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A comparison of gentian violet and hexylresorcinol in the treatment of pinworm infestation
A COMPARISON OF G E N T I A N V I O L E T AND t t E X Y L R E S O R C I N O L I N T H E T R E A T M E N T OF P I N W O R M I N F E S T A T I O N HOWARD •.
EVANS,
M.D.,
AND ~-IALCUIT MOORE,
M.D.
DALLAS, TEX A S
the past few years numerous investigations have proved D URING the high incidence of pinworm infestation in various parts of the United States and Canada. 1-~ It is only n a t u r a l t h a t m a n y types of t h e r a p y have been advocated f o r the eradication of this intestinal parasite. 4 Of the different forms of treatment proposed, two have app a r e n t l y given outstanding success, hexy]resorcinol (caprokol pi]ls~) 5 and gentian vio]etf, 7 Considerable impetus to the use of gentian violet followed the i n t r o d u c t i o n of an enteric coating (seal-inM) which does not release the drug until four and one-half hours a f t e r being swallowed, thus avoiding most of the gastric irritation 9 Reports on the use of hexylresorcinol 4, 5 and other reports on the use of gentian violet ~, 7 ind:icate that these two drugs are effective in a f a i r l y high p e r c e n t a g e of cases in the eradication of Enterobius (Oxyuris) vermi-
cularis. I n order to compare the effectiveness of these two drugs in the treatment of p i n w o r m infestation, a group of children in an orphans' home was selected. The superintendent of the institution and each member of the staff were unusually cooperative; t h e r e f o r e we were able to nlake a much more careful and intensive s u r v e y t h a n ordinarily would have been possible 9 A p p r o x i m a t e l y 100 individuals were included in this study. T h e y r a n g e d in age from 6, months to 23 years, the majority being between the ages of 8 and 14 years. T h e r e was some change in the p o p u l a t i o n u n d e r s t u d y during the time of the s u r y e y due to the f a c t t h a t some children left the institution and new children were admitted. The children of school age a t t e n d e d public schools, and children of all ages were allowed to visit f r e q u e n t l y in private homes. -In spite of the fact t h a t the group did not constitute an absolutely closed poPUlation , the use of a group of institutionalized children permitted r e l a t i v e l y close supervision over the driagnostic tests, administration of therapy, and post-treatment check-up to ascertain the result of t r e a t m e n t . 1V[ETHOD OF STUDY
The Children were examined by means of a modification of the N I H cellophane swab technique s as follows: Cellophane of the nonwaterF r o m the D e p a r t m e n t of I ' a r a s i t o l o g y a n d the D e p a r t m e n t of P e di a t ri c s , B a y l o r U n i v e r s i t y College of 1V~edicine. 9 *The Calorokol pills used in this i n v e s t i g a t i o n w e re k i n d l y f u r n i s h e d by the ~Sharp & Dohme Co. r g e n t i a n v i o l e t S e a l - I n s used in t h i s i n v e s t i g a t i o n w e re k i n d l y f u r n i s h e d by t he SeaI-Ins L a b o r a t o r i e s , Inc. 627
628
THE
J O U R N A L OF P E D I A T R I C S
p r o o f type was cut into strips slightly smaller t h a n the size of standard slides, and one of these strips was w r a p p e d around the smooth end of a glass rod. A f t e r swabbing the p e r i a n a l region, the cellophane strip was r e m o v e d f r o m the glass rod, placed on the slide with the clean surface of the cellophane uppermost, and then secured with a gummed label on which the name of the child was written. Each child was swabbed in this manner on seven consecutive mornings as soon as he got out of bed, before having a bath or a stool No child was considered free of pinworm infestation until seven negative swabs were obtained. During the course of the survey, at ]east three stool specimens f r o m each child were obtained an~ examined f o r ova. l~ESULTS
OF
SURVEY
One h u n d r e d and two children were examined, and 80 (78 per cent) were f o u n d to be infested with Enterobius vermiculcris. I t is significant t h a t routine stool examination revealed only four of this group to have this parasite. Signs and Symptoms.~All the children were questioned as to various signs and symptoms which might be the result of pinworm infestation, and the matrons in charge of each group of children were questioned also to gather the same information. The signs and symptoms searched f o r were as follows : loss of weight, pallor, anorexia, pruritis, enuresis, vaginitis, nausea, vomiting, and restlessness. Ten of the girls did have vaginitis, which in e v e r y instance was relieved d u r i n g the subsequent t r e a t m e n t for pinworm infestation. The other signs and symptoms occmTed ~o i n f r e q u e n t l y or were so vague that it would be difficult to a t t r i b u t e them to pinworm infestation. TREATMENT
The 80 infested children were divided into two equal groups comparable as to age and sex. One group was t r e a t e d with hexylresorcinol (caprokol pills) in a dose of 12 rag. per pound of body weight, the m a x i m u m single dose being 1 Gin. This d r u g was given once a week f o r five consecutive weeks. I t was administered in the morning and the p a t i e n t was encouraged to d'rink two glasses of water. No breakfast was allowed, and nothing except w a t e r was p e r m i t t e d for the n e x t five hours. This period of fasting is necessary to minimize vomiting. The other group was t r e a t e d with gentian violet (seal-ins) having the f o u r and one-half hour timed enteric coating. The dosage used was 1 rag. p e r pound of body weight per day, this dbsage being divided into three approximatel2~ equal doses and administered t h i r t y minutes before each of the three meals. This a d j u s t m e n t of the size of the three doses was simplified b y the use of two sizes of gentian violet pills, one which contains 3/2o gr. (10 rag.) and the other which contains ~ gr. (32 rag.). The drug was given e v e r y day in this m a n n e r for one w e e k ; then a rest period of one week was, allowed, followed b y a
EVANS AND MOORE:
G E N T I A N V I O L E T AND H E X Y L R E S O R C I N O L
629
week of t r e a t m e n t , then a n o t h e r rest l~eriod of one week, and finally a t h i r d w e e k of t r e a t m e n t . Thus the entire course of the t r e a t m e n t covered five weeks. No enema t r e a t m e n t was included in our regime, because we w e r e p r i m a r i l y i n t e r e s t e d in c o m p a r i n g the efficacy of the two d r u g s w h e n orally administered. REACTIONS TO DRUGS I n one case t r e a t e d with hexy]resorcinol, the child chewed the pill and this resulted in a phenol-like b u r n of the buccal mucous membrane, which f o r t u n a t e l y caused v e r y little discomfort. I n eight of the f o r t y cases given hexylresorcinol, there were nausea and v o m i t i n g of considerable degree. The dosage was r e d u c e d in these eight, and f o u r of these children were continued on the same d r u g with no f u r t h e r trouble. Because of persistent nausea even on the reduced dose of hexylresorcinol, the other f o u r children were shifted to gentian violet t r e a t m e n t , which was well tolerated. There were v e r y few reactions in the group t r e a t e d with gentian violet. Only one child out of the f o r t y giverL this d r u g h a d nausea and vomiting. Two other children suffered only nausea. These three child r e n were c o n t i n u e d on gentian violet t h e r a p y in the same dosage and had no f u r t h e r n a u s e a or vomiting. There were no other complaints a t t r i b u t a b l e to the gentian violet medication. Therefore, only 7.5 per cent of the children t r e a t e d with gentian violet w e r e b o t h e r e d b y the drug, and in each case continuation of the d r u g in the same dosage caused ~o f u r t h e r reactions. The dose we used was I rag. p e r p o u n d of b o d y w e i g h t p e r day. This is different f r o m the scheme a d v o c a t e d b y W r i g h t a n d B r a d y s and employed b y other i n v e s t i g a t o r s ; namely, s~ o gr. (10 rag.) f o r each y e a r of a p p a r e n t age. W e have p u r p o s e l y given our g r o u p of children this r e d u c e d dosage ( a p p r o x i m a t e l y 25 p e r cent less t h a n is usually administered) because we desired to reduce the incidence of gastrointestinal irritation. T h a t we succeeded in doing this is shown b y the low incidence (7.5 p e r cent) of nausea and vomiting, m o s t of which w a s of only slight degree, in c o n t r a s t to the incidence of 23 p e r cent r e p o r t e d b y W r i g h t and B r a d y . RESULTS OF TREATXVIENT I n order to d e t e r m i n e the efficacy of this p l a n of t r e a t m e n t , a 1oeriod of f o u r weeks was allowed to elapse a f t e r the date of the last t r e a t m e n t . Then a second series of seven anal swabs w a s e x a m i n e d f r o m the whole group, including t r e a t e d a n d u n t r e a t e d children. This i n t e r v a l of f o u r weeks was selected so t h a t in a n y p a t i e n t not c o m p l e t e l y f r e e d of pinw o r m s t h e r e w o u l d be time for the r e m a i n i n g p i n w o r m s to m u l t i p l y and deposit ova a t the anus. Of the original f o r t y cases receiving each drug, some h a d m o v e d a w a y f r o m the institution a n d were not available f o r re-examination. As shown in Table I, g e n t i a n violet medication was effective in curing 74.3 p e r cent of the children to w h o m it
630
THE JOURNAL OF PEDIATRICS
was given, and hexylresorcinol was successful in 50 per cent of the children to whom it was administered. The a r b i t r a r y criterion of cure we adopted is that a patient have seven consecutive negative anal swabs. The f o u r children who suffered f r o m nausea and vomiting when given the hexylresorcinol and who were given the routine dose of gentian violet are not included in Table I. All f o u r were cured of Enterobius infestation. I f these are included with the gentian violett r e a t e d cases, we have t h i r t y cures among the thirty-nine t r e a t e d with this drug, or 77 per cent cures. TABLE I CHILDREN TI%EATED WITII tIEXYLt~ESORCINOL N u m b e r of Cases N u m b e r of Cases. N e g a t i v e on P o s t - T r e a t m e n t Swabs P e r c e n t a g e of Cures
34 17 50% L
CttIL])t~EN TREATED WITH GENTIAN V~OLET N u m b e r of Cases 35 N u m b e r of Cases N e g a t i v e on P o s t - T r e a t m e n t S w a bs 26 P e r c e n t a g e of Cures 74.3%
At this examination, four of the eighteen children who had previously shown seven consecutive negative swabs were positive. Also, nine new children who had been a d m i t t e d to the institution during this interval were examined, and six of these nine showed pinworm ova. This is evidence that infestation is constantly taking place and that t h e r e is ample o p p o r t u n i t y for the entire population of the institution to become reinfested, in spite of the large n u m b e r of children whom the medication a p p a r e n t l y cured. DISCUSSION
This survey of an orphans' home confirms the findings of investigators in various parts of t h e c o u n t r y t h a t infestation with Enterobius vermicularis is v e r y common, that either hexylresorcinol or gentian violet m a y be used to eradicate the parasites from the intestinal tract, and t h a t reinfestation occurs with ease. Such reinfestation can occur even in an institution where considerable attention is paid to cleanliness, as is the Case in the home where this investigation was carried out.
W e believe t h a t gentian violet medication causes considerably less nausea an8 vomiting than hexylresoreinol and is easier to administer. I t does not inconvenience the patient as does the five-hour fast imposed upon him a f t e r taking hexy]resorcinoL The percentage of cures a f t e r giving gentian violet was 77 per cent; after hexylresorcinol it was 50 per cent. The reduction in the dosage of gentian violet proved to be a sound policy, as reactions were i n f r e q u e n t and the percentage of cures was high. I t may well be that the success of this regime of t h e r a p y is p a r t l y a t t r i b u t a b l e to the e x t r a week of t r e a t m e n t . Because of the ease with which reinfestation takes place, it is not such a radical policy to t r e a t e v e r y m e m b e r of a household where any
EVANS AND i~IOORE:
GENTIAN u
AND HEXYLRESORCINOL
~1
one member is k n o w n to have enterobius infestation. Likewise, it may be necessary to r e p e a t the t r e a t m e n t some weeks or months later. ]n institutions the only means of control of the infegtation would be periodic repetition of the treatment. E x c e p t f o r a few instances of vaginitis, the signs and symptoms usually a t t r i b u t e d to pinworm infestation were not observed to a significant degree in this group of children. CONCLUSIONS
1. Seventy-eight loer cent of the individuals in an orphans' home were found to be infested with pinworms (Enterobius vermicularis). 2. The value of the N I I t cellophane swab m e t h o d of diagnosis was clearly evident, and the failure to discover ova of this parasite by routine stool examination was demonstrated. 3. P a t i e n t s seemed to tolerate gentian violet b e t t e r than they did hexylresorcino]. 4. Smaller doses of the drugs were given over longer periods of time with considerably less reactions, than previously reported. 5. Gentian v i o l e t ' w a s effective in 77 per cent of the cases; hexylresorcinol was effective in 50" per cent. 6. The ease with which reinfestation may occur was demonstrated. REFERENCES ]. 2. 3. 4. 5. 6. 7. 8.
Cram, Eloise B., and Reardon, Lucy: Am. J. Hygiene 29: 17, ]939. Sawitz, W., D'Antoni~ J. S., ]~hude, X., and Lob, S.: South. M. J. 33: 913, 1940. XV[iller, D/lax J., and Choquette, L.: Canad. !VL A. J. 43: 453, 1940. W r i g h t , W. tt., Brady, Y. J., and Bozicevich, J.: Pub. H e a l t h Rep. 54: 2005, 1939. Craig, C. F , and Faust, E. C~: Clinical Parasitology, Philadelphia, 1937, Lea & Febiger, p. 281. W r i g h t , W. I-L, and Brady, F. J.: J . A . M . A . 114: 861, 1940. D ' A n t o n i , J. S., a n d Sawitz, Willi: Am. J. Trop. IVied. 20: 377, ]940. tIal], !~[. C.: Am. g. Trop. Med. 17: 445, 1937. 3301 JUNIUS ST. 4105 LIVE OAK ST.
EVANS,
M.D.,
AND ~-IALCUIT MOORE,
M.D.
DALLAS, TEX A S
the past few years numerous investigations have proved D URING the high incidence of pinworm infestation in various parts of the United States and Canada. 1-~ It is only n a t u r a l t h a t m a n y types of t h e r a p y have been advocated f o r the eradication of this intestinal parasite. 4 Of the different forms of treatment proposed, two have app a r e n t l y given outstanding success, hexy]resorcinol (caprokol pi]ls~) 5 and gentian vio]etf, 7 Considerable impetus to the use of gentian violet followed the i n t r o d u c t i o n of an enteric coating (seal-inM) which does not release the drug until four and one-half hours a f t e r being swallowed, thus avoiding most of the gastric irritation 9 Reports on the use of hexylresorcinol 4, 5 and other reports on the use of gentian violet ~, 7 ind:icate that these two drugs are effective in a f a i r l y high p e r c e n t a g e of cases in the eradication of Enterobius (Oxyuris) vermi-
cularis. I n order to compare the effectiveness of these two drugs in the treatment of p i n w o r m infestation, a group of children in an orphans' home was selected. The superintendent of the institution and each member of the staff were unusually cooperative; t h e r e f o r e we were able to nlake a much more careful and intensive s u r v e y t h a n ordinarily would have been possible 9 A p p r o x i m a t e l y 100 individuals were included in this study. T h e y r a n g e d in age from 6, months to 23 years, the majority being between the ages of 8 and 14 years. T h e r e was some change in the p o p u l a t i o n u n d e r s t u d y during the time of the s u r y e y due to the f a c t t h a t some children left the institution and new children were admitted. The children of school age a t t e n d e d public schools, and children of all ages were allowed to visit f r e q u e n t l y in private homes. -In spite of the fact t h a t the group did not constitute an absolutely closed poPUlation , the use of a group of institutionalized children permitted r e l a t i v e l y close supervision over the driagnostic tests, administration of therapy, and post-treatment check-up to ascertain the result of t r e a t m e n t . 1V[ETHOD OF STUDY
The Children were examined by means of a modification of the N I H cellophane swab technique s as follows: Cellophane of the nonwaterF r o m the D e p a r t m e n t of I ' a r a s i t o l o g y a n d the D e p a r t m e n t of P e di a t ri c s , B a y l o r U n i v e r s i t y College of 1V~edicine. 9 *The Calorokol pills used in this i n v e s t i g a t i o n w e re k i n d l y f u r n i s h e d by the ~Sharp & Dohme Co. r g e n t i a n v i o l e t S e a l - I n s used in t h i s i n v e s t i g a t i o n w e re k i n d l y f u r n i s h e d by t he SeaI-Ins L a b o r a t o r i e s , Inc. 627
628
THE
J O U R N A L OF P E D I A T R I C S
p r o o f type was cut into strips slightly smaller t h a n the size of standard slides, and one of these strips was w r a p p e d around the smooth end of a glass rod. A f t e r swabbing the p e r i a n a l region, the cellophane strip was r e m o v e d f r o m the glass rod, placed on the slide with the clean surface of the cellophane uppermost, and then secured with a gummed label on which the name of the child was written. Each child was swabbed in this manner on seven consecutive mornings as soon as he got out of bed, before having a bath or a stool No child was considered free of pinworm infestation until seven negative swabs were obtained. During the course of the survey, at ]east three stool specimens f r o m each child were obtained an~ examined f o r ova. l~ESULTS
OF
SURVEY
One h u n d r e d and two children were examined, and 80 (78 per cent) were f o u n d to be infested with Enterobius vermiculcris. I t is significant t h a t routine stool examination revealed only four of this group to have this parasite. Signs and Symptoms.~All the children were questioned as to various signs and symptoms which might be the result of pinworm infestation, and the matrons in charge of each group of children were questioned also to gather the same information. The signs and symptoms searched f o r were as follows : loss of weight, pallor, anorexia, pruritis, enuresis, vaginitis, nausea, vomiting, and restlessness. Ten of the girls did have vaginitis, which in e v e r y instance was relieved d u r i n g the subsequent t r e a t m e n t for pinworm infestation. The other signs and symptoms occmTed ~o i n f r e q u e n t l y or were so vague that it would be difficult to a t t r i b u t e them to pinworm infestation. TREATMENT
The 80 infested children were divided into two equal groups comparable as to age and sex. One group was t r e a t e d with hexylresorcinol (caprokol pills) in a dose of 12 rag. per pound of body weight, the m a x i m u m single dose being 1 Gin. This d r u g was given once a week f o r five consecutive weeks. I t was administered in the morning and the p a t i e n t was encouraged to d'rink two glasses of water. No breakfast was allowed, and nothing except w a t e r was p e r m i t t e d for the n e x t five hours. This period of fasting is necessary to minimize vomiting. The other group was t r e a t e d with gentian violet (seal-ins) having the f o u r and one-half hour timed enteric coating. The dosage used was 1 rag. p e r pound of body weight per day, this dbsage being divided into three approximatel2~ equal doses and administered t h i r t y minutes before each of the three meals. This a d j u s t m e n t of the size of the three doses was simplified b y the use of two sizes of gentian violet pills, one which contains 3/2o gr. (10 rag.) and the other which contains ~ gr. (32 rag.). The drug was given e v e r y day in this m a n n e r for one w e e k ; then a rest period of one week was, allowed, followed b y a
EVANS AND MOORE:
G E N T I A N V I O L E T AND H E X Y L R E S O R C I N O L
629
week of t r e a t m e n t , then a n o t h e r rest l~eriod of one week, and finally a t h i r d w e e k of t r e a t m e n t . Thus the entire course of the t r e a t m e n t covered five weeks. No enema t r e a t m e n t was included in our regime, because we w e r e p r i m a r i l y i n t e r e s t e d in c o m p a r i n g the efficacy of the two d r u g s w h e n orally administered. REACTIONS TO DRUGS I n one case t r e a t e d with hexy]resorcinol, the child chewed the pill and this resulted in a phenol-like b u r n of the buccal mucous membrane, which f o r t u n a t e l y caused v e r y little discomfort. I n eight of the f o r t y cases given hexylresorcinol, there were nausea and v o m i t i n g of considerable degree. The dosage was r e d u c e d in these eight, and f o u r of these children were continued on the same d r u g with no f u r t h e r trouble. Because of persistent nausea even on the reduced dose of hexylresorcinol, the other f o u r children were shifted to gentian violet t r e a t m e n t , which was well tolerated. There were v e r y few reactions in the group t r e a t e d with gentian violet. Only one child out of the f o r t y giverL this d r u g h a d nausea and vomiting. Two other children suffered only nausea. These three child r e n were c o n t i n u e d on gentian violet t h e r a p y in the same dosage and had no f u r t h e r n a u s e a or vomiting. There were no other complaints a t t r i b u t a b l e to the gentian violet medication. Therefore, only 7.5 per cent of the children t r e a t e d with gentian violet w e r e b o t h e r e d b y the drug, and in each case continuation of the d r u g in the same dosage caused ~o f u r t h e r reactions. The dose we used was I rag. p e r p o u n d of b o d y w e i g h t p e r day. This is different f r o m the scheme a d v o c a t e d b y W r i g h t a n d B r a d y s and employed b y other i n v e s t i g a t o r s ; namely, s~ o gr. (10 rag.) f o r each y e a r of a p p a r e n t age. W e have p u r p o s e l y given our g r o u p of children this r e d u c e d dosage ( a p p r o x i m a t e l y 25 p e r cent less t h a n is usually administered) because we desired to reduce the incidence of gastrointestinal irritation. T h a t we succeeded in doing this is shown b y the low incidence (7.5 p e r cent) of nausea and vomiting, m o s t of which w a s of only slight degree, in c o n t r a s t to the incidence of 23 p e r cent r e p o r t e d b y W r i g h t and B r a d y . RESULTS OF TREATXVIENT I n order to d e t e r m i n e the efficacy of this p l a n of t r e a t m e n t , a 1oeriod of f o u r weeks was allowed to elapse a f t e r the date of the last t r e a t m e n t . Then a second series of seven anal swabs w a s e x a m i n e d f r o m the whole group, including t r e a t e d a n d u n t r e a t e d children. This i n t e r v a l of f o u r weeks was selected so t h a t in a n y p a t i e n t not c o m p l e t e l y f r e e d of pinw o r m s t h e r e w o u l d be time for the r e m a i n i n g p i n w o r m s to m u l t i p l y and deposit ova a t the anus. Of the original f o r t y cases receiving each drug, some h a d m o v e d a w a y f r o m the institution a n d were not available f o r re-examination. As shown in Table I, g e n t i a n violet medication was effective in curing 74.3 p e r cent of the children to w h o m it
630
THE JOURNAL OF PEDIATRICS
was given, and hexylresorcinol was successful in 50 per cent of the children to whom it was administered. The a r b i t r a r y criterion of cure we adopted is that a patient have seven consecutive negative anal swabs. The f o u r children who suffered f r o m nausea and vomiting when given the hexylresorcinol and who were given the routine dose of gentian violet are not included in Table I. All f o u r were cured of Enterobius infestation. I f these are included with the gentian violett r e a t e d cases, we have t h i r t y cures among the thirty-nine t r e a t e d with this drug, or 77 per cent cures. TABLE I CHILDREN TI%EATED WITII tIEXYLt~ESORCINOL N u m b e r of Cases N u m b e r of Cases. N e g a t i v e on P o s t - T r e a t m e n t Swabs P e r c e n t a g e of Cures
34 17 50% L
CttIL])t~EN TREATED WITH GENTIAN V~OLET N u m b e r of Cases 35 N u m b e r of Cases N e g a t i v e on P o s t - T r e a t m e n t S w a bs 26 P e r c e n t a g e of Cures 74.3%
At this examination, four of the eighteen children who had previously shown seven consecutive negative swabs were positive. Also, nine new children who had been a d m i t t e d to the institution during this interval were examined, and six of these nine showed pinworm ova. This is evidence that infestation is constantly taking place and that t h e r e is ample o p p o r t u n i t y for the entire population of the institution to become reinfested, in spite of the large n u m b e r of children whom the medication a p p a r e n t l y cured. DISCUSSION
This survey of an orphans' home confirms the findings of investigators in various parts of t h e c o u n t r y t h a t infestation with Enterobius vermicularis is v e r y common, that either hexylresorcinol or gentian violet m a y be used to eradicate the parasites from the intestinal tract, and t h a t reinfestation occurs with ease. Such reinfestation can occur even in an institution where considerable attention is paid to cleanliness, as is the Case in the home where this investigation was carried out.
W e believe t h a t gentian violet medication causes considerably less nausea an8 vomiting than hexylresoreinol and is easier to administer. I t does not inconvenience the patient as does the five-hour fast imposed upon him a f t e r taking hexy]resorcinoL The percentage of cures a f t e r giving gentian violet was 77 per cent; after hexylresorcinol it was 50 per cent. The reduction in the dosage of gentian violet proved to be a sound policy, as reactions were i n f r e q u e n t and the percentage of cures was high. I t may well be that the success of this regime of t h e r a p y is p a r t l y a t t r i b u t a b l e to the e x t r a week of t r e a t m e n t . Because of the ease with which reinfestation takes place, it is not such a radical policy to t r e a t e v e r y m e m b e r of a household where any
EVANS AND i~IOORE:
GENTIAN u
AND HEXYLRESORCINOL
~1
one member is k n o w n to have enterobius infestation. Likewise, it may be necessary to r e p e a t the t r e a t m e n t some weeks or months later. ]n institutions the only means of control of the infegtation would be periodic repetition of the treatment. E x c e p t f o r a few instances of vaginitis, the signs and symptoms usually a t t r i b u t e d to pinworm infestation were not observed to a significant degree in this group of children. CONCLUSIONS
1. Seventy-eight loer cent of the individuals in an orphans' home were found to be infested with pinworms (Enterobius vermicularis). 2. The value of the N I I t cellophane swab m e t h o d of diagnosis was clearly evident, and the failure to discover ova of this parasite by routine stool examination was demonstrated. 3. P a t i e n t s seemed to tolerate gentian violet b e t t e r than they did hexylresorcino]. 4. Smaller doses of the drugs were given over longer periods of time with considerably less reactions, than previously reported. 5. Gentian v i o l e t ' w a s effective in 77 per cent of the cases; hexylresorcinol was effective in 50" per cent. 6. The ease with which reinfestation may occur was demonstrated. REFERENCES ]. 2. 3. 4. 5. 6. 7. 8.
Cram, Eloise B., and Reardon, Lucy: Am. J. Hygiene 29: 17, ]939. Sawitz, W., D'Antoni~ J. S., ]~hude, X., and Lob, S.: South. M. J. 33: 913, 1940. XV[iller, D/lax J., and Choquette, L.: Canad. !VL A. J. 43: 453, 1940. W r i g h t , W. tt., Brady, Y. J., and Bozicevich, J.: Pub. H e a l t h Rep. 54: 2005, 1939. Craig, C. F , and Faust, E. C~: Clinical Parasitology, Philadelphia, 1937, Lea & Febiger, p. 281. W r i g h t , W. I-L, and Brady, F. J.: J . A . M . A . 114: 861, 1940. D ' A n t o n i , J. S., a n d Sawitz, Willi: Am. J. Trop. IVied. 20: 377, ]940. tIal], !~[. C.: Am. g. Trop. Med. 17: 445, 1937. 3301 JUNIUS ST. 4105 LIVE OAK ST.