48 
vulsions for four montlis after leaving tlie hospital, hut they then disappeared and 
had not since returned. She felt entirely well and appeared happy and in the hest 
of health. 
<'ase f\h. 40 (Senna’s Case III). — Sinistral heiniparesia and other diffuse nervous 
disturbances (from '//one /). j 
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 <li>- 
position. 
In the beginning of February, 1889, it was noticed that the girl, when standing or 
walking, swayed upon her legs as if to fall. AVhen 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 was no fever, no vomiting, no spasms of any sort, 
and the child continued to go to school with iio 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 i 
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 traiKiuil. 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 outward being deficient; occasionally there is a 
slight nystagmus; the patient no longer c-omplains of diplopia. Epiphora of the 
left eye, lachrymal duct open; anesthesia of cornea and conjunctiva. No objective 
change in the sensibility of the face, no tender spots. Tongue and uvula deviate to 
the right. Appetite is good, thirst moderate. Phonation, mastication, and deglu- 
tition normal; no abnormal sensation at the throat, no i)ainful spots nor spasms in 
the neck. No pains nor abnormal sensations in chest or abdomen; digestion and 
other functions regular. Examination of the S[)inal 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 1 
side of the body (excepting the face). Electro-mu.scular contractility same on both | 
sides; the cutaneous and tendinous reflexes are regular, with the left patellar reflex a 
little more conspicuous than the right. Urine and pulse are normal. No fever. 
Eggs of Jlyrnenolepis mwo ju’esent 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 1 
extraordinary number of the ta{>eworms were passed. ‘ i 
In diagnosing this case Orsi excluded cerebral tumor on account of the rather rapid 
rise of the morbose phenomena, unaccompanied with much pain, partial or general | 
spasms, or vomiting. Tubercular meningitis was excluded l)y the lack of tuber- 
cular or scrofulous antecedents, and the absence of febrile symptoms and of abdomi- j 
nal or thoracic tuberculosis. The symptoms were similar to those of a cerebral 
hemorrhage with multiple foci, but the age of the patient rendered this diagnosis 
very doubtful. Senna remarks uimn the possibility of a reflex paralysis from irrita- ' 
tion caused by the parasite. 
After the elimination of the worms the ])atient became no V)etter, although lier 
feees no longer contained eggs. She left the hospital the 8th of March, continued i" 
to grow worse, without the reappearance of eggs in the feces, and returned again to 
the hospital in the early part of April. She was still intelligent, but appeared to be 
dazed and could speak only with great difficulty. The sinistral heiniparesia was - 
more marked, and the rigid leg had become weakened. The other symptoms were | 
