Fig. 45.—Head of Oxyuris vermicularis. Highly magnified. After Busk.
Oxyuris vermicularis, Bremser.—Of all the parasites infesting the human body this is the one concerning which the medical practitioner is most frequently consulted, partly on account of its remarkable frequency in children, and more particularly on account of the difficulty often experienced in getting permanently rid of it. The Oxyuris vermicularis is by no means confined to young persons, seeing that adults are infested even to old age. It is familiarly known as the threadworm or seatworm. The male measures about 1/6″, and the female from 1/3″ to 1/2″ in length. The female possesses a long capillary tail, which terminates in a three-pointed end. The extremity is said to act as a kind of holdfast. The tail of the male is obtusely pointed. In both sexes the body presents a more or less fusiform shape, the anterior end being narrowed to form a somewhat abruptly-truncated head, which is often rendered very conspicuous by a bulging of the transparent integument surrounding the mouth. This presents in profile the aspect of winged appendages (fig. 45). The oral opening is tripapillated, leading into a triangular œsophagus. The integument is transversely striated, and of a silvery-white appearance. The spicule is simple, single, and very minute. The eggs are oblong and unsymmetrical. They measure about 1/900″ from pole to pole, and 1/1400″ transversely.
Fig. 46.—Section of a female Oxyuris vermicularis, magnified 220 diameters (after Busk); and also several free eggs (original). a, With an imperfectly formed embryo; b, c, d, with three tadpole-shaped embryos, magnified 450 diameters.
Many years back (1863) I pointed out that the most advanced eggs whilst still within the body of the pregnant female contained tadpole-shaped embryos, and about the same time the fact was noticed by Claparède. In his beautiful and scholarly memoir, ‘De la formation et de la fécondation des œufs chez les vers Nématodes,’ he wrote concerning the ova as follows:—“The egg, which exhibits the form of a very narrow disk in the ovary, acquires the shape of an elongated ellipsoid in the oviduct, and at the surface differentiates itself into a very thick vitelline membrane. Then it forms a strong and resisting chorion, which imparts to the egg an outline similar to that of a bridge’s span. It has an oval figure flattened at one of its sides. This chorion is very fragile; it frequently gives way under slight pressure from the thin plate of glass which covers the object. It extends itself considerably under the action of acetic acid, acquiring a size three or four times greater than that of the egg. The constitution of this chorion is perfectly identical in the eggs both before and after impregnation. It is, nevertheless, easy at first sight to know whether or not we have to deal with a fecundated egg. In the impregnated females the uteri are filled with thousands of ova, each one of which encloses an embryo already well formed. The ventral surface of the embryo and the tail are, without exception, applied to the flattened side of the egg. The embryo is very broad in the body, and occupies all the interior space. An embryo such as Küchenmeister has represented under the form of a small filiform worm folded on itself, and only occupying a very small part of the cavity of the egg, is never to be seen. In the non-fecundated females, on the other hand, the uteri are filled with eggs, which, instead of the embryo, enclose a non-segmented yolk furnished with a large germinal vesicle. This vesicle is not visible so long as the eggs have the form of thin disks; it only shows itself when the eggs begin to acquire an elliptical form in the oviduct. It is, however, probable that this vesicle is the same which was originally visible in the ovary.” The chorion itself is homogeneous, but in an allied species (Oxyuris spirotheca) Gyoery and Claparède found that this egg-covering consists of spirally-coiled bands resembling the tracheal spiral fibre of an insect. Under suitable conditions the tadpole-shaped embryos rapidly assume a vermiform character. The investigations of Leuckart have shown that “one only needs to expose the eggs to the action of the sun’s rays in a moistened paper envelope when, at the expiration of five or six hours, the tadpole-shaped embryos will have already become slender elongated worms.” According to Heller, the simplest way to rear the vermiform stage of Oxyuris is to put a number of the eggs in a glass tube filled up with saliva. The tube should then be placed in the arm-pit, in which situation it can be carried about with little inconvenience. In a few hours the transformations will commence and go on continuously until the vermiform condition is attained. If, as remarked in my ‘Lectures,’ it be asked whether the embryos which have escaped into the bowel are capable of arriving at the vermiform stage, the answer is in the affirmative; for, as Leuckart says, “the elongated embryos are to be found not only in the fæces but also in the mucus of the rectum above and around the anus.” Vix has also asserted that free vermiform embryos are occasionally to be detected in the intestine of the human bearer along with the eggs; this hatching within the lower bowel, however, must, in my opinion, be regarded as exceptional. Heller is of the same opinion. According to Leuckart, the escape of the embryos from the eggs “ordinarily takes place under the action of the gastric juice, also primarily in that condition when they have by some means or other gained access to a new bearer.” Prof. Leuckart and three of his pupils courageously infected themselves by swallowing the eggs, and had the satisfaction of observing young Oxyurides in their stools fifteen days afterwards.
Fig. 47.—Adult male Oxyuris vermicularis. Magnified. After Küchenmeister.
From the united labors of Professors Zenker and Heller it is now rendered certain that all the further changes necessary to bring the larvæ to sexual maturity are accomplished within the small intestines of the human bearer; and it is not necessary that a change of hosts should occur at any time during the life of the parasite. Infection ordinarily takes place by the accidental and direct conveyance of the eggs that are lodged in the neighbourhood of the victim’s anus to the mouth. Since the victim may accomplish this during sleep, it is not in all cases fair to charge infected persons with uncleanliness. On the other hand, it too often happens that due care in this respect has not been exercised, and from such persons you may remove the eggs of Oxyurides from the margins of the finger nails. One aristocratic person, who was infested by myriads of these entozoa, confessed to me that in his extreme distress, and consequent rage, he had freely bitten the live worms in halves between his teeth. He had thus exposed himself to a terrible revenge, since multitudes of the ova entering his mouth subsequently found their way into the stomach and intestines. By whatever mode the eggs are conveyed to the mouth their subsequent passage to the stomach ensures their being hatched. In the duodenum and other divisions of the small intestines, as Zenker and Heller have shown, the embryos undergo transformation, casting their skins, and growing with great rapidity. Probably not more than three weeks or a month is necessary to complete their growth. Heller obtained mature worms from an infant only five weeks old. Finally the worms are transferred to the cæcum, which constitutes, so to speak, their headquarters. It is an error to suppose that the lower bowel or rectum forms their especial habitat, nevertheless the most approved manuals, vade mecums, and general treatises have for a long time supported this erroneous view. The error had been pointed out by Stricker in 1861.
The symptoms produced by Oxyurides are occasionally very serious. In the mildest cases they have a tendency to undermine the health. As remarked in my ‘Entozoa,’ the unpleasant sensations chiefly develop themselves in the evening and at night, consisting for the most part of feelings of heat and irritation within and around the margin of the anus. The symptoms may become extremely distressing and almost intolerable, especially when the itching extends to the genito-urinary passages, in consequence of the escape and migration of the parasites about these parts. By-and-by various sympathetic phenomena, such as restlessness, general nervousness, itchings at the nose, involuntary twitchings, grinding of the teeth during sleep, chorea, convulsions, and even epileptiform seizures, may supervene. At the age of puberty special local disorders arise, the nature of which will be readily understood when merely spoken of as the morbid phenomena of sexual irritation. In the female the occurrence of pruritus and leucorrhœa is not uncommon, accompanied or not, as the case may be, with hysteria in various forms. There is usually general asthenia, with more or less emaciation. The anæmia is sometimes remarkable, but in place of anorexia, which is, however, an occasional symptom, one frequently finds a most voracious appetite, especially in young people. Sometimes there are obscure symptoms simulating those of local organic disease.