or
three would seem to be due to the development of two or three distinct
ova within the intestine.

Deriving as it does its support from the system of the child, and not as
the other worms do from the contents of the bowel, the tape-worm often
produces graver inconveniences. It sometimes causes uncomfortable
colicky sensations, which may even be very distressing, and the
disorders of digestion which accompany it are often very considerable;
certainly more so than in the case of the other varieties of worms; but
I have seen no instance of convulsions which could be attributed to
them, notwithstanding the generally received opinion to the contrary.

When the existence of worms is suspected, one or two doses of a simple
aperient, such as castor oil, repeated two days successively, seldom
fail to produce evidence of their presence; which in the case of
tape-worm is also furnished by the spontaneous detachment of some of the
joints. It must be remembered, however, that until the head has been
detached from its connection with the bowel, nothing has been gained,
and the tape-worm will in a short time grow again. To obtain the
detachment of the head it is necessary that any worm medicine should be
given when the intestines are empty. I am, therefore, always accustomed
to give a dose of castor oil about two hours after the child's mid-day
meal; and to send the child to bed as soon as the aperient begins to
act, and to give it no more food except a biscuit and a little milk and
water during the rest of the day. In the early morning, the special worm
medicine is given, and over and over again I have known the worm to be
brought away completely after many previous failures. When the smallness
of the joints shows that the greater part of the worm has been thrown
off, and that little more than the head remains, it is necessary to have
recourse to the unpleasant proceeding of mixing the evacuations with
water, and then straining them through muslin, in order that the doctor
may by means of the microscope make out whether or no the head has been
really detached. This is no question of mere curiosity, but a matter of
the gravest moment, since nothing has been really gained so long as the
head of the worm remains adherent to the bowel.

Precautions such as these are not needed in the case of the other kinds
of worms. Thread-worms, however, are best attacked in their habitation;
that is to say, in the lower bowel, by means of lavement