The presence of intestinal worms, such as the roundworm, Ascaris lumbricoides, and various species of cestodes or tapeworms, requires no special dietetic care beyond the preventive treatment of avoiding raw or imperfectly cooked flesh and submitting to a period of starvation for twenty-four hours, in order that the intestine may be completely emptied of food before an anthelmintic is given, so that it may more certainly reach the worms.

There are two principal varieties of tapeworm in man, besides four or five others, which are very rarely present in the intestine, being derived from the lower animals through habits of filth or carelessness in preparing food.

Of these two varieties, the commonest in this country is the Tcenia saginata, or mediocanellata; the other, the pork tapeworm, or Tcenia solium, is more often found in Europe and Asia. The larval stages of Tcenia solium and Tcenia echinococcus also are observed in man, and, according to C. W. Stiles, one half the persons affected by the latter die within five years. H. O. Sommer has collected ioo cases of echinococcus (hydatid) disease in this country. The larvae are derived from the dog.

The Tcenia mediocanellata is a segmented worm, having a large square head presenting four suckers, by which it maintains its hold upon the intestinal mucosa without the aid of hooklets. The segments increase very slowly in size behind the head, and finally attain a breadth of eight to ten millimetres and a length of seventeen to eighteen millimetres, while the whole animal may reach a length of twenty feet, or even become longer than the intestine. Fragments of the worm are constantly breaking off, compressed by the waste matter of the food, and with it are swept out of the gut. The larvae live in swine.

The Tcenia solium is not so long as the mediocanellata, measuring usually from six to twelve feet. The head, which is quite small, presents four suckers and several minute hooks, which enable the animal to secure a firm hold upon the mucous membrane. Behind the head are a series of segments, many hundred in number, constituting the body. They gradually increase in size, and the larger ones contain male and female organs of generation, each segment being supplied with both varieties. The larger segments attain a size of seven to eight millimetres by ten millimetres. Each mature segment contains an enormous number of ova - often several thousand - and in about three months, when the worm has reached its full size, the segments, which are narrower and smaller than those of mediocanellata, are continually breaking off and passing out with the faeces. Pigs eat the ova, and digest them. The ova consist of shells which contain minute embryos with six hooklets. The embryos make their way into the viscera or muscles of the animal, where they lodge and develop to form the larvae or cysticerci, called also "measles." If the measled hog meat is eaten by man, and imperfectly cooked, the cysticerci develop with the intestinal worms above described.

The worms infest man at all ages, from early childhood up. They may cause no symptoms, but sometimes give rise to a ravenous appetite, as they interfere with intestinal digestion and absorption. They occasionally excite reflex nervous disturbances. Their presence is made certain by the finding of either the ova or the complete segments in various lengths in the stools.

Treatment

The patient should be put upon very short rations for two days, during which time the bowels must be well emptied. The evening before giving the vermifuge the patient should take a light supper of bread and milk or a sandwich, and that nig"ht a brisk cathartic. It is best to give the medicine the next morning fasting. By this means the intestines become almost empty, and the head of the worm is left unprotected, so that whatever remedy is used to kill it will make it loosen its hold. Another laxative may be given a few hours later, and if the patient eats bulky food, such as bread and potatoes, for a day or two, and keeps the bowels active, the worm may be completely dislodged and crowded out. The stools must be floated in water and closely examined for the head, for if this is not obtained the worm is sure to grow again in three or four months. There are many taeniacides. One of the least disagreeable and most efficient when properly administered is pumpkin seed. The seeds should be husked, and three ounces may be pounded in a mortar, macerated, mixed with honey into a paste, and eaten spread like jam upon a thin slice of bread.