WOEMS. 59 



characteristic form of cirrhosis of the liver result. Hsematuria 

 may be present, chiefly at the end of micturition, owing to 

 pressure exerted by the contracting bladder. 



Worms. The common round worms are practically confined to 

 the intestinal tract, being inhabitants of the small gut ; the bowel 

 is sometimes obstructed by tangled masses of these worms. The 

 parasites have a tendency to wander, and are especially prone to 

 insinuate themselves into small openings and canals. They have 

 been found impacted in the biliary and pancreatic ducts, have 

 wandered through holes in the bases of ulcers of the bowel, and 

 escaped also through a perforated vermiform appendix. They 

 have crawled into the oesophagus, or been ejected from the 

 stomach and so made their way into the larynx, trachea and 

 bronchi, into the accessory sinuses of the nose, and even into the 

 Eustachian tube and middle ear, escaping through a ruptured 

 tympanic membrane. By passing through adherent perforated 

 bowel they may reach cavities with which the latter has no 

 normal communication, such as the urinary bladder. The worms 

 are sometimes found in abdominal abscesses, having reached 

 them from the bowel, or possibly, in those which point at the 

 umbilicus, along a patent Meckel's diverticulum. Wandering 

 from the anus they have been known to find their way into the 

 neighbouring vagina. 



Thread worms are said mostly to congregate in the caecum 

 and ascending colon ; they have been found in numbers in the 

 vermiform appendix. The females, migrating towards the anus 

 to deposit their eggs, set up intolerable itching, and by wandering 

 to the vulva irritate that part. They may even enter the 

 bladder by the urethra. As the result of the irritation and 

 consequent scratching, auto-infection occurs, the ova being 

 unconsciously conveyed to the mouth by the fingers and 

 swallowed. 



Whip worms, like thread worms, favour the caecum and bowel 

 in its immediate neighbourhood. 



The parasites of anklyostomiasis gain access to the body by the 

 mouth and possibly through the hair follicles of the skin in those 



