5. Tanict mina (Fig. 511) has frequently been encountered in Italy, but only exceptionally. in Germany. It becomes 2 to 3 cm. long, and half a millimetre thick. The rostellum has 25 booklets and 4 suckers. On account of their small size, the proglottides passed do not usually help in the diagnosie. The eggs, round or oval, have a diameter of .04 to .05 min. The embryo has six hooks. The life-history of this tapeworm, which is widely distributed over Italy and Sicily, is not yet entirely known. Ae.cording to Grassi, an intermediary host is not necessary to convey the parasite to man—a view- that Leuckart opposes. The twilit". native infect children especially. and are found in enormous number—often 700 to 1000 in one individual. They. have given rise to epileptiform attacks.
Symptoms.—What little we know of the symptornatology of twilit), disease may be summed up as follows: In less than one per cent. of the individuals attacked, the Bothrioeephalus latus gives rise to severe, and often fatal, amernia. In other eases, like other tamim, it gives rise to no symptoms, or to no especial pathognomonic symptoms. Dyspeptic disturbances, sour eructations, and nausea with vomiting—often head ache and vcrtigo—are encountered. Colicky pains are frequent. Older children that know they have a tapeworm sometimes complain, just as is the habit of adults, of 'the crawling and biting of the worm. In tender and sensitive children, reflex symptoms, with epileptiform and choreiforrn conditions, have been observed. The previously mentioned formation of toxins by the.se parasites will explain the nervous symptoms, as well as the presence of amemia, which is so frequent with t;enia; but only those cases in which the whole symptom-complex disappears with the destruction of the worms can be considered positive; since it is evident that persons with epilepsy', chorea, and anaunia may become infected with tamia.
The diagnosis of the different forms of tamia is easily made, as a rule. The parents often bring links or portions of links passed, pre served in alcohol. In every ease the true nature of these formations must be considered, and this may offer considerable difficulty. When the history is not clear after the careful passing of a rectal sound, the feces must be investigated for eggs; or a. laxative tnay be given, which, as a rule, causes the evacuation ctf proglotticies.
The differential diagnosis between trenia solium and tmnia saginata can usually be made by studying the links between two glass slides, but not always; since the individual proglottides may not show the branches of the uterus, on account of the absence of eggs ttnia saginata). The anamnesis, giving us a history of eating raw pork or beef, often leads to a correct diagnosis. Since the tamia soliurn must be removed as
soon as possible, on account of the danger of cysticercosis, an exact diagnosis is of great importance—especially, since this disease gives greater chance for complete recovery after the removal of the worms than cloes that caused by the tamia saginata.
Treatment. —Since the usual remedies for tapeworm have a bad taste and are taken with difficulty; since they irritate the gastro-intes tinal canal and sometimes cause severe toxic symptoms (especially the extract of filix mas), with lasting bodily injury, and even death; and since tapeworms do not, as a rule, give rise to alarming symptoms,— the institution of a cure for the condition is by no means a matter to be undertaken lightly and without careful consideration. A tapeworm cure must never be carried out without absolute certainty of diagnosis or without taking into consideration certain contraindications, such as early age; severe recent gastro-intestinal disease (appendicitis, peri tonitis, typhoid fever, or other severe infectious diseases); heart disease with loss of compensation; severe phthisis; or recent recovery from abdominal operation. In such cases, one should hesitate at least for a time, or should bc satisfiecl with the throwing off of large sections of proglottides: in order to avoid the danger of cysticereosis.
The day before the administration of the cure, the intestine must be thoroughly- evacuated by means of castor-oil, Hunyadi water, etc.; and the children must receive a bland diet. The following clay, tea or coffee must be given for breakfast; and an hour later, the venni fuge. In the Kaiser Francis Joseph Children's Hospital at Prague, in Professor Ganghofner's clinic., the tapeworm remedy prepared by H. A. Jungclaussen, of Hamburg, has been used exclusively in later years. This is called Cucumerin, and is a concentrated extract of 300 grants (9 oz.) of pumpkin-seeds. It has been extensively used in Mexico as a tapeworm remedy, and has been warmly recommended by- v. Storch of Copenhagen. The bottle.s contain about 40 grams (1 oz.). It tastes like beef-juice, and can be given dissolved in soup or cocoa, one or two hours after breakfast. It i.s nearly always well taken by the children. Two hours later, a purge of castor-oil, for example, may be given; a table spoonful every half-hour, until free stools result. Large intestinal irri gations are also of use. The results are not always equally good, and it is not easy to say whereon this depends. Sometimes repeating the cure once or twice produces the desired result.