In the treatment of oxyuriasis, always a difficult task, the physician must first of all prevent (1) the constantly recurring self-inocu lation of the patient with oxyuris eggs, by the exercise of the most rigid cleanliness—repeated cleansing of the hands, with removal of the dirt under the finger-nails; sleeping with tights and gloves; and a morning bath or, at least, careful washing of the anus and genitalia. (2) The sexually ripe female worm must be removed from the rectum by injections. The usual cleansing enemata must be given daily for several weeks and medicated injection given twice a week, and always after a cleansing enema. As medicaments, one to two tablespoonfuls of vinegar, glycerin, lime-water, or salt solution inay be added to one quart of water. Do not use carbolic acid or corrosive sublimate injec tions. (3) Internally, we can give santonin, as in the treatment of round worms; or naphthalin (according to Ungar).
An eight-day interval must follow; then the cure is repeated once or twice at two tveeks intervals. On account of the solubility, of the naph thalin, the use of fats, butter, and oil during the naphthalin cure must be avoided; otherwise strangury may be caused. (4) The destruction of the oxyuridcs present in the rectum or those that have wandered out. This is accomplished by the use of mercurial suppositories or salves applied about the anus. For the latter purpose, the citrine ointment diluted half with vascline may be used. In obstinate eases, one should investigate all the members of the family and institute treatment in all those found infeeted. The only prophylaxis is in maintaining absolute cleanliness, as is evident from our knowledge of the life-conditions of the parasite and its modes of infecting the organism.
3. The Trichorephalus dispar (whip-worm) is named from the thin head and neck, which are about two-thirds the length of the body. The mouth, which is at one end of the intestinal canal, has no booklets. In the posterior third of the body are the sexual organs. The tricho cephalus attaches itself very firmly to the intestinal wall, principally in the cecurn, and less often in the colon or small intestine. It penetrates very deeply into the mucous membrane.
The male is three to three and a half centimetres long. The pos terior part of the body is usually curved in on itself; and a hairy spicule projects from the cloaca, the sexual organ. The posterior part of the female, which is three and a half to four and a half centimetres long, is always straight. The sexual opening is in the anterior part of the thick bod3-. The eggs, 0.03 nun. long to 0.02 nun. broad, are long and oval, and have a smooth brownish envelope and a cork-like closure at each end. The embryo develops very slowly and shows great resistance
to external influences. The yolk and the developed embryo are not injured by prolonged immersion of the eggs in water; so that, besides earth, dirty water plays a part in the conveyance of this parasite.
The diagnosis of triehoeephalus is always casy. We find the char acteristic eggs, which are often associated with other worms, especially the ascaris.
The symptoms of the presence of trichocephalus are by no means definite. Besides a series of nervous symptoms, severe forms of enteritis have been observed when the trichocephali were present in large num hers. Of late, Girard has brought trichocephali into etiological rela tion with appendicitis. The parasite has the reputation of being hard to remove; but Leichtenstern mentions that he has seen individual triehoeephalus worms: passed after cures with extract of filix mas and thymol, anchylostornum clisease. Benzine 110.6 also been recommended. The prophylca is is similar to that for round W01112S.
4. Anchylostomu»t duodenale (Dochmiu$ duodenalis). —This para site deserves our attention, since its presence in children and youthful persons has often been determined; though it more particularly attacks day laborers that work in mountain and tunnel excavation, quarry workers, and tillers of the soil. The male is eight to ten nun. long. The female is ten to twelve mm. long and 0.5 rnm. thick (Fig. 43). The mouth has hooklike teeth; through the grayish white body, the intestinal canal, which is filled with blood. shines. The posterior part of the body of the male shows an evident broadening, from the presence of a bursa copulatrix (Fig. 43, b). The worm chiefly inhabits the duodeuum and the upper ileum. The oval eggs arc 0.05 to 0.00 min. long, and 0.035 rum. broad: and are enveloped by a tender membrane. In fresh preparations froni the feces, different stages of cleavage of the yolk are usually present iFig. 44). In a few days after the evacuation of the feces, the ernbryo is formed. It soon escapes into the larval stages and grows to a length of 0.5 min. and a thickness of .02 lom. In this stage, it becomes encysted. The outer coat of the larva becomes ele vated; and between this and the new skin, a hyaline globule collects. The latter protects the larva from desiccation and from the action of water. Thc larvie are usually taken into the system through the drinking water. Looss and other authors have ascribed anehylostomurn disease to penetration of the larvai through the skin. Pieri doubts this.