49 
as before. Male fern was administered without results. The patient died a few 
weeks later, in the early part of June, 1889, after suffering for three or four days with 
a violent headache, especially on the right side, and a high fever. Xo autopsy was 
made. 
Case Xo. 41 (Senna’s Case IV). — Complete paralysis of the right external oculo- 
motor, and corresponding facial paresis, with Ilymenolepls nana. 
Female, 7 years old, daughter of a fruit vendor, from Borgorato i\Iormorolo (Vog- 
hera). Family history good ; no preceding illness of any importance. In September. 
1888, the patient began to show a weakness in the extremities of the right side; gait 
became irregular; the mouth was drawn to the left; when she held anything in her 
hands clonic convulsions of the right arm were often observed. Toward the middle 
of February, 1889, diplopia and convergent strabismus, affecting the right eye, 
appeared. Shortly after this she began to have slight headaches at intervals; her 
intelligence remained good but speech became difficult. An anthelmintic Avas admin- 
istered; the general state of her health was improved, but the strabismus persisted. 
The patient on examination appeared Avell developed, and of healthy color. She 
walked very Avell, but exhibited a little uncertainty in rapid movements, and held the 
head slightly inclined toAvard the right shoulder. She no longer complained of Aveak- 
ness of the right arm and leg, nor of headache. She Avas quite intelligent, the size 
and form of the head AA’ere normal, there Avas no objectiA'e change in the sensibility 
of the face, senses normal, no tender spots nor spasms. There Avas apparently com- 
plete paralysis of the right rectus externus, the eye could be moA’ed upAvard or doAvn- 
ward, but lateral moA^ement Avas impo.ssible. Diplopia Avas present. The pupils 
Avere regular and reacted Avell to light. The left angle of the mouth Avas draAvu 
upAvard and outAvard. The appetite Avas good; thirst moderate; the tongue nor- 
mal, deglutition good; speech difficult, but according to the patient, improved some- 
Avhat compared Avith its former condition. There Avas an occasional dry cough, 
someAvhat spasmodic; noAv and then a deep sigh. Xeck, chest, and abdomen nor- 
mal. Xo pains nor paresthesia in abdomen. 
The gastro-intestinal and uropoietic functions Avere regular. There Avere no objec- 
tiA’e evidences of diminished poAver of the limbs, and hyperkinetic manifestations 
and alterations of sensibility Avere absent; reflexes persistent. Urine and pulse regu- 
lar. Xo fever. The feces contained the eggs of Hi/inenolepis nana and A.^caris lurn- 
hricoides in moderate numbers. Three grams of ethereal extract of male fern folloAved 
by a purgative Avere administered and a large number of H. nana Avere expelled. 
The speech and gait Avere much improved in a few days, although the strabismus 
and deviation of the mouth continued. The strabismus finally shoAved signs of 
amelioi'ation, and the right eye could be moved outAvard to a liarely ])erceptiblc 
degree. The eggs Avere no longer present in the feces. 
Case Xo. 42 (Senna’s Case V). — Chronic chorea minor caused by Ilyrnenolepis nana. 
Boy, 11 years old, peasant, from Cei'A’esina. Family history good. Operated upon 
when a baby for A'esicular calculus; has had malaria; and several times intestinal 
helminthiasis, Avith Auolent colic, Avithout reflex ner\*ous phenomena; cured after the 
expulsion of ascarids Avith santonin. 
In January, 1889, the patient began to experience a difficulty in talking and in 
moving his tongue. Some days later he Avas affected with coiiA'ulsive movements of 
the head and face, then of the arms. Afterwards the trunk and loAver extremities 
became similarly affected. His condition continued to groAv Avorse, and he entered 
the hospital in the latter part of April. 
The patient is tolerably Avell developed, Avith fine skin and rather pallid mucous 
membranes. Irregular, clonic, involuntary muscular contractions occur continually, 
sometimes inAmlving the entire body, Avhich render the erect posture and the gait 
uncertain and A'acillating. In brief, the symptoms are those common to chorea 
minor. Everything that excites or stimulates the patient aggravates the muscular 
19203— Xo. 18—04 
4 
