46 
form convulsions almost eveiy night, more rarely by day. often accompanied by 
involuntary micturition; there vrere occasional manifestations of somnambulism. 
She was more taciturn than before, and somewhat stupid. Eggs of Ascaris and 
Hymenolepis were again found in the feces. Male fern was administered, but no 
worms were obtained. The patient, after a month, left the hospital. 
She returned a thuxl time in the middle of April, 1889. Eor some time after leaving 
the hospital she had been fairly well, but more recently the con\'ulsions had reap- 
peared, and occurred almost every night. She had menstruated for the first time in 
August, 1888; afterwards only in October, and again in February. The girl is still 
more melancholy and self-centered than before, does not wish to associate with any 
one, is restless, inclined to lament over everything, and is very slow and unwilling 
in answering questions. Physically she is fairly well developed, but is somewhat 
pale and languid. There are evident scrofulous signs — a peculiar softness of the 
skin, tumid lips, scar on the right eyeball from keratitis, sinistral cervical adenitis. 
The head is of normal size and shape, intelligence good, no defects in the special 
senses, appetite and thirst moderate, tongue coated, breath fetid, digestion diflicult, 
defecation and uropoietic functions more or less regular, a rough diffuse vesicular 
murmur in the chest, no cough nor dyspnea. Patient complains of a troublesome 
abdominal paresthesia, a sensation as of a snake crawling through the abdomen and up 
to the fauces, with a sense of heat in the epigastrium, and strangulation at the throat. 
This sensation is often more intense before the daily convulsive attack. The pulse 
is regular, urine normal, and there is no fever. In the feces are eggs of Ascaris, 
Trichuris, and a few of Hymenolepis nana ( 1 to 2 per slide). 
After entering the ho.spital the patient had one convulsive attack during the day- 
time. She fell suddenly, with diffuse clonic spasms, foamed at the mouth, and was 
entirely unconscious. When seen by Senna she was in a comatose condition, not 
responsive to command nor reacting to cutaneous stimuli; the pupil was not abnor- 
mally dilated and reacted a little to light. Another day she was observed during an 
attack of diffuse tremor, which she said was of freciuent occurrence. Almost every 
night she was taken with fleeting convulsive attacks, moved arms and head, foamed 
at the mouth, and uttered a groan or a whistling sound. In the morning she had no 
recollection of the occuiTence. 
Five grams ethereal extract of male fern, followed by a purgative, were adminis- 
tered. In the copious watery stools no tapeworms could be found, but for several 
days following the patient was much improved, no longer felt the peculiar sensations 
in the epigastrium and throat, and was not troubled with the muscular spasms. The 
eggs of the tapeworm were absent from the' feces. After a short time light convul- 
sive attacks during the night again appeared, but the patient felt so much improved 
that she left the hospital toward the end of the month. 
It is evidently not possible in this case to establish an absolute connection between 
the epileptic attacks and the presence of Hymenolepis nana, since a complete a.nd last- 
ing cure was not attained, and since the patient was scrofulous, debilitated, and the 
child of an alcoholic father. It is certain, however, that she improved after each 
treatment, and it is justifinble to consider. Senna thinks, that the presence of Hyrnen- 
olepis nana, and perhaps also of the other intestinal worms, if not the sole cause, at 
least had great influence upon the epileptiform manifestations, since they reappeared 
or became less frequent in correspondence with the presence or absence of eggs in 
the feces. 
Case Ho. 39 (Senna's Case II). — Epileptiform convulsions, with intestinal helmin- 
thiasis {Hymenolepis nana). 
School girl, 16 years old, native of Stradella. Lombardy. Mother died in child- 
birth; three brothers and one sister dead: causes not known. One brother living; 
healthy. Father living; inebriate. 
The patient had always been in the best of health imtil the year before, when she 
