688 THE ANIMAL PARASITES OF MAN 



give rise to any symptoms at all, whereas a large number may 

 eventually give rise to severe local symptoms, or those of a toxic or 

 reflex nature which have been discussed in the General Section. 



Among the local symptoms are the following : loss of appetite, 

 excessive appetite, perverted sense of taste, foetid breath, sensitiveness 

 to pressure over the abdomen, colicky pains and irregularity of the 

 bowels. The appearance and state of health suffer ; the patients, 

 children in especial frequency, become remarkably pale ; their com- 

 plexions undergo rapid change, and rings of grey or bluish-brown are 

 seen about the eyes. Children may become so reduced by this rare 

 condition, enteritis verminosa, due to Ascarides in large numbers, that 

 suspicion of the existence of intestinal tuberculosis arises. Emaciation 

 to a skeleton, excessive meteorism, and evacuations of thin gruel-like 

 stools, sometimes blood-stained, are observed in these cases. Even in 

 the case of adults, chronic uncontrollable vomiting with severe 

 inanition due to the Ascarides has been observed. When the 

 Ascarides escape spontaneously per nnuiti, they frequently cause an 

 exceedingly troublesome irritation in the anal region (pruritus ani). 



The most disagreeable symptoms and those most dangerous to 

 life arise from the migrations of Ascarides when they invade the bile- 

 clucts; no inconsiderable number of cases of this kind are recorded 

 in the literature (summarized, up to the year 1901, in Sick's 1 Disser- 

 tation). Penetration post mortem (or shortly before death) of the 

 worms into the bile-ducts cannot be considered as a rarity; the laxity 

 of the muscular orifices easily allows of this invasion also in other 

 directions on the part of the parasite in its escape from the body of its 

 dead host. The occurrence of the worm in the biliary passages in the 

 living is to be regarded as still less frequent, but nevertheless often 

 enough according to the records in literature. Sick 2 was able to 

 collect as many as sixty-one such cases, to which he added two further 

 fresh cases from the Tubingen clinic, that is, from the material pro- 

 vided by his father. In the year 1891 Borger 3 collected fifty-nine 

 cases relating to the invasion by Ascaridce of the bile-ducts and 

 passages, and Dauernheim's 4 Dissertation treats of this question as 

 well. A further case of Ascaris in the ductus choledochus (chole- 

 dochotomy) is recorded by Neugebauer. 5 In the ca^e of Schupper 6 

 (woman, aged 52), all the biliary passages were distended and filled 

 with fourteen living Ascaridw (perhaps as they were living they had 

 not led to a septic infection of the biliary passages) ; in the case 



1 Sick, " Diss. Tubingen," 1901. - Sick, ibid., 1901. 



3 Borger, "Diss. Miinchen," 1891. 4 Dauernheim, " Diss. Giessen," 1900. 



"' Neugebauer, Arch. f. klin. C/izr., 1903, Ixx. 



6 Schupper, Gaz. d. Osf., 1904, xxxiii. 



