656 THE ANIMAL PARASITES OF MAN 



as at least a rare occurrence. Gerhardt 1 does not doubt that the 

 worms can actively perforate the intestine. Cases like those of 

 Abrault, 2 Apostolides, 3 Marcus 4 (recorded by Perls as a valid 

 example of " ascaridophagous" gut perforation), Wischnewsky, 5 

 Galvagno, 6 Salieri 7 certainly show that perforation of the healthy 

 gut wall cannot be denied, but at the same time that this occurrence, 

 compared with the frequency of Ascaridcc, should be regarded as 

 exceedingly rare. It is another matter as to whether it is possible 

 for the worms to penetrate an intestinal wall already diseased, 

 especially when ulcerated ; a whole series of observations are in 

 favour of this. In Lini's 8 case (fifty-six Ascarides escaped from the 

 umbilicus of a girl, aged 7), in Graffe's" (eighty Ascarides escaped 

 from an inguinal tumour), in Nicolino's 10 (perforation of the intestinal 

 wall with strangulated hernia), in Liesen's 11 (a living Ascaris in the 

 peritoneal cavity in a woman suffering from a peritoneal abscess) 

 in these it is clear that disease processes in the intestine preceded the 

 exit of the worms. In a case described by Boloff 12 the Ascarides 

 appear to have produced, by forming a tight coil, necrosis of the 

 gut with perforative peritonitis. In a case recorded by Lutz 13 the 

 perforative peritonitis was without doubt provoked by Ascaris, and 

 in one by Schiller 14 the Ascaris had clearly gained access to the 

 peritoneal cavity through a gunshot wound opening. In a case 

 observed by Rehn 15 the worm probably entered through a gangrenous 

 portion of the intestine in a hernial sac. Broca 16 is unable to deter- 

 mine whether in his case the intestinal perforation was primary 

 (a worm escaped from the abdominal wound about two months after 

 a laparotomy for suppurative peritonitis). The case reported by 

 Lutz 17 is of special interest : it was that of a young man who had 

 shot himself in the region of the abdomen, and who died after fifteen 

 days. At the post-mortem two Ascarides were found in the pulmonary 

 artery ; they had probably escaped from the intestine, and had gained 

 access to the inferior vena cava. Froelich 18 assumes that in his case 



1 Gerhardt, quoted by Liesen, " Dissert. Bonn." 



2 Abrault, quoted by Seifert, " Lehrb. d. Kinderkrankh." 

 Apostolides, Lancet, 1898. 



Marcus, quoted by Seifert, " Lehrb. d. Kinderkrankh." 

 Wischnewsky, quoted by Seifert, ibid. 

 Galvagno, Arch, de Patol. et Clin. inf., 1902. 



Salieri, Rif. med., 1902. 8 Lini, Schmidt's Jahrb., 1838. 



Graffe, Ptotokoll d. Ges. f. Natnr u. Heilkunde, Dresden, 1853. 

 10 Nicolino, Clin. mod., 1902. " Liesen, "Dissert. Bonn," 1904. 



12 Boloff, quoted by Seifert, "Lehrb. d. Kinderkrankh." 



13 Lutz, Centralbl. f. Bakt. 



14 Schiller, Beitr. z. klin. Chir., xxxiv, p. 200. l5 Rehn, see Schiller, loc. cit., p. 201. 



16 Broca, Rev. mens. des Mai. de FEnf., 1904. 



17 Lutz, Wien. klin. Wochenschr., 1905, xv. 



18 Froelich, Rev. mens. des Mai. de FEnf., 1897. 



