CESTODES 523 



irritant action. If the tape-worm is only seen after it has been expelled, or 

 after it has died, it is difficult to understand what energy and motility 'the 

 parasite possesses under normal circumstances in the warm intestine of its 

 host, and how greatly it may irritate the intestinal mucous membrane. This 

 may be noted sometimes as pain, at other times as a digestive disturbance. 

 Intestinal catarrh, constipation, marked irregularity of the bowels are, in 

 fact, very frequent accompaniments of tape-worm disease. We have repeat- 

 edly noted the disappearance of all these symptoms after the removal of the 

 parasite. 



Besides these local symptoms, in a number of patients suffering from 

 tape-worm there are also general phenomena and so-called reflex symptoms, 

 existing alone or together with the gastric phenomena. It is quite certain 

 that formerly in investigating these symptoms, as the result of incorrect views 

 and on account of erroneous pathological deductions, diagnoses have been 

 made which would not bear strict critical analysis. To deny them utterly 

 would, however, not be correct. There are to be mentioned: Vertigo, and 

 attacks of syncope, headache, stubborn singultus, pupillary differences, rapid 

 change of color in the face, pruritus, spasmodic attacks which occasionally 

 have the characteristics of epilepsy. According to the observations of Grassi, 

 in the case of tenia nana epileptic attacks are especially frequent. In deciding 

 upon the connection of phenomena of this kind, it will aid us in every case 

 to note whether they persist after the disappearance of the worm, and are 

 therefore to be looked upon as a purely reflex condition. If this be the case 

 they are, of course, only an accidental complication. 



How far the symptoms on the part of the nervous system are to be regarded 

 as reflex, cannot always be immediately decided. We must first exclude those 

 cases in which cysticercus invasion has to be considered, as in the case of tenia 

 solium. We know positively from autopsies that the brain is the seat by pref- 

 erence of cysticerci. On the contrary, it must be questioned whether the 

 central nervous organs are not under the influence of toxic substances produced 

 by the parasite. It is more than likely that these animal parasites engender 

 toxic products which have a particularly deleterious effect upon the nervous 

 system as well as upon blood formation. 



Eeyher, Euneberg, Schapiro, Dehio and others have called attention to the 

 fact that the severe anemic conditions occurring in persons affected with 

 the bothriocephalus may assume the character of pernicious anemia and run 

 a course as such. These symptoms may certainly be referred to the presence 

 of the parasite. There is no longer any doubt of the etiologic connection. 

 The circumstance that the majority of infected persons are not anemic sug- 

 gests the thought that the poison is found only under special circumstances 

 as, for instance, the illness or death of the worm, or the presence of the para- 

 site for a considerable time. Lately Schaumann and Talqvist fed dogs with 

 segments of the bothriocephalus taken from a case of pernicious anemia, and 

 produced undoubted dissolution of blood in the dog. The forms of bothrio- 

 cephalus which do not produce anemia also contain the hematogenous poison. 

 Occasionally this is present in other teniae. Eisenlohr soon effected a cure of 

 a case of severe anemia by expulsion of a tenia saginata. 



