654 TIJE ANIMAL PARASITES OF MAN 



jn the origin of appendicitis ; in 163 cases he found worms in three 

 -instances. Wirsaladze 1 expresses himself in a similar fashion. 

 Oppe 2 observed Oxyuris six times in excised appendices, and 

 emphasizes the opinion that in appendicitis the question of a worm 

 cure ought to be taken into consideration. Ascaris and Oxyuris, if 

 no contra-indication exists, may be expelled, but in the case of 

 Trichocephalus, which frequently defies all expulsive treatment, no 

 attempt should be made, but operation proceeded to forthwith. 

 In a case briefly reported by Hanau 3 Oxyuris was undoubtedly the 

 etiological starting-point; in a case of Galli-Vallerio 4 Oxyuris and 

 Trichocephalus. In the opinion of Ssaweljews 5 in some cases of 

 appendicitis, in addition to other causes, intestinal parasites play a 

 prominent part. The case recorded by Nason 6 is an interesting one ; 

 in this an Ascaris in the appendix became twisted with it round a coil 

 of gut, causing obstruction. Spieler 7 argues against the under- 

 estimation by many authors as to the part played by intestinal worms 

 in producing appendicitis, although he also does not regard them 

 as a frequent, to say nothing of an exclusive, cause of the disease. 

 In a case recorded by Begonin 8 fifteen Oxyuris were found in the 

 excised appendix (the mucosa showed some ulceration), and in another 

 recorded by Putnam 9 twenty Oxyuris were present in the appendix, 

 in which there was no evidence of any change. The standpoint 

 Schilling 10 takes is to the effect that entozoa irritate the mucosa and 

 can increase an already existing inflammation, but he considers it 

 very questionable whether they can produce appendicitis. Blanchard 11 

 assumes the possibility of a secondary infection arising from lesions 

 of the mucosa produced by helminthes (Ascaris and Oxyuris). 

 Moore 12 considers Trichocephalus the excitant of the appendicitis 

 in his case. In a second case of appendicitis recorded by Auley 13 

 operation became unnecessary owing to the passage of the Ascaridcv. 

 Page's 14 case is an interesting one ; it was that of a man who came 

 up for operation with a diagnosis of appendicitis. On incising the 

 abdominal wall numerous Ascarides were found at the base of the 



I Wirsaladze, Bobntsch. Gaz. Botkina, 1902. 2 Oppe, Munch, med. Wochenschr., 1903. 



3 Hanau, ibid., 1903. 



4 Galli-Vallerio, CentrML f. Bakt., 1903, p. 1094. 



5 Ssawtljews, Deutsch. med. Zeilg., 1903. 



6 Nason, Jonrn. Amer. Afed. Assoc., 1904. 



7 Spieler, Wien. klin. Wvchenschr., 1904. 



8 Begonin, Journ. de AIM. de Bordeaitx, July, 1902. 



9 Putnam, quoted by Spieler. 10 Schilling, " Wurzb. Abhandl.," 1905. v. 



II Blanchard, Acad. de Med., July 3, 1904. 



2 Moore, Brit. Med. Journ., Augu t 18, 1906. 



13 Auley, ibid. ,1906. 



14 Page, New York Med. Jonrn., Januaty 20, 1906. 



