TAPEWORM.
Male Fern maintains its supremacy as the best of all remedies for the N'a rillus species of tapeworm found in the human intestines. The 13.P. Liquid Extract is the only reliable preparation of the drug. By care in its administration, and by a knowledge of the way in which it acts, the physician will very seldom have to resort to any other agent. Its only drawback is its very nauseous taste and its liability to upset the stomach, but these objections can be overcome by improved pharmacy.
The dose of this preparation should not he less than 6o mins., and never greater than qo mins. A very serious discrepancy in the dosage may be observed in the literature of the drug, one authority giving the average dose as 6 drs. or 36o mins. This dose would be fatal if the ex tract had been skilfully prepared from an active rhizome. The male fern is of varying activity, according to the soil and climate in which it has been grown, and the only way to reconcile the above statement of dosage is by assuming that an inferior preparation or a totally different rhizome was employed. Potain has pointed out that certain parts of Normandy, for example, produce male fern which has no effect. The writer thinks that the various discrepancies regarding dosage may also to a large extent he explained by the difficulty in distinguishing the fronds and rhizomes of Aspidium Fili.v eras, Asplenium and others; the exhibits eight fibro-vascular bundles on a transverse section of the petiole-base. The identity of the fern should he carefully made out before the extract is prepared, and the physician should be very particular about the pharmacist to whom the dispensing of this drug is entrusted. Of an active liquid extract 4 drs. have several times caused death. This preparation is now standardised in the last I3.P.
In order to obtain the best effects of an anthelmintic several pre cautions are necessary. Thus, the alimentary canal must be as empty as possible, so as to permit the drug to exercise its undiluted effect upon the parasite. For this reason these drugs should be given after a long fast, or, better still, after a brisk saline cathartic. It is also advisable
to recommend the patient to maintain the recumbent posture for a few hours, as vertigo, and even syncope, may follow the action of a full anthel mintic dose of most of the agents employed in tapeworm disease. Then, as many of these agents simply act by killing the worm, a purgative should he given soon after or along with the vermicide.
The fragments of the worm must be very closely examined after expulsion. Very often only a large number of the so-called " joints " are passed, and the head is left behind. Failure then, of course, results, as the neck goes on growing, and treatment should he repeated in such a case after an interval of rest. There may be more than one worm—an event more frequent than is usually supposed—and only a scrutiny of the detached portions will enable the physician to be sure of this.
For the successful treatment of a patient suffering from tapeworm it is advisable to insist upon a liquid diet for .48 hours before administering the anthelmintic. The plan of administering alkalies with the view of dissolving mucous secretions in the is probably a useless one, as these drugs are absorbed rapidly from the stomach or neutralised soon after being swallowed. It is a wise precaution to confine the patient to his bed for the forenoon of the day in which treatment is being employed, but there is no necessity for a preliminary sojourn of several days in bed as is sometimes insisted upon.
Very early in the morning a dose of 4 to 6 drs. Sulphate of Magnesia dissolved in a tumblerful of effervescing Lemonade should be administered to the fasting patient to cause smart purging. In a couple of hours afterwards r to r drs. of the extract should be given whilst the patient remains in bed.
As regards the form in which the liquid extract of male fern is to be administered, there is much diversity of opinion. It may he emulsified by r dr. powdered Acacia or by Mucilage of Tragacanth, or the following formula may be used: R. Ext. Filicis Liq. Lxxv.