Kousso

Confirmed tapeworm segments passed in stool with a history of eating undercooked meat or fish

Persistent intestinal parasitism unresponsive to gentler vermifuges, in an otherwise robust patient able to tolerate a strong purgative

Overview. Hagenia abyssinica is a small flowering tree native to the highlands of Ethiopia and other parts of eastern and central Africa, long valued there as the principal traditional remedy for tapeworm. The part used is the dried, tightly clustered female flower panicles, known in commerce as kousso or cusso. It entered European and American eclectic and regular medicine in the nineteenth century as one of the most reliable botanical taeniacides available before synthetic anthelmintics, prepared fresh as an infusion or fluid extract and taken on an empty stomach.

Clinical Notes. Kousso was used almost exclusively for one purpose: expelling tapeworm. The classic method was to take the infusion in two divided doses an hour apart on an empty stomach, the powdered flowers being swallowed along with the liquid, followed if needed by a mild purgative such as castor oil to hasten expulsion of the worm.

Action and Therapy. Taeniacide and purgative. Kousso is among the rarely used though efficient anthelmintics for the removal of tapeworm. Being more or less irritant to the gastro-intestinal tract it is not always well retained by the stomach. About 4 to 5 drachms of the flowers are to be suspended in water, or made into an infusion, and taken in two or three doses at short intervals upon an empty stomach. Some prefer the fluidextract in doses of 2 to 4 fluidrachms. Kousso is liable to fail unless made fresh and in prime condition.

Action, Medical Uses, and Dosage. As a vermifuge, this infusion should be taken fasting, one-half the quantity being given an hour before the second portion, the flowers being swallowed with the infusion. This is the original Abyssinian method of administering cusso.