Fig. 24.—Head of a Cysticercus removed from the brain. Magn. 5 diam. with detached hooks. Original.
It is worthy of remark, as Griesinger has also observed, that in cases where the Cysticerci have taken up their temporary residence in the brain, they are usually found, post mortem, in the grey cortical or peripheral substance of the cerebrum. The particulars of such a case are given in my ‘Entozoa’ where the victim suffered from epileptic fits due to the presence of numerous Cysticerci (fig. 24). The patient was under Mr Hulke’s care.
As regards infection by the adult worm it is not alone sufficient that we avoid underdone meat, as brought to the dinner-table, but we must be especially careful to have our sausages well cooked. Under ordinary circumstances, we are safe for the following reasons:—No respectable butcher will knowingly supply us with pork or with sausages which are measled. Even in the case of underdone meats, in whatever way prepared, it is usually only a small portion which is unaffected by cooking. As we have seen a temperature of 140° Fahr. is sufficient to kill the Cysticerci.
The successful rearing of pork measles by experimentation with the eggs of T. solium has been accomplished by many helminthologists, amongst whom may be particularised Van Beneden, Leuckart, Küchenmeister, Haubner, Gerlach, and Baillet. The converse experiment of rearing the adult worm from the Cysticercus was first successfully undertaken by Küchenmeister on a condemned criminal; Leuckart, Humbert, and others having repeated this method with more or less success.
The dangers arising from infection by swallowing the larval worms or six-hooked embryos are not easily avoided. Our flesh, like pork, thus becomes measled, although certainly not to the spawn-like extent so often seen in the lower animals. A single measle is sufficient to prove fatal; and this humiliating contingency, moreover, is one which we can never be absolutely certain of avoiding. We become the “host” or bearer of the measle by swallowing the fully-developed eggs of the Tænia solium. This we may do directly by handling fresh tapeworms, whose eggs, being concealed under our nails or in our clothing, may subsequently be swallowed, and develop within us accordingly. Even a thorough washing of the hands will not ensure absolute security. In like manner, those who partake of choice salads, prepared from the stores of the market-gardener, run a certain amount of risk. The vegetables may have been manured with night-soil containing myriads of tapeworm eggs, or they may have been watered with fluid filth into which the eggs were accidentally cast. In such cases, one or more tapeworm ova will be transferred to the digestive organs, unless the vegetables have been very carefully cleansed. In the same way, one perceives how fallen fruits, all sorts of edible plants, as well as pond, canal, and even river water procured from the neighbourhood of human habitations, are liable to harbour embryos capable of gaining entrance to the human body. One individual suffering from tapeworm may infect a whole neighbourhood by rendering the swine measly, these animals, in their turn, spreading the disease far and wide. As already remarked, measles sometimes occur in great numbers in different parts of the body. Among the more remarkable cases of the multiple Cysticerci are those recorded by Delore (1864) and Giacomini (1874). In M. Delore’s case, about 2000 were obtained post mortem. Of these, 111 occurred in connection with the nervous centres, eighty-four being in the cerebrum, twenty-two in the membranes of the brain, four in the cerebellum, and one within the substance of the medulla oblongata. Dr Knox published a less notable instance in the ‘Lancet’ (1838); and in the year 1857, Dr Hodges, of Boston, U.S., published a case where the cysts, which in size he compared to rice grains and coffee beans, were felt subcutaneously. The coexistence of Tænia and Cysticerci in the same individual has also recently been observed in France (‘Lond. Med. Rec.,’ 1875). Besides these, several remarkable instances have lately been reported by Davy, Tartivel, and others.
To the literature already quoted in connection with the beef tapeworm the following may be added:
Bibliography (No. 14).—Aran, in ‘Archives Gén. de Médecine,’ 1841.—Baillet, “Helminthes,” art. in ‘Bouley and Reynal’s Dict. Vétérin.,’ tom. viii, 1869.—Bécoulet and Giraud, “On Cysticercus in the Brain,” ‘Bullet. de la Soc. Méd. de Gand,’ 1872; and in ‘Lond. Med. Rec.,’ Feb., 1873.—Birkett, J., Cases, ‘Guy’s Hosp. Rep.,’ 1860.—Bouchut, “Cyst. in the Brain,” ‘Gaz. des Hôp.,’ 1857, and ‘Journ. für Kinderkrankheit.,’ 1859.—Bouvier, ‘Bullet. de l’Acad.,’ 1840.—Burton, in ‘Med. Times and Gaz.’ (supposed hydatids), 1862.—Cobbold, “On Measly Meat and Measles in Man,” the ‘Veterinarian,’ 1876.—Czermack, “Cysticerci causing Insanity,” Corresp.—Blatt, 1838.—Dalton, J. C., “Cyst in the Scrotum,” ‘New York Journ. of Med.,’ 1857.—Davaine (see his ‘Traité’ for many additional references; p. 676).—Davy, R., “Cysticerci in the Muscles,” ‘Rep. of Lond. Med. Soc.,’ ‘Lancet’ for Nov., 1876.—Estling, “Cases of Cysticercus,” ‘Lond. Med. Gaz.,’ 1838–39.—Frédet, “Cysticercus in the pons Varolii,” in the ‘Lancet’ for June 23rd, 1877 (p. 925), from ‘Giornale Veneto de Scienze.’—Fournier, ‘Journ. des Connois. Med. Chir.,’ 1840.—Griesinger, “On Cysticerci of the Brain,” from ‘Med. Jahrb.’ in ‘Med.-Chir. Review,’ 1863.—Harley, J., “Cyst. in the Brain,” ‘Lancet,’ 1867.—Hodges, R. M., “Specimens of Cyst. cell., felt as small tumours just beneath the skin, varying in size from that of a grain of rice to that of a coffee bean,” ‘Rep. of Boston Soc. for Med. Improvement,’ in ‘Brit. Med. and Surg. Journ.,’ 1857.—Hogg, J., “Obs. on Cysticercus,” in his ‘Manual of Ophth. Surgery,’ 3rd edit., 1863.—Holler, A., “Cyst. cell., im Gehirne einer Geisteskranken,” ‘Allgem. Wiener Med. Zeitung,’ 1878.—Logan, R., “Probable Cases of Cyst. cell.,” removed by Robertson, ‘Ed. Med. and Surg. Journ.,’ 1833.—Mackenzie, W., “Cyst in the Eye,” ‘Lancet,’ 1848, ‘Lond. Med. Gaz.,’ 1839.—Mazotti, L., “Caso di numerosi cisticerchi del cervello e delle meningi,” ‘Rivista Clin. di Bologna,’ 1876.—Mégnin, P., “La Ladrerie du porc et le Tænia solium,” ‘La France Médicale,’ 1876.—Putz, H., “Ueber die Lebenszähigkeit des Cysticercus cellulosæ,” &c., ‘Zeitsch. f. pr. Vet.-Wissenschaften,’ 1876.—Rainey, G., “On the Structure, &c., of Cyst. cell.,” ‘Phil. Trans.,’ 1857.—Rizzetti, G., “Rendiconto Statistico dell’ufficio d’igiene di Torino per l’Anno 1873.”—Rudall, J. T., “Cyst. in the Brain,” ‘Australian Med. Journ.,’ 1859.—Tartivel, De A., “Cysticerques multiples dans le tissu cellulaire sous-cutané et dans certain viscères,” ‘Rec. de Méd. Vet.,’ 1876.—Von Gräfe, A., in ‘Arch. für Ophthal.,’ 1857.—Wells, S., Bourman’s Case, ‘Ophth. Hosp. Rep.,’ 1860.—Windsor, J., “Cyst. in the Eye,” ‘Brit. Med. Journ.,’ 1861.
Tænia tenella, Cobbold.—I have long been acquainted with the fact that there is a comparatively small human tapeworm which cannot be referred to either of the foregoing species. In the absence of experimental proof, I incline to the belief that the worm in question owes its existence to measly mutton. The sheep harbours an armed Cysticercus (C. ovis), which I regard as the scolex of Tænia tenella. The specific name (tenella) was originally applied by Pruner to a cestode six feet in length, which he found associated with a larger tapeworm. This latter he called Tænia lata. Whilst Diesing has pronounced Pruner’s Tænia lata to have been a T. mediocanellata, I, on the other hand, consider Pruner’s T. tenella to have been a T. solium. Mr J. C. Mayrhofer has suggested its identity with Bothriocephalus tropicus. When, some years back, I applied the term T. tenella to a new tapeworm (of which I possess several strobiles) I was quite unaware than any similar nomenclature had been adopted by Pruner. From the few facts supplied by Pruner and Diesing, I cannot suppose that our cestodes are identical. Unfortunately my specimens are imperfect, wanting the so-called head. It is not possible to estimate the length of the worm accurately, but the perfect strobile must measure several feet.
On one slide I have mounted nine mature proglottides of a worm which I procured on the 15th Dec., 1875. The segments measure, on the average, exactly 1/10″ in length, and only 1/20″ in breadth. The uterine rosettes are all full of eggs, and their branches so crowded together that I am unable to ascertain their average number. The segments are perfectly uniform in character, their reproductive papillæ alternating irregularly at the margin.