THE ASCARIS LUMBRICOIDES. 97 



intestme is very small. Should they find their way 

 back again into the intestine the real cause of the 

 inflammatory symptoms which they had produced 

 whilst m the ducts, might be suspected if the jaun- 

 dice and other symptoms had disappeared suddenly, 

 and if their disappearance had been accompanied, or 

 soon followed, by the expulsion of a round- worm, 

 either by vomiting or with the evacuations. 



Lumbrici may also pass out of the intestine 

 through passages which are accidentally formed, 

 owing to gangrenous destruction or to ulceration of 

 a portion of the intestine. After their escape from the 

 intestme they may enter the cavity of the peritoneum, 

 or one of the abdominal viscera, such as the bladder, 

 or the substance of the abdominal walls, or some 

 adventitious cavity ; or else they may arrive imme- 

 diately at the exterior of the body, if the perforation 

 of the intestine happen to communicate with a 

 fistulous opening externally. 



When the worms escape into the peritoneal cavity, 

 peritonitis commonly superv^enes, and the patient 

 dies very shortly. The absence of these results in a 

 few cases which have been recorded was most pro- 

 bably due to the circumstance that the lumbricus 

 did not pass out of the intestme into the peritoneum 

 until after the death of the persons in whom they 

 were found upon a post-mortem examination. 



When the lumbrici traverse the abdominal walls 

 after leaving the intestine, they usually emerge at 

 some point near to the umbilicus ^ or to the groin ; the 



^ The cases in "wbich lumbrici have issued through the abdo- 

 minal walls near the umbilicus have most frequently occurred in 

 yovmg children, a circumstance which serves to show the connec- 



H 



