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. No autopsy was 
made. 
Case X(K 41 (Senna’s Case IV). — Complete paralysis of the right external ocnlo- 
1 motor, and corresponding facial paresis, with Hymenolepis nana. 
Female, 7 years old, daughter of a fruit vendor, from Borgorato Mormorolo (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 Avas drawn to the left; Avhen 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 loatient 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 
; an«I form of the head Avere normal, there Avas no objectiA^e change in the sensibility 
j of the face, senses normal, no tender spots nor spasms. There Avas apparently com- 
I plete paralysis of tlie right rectus externus, the eye could be moved upAvard or doAvn- 
Avard, but lateral movement Avas impossible. Diplopia Avas present. The pupils 
i Avere regular and reacted Avell to light. The left angle of the mouth Avas draAvn 
upAvard and outAvard. The appetite Avas good; thirst moderate; the tongue nor- 
mal, deglutition good; speech difficult, but according to the patient, improA^ed some- 
Avhat compared Avith its former condition. There Avas an occasional dry cough, 
someAvhat spasmodic; uoav and then a deep sigh. Neck, chest, and abdomen nor- 
mal. No pains nor paresthesia in abdomen. 
The gastro-intestinal and uropoietic functions AA'ere regular. There Avere no objec- 
tive evidences of diminished poAver of the limbs, and hyperkinetic manifestations 
and alterations of sensibility Avere absent; reflexes persistent. Urine and pulse regu- 
lar. No fever. The feces contained the eggs of Hiimenolepis nana and Ascaris liim- 
f/ricoide.^ in moderate numV)ers. Three grams of ethereal extract of male fern folloAA'ed 
by a purgative AA’ere administered and a large number of IT. nana Avere expelled. 
The sj>eech and gait Avere inuch improved in a feAV days, although the strabismus 
and deviation of the mouth continued. The strabismus finally shoAved signs of 
ameliorafion, and the right eye could be moved outAvard to a barely perceptible 
degree. The eggs Avere no longer present in the feces. 
( 'axe No. 4~ (Senna’s Case V ). — Chronic chorea minor caused by Hymenolepis nana. 
Boy, 11 years old, peasant, from Cervesina. Family history good. Operated upon 
Avhen a baby for vesicular calculus; has had malaria; and several times intestinal 
helminthiasis, Avith violent colic, Avithout re*flex nervous 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 Avith coiiAUilsive moA’ements of 
the head and face, then of the arms. AfterAvards the trunk and loAver extremities 
became similarly affected. His condition continued to groAv Avorse, and he entered 
the hospital in the latter paid of April. 
The patient is tolerably Avell developed, Avith fine skin and rather }>allid mucous 
membranes. Irregular, clonic, iiiA’oluntarA^ muscular contractions occur continually, 
sometimes involving the entire body, Avhich render the erect jiosture and the gait 
uncertain and vacillating. In brief, the symptoms are those common to chorea 
minor. EA^erything that excites or stimulates the patient aggraA’ates the muscular 
19203— No. 18—04 4 
