TAPEWORMS. 59 



departed from my general rule, and advised a third 

 dose, in the hope of dislodging the isolated head, 

 but without avail. At the expiration of three 

 months the proglottides reappeared, and in the 

 following September she was again under my care. 

 On this occasion I prescribed the areca-nut powders, 

 followed by brisk salines, when, for the second time, 

 almost the entire creature was effectually dislodged. 

 In about three months more the parasite reap- 

 peared for the third time, when I advised by letter 

 a repetition of the areca-nut method. In this 

 instance, therefore, I had unfortunately no oppor- 

 tunity of ascertaining the results, as the patient 

 was either unwilling or unable to visit the metro- 

 polis again. No doubt, as too many under like 

 circumstances are apt to do, she began to despair 

 of ultimate success ; yet there was nothing in her 

 case which need have led her to such a conclusion. 



If you have followed me in this and certain 

 other cases you may have noticed the reluctance 

 with which I have, in a few instances, recommended 

 immediate treatment. I am quite aware that in 

 doing so I am departing from the ordinary practice 

 pursued by others ; but I have the strongest reasons 

 for such a course. As a rule it may be said that 

 the more you have to operate on, the more likely 

 are you to be successful. Obviously therefore 

 when a patient presents himself who has only 

 shortly before got rid of a portion of the tapeworm, 



