In addition to the above-named structures, the entire series of joints from the head downwards are traversed by a set of vascular canals, which are doubled in the region of the head. These form the so-called aquiferous system. There are two main channels, one passing down on either side of the worm, both being connected by transverse vessels, which occur singly at one end of every joint.
The eggs in their mature condition are globular, and contain a six-hooked embryo. They present an average diameter of 1/694 of an inch, the shell itself measuring about 1/4000″ in thickness. In 1856 I observed that many of the eggs, whilst still within the uterine branches, displayed an outer envelope, very delicate in structure and totally dissimilar from the egg-shell proper. This has since been more accurately described by Weinland, Van Beneden, and Leuckart. The outer membrane, according to the last-named authority, constitutes the primitive yolk-membrane, within which a part of the yolk-contents separates to form the true egg and embryo by a process of daughter-cell formation. The remaining part of the yolk forms a granular mass, being probably concerned in the formation of the true chitinous shell. The true shell displays a series of radiating and circular lines; the former, however, are more conspicuous than the latter, being due, according to Leuckart, to the presence of a series of fine rod-like chitinous elements, which are formed on the external surface of the original true shell-membrane. The enclosed embryo is furnished with six boring spines, arranged in three pairs, its granular body being invested by an extremely delicate skin-membrane, which is separated from the inner surface of the shell by a clear transparent fluid. The embryo measures 1/1250″ in diameter.
The scolex or higher larval stage of growth forms the well-known pork measle or Cysticercus (telæ) cellulosæ of authors. The smallest measles found by Leuckart measured 1/25″ in length. They were obtained from the brain, liver, and intermuscular substance of a pig fed with proglottides about thirty days previously. Only those specimens, however, occurring in the liver at this early period displayed an outer membrane proper to the worm itself, the others being simply invested with capsules formed out of the connective tissues of the host. Many measle-masses in the same host were much larger, presenting an average diameter of 1/6″. The smallest already displayed a smooth, transparent, homogeneous, outer, cuticular membrane, overlying a double, finely-granular corium, the latter being traversed by a branched system of aquiferous vessels. These vessels proceed from a central spot, which marks the position of the so-called head-cone, or receptaculum capitis. It is, in fact, the first well-marked indication of that flask-shaped capsule within which the head, neck, and body of the Cysticercus is formed, and which Goeze long ago very aptly compared to a lantern. As growth proceeds, a central granular mass forms the true foundation of the head, its upper or stalk-like extension becoming the future neck and body. Further changes result in the evolution of the internal water-vascular system, the calcareous corpuscles, the marginal transverse foldings of the body, the four suckers, the rostellum, and, in particular, the double coronet of hooks. All these metamorphoses were minutely followed and described by Leuckart, who found the development of the larva to be completed within the space of ten weeks.
As regards the injurious effects of this parasite upon man, it may be said to act prejudicially in three separate ways. I have remarked in my ‘Entozoa,’ that this parasite may cause disease and death both by its action in the larval and adult states. It may likewise injure us by rendering the flesh of swine unwholesome.
When one or more sexually-mature tapeworms have developed themselves within the human intestine, they are apt to give rise to a variety of unpleasant symptoms, more or less marked according to the habit or irritability of the patient. According to Davaine (p. 103 of his ‘Traité’) the principal features are “vertigo, noises in the ears, impairment of sight, itching of the nose and anus, salivation, dyspepsia and loss of appetite, colic, pains over the epigastrium and in different parts of the abdomen, palpitation, syncope, the sensation of weight in the abdomen, pains and lassitude in the limbs, and emaciation.” In ordinary cases there is always more or less anxiety and restlessness; but in severe cases the sympathetic symptoms are very strongly marked, showing themselves in hysterical fits, chorea, epilepsy, and epileptiform seizures, attended by more or less alarming convulsions.
Amongst some of the more interesting and remarkable cases recorded in our English journals, I may instance that of Mr Hutchings, where a complete cure followed the evacuation of the worm which had produced convulsions. Mr Tuffnell records a case where irritability of the bladder and stricture of the urethra were entirely dependent on tapeworm, as proved by the subsequent recovery. At a meeting of the Pathological Society, in 1853, Dr Winslow mentioned his experience of three or four cases of mania arising from tapeworm; whilst on the same occasion Drs Ryan and Davey each recorded a similar instance. A case has also been previously published by Mr W. Wood. At a meeting of the London Medical Society, held on the 10th of April, 1837, Dr Theophilus Thomson (during an interesting discussion on this subject) stated the facts of a case where the presence of tapeworm had given rise to a tumultuous action of the heart, this symptom entirely disappearing after evacuation of the worm. Our journals likewise (anonymously) record a considerable number of cases from foreign sources. Thus, in the ‘London Medical Gazette’ for 1840, there is the case of a lady, aged thirty-seven, who had convulsions attended with a complete loss of consciousness, the separate fits lasting an hour at a time. The passage of the worms effected a complete cure. In the same journal for 1838, there is also the case of a younger lady (aged twenty-seven) suffering from epilepsy, in whom a complete cure had been similarly brought about; here, however, in addition to a single specimen of the Tænia solium, there were two lumbrici present. This journal also gives Ettmüller’s case, where eighteen tapeworms were the cause of hysteria; and likewise the case published by Steinbeck, where the symptoms presented an altogether peculiar character. More precise references to some of the above cases will be found in the ‘Bibliography’ below; and I may also refer to my published lectures on Helminthology and especially to my separate work on Tapeworms, where particulars of one hundred cases are briefly recorded. These were all average cases occurring to me whilst in private practice. Davaine’s book also abounds with remarkable cases.
Whilst the adult worm is capable of producing serious and even fatal mischief to the bearer, the larvæ or measles much more frequently prove fatal. The Cysticerci may develop themselves in almost any situation in the human body, but they occur most commonly in the subcutaneous, areolar, and intermuscular connective tissue; next, most commonly in the brain and eye, and lastly, in the substance of the heart and other viscera of the trunk.
In my ‘Entozoa’ I have stated that probably not less than one hundred cases have been observed where death had resulted from Cysticerci in the brain. Griesinger alone collected between fifty and sixty such cases. Mental disturbance occasioned by the presence of measles in the brain may occur with or without epilepsy. When Griesinger states that “the epilepsy from Cysticercus is in all respects like cerebral epilepsy and the psychical disturbances have nothing characteristic about them,” he tacitly admits the impossibility of correct diagnosis during life.
Since the publication of Griesinger’s well-known memoir on Cysticerci of the brain, many similar cases have appeared, and amongst the more recent of these is one by Dr Frédet in which the victim was a young man twenty-two years of age. Though apparently in good health he fell dead in the street; the fatal result being due to the presence of a Cysticercus within the pons Varolii.
Many other cases of earlier date are especially noteworthy. Thus Mr Toynbee recorded a case where an hydatid (which I take to have been the Cysticercus cellulosæ) situated in the middle cerebral fossa beneath the dura mater, but in this instance death ensued from other causes. Mr Ottley gives the case of a woman aged forty, where an undoubted Cysticercus in the brain gave rise to distressing fits, convulsions, and death. Then, again, there was Dr Burton’s workhouse patient, only twenty years of age, who was found dead in bed, but who at the time of admission merely complained of pain in the head. After death, four hydatids (Cysticerci) were found in the tuber ancillare at the summit of the spinal marrow. M. Bouvier’s similar case is also reported in our periodicals. Of instances where Cysticerci occupied the cavity of the eye, we have one or two cases by Mackenzie of Glasgow, one by Mr Rose of Swaffham, and others by Windsor, Logan, and Estlin. Amongst the more peculiar cases, I may mention that described by Dr Greenhalgh in the ‘Lancet’ (1848), where the Cysticercus was lodged within the substance of the lip. Five similar cases are likewise recorded by Heller of Stuttgard. Then there is Dupuytren’s case of a Cysticercus ensconced within the great peroneus muscle; and also Fournier’s, where several of these scolices were said to have been found in a boil. The so-called Trachelocampylus, discovered by Frédault in the human brain, was neither more nor less than a common Cysticercus cellulosæ.