Ovi j.
Aquee Chloroformi et Syr. Simp. q.s. ad ij. Misce.
Fiat haustus, mane sumendus.
The freshly prepared extract can now be obtained in soft gelatin capsules, each containing 15 mins.: 4 to 6 of these may be swallowed, and as the stomach is quite empty they may glide directly through the pylorus into the intestines before the gelatinous envelope is dissolved, and in a concentrated condition the remedy is brought into direct contact with the parasite. Some authorities recommend that the dose should be divided into two, the second half being given after an interval of 2 hours. Manson and others advise that one-quarter of the full dose should be given every r5 minutes.
The writer's experience is against these and he believes that the best effects of the drug are to be obtained by a single large dose whereby the full lethal action of the vermicide is secured.
If purgation does not follow in or 5 hours after the administration of the extract (which is seldom the case when 90 mins. have been swallowed in a single dose), 6 drs. of Castor Oil may be prescribed. Some physicians add r dr. of Oil of Turpentine to the castor oil, hut the writer has seldom found it necessary to give any purgative after the dose of male fern when the drug was obtained from a reliable source. Jalap. Scammony, Calomel and other purgatives are also recommended for following up the action of the male fern.
Some authorities recommend that other anthelmintics should he mixed with the drug before swallowing; if any such plan is adopted in order to dislodge an obstinately fixed T(zwitz sulium the only drug to be selected is Turpentine Oil in f oo-min. dose. Duchesne advises the following made into a firm jelly, which can be easily taken by children: Ext. Filicis Liq., 3j.; I lydrg. Subchlor., gr. vj.; Sacch. Alb., 5ij.; Gelatin q.s. ut fiat electuarium. "Phis quantity would certainly be too much for a very young child. A boy 5 or 6 years old might take the half of it. Rothe recommends that Chloral Hydrate should be combined with the male fern in combination with a smart cathartic in the form of a capsule, the whole given together, thus avoiding subsequent pain and the adminis tration of a purgative. His formula is—Chloral, 18 grs.; Extract of Male
Fern, 3o grs.: Croton Oil, i or 2 drops. This is a severe dose, though lie says it prevents pain and griping, and acts inside 3 hours. Chloroform and Ether have been often added to the anthelmintic draught to prevent griping; 5 grs. would meet such a purpose more effectually, but the simpler the prescription the better, and the capsules of pure extract of male fern meet every requirement.
If a case comes before the physician with the history of previous unsuccessful attempts at treatment with male fern, the following modi fication of the above plan should be instituted: After 48 hours on liquid diet and a 'ID hours' fast, the draught of Mag. Sulph. is administered; when the bowel has been cleared out by this means, four capsules of male fern extract (6o mins.) are then administered, and in r hour this dose is to be repeated. Should purging not follow, 6 drs. Castor Oil may be given after waiting for at most 4 hours.
When the head of the tapeworm is not found in the motions, it is usually recommended that in a few hours another dose of male fern should be administered. The writer believes that the wiser course in such an event is to wait. If the minute head has escaped observation in the mass of bowel evacuation nothing more will be heard of the trouble; if, however, it has not been detached from its hold on the bowel the patient will find proglottides in the motions after the elapse of about moo days, when the treatment should be again resorted to, a larger dose being employed. A severe or even fatal gastro-enteritis may he set up by repeated continuous attempts to expel the head of the worm, and a more satisfactory result is to be expected by waiting till the proglottides have developed, whereby a greater traction is exercised on the parasite.