SUPPLEMENT 695 



been described as occurring in the intestinal mucosa. Oxyuridcv 

 may also give rise to prolapse of the anus, either by the tenesmus 

 they bring about having such a prolapse as its direct sequel, or the 

 proctitis that supervenes constituting a further etiological factor for 

 its occurrence (Ungar 1 ). Anal nstulae which still further increase 

 the trouble, and even rectal listulae, appear to be capable of onset in 

 consequence of the irritation of the mucosa brought about by Oxy- 

 nridce. (Trendelenburg 2 ). The conditions recorded by von Wagener 3 

 and Ruffer 4 appear to be of interest. At the posl-moitein on a child, 

 aged 5, the former found fifteen to twenty quite minute nodules on 

 some Peyer's patches, and in several of these Oxyuridcc were found 

 upon microscopical examination between the calcareous concretions 

 within the patches. He presumes that the parasites penetrated the 

 follicular ulcers, and after healing of the latter that they died and 

 became calcified. In the case of a man who died from cirrhosis 

 of the liver, Ruffer found in the rectum, at a distance of about 6 in. 

 from the anal orifice, several tumours covered by the intestinal 

 mucosa, the smallest of which was the size of a pin's head and the 

 largest that of a walnut. The tumours looked like calculi overgrown 

 by connective tissue ; under the microscope, countless Oxyuridcv ova 

 were found in their interior. 



The symptoms of irritation set up by these migrations from the 

 intestine are troublesome to the last degree ; the pruritus thereby 

 induced is often unendurable ; as this irritation from itching comes 

 on with especial severity during the night, the night's rest is grievously 

 interfered with ; many attacks of night terrors appear to be occasioned 

 by these worms. But the general condition suffers as well ; the 

 children become pallid and affected with nervous excitability. 

 Through the act of scratching the irritated parts the ova of the 

 parasites may be conveyed by contaminated fingers directly into the 

 oral or nasal cavities, certainly also into the oral cavity by the 

 contamination of food (auto-infection). In the case of boys the 

 sexual organs may be excited sympathetically through irritation of 

 the sacral nerves of the rectum ; girls may be induced to practise 

 onanism in consequence of the entrance of the worms into the vulva. 



As a result of the itching irritation which the scratching gives rise 

 to, and of the irritation due to the parasites migrating to the area 

 surrounding the anus, congestion and inflammatory symptoms may 

 arir^e in the peri-anal and perineal regions (weeping eczema, Seifert), 5 



1 Ungar, see Seifert, " Lehrbuch der Kinderkrankh.," p. 246. 

 - Trendelenburg, see Seifert, idem. 



3 von Wagener, Deutsch. Arch. f. kliti. J\Ied.> Ixxxi. 



4 Ruffer, Brit. Med.Jonrn., 1901. 



;> Seifert, " Lehrb. d. Kinderkrankh.," and Lesser's "Encyklop. d. Haut-u. Gescblechts- 

 krankh.," p. 373. 



