486 OCCURRENCE AND MEDICINAL SIGNIFICANCE. 



into a coil as large as an apple. ^ Sometimes it even happens that the 

 end of the tape-worm protrudes from the anus during defsecation, and 

 on any attempt to remove it (as Andry has observed), quickly with- 

 draws again into the intestine (p. 425, note). The knots which are 

 sometimes observed on the thin anterior body of expelled worms, can 

 hardly be regarded as normal structures, since they probably arise 

 only from the unusual cramp-like contractions, caused by the use of 

 anthelminthic medicines. 



If the stream of chyle turn in consequence of powerful anti- 

 peristalsis (especially in vomiting), the position of the tape-worm in 

 the alimentary canal may be occasionally reversed — that is to say, the 

 posterior end may be turned forwards. Cases are known in which the 

 whole or portions of the tape-worm have been vomited,^ and in one 

 case forty yards are said to have been ejected in this way (van 

 Doeveren). Lavalette, a French physician, has lately reported the 

 case of a pregnant woman who expelled the proglottides singly 

 through the mouth. ^ 



Where abnormal openings occur in the alimentary canal, like the 

 so-called fsecal or intestinal fistulse, the proglottides, and even whole 

 worms, occasionally find an exit through them (Eichter, Spoering). 

 We are even informed of an instance in which the tape-worms broke 

 through the wall of the abdomen through a newly formed abscess,'' 

 so that it almost appeared as though the worm had caused the forma- 

 tion of the abscess, although the nature of the tape- worm body hardly 

 permits us to suppose that it could bore through the intestine, if the 

 latter had not been already in a diseased condition. ' Especially in- 

 teresting, in this connection, is a case mentioned by Herz, in which 

 the tape-worm (whether it was Tmnia saginata is, of course, uncertain) 

 issued through the navel, without, however, bringing any of the con- 

 tents of the intestine along with it, so that the patient could be dis- 

 missed as cured a few, days after the exit of the worm." 



Of a similar nature are the rare cases in which the tape-worm was 

 expelled through the urethra. In such cases, even when the ordinary 

 signs of vesico-rectal fistula are wanting, it is evident that the worm 

 can only have reached the urinary apparatus from the intestine. In 

 one of the three cases mentioned by Davaine, the tape-worm remained 



' Joum. demed., t. xxv., p. 222, 1766. 



"^ See the cases collected by Davaine, loo. cit., p. 100. 



^ Quoted by Davaine, loc. cit. 



* lUd., p. Hi. 



° Like Goze and other observers, I have repeatedly found Tcenia pectinata living free 

 in the body-cavity of the rabbit, but have never succeeded in finding any wound in the 

 intestine. 



« Med. Zeitung des ^<'^-^jjN(l^^ffjW^^ji^g§^fffl^, P- 75, 1843. 



