SUPPLEMENT 66l 



of mint, and given by means of a stomach tube (Rosenberg 1 ). A few 

 hours afterwards a mild laxative may be taken one to two table- 

 spoonfuls of aqueous tincture of rhubarb (Asam) or an enema may 

 be given. In a case reported by Sonnenschein decoction of pome- 

 granate root had no effect, as it was vomited up. 



Hymenolepis nana. 



This species, very rare in Central and Northern Europe, inhabits 

 the small intestine, especially of children ; it burrows very deeply into 

 the inticosa. Not uncommonly several thousand have been found in 

 one case (Nicolo, 2 E. Stoerk and Haendel 3 ). It is remarkable that 

 these Cestodes have been found so frequently post mortem and after 

 vermifuges given for other reasons. Thus the clinical symptoms 

 must often be very indefinite (Stoerk and Haendel), so that one 

 may assume that only a slight percentage of cases of Hymenolepis 

 nana come under observation and are published as such. On the 

 other hand, it is certainly conceivable that with the large number of 

 parasites that frequently occur in one individual a whole series of 

 symptoms, in part quite severe, are capable of being produced. 

 These are partly symptoms of intestinal catarrh, consisting of 

 abdominal pains, constipation, alternating with attacks of diarrhoea, 

 perverse appetite,' and boulimia, abdominal pains of a cramp-like 

 nature, followed by emaciation, headache, sleeplessness, pallor, 

 lassitude, and in part nervous symptoms epileptiform attacks 

 without loss of consciousness, weakness of memory, melancholia, 

 irregular febrile attacks (Lutz 4 ). Possibly, too, Hymenolepis nana 

 infects the urinary organs, producing true chyluria (Predtetschensky 5 ). 

 Stoerk and Haendel are inclined to think that this species, unlike 

 other Cestod.es parasitic in man and domestic animals, needs no 

 intermediate host for its development, and that the larval forms 

 (cysticercoid) live in the same host as the adults. The diagnosis 

 is based on the demonstration of ova in the stools. As far as 

 expulsion of this Cestode is concerned, santonin, kamala, kousso 

 flowers and thymol appear to have no effect of importance ; whilst 

 extract of male fern, recommended by Grassi 6 as a result of his 

 considerable and successful experience, has been given, with the 

 result that the worms really are expelled, and that after the treatment 

 neither worms nor ova are any longer demonstrable in the stools of 

 patients. In his cases of chyluria Predtetschensky prescribed ol. 



1 Rosenberg, Ges. f. inncre Med., February 16, 1904. 2 Nicolo, Gaz. d. Osp., 1904. 



3 Stoerk, E., and Haendel, Wicn. klin. Wochenschr., 1907, xxix. 



4 Lu'z, Centralbl.f. Bakt., 1894. 5 Predtetschensky, Zeitschr. f, klin. Med., xl. 

 6 Grassi, Centralbl.f. Bak:., 1887. 



