sometimes there is disturbance of the senses, as vertigo, tinnitus aurium, &c.

No age is exempt from this pest, and it spares neither rank nor condition in life. Dr. Gull has suggested that the locality of Rotherhithe, Bermondsey, and the Borough, renders the inhabitants peculiarly liable to this complaint, probably owing to its great dampness, and the quality of the water; but it is far from being confined to such localities. The worm consists of an immense number of segments, whitish in colour, and resembling portions of tape appended the one to the other. Each segment contains double and complete organs of generation, a ramifying, branching oviduct, which terminates in the tænia solium, at the margin of the segment; and a minute spermatic duct, which opens at the same part. Nutriment appears to be imbibed by the surface, but ganglia and a circulatory system have been described by some as existing near the head. The general size of the sections is about three to five lines in breadth, and rather more in length; but towards the head the segments become exceedingly small, and at last slightly expand, so as to form a minute rounded head, about half a line in diameter; this is furnished with four suckers, which resemble disks depressed in the centre; these are situated in a regular manner round the most prominent part of the head, and quite at the extremity are sometimes seen a minute circle of hooklets; but these are often absent. Neither mouth nor opening has been found, and the appendages are probably merely for attachment. I have never examined an unbroken worm, but they are described as measuring from twenty to one hundred feet, and even three hundred in length. They sometimes continue to distress a patient year after year, who, supposing himself free after a few months of comparative comfort, finds himself again annoyed by them. The hydatid or echinococcus is sometimes discharged through the alimentary canal, from the liver, or other parts, but is not found in the canal itself. The investigations of Von Siebold, Küchenmeister, &c.,* have shown, that the tænia is the same animal as the cysticercus, but in a different developmental con

* British and Foreign Med.-Chir. Review,' Jan., 1857, on "Entozoa of the Human Subject."

dition. The tænia solium is that which we almost always observe in this country, but I have several times seen the bothriocephalus. In this the head is destitute of hooklets and suckers, but has a transverse fissure in the segments; the generative orifice is in the centre, not on the margin. The bothr. latus is found in Switzerland, Poland, Russia, whilst Holland and Germany have, like ourselves, the tænia solium.

As to the treatment of these cases, the remedies called anthelmintics have been most varied; many appear to act by destroying the worm, and then by expelling it. This is the case with the oil of turpentine given in doses of 3ss, and followed by castor oil, or other purge, if necessary; it constitutes a very effective remedy, although sometimes producing vertigo and sickness; but these symptoms are transient. Turpentine, however, is a nauseous remedy, and very trying to the patient, although almost anything will be willingly borne to be freed from such a companion as tapeworm. The turpentine was a few years ago followed by the bulky remedy, the Kousso, from Abyssinia; this was less effective, and has now, in the hands of my colleagues and myself, given place to the oil of male fern, an old remedy, but one deservedly approved; and I can bear testimony to its value. Drs. Hughes and Gull administered it in numerous cases, which are stated in the paper previously cited, and we now seldom find that it fails. In several instances I have found the patients return, after a few months, again complaining of the same disease, having passed segments; the male fern has been repeated, and with apparent success. In one instance the patient came a third time. It is true that in this case the head was not found, and without this we can never be sure that the disease is eradicated. The oil of male fern does not appear to produce any injurious effect, thus, a child, by mistake, took 3iss. of it every night for a week; purging was the only uncomfortable symptom that followed.

It is generally given quite on an empty stomach, and I usually follow it by a dose of castor oil in about six hours. It is well not only to give the oil on an empty stomach, but to avoid taking food till it has acted, so that it is well to administer it at bed-time. I have no experience in the pomegranate root, which is stated to be of service; and none whatever in the almost ex

ploded remedies of cowhage or metallic tin.* After the worm has been discharged, vegetable tonics, with mineral acids, and especially some of the preparations of steel, according to the age and condition of the patient, ought to be prescribed; as the steel wine, or the ammonio-tartrate, or the tincture of iron, with quassia, &c.

Dr. Gordon, in his 'Report of Diseases of the Stomach and Bowels in India,' describes a remedy for tapeworm, which he has found exceedingly effective, namely, the Kameela, or Rottlera tinctoria, in 3j doses; Dr. Osborne recommends tannin; and the aromatic sulphuric acid has been used beneficially.

CHAPTER XVI.

PERFORATION OF INTESTINE FROM WITHOUT. ABSCESS IN ABDOMINAL PARIETES EXTENDING INTO THE INTESTINE. FECAL ABSCESS.

PERFORATION of the coats of the small intestine ranks in the order of frequency next to perforation of the stomach; the colon is, however, perforated more frequently than is generally supposed. These perforations of the intestinal tract divide themselves into two great classes: 1st. Those which arise from disease commencing in the intestine itself, and to which we have referred in numerous instances, as perforation of the ileum in fever and in struma; of the cæcum and its appendix; of the colon in dysentery, in cancerous disease, and in several forms of insuperable constipation. 2nd. Those in which the perforation is from without, or from the extension of disease from adjoining structures. These latter cases constitute an important and an exceedingly interesting class of diseases; and the following causes of external perforation may be enumerated:

1. From the peritoneum, as in strumous peritonitis.

2. From disease of the stomach, as ulceration and cancer extending into the transverse colon.

3. From hydatids and abscess of the liver, thus forming a means of escape into the small or large intestine.

4. From calculi in the gall-bladder, setting up ulceration of the duodenum or of the colon.

5. From abscess in the spleen.

6. From abscess in the kidney.

7. From abscess in the abdominal parietes and loins opening into the intestine.

8. From diseased ovary communicating with the cæcum, colon,

or rectum.

9. From cancer of any of the abdominal organs extending

into the intestine.

10. From extra-uterine fœtation.

11. From one portion of intestine opening into another, as the appendix into the rectum.

12. From blows, and external injury.

In many of these forms of disease last enumerated, various and characteristic symptoms precede the perforation of the peritoncum and of the intestine; thus, the signs of cancerous disease of the stomach arise some time before fæcal eructation or vomiting indicate extension into the colon. In hydatid disease of the liver a rounded tumour, of slow formation, is detected, having often a peculiar vibratory thrill, and without general disturbance, before the occurrence of local peritonitis takes place, and the hydatids are discharged either by the mouth or with the evacuations per rectum.

In gall-stone very severe pain in the region of the gall-bladder arises, with vomiting and often jaundice, before intense peritonitis, from rupture into the general cavity of the abdomen, and before obstruction by its impaction in the jejunum or ileum take place.

In abscess of the spleen the symptoms are more obscure, and constitute part of a general constitutional disturbance, till perhaps the discharge of pus by stool indicates that a communication has been formed with the transverse or descending colon.

In abscess of the kidney, and pyelitis, there is purulent urine; but when there is suppuration external to the tunic of the gland the symptoms are more obscure.

In ovarian and cancerous tumours tactile examination will detect them. Some of these forms of disease are more obscure than others, but when fæcal abscess is the result there is considerable uniformity in their character; severe local pain and tenderness come on, with hectic fever, and steadily increasing prostration; and when the abscess is not limited by adhesion, a rapidly fatal result occurs.

Suppuration in the parietes of the abdomen is frequently observed, and simulates deeply-seated mischief; and for a short