ASCAEIS LUMBRICOIDES. 417 



In this case there is no formation of fistula. At other times the 

 fistula may still be produced, or the worm may arrive in the 

 bladder by vesicointestinal fistulas, in the vagina by intestino- 

 vaginal fistulae, or in the ovaries by ovarian fistulse, and be found 

 in these places on dissection, or pass out from them. Lastly, 

 having got access to the free abdominal cavity, it may become 

 encysted there, and form an encysted abscess ; or it may reach 

 the cavity of the pleura by adhesions of the intestine and dia- 

 phragm, and the formation of a communication in this way, or 

 through abscesses of the liver which perforate towards the pleura, 

 just as well as by penetrating wounds. The experienced will know, 

 that the wanderings of the worms after the death of the patients, 

 must be well distinguished from this. Bat the worm can never 

 actively bore through the healthy intestine. For this it is rendered 

 unfit by the structure of its head and its thin lips, which are cer- 

 tainly adapted for suction, but not for boring. I express this 

 opinion without hesitation, although I stand again in opposition 

 to the authority of Von Siebold and that of Mondiere, who assert 

 that the worms are able to force asunder the fibres of the intes- 

 tine with their resistant heads, and agree exactly with lludolphi, 

 Bremser, Rokitansky, and Bamberger. 



Finally, let us refer to the symptoms which are produced by 

 the Ascarides whilst remaining within the intestine. Starting 

 from the above points of view, we shall be in a position to com- 

 prehend the whole series of the direct mechanical and reflex 

 symptoms; these are the phenomena of an ordinary catarrhal 

 affection of the stomach and intestine, from its lowest to its 

 highest degrees, with all its consequences upon the general health, 

 the general alimentation and the nervous system. For the phy- 

 siological practitioner it suffices for the prognosis and treatment 

 which will always be introduced when a conviction is obtained of 

 the presence of the worms by their passage out. Amongst the 

 reflex phenomena we have especially to mention, without 

 particular reference to the species of worm, the collection of 

 water in the mouth, yawning, hiccough, and snuffling in the 

 nose. Their presence is not to be denied, but the latter pro- 

 bably rather belongs to the issuing proglottides of Taenia and 

 Oxyurides, which tickle the anus, than to the Ascarides living in 

 the middle of the intestine. But in this case still more common 

 observations must be made. It is very difficult to say whether 

 Ascarides can produce intestinal catarrhs, or whether they only 



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