272 
A Cause of Appendicitis 
itself and the appendix (like a finger in a glove) around the intestine as 
to cause an obstruction : Page (1906) records an operation on a man in 
whom appendicitis had been diagnosed, which revealed a number of 
Ascarids in the body cavity, and the specimens of this worm continued 
to make their way through the wound even eight days after the opera¬ 
tion : other cases might be quoted, but I think enough has been said to 
show that in some cases Ascaris lumbricoides is an etiological cause of 
appendicitis and peritonitis. 
Trichocephalus trichiurus (Linnaeus, 1771 x ). 
Of all the common parasites in the human alimentary canal this is 
the one most generally recognized as causing appendicitis. Its normal 
habitat is the caecum and the colon, but it is found, though more 
rarely, in the vermiform appendix and in the small intestine. It occurs, 
with the exception of sucklings, in persons of all ages. It is cosmo¬ 
politan in its distribution, but is less common in the colder regions, 
though common in temperate climes. Braun (1908) states that 
dissection shows it to be present in the body in the following per cent, 
of those investigated in various places: Kiel 31'8°/ 0 , Munich 9'3°/ 0 , 
Gottingen 46'1 %, Basle 23’7 °/ 0 , Greenwich 68°/o. Dublin 89 °/ 0 , Paris 
about 50°/o> and in Southern Italy almost 100 °/o of the people are 
infected. Its presence as determined by the presence of the eggs in the 
faeces gives—where they are comparable—slightly different figures : 
Kiel 45'2°/o, Munich 8'26°/o> London 7’8°/o and Switzerland over 50°/ 0 1 2 . 
Although the worm has been known, at least since the time of 
Linnaeus, but little has been done until recently to investigate its 
relations with the wall of the alimentary canal in which it lives. 
Askanazy (1896, p. 104) found that the T. trichiurus fed upon blood 
and that the only means of getting its food must be by piercing the 
mucosa. Wichmann (1889) made a painstaking examination of the 
subject, and his conclusions were that although the worm was so 
1 = T. dispar Rudolphi, 1801. 
2 These statistics date from some years ago and are probably not accurate for the 
present date. More recently French and Boycott (1905) found 7'8 % of infection in 500 
in-patients of Guy's Hospital, varying in age from a babe to over seventy. 84 °/ 0 of 
infections fell between the ages of five and forty, and of the patients examined between 
these years 11-75 °/ 0 were infected. I feel bound to add that in the opinion of these 
observers their research affords no support “ to the notion that Trichocephalus has any 
aetiologieal relationship to appendicitis.” 
