48 
vulfiions for four months after leaving the hospital, but they then disappeared and 
had not since returned. She felt entirely well and ap]>eared happy and in the best 
of health. 
Case 4<> (Senna’s Case III). — Sinistral hemiparesia and other diffuse nervous 
disturbances (from Hijmenolepls nana C). 
School girl, 11 years old, from Sanazzaro. Family history good. According to 
her mother, child was always bright, vivacious, and of a sweet and affectionate dis- 
position. 
In the beginning of February, 1889, it was noticed that the girl, when standing or 
walking, swayed uj^on her legs as if to fall. IVhen talking, the angle of her mouth 
was drawn toward the right side. She complained of slight headaches, and occa- 
sional vertigo; fell to the ground one day while going to school. The appetite and 
digestion remained good, there Avas no fever, no vomiting, no spasms of any sort, 
and the child continued to go to school with no appreciable change in character or 
intelligence. Little by little walking became more difficult, the left arm and leg 
became weakened, and there was often diplopia. 
The patient entered the hospital the 18th of February, 1889. She is well de- 
veloped for her age; of healthy color. Gait is uncertain and vacillating, and left leg 
drags. The eyes are fixed, and she carries the head inclined toward the left shoulder 
with the chin turned to the right. Closing the eyes has no effect on the gait. The 
decubitus is indifferent, patient is calm, and the sleep tranquil. Form and size of 
head is normal. There is considerable deficiency in the action of the muscles on 
the left side of the head. Special senses are normal; pupils somewhat dilated, nor- 
mal in reflexes and accommodation. Moderate degree of convergent strabismus, 
the movement of the right eye outAvard being deficient; occasionally there is a 
slight nystagmus; the patient no longer complains of diplopia. Epiphora of the 
left eye, lachrymal duct open; anesthesia of cornea and conjunctiA’a. No objectiA'e 
change in the sensibility of the face, no tender spots. Tongue and uvula deA’iate to 
the right. Appetite is good, thirst moderate. Phonation, mastication, and deglu- 
tition normal; no abnormal sensation at the throat, no painful spots nor spasms in 
the neck. No pains nor abnormal sensations in chest or abdomen; digestion and 
other functions regular. Examination of the spinal column negative; attitude of 
extremities normal; no change in sensation, no muscular spasms. Weakness of the 
extremities of the left side. Painful sensation of tingling and formication on the left 
side of the body (excepting the face). Electro-muscular contractility same on both 
sides; the cutaneous and tendinous reflexes are regular, Avith the left patellar reflex a 
little more conspicuous than the right. Urine and pulse are normal. No fever. 
Eggs of Hymenolepis nano present in the feces to the number of 5 or more in every 
preparation. After the administration of 3 grams of ethereal extract of male fern an 
extraordinary number of the tai)eworms Avere passed. 
In diagnosing this case Orsi excluded cerebral tumor on account of the rather rapid 
rise of the morbose phenomena, unaccompanied Avith much pain, partial or general 
spasms, or A’omiting. Tubercular meningitis Avas excluded by the lack of tuber- 
cular or scrofulous antecedents, and the absence of febrile symptoms and of abdomi- 
nal or thoracic tuberculosis. The symptoms Avere similar to those of a cerebral 
hemorrhage Avith multiple foci, but the age of the j)atient rendered this diagnosis 
A’ery doubtful. Senna remarks upon the possibility of a reflex paralysis from irrita- 
tion caused by the parasite. 
After the elimination of the Avorms the patient became no better, although her 
feces no longer contained eggs. She left the hospital the 8th of March, continued 
to grow Avorse, Avithout the reappearance of eggs in the feces, and returned again to 
the hospital in the early part of April. She Avas still intelligent, but appeared to be 
•lazed and could speak only Avith great difficulty. The sinistral hemiparesia Avas 
more marked, and the right leg had become Aveakened. The other symptoms Avere 
