462 The Philippine Journal of Science ms 



The above findings, coupled with the advanced inflammatory 

 reaction of the tissue involved, afford us no scientific basis upon 

 which we might determine the exact location of the eggs in 

 spite of the fact that serial sections were made of the affected 

 area. It is probable that they were confined originally within 

 the portal area and that the inflammatory process and necrosis 

 extended afterwards into the parenchyma of the liver tissue. 

 This explanation is more or less in harmony with the observa- 

 tions of several authors who found ascarides very frequently in 

 the intrahepatic bile ducts; and, although in the present case 

 the worms were not found in the bile ducts on the autopsy table, 

 the cellular infiltration and fixed tissue reaction of the portal 

 areas as found microscopically are factors that can be taken into 

 consideration, and they perhaps explain within certain limits 

 the result of the migration of the worms into the interlobular 

 bile ducts. 



On the other hand, the extensive productive inflammation and 

 the necrosis around the ova can be interpreted as due not only 

 to a simple mechanical factor (as any other foreign body) , but 

 probably also to the presence of some substance secreted by the 

 worms. In this connection we might mention the names of Shi- 

 mamura and Fujii who have isolated from the horse ascaris a 

 toxic substance which consisted of a mixture of albuminoses 

 and peptone that gives rise to toxic symptoms when injected into 

 the horse. 



DISCUSSION 



The peculiar location of these eggs naturally raises the ques- 

 tion as to how they happen to be deposited there. The absence 

 of ascaris in any part of the alimentary tract and accessory 

 organs at autopsy precludes the possibility of any post-mortem 

 oviposition in that locality by migrating ascarides. The advanced 

 tissue reaction of the part involved and the advanced stages 

 of segmentation that the eggs have undergone, taking into con- 

 sideration the relatively short time that elapsed between death 

 and autopsy, support this view. Because of these facts we are 

 inclined to believe that they must have been deposited ante 

 mortem, previous to admission, in as much as there was no 

 history of the passage of ascaris during the patient's stay in the 

 hospital and no ascaris was encounted during autopsy. 



Migration of ascarides into the common bile ducts and thence 

 into the gall bladder or into the intrahepatic bile ducts has been 

 frequently reported, and verified by frequent findings at opera- 

 tion or autopsy. 



