(4) Bothriocephalus Cordatus

This tapeworm resembles in all particulars the bothriocephalus latus except that it is much shorter and that the head merges into the proglottides directly without an intermediary neck. It occurs in the intestine of men and dogs in Greenland.

The list of the tapeworms enumerated above is not complete, for there exist the tenia madagascariensis, bothriocephalus liguloides, and others, but as these do not occur in Europe or America a description of them does not appear to be of practical interest.

Treatment Prophylaxis

In order to escape infection with tapeworm it is necessary to abstain from raw or medium done meats, including fish. The sanitary inspection of the meat is no absolute guarantee that it is free of measles. Thorough boiling or broiling of the meat destroys the cysticerci and thus the danger is avoided. In order to diminish the spread of tapeworm it is advisable to free the patient of the worms and thoroughly to destroy them as soon as possible after they have left the intestine. Whoever examines the proglottides or the ova should carefully wash and disinfect his hands immediately afterward in order to avoid auto-infection.

The direct treatment of the tapeworm consists in measures to expel it from the intestinal canal. This is accomplished by emptying the bowels previously and giving a vermifuge afterward. The treatment is carried out in the following way: For about two days before giving the vermifuge the patient is kept on a scanty diet, consisting of some milk, meat and broth, very little bread or none at all. A laxative (calomel eight to ten grains or castor oil one tablespoonful) is given once a day. On the evening preceding the administration of the vermifuge the patient should have no supper or should take only salt herrings with onions. On the following morning a cup of coffee or tea is given. Half an hour to one hour later the vermifuge is administered. Among the drugs for the removal of the tapeworms the following are the most efficient:

Male-fern extract is given in doses of 6 to 10 gm. ( 3 iss.-iiss.), as for instance:

Treatment Prophylaxis 67

Extr. filicis mar. aether...........

8.0

(3ij.)

Syr. simpl..............

40.0

(Treatment Prophylaxis 68 i 1/3)

S. To be taken in ten minutes.

The dose of male-fern should never be very high and should not exceed 10 gm. ( 3 iiss.), as symptoms of intoxication have frequently been observed.

Pomegranate root is also an efficient remedy, especially if it is fresh. It may be given in an infusion of the bark, three ounces of which are macerated in ten ounces of water and then reduced to one-half by evaporation. The entire quantity is then taken within half an hour.

Pelletierine, the active principle of pomegranate root, may also be used in doses of five to eight grains.

Flores koosso, about 20 to 30 gm. (3 v. to Treatment Prophylaxis 69 i.) of the blossoms are thoroughly mixed in sugar water or lemonade and should be taken within one-half or one hour, or-

Treatment Prophylaxis 70

Flores koosso,

Mellis despumati................

aa 3 v.

(20 gm.)

Fiat electuarium. S. To be taken in two portions.

Kamala may also be employed in doses of 10 gm. ( 3 iiss.) mixed in aqua foeniculi or in wine and taken in the same way.

Turpentine 30 to 60 gm. (Treatment Prophylaxis 71 i.-ii.) may be given in capsules. After this medicament one or two glassfuls of milk should be taken.

Pumpkin seeds (semina cucurbitae) may be administered in doses of 120 gm. (Treatment Prophylaxis 72 iv.), thoroughly mixed with the same amount of grape sugar.

Cocoanut has also been recommended for this purpose. The milk and albumin of an entire nut should be consumed within one hour.

Naphthalin in doses of 0.6 to 2.0 gm. (gr. x.-xxx.) may be given in capsules.

Salol 3 gm. (gr. xlv.) in capsules may also be advantageously employed.

One or two hours after the administration of the vermifuge a cathartic should be given, usually about two tablespoonfuls of castor oil, or citrate of magnesia one to two teaspoonfuls. The resulting evacuation must be thoroughly examined and the tapeworm looked for, especially its head.

Children require a correspondingly smaller dose of the above remedies, according to their age. Patients who are debilitated, or have intestinal disorders or organic lesions of the digestive tract, should not be subjected to this treatment, nor should it be employed shortly after typhoid fever or other grave diseases. In these conditions it is necessary to postpone the treatment until a more opportune time.