46 
form convulsions almost every night, more rarely by day, often accompanied by 
involuntary micturition; there were occasional manifestations of somnambulism. 
She was more taciturn than before, and somewhat stupid. Eggs of Ascaris and 
Hymenolepis were again found in the feces. INIale fern was administered, but no 
worms were obtained. The patient, after a month, left the hospital. 
She returned a third time in the middle of April, 1889. For some time after leaving 
the hospital she had been fairly well, but more recently the convulsions 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 difficult, 
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, 
Trichur is, .and a few of Hymenolepis nana (1 to 2 per slide). 
After entering the hospital the patient had one convulsive attack during the day- 
time. She fell suddenly, Avith diffuse clonic spasms, foamed at the mouth, and Avas 
entirely unconscious. When seen by Senna she Avas in a comatose condition, not 
responsive to command nor reacting to cutaneous stimuli; the pupil Avas not abnor- 
mally dilated and reacted a little to light. Another day she Avas obserA’ed during an 
attack of diffuse tremor, AA'hich she said Avas of frequent occurrence. Almost every 
night she Avas taken Avith fleeting convulsive attacks, moved arms and head, foamed 
at the mouth, and uttered a groan or a Avhistling sound. In the morning she had no 
recollection of the occurrence. 
FiA^e grams ethereal extract of male fern, folloAved by a purgatiA'e, Avere adminis- 
tered. In the copious Avatery stools no tapeAvorms could be found, but for several 
days folloAving the patient Avas much improved, no longer felt the peculiar sensations 
in the epigastrium and throat, and Avas not troubled Avith the muscular spasms. The 
eggs of the tapeAvorm Avere 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 betAveen 
the epileptic attacks and the presence of Hymenolepis nana, since a complete and last- 
ing cure Avas not attained, and since the patient Avas scrofulous, debilitated, and the 
child of an alcoholic father. It is certain, hoAvever, that she improved after each 
treatment, and it is justifiable to consider. Senna thinks, that the presence of Hymen- 
olepis nana, and perhaps also of the other intestinal Avorms, if not the sole cause, at 
least had great influence upon the epileptiform manifestations, since they reappeared 
or became less frequent in correspondence Avith the presence or absence of eggs in 
the feces. 
Case Xo. 39 (Senna’s Case II). — Epileptiform convulsions, Avith intestinal helmin- 
thiasis {Hymenolepis nana). 
School girl, 16 years old, natiA^e of Stradella, Lombardy. Mother died in child- 
birth; three brothers and one sister dead; causes not knoAA.n. One brother liAung; 
healthy. Father living; inebriate. 
The patient had ahvays been in the best of health until the year before, Avhen she 
