652 THE ANIMAL PARASITES OF MAN 



escape of fluid into the peritoneal cavity led to severely itching 

 urticaria, which usually disappeared again after one or two days. 

 On one occasion, indeed, urticaria occurred after rupture into the 

 pleural cavity. In the case recorded by Caff arena 1 of echinococcus 

 of the right lobe of the liver, widespread urticaria developed as the 

 result of the exploratory puncture. In the case of an echinococcus 

 of the liver rupturing into the abdominal cavity La Spada 2 ascribed 

 the symptoms leading to death to toxic influence while the peritoneal 

 symptoms were less marked. Eosinophilia in hydatid disease is slight 

 according to the investigations of Bindi 3 and Santucci,* and is, 

 according to Welsh and Barling, 5 no certain sign of echinococcus ; 

 it is independent of the age, sex and temperature of the patient, but 

 upon rupture of the cyst eosinophilia invariably sets in. 



The question as to the importance of helminthes in relation to 

 certain diseases of the gut requires special discussion, but it concerns 

 only Ascaris linnbricoides, Oxyuris vermicular is, and Trichocephalus 

 dispar, and the question of appendicitis first of all. The entrance of 

 intestinal parasites into the vermiform appendix was already known 

 to medical men in the fifties of last century, as is shown by the works 

 of Merling 6 (1836), Zebert 7 (1859), Platonor 8 (1853), and Schachtinger 9 

 (1861). Most of these authors have considered intestinal worms, 

 together with other foreign bodies, to be the cause of appendicitis. 

 As regards the part played by these intestinal parasites in the etiology 

 of appendicitis, so much discussion has taken place during the last 

 few years that it is worth while to give a resume of the later views on 

 this question, even though at the outset it must be admitted that the 

 matter is not cleared up. Bergmann 10 records a case in which an 

 Ascaris perforated the appendix and got into the peritoneal cavity. 



Strumpell 11 reckons among the symptoms of Trichocephalus the 

 possibility of a " typhlitis." On account of the marked sensitiveness 

 of the ileo-csecal region, Boas 12 mentions the possibility of confusing 

 it with appendicitis. Still 13 regards Oxyuris as a principal cause of 

 catarrhal affections of the appendix. Arbore-Rally 14 regarded severe 

 symptoms of appendicitis in a boy, aged 10, as due to Ascarides. 

 In all cases of appendicitis MetschnikofP 5 requires a microscopical 

 examination to be made for eggs, and considers treatment for worms 



1 Caffarena, Convers. din. Geneva, 1902. 2 La Spada, Gaz. d. Osp., 1904. 



3 Bindi, ibid.) 1907. 4 Santucci, " Clinica moderna," 1905. 



5 Welsh and Barling, Scot. Med. and Surg. Journ., 1907. 



6 , 7 , 8 , 9 quoted by Rostowzeff, Bobritsch. Gaz. Botkina, 1902. 



10 Bergmann, Prag. med. Wochenschr.^ 1890. 



Strumpell, " Lehrb. d. spez. Path. u. Therap.," 1894. 



12 Boas, Deutsch. med. Wochensckr., 1895. 13 Still, Brit. Med. Journ., 1899. 



J4 Arbore-Rally, Arch, de Mid. des Enf., 1900. 15 Metschnikoff, Bull, med., 1901. 



