SUPPLEMENT 691 



child, aged 4, in whom an Ascaris reached the nasal cavity through 

 the act of vomiting, and from there it gained access through the 

 naso-lachrymal duct and the inferior lachrymal sac into the lower 

 punctum lachrymale, from which half of it protruded. 



Among the rarer causes of the occurrence of strange bodies in the 

 pharynx and naso-pharyngeal cavity, Jurasz 1 mentions in the first 

 place vomiting, which may afford opportunity for the more solid 

 bodies of the stomach contents, and even parasites of the digestive 

 tract, especially Ascaridce, to become firmly lodged in the pharyngeal 

 or naso-pharyngeal cavity. Ascaridcc may obtain access from the 

 naso-pharyngeal cavity to the middle ear by way of the Eustachian 

 tube, as has been observed by Reynolds 2 and Wagenhauser 3 ; in the 

 case recorded by Turnbull (girl, aged 8, with pains in her ear) the 

 Ascaris apparently reached the external auditory meatus by the same 

 route. 



The irritation of the larynx and air passages by Ascaridcv is far 

 more dangerous than their penetration into the nose and naso- 

 pharyngeal cavity, because not only are attacks of suffocation, but 

 sudden suffocation thereby induced. Oesterlein 5 records a fatal 

 attack of choking from Ascaridcc in the trachea. In a case recorded 

 by Smyly 6 of a boy, aged 3^, tracheotomy for extreme asphyxia was 

 performed without relief. At thepost-uwrtem the cause of the asphyxia 

 was found to be an Ascaris in the trachea. Furst 7 collected twenty- 

 five observations of invasion of the larynx and trachea by Ascaris. 

 Mosler 8 reports the case of a patient with aphonia and dyspnoea 

 from whose larynx an Ascaris was removed. Don'ati 9 reports a case 

 of four Ascarides in the larynx, and Cerchez 10 of asphyxia from 

 Ascarides in the larynx or trachea. Wagner 11 records the case of 

 a boy, aged 8, in whom a coil of worms was ejected from the stomach 

 by vomiting ; the mass blocked the entrance to the larynx and led to 

 death from suffocation. A case similar to that recorded by Smyly is 

 communicated by Rabot 12 ; it was that of a child who underwent 

 tracheotomy for diphtheria, and who was not relieved by the opera- 

 tion ; when, however, an Ascaris appeared in the cannula and the 

 parasite was removed the child breathed well. In Negresco's 13 case, 

 that of a boy, aged 3, an Ascaris gained access to the larynx and from 

 there into the trachea, and a fatal issue from asphyxia resulted. 



1 Jurasz, Heymann's "Handb. d. Laryngol. u. Rhino!.," iii. 



- Reynolds, Lancet, 1880. 3 Wagenhauser, Arch. f. Ohrenheilk., 1889, xxvii. 



4 Turnbull, Virchow-Hirsch Jahresbenchf, 1880. 



ft Oesterlein Deutsch. Klin. 1851. (i Smyly, Dubl. Journ., 1867. 



7 Fiirst, Wien. ined. Wochenschr., 1879. s Mosler, quoted by Liesen. 



9 Donati, Ann. Univ. de M&d. et Chir., Milano, 1875. 



10 Cerchez, Clinica, 1891, iv. " Wagner, Deutsch. med. Wochenschr., 1902. 



'-' Rabot, Soc. de Sci. m6d.de Lyon, September 9, 1904. 

 1:1 Negresco, Soc. de Med. leale y November 9, 1903. 



