[Extracted from the Transactions of the Medical Society of the State of 
Pennsylvania. Vol. XII. 1879.] 
ON CYSTICERCUS CELLULOSE. 
C. S. TURNBULL, M.D 
01' PHILADELPHIA. 
Through the courtesy of our friend Dr. J, E. 
enabled to present the notes of an interesting case of cy^^etjpqs 
within the human eye, concerning which rare lesion a few remarks 
we trust will be pertinent. 
“ History of case. Patient, J. J. Andrews, of Philadelphia, aged 
55. Temperament, sanguine; health, vigorous; occupation, mer- 
chant. When a boy, the patient was struck upon the eye (in which 
was found the hydatid) by a basket in the hands of a playmate. As 
an immediate result ot this accident great inflammation ensued in 
the injured organ, which, after a lengthy resistance to the means of 
cure employed, finally yielded, becoming as comfortable as before 
the blow. In early manhood the lens of this eye began to grow 
cataraetous, the opacity progressing rapidly to complete monocular 
blindness. 
Twenty years now passed, the patient finding satisfaction in an 
increased sight residing in the well eye. To use his own expression 
‘ this well eye had taken on itself the office of the sick one.’ 
Five years and a half ago another change occurred. Without 
explainable cause the cataraetous eye became the seat of paroxysmal 
pains, recurring with a frequency and regularity suggestive of mala- 
rial influence, A peculiarity of diagnostic signification in connec- 
tion with these pains lay in a gradually increasing intensity charac- 
terizing them. The cause, whatever it might prove to be, was evi- 
dently of a growing nature, and as a culmination of this intense 
pain the patient became conscious of blows struck on the inside of 
the eye, the sensation being described as ‘ hammer strokes.’ 
A marked feature associated with the painful paroxysms was vas- 
cular engorgement. In ten minutes from the striking of a blow the 
conjunctiva would congest to a condition of chemosis. Lachryraation 
was unusually profuse. The paroxysms (and the pain was described 
as excruciating) were about bi-weekly. The palpebral conjunctiva 
was somewhat granular. 2 
CYSTICERCUS CELLULOSE. 
Search after a Diagnosis.—The granulated lids, a bad tooth, and 
the periodicity characterizing the attacks were features attracting 
attention. As negatives, there was absence of all external glauco- 
matous expression, No history of specific or other peculiar disease. 
No neuralgic tendencies. 
Treatment was commenced with reference to the derangements 
seen to exist. The granulated lids were given attention after the 
usual manner, a zinc and alum solution being combined. The affected 
tooth was extracted, while its alveolus, which was found carious, 
was scraped by means of a burr revolved by the surgical engine. 
Quinine was administered in consideration of the periodicity. 
The treatment adopted meeting with no satisfactory result, thus 
exhibiting fallacy in inference, the search after cause was renewed. 
In pursuit of this search attempt was made by means of atropia to 
produce such dilatation of the pupil as should expose the whole cir- 
cumference of the crystalline lens; this dilatation was found exceed- 
ingly difficult, to secure, the iris being almost entirely wanting in 
response. 
For three days a strong solution of atropia was used; on the 
third the iris had fully dilated. The patient, thus presenting, w7as 
subjected to an ophthalmoscopic examination; the illumination re- 
vealing the fundus of a sac existing in the posterior chamber. 
The cyst, or whatever it might prove to be, was evidently united 
to the ciliary margin. The sight obtained at this view was too in- 
distinct to suggest thought of a cysticercus. The atropia being 
continued, a succeeding visit, made on the following day, revealed 
the secret of the diagnosis. 
A balloon-shaped body was now plainly to be seen, in the act, evi- 
dently, of detaching itself from a part to which it had been adherent. 
The next day the detachment was complete, the parasite floating 
free in the aqueous humor. 
To illustrate the movement of the animal, reference may be made 
to a balloon. A cysticercus is in form a miniature balloon, the 
head of the parasite, which is the dependent part, bears close like- 
ness, when extended, to the basket. 
To imagine a floating and swaying balloon suddenly drawing 
into its interior, and as suddenly throwing out its basket, is to se- 
cure the fullest notion of the action of the hydatid. 
For a whole week the act of floating was continued in the poste- 
rior chamber. At one time the animal would be in full view; at 
another he would have retired within his sac, and be lost to view 
behind the iris. At no time did the parasite come through the pupil 
into the anterior chamber. CYSTICERCUS CELLULOSiE. 
3 
On the ninth day of observation, the head of the cysticercus was 
found fixed to the centre of the capsule of the crystalline lens, into 
which it seemed to be trying to force a way. This attachment con- 
tinued unchanged until the hour of operation, three days later. 
A diagnosis established, removal of the parasite was affected by 
the performance of Graefe’s method for extraction of the lens.” 
The parasite lived for some time, after being placed in a warm 
saline solution. Macroscopically the animal presented its charac- 
teristic appearances, and subsequently, microscopically, the suckers 
and booklets were plainly discernible. 
The description quoted has been copied verbatim from Dr. Garret- 
son’s account, because of its peculiar clinical value, describing as it 
does most vividly “ the search after a diagnosis,” and as giving also 
the “fullest notion of the actions of the hydatid.” 
As the subject under consideration is one of unusual interest, we 
have thought it best to include a brief and concise account of the 
method of development of the cysticercus cellulosse or larval tape- 
worm from the eggs of the tmnia solium or parent tapeworm. Its 
novel course of life and travel, i. e., from one individual to another, 
and unique method of propagation must be thoroughly understood 
before the significance of this peculiar lesion can be appreciated. 
The entozoon under consideration is the larval form of what is 
known as the Tsenia Solium or tapeworm. 
It was known in the very earliest times, and was described by 
Plater1 in 1602. Goze2 first recognized its animal nature in 1184, 
Werner3 found it in man in 1186, and Kiichenmeister was the first 
who showed it to be the larval condition of the tsenia solium. 
The cysticercus cellulosse is, as its name implies, a bag-tailed en- 
tozoon of the cellular tissue. It has its origin in the inter-muscular 
connective tissue of the “ measly pig,” the uncooked meat of which 
contains the embryos. People become measly, then, not directly 
from eating “measly pork,” as we even now sometimes read, but by 
the circuitous mode of the tapeworm developing in the intestine. 
The person infected may derive the mature eggs of the taenia solium 
from his own intestine or from the tapeworm of some other individual. 
The former—self infection—may occur in two ways, mature eggs 
either free or accompanying the detached and expelled joints of a 
tapeworm may be taken into the mouth and swallowed, or mature 
egg containing segments may, by vomiting, be regurgitated into the 
1 Ziernssen, yol. vii. p. 686. 
2 Goze, “ Neuste entdeckung, das die Pinnen im Schweinefleisch keine 
di’nsen krankheit, sondern Blasenwiirmer, sind.” Halle, 1784. 
3 Werner, Venn, intest, brev. expositions cont. 11., Lips. 1786. 4 
CYSTICERCUS CELLULOSE. 
stomach. In the second way by food or through the use of cooking 
utensils. 
The ways and means by which tapeworms are acquired may in a 
general way be deduced from a consideration of their development. 
The habit, or rather the bad habit, says Ziemssen,1 of using meat 
imperfectly cooked or quite raw, which is becoming every day more 
common, is extremely favorable to the propagation of tapeworms or 
the development of their embryos (cysticercus cellulosse). 
Butchers, bakers, and cooks who harbor tapeworms are, in con- 
sequence of their occupations, especial^7 likely, from lack of cleanli- 
ness, to infect the food supplied or prepared by them, and in this way 
bring about the measly infection. Every person affected with tape- 
worm, not only carries with him danger, but is constantly threaten- 
ing the health of his neighbors. 
Concerning prophylaxis we would here reiterate the, advice 
Ziemssen2 gives upon this important subject. “With regard to 
swine, the idea that they thrive better amid filth must be looked 
upon as a prejudice that is no longer entertained by skilled agricul- 
tui’ists. The habit that still prevails in some farm-yards of inten- 
tionally giving the animals access to the excrement of human beings, 
should at once be put a stop to as thoroughly worthy of repro- 
bation, and pigs should be so inclosed as to be unable to wallow 
about in the dung heap and other filth. Though the ruminants have 
no such filthy propensities, still they too should be shut out from 
access to human excrement. With this object, the barbarous custom 
of defecating in every place promiscuously, should be put down with 
a high hand.” 
Tsenia solium, or tapeworm, is found in the small intestines of 
man. The head is usually fastened to the mucous membrane of the 
intestine in its upper third. Up to the present time tapeworm has 
only been found in man, and seems peculiar to him. It is very fre- 
quent in Europe and America. In Europe, the middle of Germany 
is remarkable for being the land where it is most widely diffused. 
The tapeworm must be looked upon as a colony of animals having 
an alternation of generation. The so-called head is the larva-like 
nurse; the segments of the worm—the proglottides—are the animals 
with sexual organs. From the head (scolex), without any mingling 
of the sexes, are produced these segments by a process of budding. 
These segments (animals) are hermaphroditic and generate eggs, in 
which a six-hooked embryo becomes developed. If these segments 
find entry into the stomach of a suitable animal, their envelopes 
become softened or undone, and the eggs are set free. Once hatched, 
1 Ziemssen, vol. iii. 
2 Ziemssen, vol. viii. CYSTICERCUS CELLULOSE, 
5 
the embryos are set free, and boring their way through the walls of 
the stomach, disseminate themselves throughout an animal’s body. 
In the course of its boring, an embryo now and then penetrates the 
walls of a bloodvessel, and is whisked away to some remote portion 
of the body; i. 6., the head or the extremities. There it continues 
to grow; and, living a prescribed life, becomes encysted, shrivels, or 
undergoes calcareous degeneration; or, if superficial, may be dis- 
charged by abscess formation. It is no difficult matter, therefore, 
to understand, and account for, the appearance of a cysticercus 
(measle) within or about the eye of an infected animal. 
Cysticerci have been found, we might say, in all parts of the body. 
Delore and Bonhomme1 found 3000 in one individual, of which num- 
ber one was found in the heart, pancreas, and medulla oblongata, 
four in the cerebellum, seven in the parotid gland, sixteen in the 
lungs, twenty-two in the meninges, eighty-four in the brain, and 
myriads in the mesentery and cellular connective tissue Leuckart2 
found them in the blood of the portal vein, and the liver is oftenest 
the seat of these larvae. They have, also, been found in the do- 
mesticated deer and polar bear, dog and rat. 
The cysticercus celluloses is a thin-walled vesicle with limpid con- 
tents, seldom exceeding the size of a pea or bean. This vesicle has 
an irregularly wavy surface. It is usually surrounded by a capsule 
of connective tissue, to the inner surface of which it is closely ap- 
plied. Inside of the cyst and visible through it, is a firm, round, 
whitish body, which is connected with the depression in the wall of 
the cyst. On opening the cyst this body is found to be a pear-shaped 
sac. Inside this sac is the head of the cysticercus, turned inside out 
like the finger of a glove. The head resembles, in every way, the 
head of the taenia solium (tapeworm). 
F.J.FICKINGER, 
The accompanying cut representing a living cysticercus3 in the 
anterior chamber of the human eye, is taken from G-raefe’s Archives 
1 Arcliiv. Gen. 1865, i. p. 855. 
2 Menschliclien Parasiten, i. p. 199. 
8 This parasite Yon Graefe removed alive through a corneal section with 
subsequent complete restoration of sight. 6 
CYSTICEECUS CELLULOSE. 
of Ophthalmology,1 and is of peculiar value, being, doubtless, a fac- 
simile of one prepared under the direct supervision of the great 
Yon Graefe himself. 
Since Yon Graefe and Liebreich made the first exact observations 
upon this subject the number of cases has greatly increased. The 
first case of this rare lesion was one in which a cysticercus cellulosse 
(lebender Finnenwiirm) was discovered in 1829 by Sommering,2 in 
the anterior chamber of the eye of a healthy girl eighteen years of 
age. The parasite floated free in the anterior chamber, now and 
then took hold of the iris and by its motions caused intense pain. 
It was removed alive by Dr. Schott, through a corneal incision, and 
subsequently lived in warm water for half an hour. It has also 
been found by Logan in anterior chamber, Mackenzie, 1832; under 
the conjunctiva by Baum, 1838 ; under the epithelium of the cornea 
by Cunier, 1841; under the skin of the eyelid by Sichel, 1847; 
twice in anterior chamber, under the skin of the eyelid, and under 
the ocular conjunctiva, Mackenzie, 1848; ophthalmoscopically, in 
the posterior half of the eye, Yon Graefe, 1853 f in the orbit, Yon 
Graefe, 1863 ; in the lens, Yon Graefe, 1864. 
The late Albrecht Yon Graefe4 in a practice of thirteen years, saw 
about 80,000 eye patients, out of which there were 81 cases of C3-sti- 
cercus, within or about the eye; that is, about one in a thousand 
cases. Out of this number it occurred three times in the anterior 
chamber, five times under the conjunctiva, once in the lens, and 
once in the orbit, whilst the greatest number were found situated in 
the posterior portion of the eyeball, i. e., retinal or sub-retinal, and 
generally escaping into the vitreous. Yirchow, up to 1866, had 
seen it in the brain in two per cent, of all the post mortems made in 
Berlin. The jmnngest individual affected was eight years of age. 
Ninety per cent, were between 15 and 55 years, and it occurred only 
once under the retina in a man aged seventy. Two-thirds of the 
cases occurred in males. Only five or six of the patients previously 
had tapeworm, while very frequently other inmates of the house 
were giving lodgment to them. ( This observation is of more than 
usual significance, as it goes to show the thoroughness with which 
Yon Graefe prosecuted all his researches.) In South Germany, 
Switzerland, and France, cysticerci are rare. Among 61,000 eye 
patients whom Graefe5 in Halle saw up to 1878, he had seen but two 
1 Graefe’s “Archiv fur Ophthalmologie,” Ester Band, Berlin, 1854. 
2 Ammon’s Zeitschrift fur die Ophthalmol. 
3 Archiv fur Oph., Bd. i. Abth. i. p. 457. 
4 Archiv fur Oph., Bd. xii. Abth. ii. p. 174. 
5 Archiv fiir Ophthalmologie, Bd. xxiv. Abth. i. p. 309. CYSTICERCUS CELLUIOSJ:. 
7 
cases of cysticerci, and these were in the anterior chamber; one was 
in the eye of a child four years of age (this fact is worthy of note 
as the youngest subject, mentioned by Yon Graefe, was eight years 
of age). In other parts of the eye he had seen it four or five times 
annually. Intra-ocular cysticercus occurs at Lisbon (Fouseca, Jr.) 
only' in the proportion of one in two thousand eye patients. The 
reason of cysticercus being so rarely found in the anterior portion 
of the ey7e, is because of the smallness of the arteries in that locality. 
Leibreich1 extracted a cysticercus by means of a canula-forceps 
through a scleral incision, aided by' an ophthalmoscope attached to 
his head, so that he was able to illuminate and observe both parasite 
and instrument. He mentions that the base of the neck of the 
parasite, which is less transparent than the rest of its structure, and 
is dotted with fine white calcareous particles, is the part that is most 
resistant, and that affords the most secure hold for the forceps. 
Hirschler2 reports a case which is identical with that of Dr. Garret- 
son, and many more interesting cases of intra-ocular cysticerci are 
reported throughout Graefe’s Archives. 
The methods of operation for the removal of intra ocular cysti- 
cerci are numerous and varied, and inasmuch as the several condi- 
tions in eacli case suggest the adoption of a particular plan of re- 
moval, it will be unnecessary7 to consider or discuss them in this 
connection. 
Yon Graefe decided that in the majority of cases of cysticercus, 
in the posterior half of the eye, phthisis of the globe was the usual 
sequence, although he3 successfully removed a living cysticercus 
from the vitreous, through a corneal section as early as 1858J Law- 
son3 mentions, without giving particulars, a similar case recorded 
by Mr. J. Pridgin Peale. Dr. D. S. Reynolds,6 of Louisville, pub- 
lished in June, 1814, “A case of cysticercus in the pupillary edge 
of the iris,” of which he sayns “ there was great pain and tenderness 
of the eyeball with a low degree of iritis. The pupil opened well 
under the influence of atropia, except at the inferior and external 
portion, where there was a white, opaque, pear-shaped tumor, the 
small end of which rested upon and was adherent to the capsule of 
1 Graefe’s Archiv flir Ophthalmologie, Bd. ii. Abth. i. p. 256. 
2 Archiv fur Oph., Bd. iv. Abth. ii. p. 14. 
3 Archiv fur Oph., Bd. iv. 
4 Dr. T. G. Morton, at a meeting of the Phila. Ophth. Society in 1870, ex- 
hibited a case of (dead) intra-ocular cysticercus, in a patient in whom both 
the late Dr. Gescheidt, of N. Y., and himself had previously seen the ento- 
zoon alive and in motion. 
5 Diseases and Injuries of the Eye, London, 1874. 
6 American Practitioner, June, 1874. 8 
CYSTICERCUS CELLULOSES. 
the lens. A portion of the iris containing the cyst was removed. 
The cyst itself was so firmly adherent to the lens capsule that it was 
necessary to seize it with a pair of forceps, and by careful traction, 
made in the same plane with the lens surface, to detach and remove 
it; and was successful in so doing, without rupturing the capsule of 
the crystalline. The cyst when placed under the microscope showed 
three suckers and a beautiful circlet of booklets.” Vision rapidly 
improved. 
Dr. Chas. J. Kipp, of Newark, New Jersey, presented at the In- 
ternational Ophthalmological Congress, in 1816, a case of cysticercus 
extracted from the ocular conjunctiva. 
WAt a meeting of the Atlanta Academy of Medicine, in March, 
1878, a case of intra-ocular cysticercus was reported by Dr. Calhoun. 
In this case, on account of the patient’s unwillingness and the gene- 
ral bad results of the operation, no interference with the entozoon 
had been attempted.”1 
For those who wish to investigate the subject of human and com- 
parative helminthology, we would cordially recommend Dr. Cobbold’s 
new “ Treatise on the Entozoa, etc.” The part of the book which 
treats of tapeworms will be found especially useful to students of 
sanitary science. To Dr. Cobbold we owe the knowledge which 
puts thus tersely the fact, that “ all kinds of tapeworm larvae, mea- 
sles, bladder worms, etc., have a natural life epoch assigned to them.”2 
He, however, reminds us, while speaking of taenia solium, of the 
danger of handling fresh tapeworms, as wre might get their eggs 
under our nails or on our clothes, and so swallow them. We are 
also reminded of the danger of eating salads which may have been 
manured with nightsoil containing, it may be, myriads of tape- 
worms’ eggs. 
For an account of the experiments of Pelizzari, Tommasi, Perron- 
cito, and Griacomini, we must refer to the book itself; it will suffice 
to say that they in no way contravene the experiments of Lewis, 
who proved that a temperature of 140° Fahrenheit was sufficient to 
destroy the vitality of cysticerci of all kinds. 
’Medical and Surgical Reporter, Philada., June, 1879. 
2 “A Treatise on the Entozoa of Man and Animals, including some 
account of the Ectozoa.” T. S. Cobbold, M.D., F.R.S., F.L.S., etc., Lon- 
don, 1879.