-like depression, and is mounted on a filiform neck. The body is thin and flat like a ribbon, except the central parts of the segments, which project outward. At this point the uterus, in the shape of a simple canal, is found. When the eggs collect here in great numbers, the lateral coils of the uterus arrange themselves in knots, producing a rosette-like appear ance. The sexual orifices lie in the median line of the ventral surface. The ovary is a double organ, which lies in the middle layer. The testicles consist of clear vesicles lying in the lateral part of the middle layer. The eggs are oval and are surrounded by a thin, brown shell.
The Bothriocephalus lades is found in Switzerland, northeastern Europe, Hol land, and Japan. Bollinger says it is quite common in Munich. It lives in the small intestine of man. The first devel opment of the eggs takes place in water. Months afterward an embryo develops, armed with hooklets, and covered with minute ciliiu. This develops in an inter mediate host into a "measle," which, ac cording to Braun's investigations in the Russian Baltic Sea provinces, seeks out as a mediate host the pike or tadpole, and either in the muscles or intestines of these fishes develops to a sexless tape-worm.
The "measle" of the Bothriocephalus latvs, according to Grassi and Parona, occurs in Italy in the pike and river perch. It is found in a Japanese fish, and in a great variety of fishes in the lake of Geneva. It is, however, most fre quently found in the tadpole and perch. The "measle" may also be brought to development in the dog or cat.
The presence of the Bothriocephatus latus in the intestine of man may give rise to progressive anTmia, resembling pernicious anemia. How it causes a diminution of the red blood-corpuscles and the percentage of hemoglobin in the blood is unknown.
Symptoms. — Tape-worms are found in human beings of all ages, but they are by no means common in children. FIolt's statistics are very conclusive on this point: of 10,000 cases studied, only 79 gave undoubted evidence of tape-worm. Cestodes may cause no disturbance what ever, and yet occasionally very grave phe nomena, such as profound anaemia, mal nutrition, and nervous symptoms. When evidences of their presence are discov ered, they are liable to produce much anxiety. In nervous folks there follows frequently profound mental depression and hypochondriasis. There is some evi dence to show that tmnim produce con vulsions and choreic symptoms, espe cially in children. The diagnosis need never be difficult, the presence in the stools of segments of the worm and ova can be demonstrated by a careful search, and are readily differentiated.
Treatment.—For the treatment of the intestinal cestodes it is necessary to pre pare the patient. who should take a very light diet for two days. A large enema of cold water or a thorough saline purge should be administered in order to pre pare as free a passage as possible for the worm. There are a number of remedies advocated, of which the best is, perhaps, pelletierine, but this is not suitable for children and is also very expensive.
For children, most authorities recom mend the oleoresin of male fern, four doses of 15 minims each in capsule given at intervals of an hour and followed by an active purge, such as castor-oil. It must be borne in mind that filicic acid dis solves more readily in the presence of castor-oil, and is hence absorbed in greater quantity, causing very consider able constitutional disturbance. Gross (La Med. Mod., Mar. 20, '95) notes a case of blindness in a man, followed by optic atrophy, thus caused. Two cases, of more or less complete amaurosis, from the use of male fern, have been noted by Mazius (La Sem. July 3, '95).
For adults the dose of the ethereal ex tract of male fern is 2 drachms. It is customary to combine felix mas with an infusion of pomegranate-root or pump kin-seeds. Ogler recommends an in fusion of pomegranate-root, ounce; pumpkin-seed, 1 ounce; powdered ergot, 1 drachm; and boiling water, 10 ounces. An emulsion of 1 drachm of the ethereal extract of male fern containing 2 minims of croton-oil is then made. After using a low diet on the previous day and an efficient laxative that night, the emulsion and infusion are mixed together and taken, fasting, the next day.
Pumpkin-seeds alone are very efficient. Three or 4 ounces should be carefully bruised and macerated for half a day and the entire amount of the infusion taken and followed in an hour by a purge. Oxide of copper, in doses of 1 '/, to 3 grains three times a day, for several days, is recommended by Sasse (Med. Week blad., Aug. 14, '9S), the only restriction being the avoidance of acid drinks. A purge is given at the end of a week.
Unless the head is brought away, the segments of the parasite reproduce them selves, and in three or four months show in the Where the head and neck are protected beneath the valvul conni ventes, the remedies may not reach the parasite. Unless the worm is killed, it is probable that no degree of peristalsis can dislodge the head. This is especially true of the Tcenia solium. A good de vice is to place warm water in the vessel into which the dejecta are received, as it is thus more likely to be preserved entire.
Visceral Cestodes.—The larval forms of certain of the tape-worms invade the solid organs and produce important symptoms. The two varieties which more commonly occur in man are, first, the Cysticercus cellulosce, the larva of the pork tape-worm, or Tcenia solium; and, second, the echinococcus, the larva of the Tcenia echinococcus. The Cysticercus tcenia saginata has been known to occur in man, but is very rare.