46 Philippine Journal of Science 1920 
parts of the Archipelago and possibly gives a fair idea of the 
adult distribution of Ascaris in the Philippine Islands. It has 
been the general impression among microscopists in Manila 
that Ascaris occurs almost twice as frequently in children under 
15 years of age as it does in adults in middle life. 
In this series, at least, it is rather hard to consider Ascaris 
and Trichuris infections apart from one another. The two 
parasites occur together with great frequency, and their asso- 
ciation seems to be accompanied by a fairly recognizable train 
of symptoms referable to the abdomen, such as pain, distention, 
tympanism, and frequently the vomiting and passage of Ascaris 
or both vomiting and passage of the worms. 
This combination of parasites is one that may be expected 
to keep the greater portion of the entire intestinal tract in a 
state of chronic to acute irritation—mechanical as well as chem- 
ical. Ascaris lives in the small intestine, but it is a confirmed 
nomad—something of an explorer—and its wanderings fre- 
quently take it from end to end of the small intestine and oc- 
casionally into the stomach, the liver, and other places where 
it properly has no business. Not infrequently it rubs elbows 
with the hookworm. Such a condition may well be held to ac- 
count for considerable trouble in the small intestine; when 
there is added to this the irritation produced in the large in- 
testines by the presence of numerous T'richuris which may even 
invade the appendix, and in rare instances the ileum, it will be 
seen that the involvement of the digestive tract is fairly com- 
plete from end to end. It is in cases such as these that we 
frequently encounter more or less severe abdominal pain, dis- 
tention, and either the vomiting or the passage, or both, of 
worms when no treatment whatever has been instituted to 
bring about the expulsion of the parasites. In connection with 
this it is interesting to review some of our Ascaris cases. 
These two cases were infected with Ascaris to the exclusion 
of all other parasites: Case 43, male, 21 months old. The pa- 
tient was under treatment for bronchopneumonia. He gave a 
history of occasional flatulence. Case 99, female, 2 years old. 
The patient was under treatment for indigestion. The child 
gave a history of having suffered from abdominal distention. 
Mentally, the girl was backward and did not talk. In both 
these cases it will be noted that the abdominal symptoms were 
decidedly mild. 
The following cases, also, are rather interesting: 
