SUPPLEMENT 649 



cured. A portion of the worm was already breaking down, the 

 absorption introducing into the body highly toxic haemolytic pro- 

 ducts, to which the anaemia must be ascribed. How far the serious 

 disturbances of the nervous system, frequently to be observed in 

 cases of Hymeiwlepis nana, are to be considered as of purely reflex 

 nature or toxic must remain an open question ; the same applies to 

 Dipylidium caninum, in which case Brandt 1 observed serious central 

 nervous symptoms. Caution is necessary in judging as to any con- 

 nection between worm stimulus and nervous symptoms in cases of 

 Ascaris infection. Peiper 2 is inclined to regard such nervous 

 symptoms not as reflex, but rather as due to a toxin contained in 

 the helminthics, or metabolic in origin. 



In cases of pernicious anaemia when the symptoms disappear after 

 expulsion of Ascaridce a toxic action must be assumed (Demme 3 ). 

 Additional clinical observations do not, indeed, lead to any definite 

 conclusion as to the question whether Ascaridce produce a toxin which 

 is capable of causing more or less injury either to the nervous system 

 or to the blood, yet it may be worth while to give a brief review 

 of this question. In a case of Kutner's, 1 that of a girl, aged 12, 

 there was a haemolysis which was cured after expulsion of twenty- 

 four Ascarida'. Attacks of opisthotonos in a girl, aged 16, ceased 

 after seventy-eight Ascaridcv had been expelled (Lutz 5 ). Unusually 

 serious disturbances were observed in a man, aged 26, who was rapidly 

 cured by Drouillard 6 by the removal of a great number of Ascarida. 

 The observations on pseudomeningitis are of especial interest ; they 

 are evidently toxic in origin as in the case of Annaratone, 7 of a man 

 who was taken ill with gastro- intestinal symptoms and who died with 

 meningitic symptoms. Post mortem the brain w y as normal, but the 

 stomach contained a great coil of Ascaridce. The cases of Delille, 8 

 Meriel, 9 Papi 10 (the occurrence of Cheyne-Stokes respiration has been 

 ascribed to the action upon the centre in the medulla oblongata of 

 the products of the Ascaridcv), and Taillens 11 related to children in 

 which the meningitic symptoms (meningismus), partly serious, dis- 

 appeared with the removal of the Ascaridce. Mareo 12 designates this 

 disease helminthiasis meningitiformis, which exhibits all the symptoms 



1 Brandt, quoted by Pollak in Centialbl.f. Bakt., 1889, v. 



2 Pc-iper, vide Seiftrt, " Lehrb. d. Kinderkrankh.,'' 1897, p. 243. 



3 Demme, -vide Seifert, ibid. 



4 Kutner, Be* I. klin. Wochenschr., 1865. 



5 Lutz, Central bl. f. Bakt. 6 Drouillard, Journ. de Med., 1900. xi. 



7 Annnratone, Giom. vied, del regie esei c. , 1900. 



8 Drlille, Joitrn, de Me</., May 10, 1907. 



9 Meriel, Annal. de Med. et Chir. inf., 1900. 



10 Pani, Gaz. d. Osp., 1901. n Taillenp, Arch, de med. d'Enf., 1906. 



12 Mareo, Allg. V/ien. med. Zeitg., 1902. 



