692 THE ANIMAL PARASITES OF MAN 



The route by which Ascaridcv obtain access to the urinary passages 

 must remain undecided. Schluter 1 treated a woman, aged 60, with 

 retention of urine. Upon catheterization the hinder end of an 

 Ascaris hung out from the catheter opening ; the anterior end was 

 fixed in the tube and the lumen was obstructed. Perhaps in the 

 female sex Ascaridce travel from the gut into the vulva and from there 

 into the bladder, as they have already been observed in the vagina, 

 where they cause troublesome symptoms (pruritus pudendi). 



The diagnosis of ascariasis is not in general difficult ; now and 

 then the worms are discharged spontaneously; if not, the ova, which 

 cannot be mistaken, can easily be detected in the faeces upon micro- 

 scopical examination. Epstein's 2 method namely, on every occasion 

 to obtain fresh material for examination is much to be recommended. 

 This consists in introducing a Nelaton's catheter into the rectum with 

 a rotatory motion and then drawing it out. A small portion of faeces 

 forced into the catheter opening is more than sufficient to demon- 

 strate the presence of ova of the parasites upon microscopical 

 examination of a preparation. 



In spite of all pressure on the part of relatives, treatment directly 

 against Ascarida 1 should not be carried out until the diagnosis is 

 certain. 



As regards prophylaxis, much can be done by not throwing the 

 worms, when expelled, on to the dung-hill or into the privy, but 

 straightway into the fire. MetschnikofP has issued a warning 

 .against the consumption of unboiled or badly washed vegetables, 

 salad, strawberries, etc., and also against drinking polluted water. 



For the expulsion of the worms flores cinae were formerly con- 

 sidered the most useful means; now, however, santonic lactone 

 santonin which is prepared from them, is almost universally 

 preferred. By many, especially in practising among children, flores 

 cinas are still recommended in the form of Stork's worm electuary 

 (consisting of flores cinae, rad. jalapae, valerian and oxymel simplex). 

 Guermonprez 4 recommends them because he thinks that santonin 

 only excites the worms and consequently causes unpleasant sym- 

 ptoms. Besides, in the form of the above-mentioned electuary, flores 

 cinae can also be given several times daily with raspberry jelly up to 

 0-5 grm. to 2 grm. (children and adults). 



Santonin is prescribed either in single doses from 0*03 to 0-05 to 

 o'i grm. with sugar in the form of powder, or else in oily solution. 

 When given in the latter form the absorption of the santonin in the 



1 Schliiter, Munch, tned. Wochenschr., 1902. 



- Epstein, see Seifert, " Lehrb. d. Kinderkrankh.," p. 273. 



:f Meischnikoff, Gaz. hebd. de Med. ei Chir., igoi. 



4 Guermonprez, see Seifert, Dentsch. wed. Zeitg., 1885. 



