Since 1915 much has been written about the great efficacy of this remedy in hookworm disease, and it has been reported of fair value for pin-worms, roundworms, whip-worms and even tape-worms. The oil is constipating and the consensus of opinion is that it should be given in association with castor oil. An acceptable plan is as follows: A dose of Epsom salts or castor oil in the morning is followed by liquid diet for the whole day. The next day a dose of Epsom salts or castor oil is administered, and one hour later oil of chenopodium, 5 to 8 minims (0.3-0.5 c.c.) or about 15 drops, in a capsule or dropped on sugar, this dose being repeated twice at one or two hour intervals, i. e., for three doses in all. Two hours after the last dose, 1-1 1/2 oz. (30-45 c.c.) of castor oil containing from 30 to 45 minims (2-3 c.c.) of chloroform is administered. The chloroform aids in the paralysis of the worms. No food is taken till after this, when a cup of tea may be allowed and later a light supper. The treatment is repeated each week. For a child of 6 years the doses are half the above.

A number of cases of poisoning have been reported, but very few in proportion to the enormous number of doses given. Levy collected 12 cases, 9 of them fatal in 2 to 5 days. The smallest doses (reported by Paramore) were 4 drops three times a day for 7 doses resulting in the death of an infant of one year, and 6 drops three times a day for seven doses causing severe poisoning in a child of three years, with recovery. Coutant reports poisoning with recovery in a man of 21 years from two doses of 10 minims (0.7 c.c.) given 24 hours apart. Pole reports recovery of a child of two years after two teaspoonfuls given in one afternoon. The symptoms are those of gastro-intestinal irritation and central depression, i. e., nausea, vomiting, diarrhea, bloody and mucous stools, and abdominal cramps, with headache, drowsiness, mental and physical depression, and collapse. There may be tinnitus aurium, ataxia, paralyses, convulsions, and coma. Salant and Livingston, 1915, state that the toxicity is distinctly increased by starvation, and decreased by feeding oils or carbohydrates. They also noted cumulative effects. Ascaridole, the active principle of the oil, was 30 per cent. more toxic than the oil. They have shown that solutions of 1 to 5000 and 1 to 10,000 of the oil cause a marked decrease of tone in the isolated intestine of rabbits, both muscle and nerve-endings being depressed; also that in intact animals there is a decline in tone of the intestines and a depression of the heart muscle and the vagus center, and an unexplained depression of the respiration.

In poisoning the treatment is symptomatic. Motter advises that inordinate sleepiness or depression call for stoppage of the drug, immediate purgation by castor oil, and central stimulation, as by caffeine and strychnine.

3. The tape-worms seen in America are mostly that of beef, Taenia saginata; that of fish, Dibothriocephalus latus; and the dwarf tape-worm, Hymenolepis nana. The remedies are sometimes called teniacides and teniafuges. The favorite remedy is oleoresin of aspidium (male-fern), 1 dram (4 gm.) in capsules. Others are cusso, 1/2 ounce (15 gm.) in infusion; granatum (pomegranate root bark), 2 drams (8 gm.) in infusion; pepo (pumpkin-seed), 1/2 ounce (15 gm.) in infusion; kamala, 1 dram (4 gm.) mixed with syrup; oil of turpentine, 1/2 ounce (15 c.c.), and chloroform, 1 dram (4 c.c.). Pelletierine, an alkaloid from granatum, in the form of the tannate, dose, 4 grains (0.25 gm.), and amorphous filicic acid, one of the constituents of male-fern, dose, 10 grains (0.7 gm.), are also employed. Power and Salway failed to find any anthelmintic properties in the constituents of pumpkin-seed.

Poisoning by aspidium, granatum, and kamala shows in gastro-intestinal irritation, with vomiting, purging, stupor, vertigo, muscular twitching, collapse, and perhaps irritation of the kidneys. There may be hemolysis with jaundice (Grawitz). Hall reports a fatal case from male-fern with hemorrhagic areas in the upper three feet of intestine. We have several times seen severe gastro-enteric irritation with vertigo and prostration result from the hospital "Early-Bird" mixture. This consists of pumpkin-seed, 2 drams (8 gm.), cusso and granatum, each, 1 dram (4 gm.), made into an infusion, to which are added kamala, 1 dram (4 gm.), oleoresin of aspidium, 1 dram (4 gm.), glycerin, 1/2 ounce (15 c.c.), mucilage of acacia, 1/2 ounce (15 c.c.), and water to make the total amount 8 ounces (240 c.c). After the usual preliminary starvation, this quantity is taken in two drafts two hours apart. The "early bird" usually gets the worm.