50 
agitation, which can not be controlled in the least by the will. The sleep is tranquil, 
and nocturnal muscular spasms are absent. He is intelligent; the speech, however, is 
incoherent, monosyllabic, and at times almost incomprehensible. The pupils are 
unequal, sometimes one, sometimes the other being the larger, but they react well 
to light. Vision is diminished in the left eye, there is diplopia, and unilateral con- 
vergent strabismus, due to insufficiency of the left rectus externus. Special senses 
and sensibility of the face are normal. Appetite and digestion are good. Apex 
beat of heart in fourth intercostal space in the nipple line, and heart of normal size. 
The systole is accompanied by a slight blowing murmur at base and apex. Size of 
liver noiTual. Spleen very shghtly enlarged. There is pain and a sense of pressure 
in the epigastric and umbilical regions. The abdomen is regular in form and volume. 
The ga.stro-intestinal and uropoietic functions are normal. Examination of the 
spinal column resulted negatively. Excepting the choreic movements, the nervous 
system showed no abnormalities in the trunk and extremities. The pulse and urine 
are normal and there is no fever. In the feces are eggs of Trichuris, Ascari.?, and 
H. nana (2 to 4 per slide) . 
The administration of 4 grams of extract of male fern was followed by the evacua- 
tion of about 50 tapeworms. The next day the patient was in a state of prostration, 
with severe pains in the abdomen. The following day he was resting much easier; 
after that improved rapidly and was soon entirely well. Eggs of Hymenolepis nana 
were no longer to be found in the feces. 
Case Xo. 4S (Senna’s Case VI). — School girl, 11 years old, from Sommo. Family 
history good, and patient had always been in good health. 
In January, 1888, the patient became taciturn and seemed stupid; weakness and 
irregular clonic spasms appeared in the extremities of the right side, and after a 
short time the speech was affected and became difficult. There was diplopia; the 
mouth was drawn upward on the right side; there were also headache, pharyngeal 
spasms, paresthesia and pains in the abdomen, but functional troubles were absent. 
The symptoms became worse, and by Fall the spasms had begim to affect the left side, 
but with less intensity. Anthelmintic powders containing santonin were adminis- 
tered repeatedly without result. In December a teniafuge of unknown composition 
was given, and the patient became much better, so that by the end of a month she 
was entirely well. After three months, however — in March, 1889 — the symptoms sud- 
denlv reappeared, but less intense and more intermittent. The child was brought to 
the hospital in May. 
The patient is rather slender, with fine pale skin. She is reserved and taciturn, 
has some difficulty in moving the extremities of the left side, has headache, and 
paresthesia and pain in the abdomen, with crawling and gnawing sensations. She 
also experiences a feeling of constriction at the throat, and sometimes diplopia.- 
Objective examination reveals nothing noteworthy except a slight diminution in the 
muscular strength of the left arm, possibly also of the leg. Clonic muscular move- 
ments, limited to the left hand and forearm, appear at long intervals. The eggs of the 
H. nana are present in the feces. Extract of male fern was administered, and, 
although no worms were seen in the stools, all the symptoms disappeared very 
shortly. 
Piedmont, Italy, 1886-1SS7 1 case. 
Case Xo. 44. — At a meeting of the Academy of Medicine of Turiji, Perroxcito 
(1887) reported the first occurrence of a case of Hymenolepis nana in Piedmont, com- 
municated by Doctor Airoldi, and later (1891) gave a fuller account. 
The patient was a male, 19 years old, peasant, of robust constitution, and up to 
the- age of 14 or 15 had not been ill, with the exception of an occasional abdominal 
pain during childhood. He had a doubtful case of typhoid fever, lasting a week, in 
the Fall of 1885. 
