SUPPLEMENT 657 



(a boy, aged n) the Oxyuris were able to penetrate the whole 

 intestinal wall, but Vuillemin 1 considers this improbable, and is 

 more inclined to think that the Oxytirides penetrated the rectum at 

 small ulcerated points, and thus gained access to the perirectal 

 connective tissue. In females Oxyuris not only have the power 

 of penetrating far into the sexual organs (Marro 2 ), and perhaps causing 

 a parasitic endometritis (Simons 3 ), but also clearly of gaining access 

 to the peritoneal cavity by way of the tubes, as is to be assumed in 

 the case recorded by Kolb 4 (that of a woman, aged 42, in whom post 

 mortem nodules were found over the peritoneum of Douglas's pouch, 

 in which the pressure of encapsuled Oxyuris could be demonstrated), 

 in that reported by Chiari 5 (adult Oxyuris in Douglas's pouch) and 

 by Schneider 6 (an Oxyuris encapsuled in the pelvic peritoneum). 

 Sehrt's 7 case is worthy of attention ; in this an abscess was found in 

 the omentum with numerous Ascaris ova in the pus and a nodular 

 lesion of the peritoneum, with Ascaris ova encapsuled in the nodules. 

 Massive accumulation of Ascarides may give rise to a complete 

 occlusion of the gut. Such an occurrence is not so surprising as 

 might be thought when one reflects that the number of Ascarides in 

 one individual may amount to several hundreds. For instance, one 

 boy evacuated within a single clay 600 Ascarides (Fauconneau- 

 Dufresne 8 ) and within three years 5,126 worms. In the case 

 recorded by Tschernomikow 9 a boy, aged 2^, evacuated during a 

 day 208 worms, partly through the stomach, partly through the 

 intestine. Coil-formation of such masses of Ascarides renders 

 possible not only constipation, but also complete obstruction with 

 symptoms of ileus, as shown by the five cases quoted by Hosier 

 and Peiper, 10 as well as from observations made by Raie, 11 Schulhof, 12 

 Rehberg, 13 Rocheblave, 14 Heller, 15 Leichtenstern, 16 Huber, 17 and 

 Wilms. 18 In two cases of Black 19 and Parkinson 20 the intestinal 

 obstruction was caused by a coil of tapeworms. 



In the earlier history of medicine the helminthes played a great 

 part as the excitants of many intestinal diseases and of enteric 

 as well. Even if to-day they no longer be regarded as such, the 

 conception that they represent the predisposing factor in typhoid 



I Vuillemin, Centralbl. f. Bakt., 1902. * Marro, Arch, per le Set. med., 1901. 

 3 Simons, Centralbl. f. Gynak., 1899. 4 Kolb, Centralbl. f. Bakt., 1902. 



5 Chiari, Prag. meJ. Wochenschr., 1902. 6 Schneider, Centralbl. f. Bakt., 1904. 



7 Sehrt, Beitr. z. klin. Chir., li. 8 Fauconneau-Dufresne, quoted by Seifert. 



9 Tschernomikow, quoted by Seifert. I0 Mosler and Peiper, loc. cit. 



II Raie, Lancet^ 1899. 12 Schulhof, Munch. med. Wochenschr., 1903. 

 13 Rehberg, "Dissert. Konigsberg," 1907. u Rocheblave, Gaz. des H6p., 1898. 



15 Heller, loc. cit. }& Leichtenstern, " Ziemssen's Handb.," vii. 



17 Huber, quoted by Rehberg. 18 Wilms, Deutsch. Zeitschr. f. Chir., xlvi. 



19 Black, Brit. Med. Jottrn., 1872. 20 Parkinson, quoted by Rehberg. 



