Pinworms

Pinworms are parasites, the appearance of which in the intestine of a person leads to the development of enterobiosis. The name of this disease comes from Enterobiusvermicularis - the Latin term, which in medical science is used to refer to the human pinworm, which is the most common type of helminthic invasion.

Provoked by pinworms, enterobiasis is also known under the commonly used name "dirty hand disease". This reflects the very essence of such a disease, as the reasons for it are disregard for the rules of personal hygiene or their adherence inadequate. For the same reason, the children at risk of being exposed to pinworms are mostly children. By pinworms, these intestinal parasites are called because of the fact that the female's body has a shape strongly tapering towards the tail.

The presence of pinworms in the body is accompanied by the appearance of intestinal disorders and a sensation of severe itching in the anus. The most common way of infection is direct contact with those people who are carriers of pinworm eggs. Entering the esophagus and further into the gastrointestinal tract into the duodenum, larvae of microscopic size appear no more than 0.15 mm from the eggs. Adult pinworm males have a 2-5 mm diameter, and females reach in sizes from 9 to 13 mm.

The development of larvae in adult individuals occurs during their movement towards the end of the large intestine, during which food is served by food passing through the intestine. The result of this migration is mating, after which the males, after fertilizing females, perish, and the latter remain at the beginning of the large intestine. Subsequently, females lay eggs on the skin surrounding the sphincter of the anus, and in turn perish.

When a person has pinworms, they are often difficult and problematic to get rid of, since permanent autoinvasions can occur. To ease the sensation of itching in the anus, many comb it, which leads to the ingestion of eggs under the nails and subsequently into food, which eventually leads to a new appearance of parasites in the intestine. Thus the circle closes.

[1], [2], [3], [4]

The structure of pinworm

So, what is the structure of the pinworm and how do these parasites look when their eggs enter the body nesting in the human intestine?

Pinworm is a parasitic round nematode worm Enterobius vermicularis from a group of fine helminths or worms. Widely used for its designation of the name of the pinworm, this parasite was obtained because the tail end of the female's body is pointed in shape.

Female size is superior to males, and their length reaches a size of up to 10 millimeters, and in the latter it is approximately half as long. Males have a length of about 5 millimeters. The shape of the body of male and female pinworms is also not identical. Unlike the spindle-shaped body of a female pointed at one end, in males the posterior end of the body is twisted like a cochlea.

The bodies of the pinworms of both sexes are white with a grayish tinge. In front of them there is a blister called vesicle. The function of the vesicle is to allow the parasite to attach to the intestinal walls of the intestine.

Female oysters lay eggs that have an oval shape and a shell without any specific color. The egg of the pin is convex on one side, and on the other it has a flattening.

The protective shell of eggs, dissolving in the duodenum, releases larvae that move towards the lower parts of the small and upper parts of the colon to the cecum and the initial part of the colon. There, in the process of growth and development, after a two-week period, the pinworms become capable of reproducing the offspring.

Summarizing the above, it can be argued that the structure of the pinworm is maximally adapted for the parasitic existence of this causative agent of enterobiasis in the human intestine. For example, because of their small size, pinworms easily penetrate the human body, and the presence of vesicles makes it easier for them to gain a foothold on the walls of the intestine.

The cycle of pinworm

The life cycle of the pinworm after the eggs of these parasites appear in the intestine begins with the hatching of these eggs from the larvae. In order for an adult to develop from the larva, it takes two to four weeks. The total life expectancy of pinworms is not more than one month.

Their places of residence in the human body is the cecum, the upper calving of the thick and the lower parts of the small intestine.

Being fertilized, females begin to move in the direction of the rectum, after which, leaving the anus, lay eggs in close proximity to it. Typically, this happens at night, since when a person is sleeping, the muscles of the anal sphincter are relaxed.

The number of eggs laid by one female can reach 13,000. Having completed their function of continuing the population, the pinworms come to an end to their life cycle. Their desiccation and transformation into an amorphous mass occurs.

Maturation of eggs is noted already after 4 to 6 hours from the time of their postponing. In order to ensure the development of eggs, certain suitable conditions are necessary. In particular, a high degree of humidity and a high temperature of 34-36 degrees Celsius. Provide those just and is capable of perineum and areas of perianal folds.

If the hygienic rules are not respected in relation to this area of the human body, female pinworms can continue to migrate until they reach the vagina and uterus, also penetrating the fallopian tubes and appearing in the pelvic cavity. Where do they bring with them from the colon colonies of pathogenic microbes.

The cycle of the pinworm during its development consists in the fact that the eggs entering the intestine are transformed into larvae that within a few weeks reach the adult state, and the adults in turn again lay eggs, thus completing the process, and everything repeats from the beginning .

Causes of pinworm

The causes of pinworm are characterized by the ways through which infection with these intestinal parasites occurs. The pinworm can be transferred according to the human-human scheme, or from the animal to man.

Their presence in a person causes severe itching in the anus, and combing the perineum, the carrier of such infection contributes to the ingress of eggs of the pinworm under the nails. If the basic hygiene rules are not observed, the patient, at mealtime, brings them back to the body, where they enter their new life cycle, appearing in the intestine. And by contacting physically with a handshake, touching other, healthy people, such a person becomes a carrier of the disease.

Eggs of pinworms in some cases can be in animal hair, so that every contact with a pet attracts the need for thorough hand washing.

Thus, the causes of pinworms are mainly reduced to factors that are due to the fact that people, and mainly children in kindergarten and junior classes of the school, often can not adhere to the prescribed hygiene rules. In particular, this applies to kindergartens and junior schools, where children not only have close contact with themselves, receiving such intestinal infection themselves, but also often become carriers of this disease for teachers, teachers and parents. No wonder that many people call enterobiasis, provoked by pinworms, "a disease of dirty hands".

[5], [6]

Infection with pinworms

Infection with pinworms occurs due to physical contact of the person being the peddler of these parasites in the intestines with healthy people. Eggs, which are deposited by female pinworms, can get on the patient's skin. In addition, their presence may be noted on objects with which a person infected with these parasites has come into contact. Infection of a healthy person occurs when the eggs of pinworms enter the body together with the inhalation of dusty air or during mealtime. As a carrier of infection with pinworms, insects as well - flies and cockroaches, carrying their eggs for food, can act.

A fairly common phenomenon is the possibility of repeated self-infection, which has the name of auto-invasion. In this case, the following is literally true. At a time when a man with pinworms combs the anal area, where there is a strong itch from the eggs laid by them, the latter appear under the fingernails. And if you wash your hands thoroughly before eating, these eggs, together with food, are again in the intestines. In this regard, the risk of repeated infection with pinworms is especially great in those who have a bad habit of gnawing their nails. Mostly it concerns children.

Therefore, in order to prevent infection with pinworms, it is necessary to wean the child off of this, and in addition shorten the nails, wash it with soap at least twice a day, in the morning and in the evening, and monitor the cleanliness of the hands.

Incubation period with pinworms

The incubation period with pinworms, or rather, in the case of enterobiasis, arising from these intestinal parasites is approximately 15 days.

In some cases, the disease takes a clinically pronounced form, and its manifestations may not be accompanied by manifestations of any obvious symptoms.

The mild form of the disease is characterized by mild itching in the anus. He appears mainly in the evening before going to bed, and after 1 to 3 days spontaneously stops. But after 2-3 weeks the time interval may resume again. This periodicity corresponds to the time in which generations of pinworms change, when reinvestment occurs. If massive re-reinfusion leads to the fact that pinworms in the intestine form a large cluster, the sensation of itching persists the person, without stopping, and becomes intolerable. The intensity of pruritus reaches a maximum, mainly at night, especially favorable for pinworms to be able to lay eggs unhindered, which by the onset of the morning will already be ripe.

Intensive infection with pinworms leads to malaise and general weakness of the body, increased fatigue and sleep disorders. Painful symptoms are concentrated around the navel and are marked by an acute character. Appear mainly in the process of eating, less often after eating.

Repeated regularly over a long period of time, painful attacks in the abdomen can be an incentive for seeking medical advice, but it is usually not possible to make a clear definite diagnosis while the incubation period for pinworms continues.

How many live pinworms?

How many live pinworms? It should be noted that currently there is no single definite opinion and confirmed data on the overall duration of their lives. According to some sources, pinworms do not live longer than one month, others on this issue quote a figure of 3 and a half months.

Nevertheless, it is unequivocal and unquestionable that these intestinal parasites are highly resistant to a variety of environmental factors and may exhibit considerable resistance to the effects of disinfectants. Outside the human body, pinworms are able to maintain viability during a time period equal to 25 days. The fundamental factor affecting the life span of pinworms is how favorable are the conditions in which these enterobiosis pathogens are located. So being in the water in the aqueduct, pinworms can stay alive for one to three weeks. The maximum life span is determined, which they can achieve in this case mainly by the degree of saturation of water with oxygen and its temperature.

Concerning how many live pinworms can be summed up such a result that it largely depends on where they are: inside the human body or in the external environment. The life span of pinworms in the human intestine is directly related to their life cycle, during which fertilization of females takes place, followed by laying eggs, hatching larvae and forming adult individuals, which in turn produce a new generation of parasites.

Symptoms of pinworm

In some cases, when infecting with these parasites, the symptoms of pinworm may not be detected in almost any manifestations, or be expressed extremely weakly, implicitly. Therefore, the first on the basis of which it becomes possible to assume that there is an enterobiosis lesion is the appearance of pruritus in the perianal region. This discomforting sensation lasts approximately 3 days from the time of onset, after which it spontaneously passes. However, there is a fairly frequent tendency to resume it after a 2-3-week break. This time interval is by no means accidental, since it shows the cyclicity with which the generations of pinworms in the patient's body change. When the infection of these intestinal parasites is massive, itching can often become simply intolerable to humans. In turn, this leads to the appearance of scratching on the skin in the perineum, dermatitis may occur. In addition, the possibility of secondary infection is not ruled out.

Called by pinworm enterobiasis is characterized by all sorts of digestive disorders. These include a frequent stool with a consistency similar to gruel, in some cases with the presence of a certain amount of mucus. There is the appearance of tenesmus - frequent urge to empty the intestines, which, however, do not lead to defecation and are accompanied by severe pain. Painful symptoms can also be noted in the abdomen and in the perineum. In addition, pinworms provoke nausea, cause urge to vomit, lead to dryness of the oral mucosa, and to a worsening of appetite.

The course of the disease, characterized by a severe degree of invasion, is accompanied by headaches and dizziness, disturbances in sleep processes, increased fatigue and the appearance of irritability.

If pinworms penetrate into the female genital organs, as a result of this, all sorts of inflammations develop, similar in their symptoms with the course of gonorrhea.

Due to the presence of these parasites in the cecum, attacks of acute appendicitis of enterobiotic origin may occur.

Symptoms of pinworms occur in the form of specific negative reactions of various organs and systems of the human body to the presence of parasites. This is manifested, first of all, in a change in the balance of useful and pathogenic bacteria in the intestines, leading to dysbiosis. This increases the risk of infection with pathogens of acute intestinal infections.

Pinworms in pregnant women

Cases when pinworms are detected in pregnant women do not represent an extraordinary, exceptional phenomenon. But if in the usual state to get rid of such infection by intestinal parasites does not represent anything so complicated and problematic with the help of appropriate drugs, then during the period when a woman carries a child, it can really become a problem raised to a certain degree. After all, for pregnant women, the use of such antiparasitic drugs is contraindicated. In addition, those who are preparing to experience all the joys of motherhood at their speed are often worried, and there is a danger that, because of their infection with pinworms, any harm to the future baby can be caused. To dispel all such fears, we note that these have absolutely no basis. The penetration into the body of a child during its intrauterine development of pinworms is not possible. Accordingly, the risk of any adverse effect on the development of the baby is excluded.

Thus, the issue acquires a different color and consists in getting rid of pinworms and minimizing the possibility of associated negative consequences primarily for a pregnant woman. To date, there are many proven and effective ways of not drug treatment of these parasites that could suit a woman in the situation. In this case, it is necessary to take into account that in order to avoid the occurrence of all kinds of allergies before using them, you should consult a doctor.

Another effective measure against pinworms is an enema with baking soda in aqueous solution. And the use of anesthetic ointment can help to cope with itching in the perineum.

Pinworms in pregnant women will not affect the development of the child during the prenatal period, however, in choosing the measures against these parasites, care must be taken to prevent harm to this same treatment to him or her future mother. There must be a preliminary medical consultation.

Oysters with lactation

While the child is not yet born and is in the womb of the mother, intestinal parasites are in no way able to get into his body. But after the birth, the woman should do everything possible to protect the newborn from this kind of infection. If a woman is diagnosed with pinworms during lactation and during the period when she is breastfeeding, breastfeeding should be discontinued. Milk must be decanted and drained. This has the basis that antiparasitic drugs taken by a nursing mother can adversely affect the baby's condition.

Continue breastfeeding while treating and preventive measures from pinworms may be permissible only if medication is not used with it.

Such measures of non-drug treatment may be, for example, the following. In order to prevent the possibility of repeated autoinvasation, the back passage between acts of defecation can be laid with a cotton swab. This will become an obstacle for pinworms to get out of the anus and lay off eggs of a new generation of parasites in the perianal area.

To get rid of pinworms, enemas may also be appropriate, which should be accompanied by hygiene measures. The use of this method, however, can adversely affect the course of the disease with hemorrhoids, if it is present in a woman. In such cases it is necessary to interrupt breastfeeding for the period of taking medications against pinworms.

Pinworms in lactation, as we see from all the above, cause the need to wean the baby from the breast for the time required to treat a nursing woman with medicines, since they can cause undesirable consequences in the child.

Pinworms in children

The nature of the disease with enterobiasis, which causes pinworms in children, manifests itself in a greater degree of manifestation of the main symptoms inherent to it in comparison with its course in patients in adulthood. These intestinal parasites in children cause a strong intoxication of the body products of their vital activity, which is accompanied by the appearance in the child of headaches, sleep disorders, increased fatigue, irritability, absent-mindedness and memory impairment. In some cases, incontinence may occur, and for girls, there is a risk that pinworms will enter the genitals, provoking vulvovaginitis.

Children do not have such self-control as adults and do not always follow basic hygiene rules, because of that they tend to comb the perineum, and as a result are more likely to be re-infected, and in addition to kindergartens and junior classes, they are in close contact with each other, becoming a friend for the friend of the parasites.

Pinworms in children require immediate start of treatment, the important point of which is to prevent re-infection, for which it is necessary to control that the child adheres to the rules of personal hygiene, and also every day to change it into fresh underwear and change clothes. It should be borne in mind that if a child has pinworms, all members of the family should be treated.

What are dangerous pinworms?

Timely detection of parasites in the human intestine and prescribed immediate appropriate treatment with a high degree of probability guarantees the onset of absolute recovery. So what are the threats to the body in the occurrence of helminthic lesions and what are dangerous pinworms?

First of all, the negative consequences of their presence are manifested in the fact that as a result of their growth and reproduction processes, all kinds of products of vital activity are formed, capable of producing toxic and poisonous effects on the body. Pinworm can also trigger inflammatory processes in the cecum, leading to cases of acute appendicitis.

In addition, the danger of pinworms is their harmfulness in relation to the beneficial microflora in the intestines, which becomes a factor causing the development of dysbiosis, as well as provoking the proliferation of pathogenic microorganisms. The harmful effect of pinworm on the functioning of the immune system, in connection with which the possibility of allergic allergies increases, and in addition increase the risk that atopic dermatitis may occur.

When there are pinworms in the intestine, this becomes the reason why during the period of this disease there may be a significant decrease in the effectiveness of the vaccination, up to the complete absence of the effect of the introduced vaccine.

Pinworms pose a danger to young girls, since they can penetrate into the genitals. Together with them, fungi and other pathogenic microorganisms that can cause disease with vulvovaginitis are entered from the intestine.

What are dangerous pinworms? First of all, the fact that at the very beginning of their appearance

Some significant anxiety symptoms may be implicit, and the consequences often make themselves felt only with the development and reproduction of parasites in the human body. It should also be borne in mind that with the initial infection with pinworms, there is often a phenomenon of autoinvasion, in which secondary and tertiary infection occurs. Therefore, when pinpointing pinworms, the hygiene issue becomes very urgent.

Consequences of pinworms

Pinworms parasitize in the human intestine, with the help of special education on the body - vesicles sticking to its walls. They damage the intestinal mucosa, so large food fragments can enter the blood through such damaged areas. This becomes one of the prerequisites for the development of an allergic reaction. In the process of their life, these intestinal parasites emit a lot of substances harmful to the body, leading to intoxication.

The consequences of pinworms in their deleterious effect on the functioning of the nervous system take place in the form of a state of increased irritability present in the patient, the appearance of headaches, and there are also dizziness and trouble with sleep. A person infected with pinworms is prone to excessive physical and mental fatigue.

Appearing in the worm-like process of the intestine, pinworms are able to provoke appendicitis.

Because of the enterobiasis caused by pinworms, there are negative changes in the processes of digestion and assimilation of food products eaten by man, the acidity of gastric juice decreases.

Many of the infants exposed to these parasites have changes in the microbiocenosis of the intestine.

With the presence of pinworms in the body is also a number of complications caused by their penetration into places other than the intestine. So as a result of a high degree of infection or due to a specific individual reaction against a background of increased susceptibility to pinworm antigens, there is a possibility of developing eosinophilic enterocolitis.

Getting into the female genitalia pinworms, provoke vulvovaginitis, accompanied by a secondary infection of the urinary tract. Further migration of parasites to the pelvic organs is fraught with oophoritis and salpingitis.

Extremely rare is the penetration of pinworms through the wall of the intestine into the cavity of the peritoneum, which can be due to the development of peritonitis.

The consequences of pinworms, as is obvious, can be the most unfavorable. But at the same time the treatment of this disease does not present significant difficulties, being timely revealed. Thus, its diagnosis becomes urgent, and the necessary medical measures are taken.

[7], [8], [9], [10]

Diagnostics of pinworms

Diagnosis of pinworms based on the results of conventional stool analysis is untenable since it is not possible to determine the presence of these parasites. This is explained by the fact that the laying of eggs does not occur in the intestines of the person, but outside it, on the skin in the immediate vicinity of the anus. Thus, when a patient is suspected of having an enterobiosis triggered by pinworms, the main method of investigation is to carry out a scraping (scraping) from the skin in the anus area in order to identify adult pinworms and eggs laid by them. To do this, use a special spatula, moistened with glycerin solution, or such a diagnostic action can be carried out by the Graham method, which uses an adhesive tape.

It is often difficult to detect adult females in normal household conditions. They can be seen in the stool immediately after the excrement. Identify eggs of parasites a person is able to do by himself examining the skin area around the anus.

So, the diagnosis of pinworms is carried out through a laboratory parasitological examination of a person for whom there is a suspicion that he is the carrier of such intestinal infection.

[11], [12], [13], [14]

Analysis for pinworms

In the presence of parasites in the intestine in a child or an adult, a characteristic pruritus appears in the perineum, usually beginning to gain intensity with the onset of evening time, signs of allergic reactions are noted, appetite worsens, sleep is broken, apathetic condition occurs, etc. Similar changes in the state health can serve as a basis for puzzling to clarify the objective cause of such negative phenomena and as one of the diagnostic measures to conduct an analysis on pinworms.

To establish an accurate diagnosis, it is advisable to use the method of microscopic examination. The material used for this analysis is obtained by scraping or imprinting the adhesive tape from a skin site in the perianal region where the eggs of the female pinworms are mainly deposited. On the basis of the obtained results, their presence is established, in connection with which an enterobiosis can be diagnosed. In order to ensure the maximum possible reliability of the diagnostic data, the analysis should be conducted for at least three consecutive days, or with a break in one day. The justification for this is the fact that egg-laying by eggs does not occur daily.

On the day preceding the analysis of the crotch of the child between the buttocks is not recommended to smear with greasy creams.

The analysis for pinworms is adequate only when performed in this way. This is due to the fact that these parasites can not be detected with the help of a conventional stool analysis because the eggs inside the intestine are not delayed.

[15], [16],

Treatment of pinworm

Pinworms from among all the parasites that appear in the human intestine are the most non-dangerous, and therefore should not cause cause for alarm and no matter how significant anxiety.

Treatment of pinworm   in many cases can be completely limited to using only alternative medicine, and as for pharmacological preparations, then, as a rule, special antihelminthic agents are used for 2 to 3 courses with interruptions of several weeks, and At the end of each such course, a control analysis is done.

All therapeutic measures should be accompanied by strict adherence to hygiene rules, and therefore parents need to closely monitor this child.

In a children's collective, if one of them has undergone such intestinal infection, the corresponding measures of a medical nature are necessarily applied also to all the others.

Strange as it sounds, but often the disease can go away spontaneously, even if you do not undertake any purposeful treatment of pinworm.

By and large, all that is necessary for this is to carefully observe the basic hygienic rules.

Diet with pinworms

As one of the effective ways to combat this kind of intestinal infection, without involvement in the treatment of pharmacological drugs may act as a diet with pinworms.

Sufficiently adequate replacement of medicines is the ability to become certain products contributing to the expulsion of parasites. This primarily implies what you need to include in the diet, such as mustard, horseradish, garlic, cayenne pepper, walnuts, pomegranate.

Of the above list of special attention with all the right garlic deserves. The beneficial effect it produces has been repeatedly confirmed. It can be consumed during a meal in the amount of 1 dent per day for three consecutive days, repeating this course after one week. Another way of using garlic with pinworms is that a special infusion of milk is made from it. To do this, a glass of milk is required to boil several denticles and leave to infuse. The child needs to drink this infusion throughout the day and observe changes in his condition.

Prepare the tincture can also be made from onions. This is done by grinding one large bulb, and filling the bay with alcohol in a ratio of 1: 1. After a week of aging in a dark place, the resulting alternative to the pinworm is ready for use.

Decoction of pumpkin seeds and crude oil of the first pressing will also be superfluous to include in the diet when infecting intestinal parasites. One glass is taken during the day before the morning meal until the symptoms begin to subside.

Well proven in the antiparasitic diet is also a banana.

Peel it must be dried, whether in the sun or in drying, then rub it. The resulting powder is mixed with half a glass of water, and this solution is drunk three times a day before meals. Do this for two days, monitoring the condition of the stool.

Diet with pinworms can be one of the important factors that contribute to an effective cure for this parasitic intestinal injury to humans. And in some cases, as well as alternative means of treatment can be a justified alternative to the use of chemical drugs, or go in addition to prescribed therapy with medications.

[17], [18], [19]

Prophylaxis of pinworms

Prevention of pinworms as one of its main tasks is to provide all the factors that exclude or minimize the possibility of infection or self-infection. In connection with this, the basic requirement is the compulsory adherence to sanitary and hygienic rules.

For young children, parents should shorten their nails, wash their hands with soap, spend morning and evening bathing with soap. Before going to bed, you need to put on your baby dense underwear, which in the morning should be ironed with a hot iron. Children's night pot after its cleaning and washing should be showered with boiling water.

If the child was infected with pinworms, in this case, all members of the family must pass at the same time without parasite treatment, and in the kindergartens - all the children's team, educators and attendants.

It is necessary to clean the premises on a regular basis in a damp manner.

In conditions of increased risk of infection, such as a child's stay in a kindergarten, in a summer camp, etc., it is required to change underwear every day, boil it and iron it.

After the successful cure of the disease with pinworms, the person is prescribed a dispensary record for one and a half months. The degree of effectiveness of the implemented treatment activities is assessed in a 3-week time interval starting from the 2nd week after the completion of treatment. Recovery is confirmed if three times with a break from 1 to 2 days in perianal scrapings of eggs is not detected.

As we see, the prevention of pinworms mainly means to protect a person against infection by intestinal parasites, and when the disease is defeated, to help prevent re-infection, autoinvasion.

Why do we dream about pinworms?

You can meet a fairly large number of the most that neither is different and diverse interpretations as to what the pinworm looks like. Dream interpreters offer a variety of all kinds of interpretations of this dream.

So, to see in a dream pinworm is able to act as a prediction that in the very foreseeable future an approach of changes in personal life is coming.

Pinworm during sleep can serve as precursors of the appearance of man, linking his life with which it will become possible to gain new meaning and experience new vivid feelings. On the other hand, for a woman such a dream can serve as a warning that the signs of attention given to her by a man in this expected new meeting will be ambiguous and ambiguous.

A man, if he dreams of pinworms, it predicts that he will find one that will bring coziness to his house and become a good mistress.

When there is a presence of people in a dream with a pinworm, it is possible that soon it will be possible to get to the celebration of the wedding or in connection with the lavish celebration of the birthday, anniversary. Sleep with a pinworm and any animals suggests a possible meeting with a friend or girlfriend, whom they have not seen for a long time.

Pinworms in a dream in large numbers speak of a victory over the wiles of adversaries. Seeing someone with pinworm disease promises life at someone else's expense. When a child suffers from pinworms in a dream, this indicates excessive anxiety and excessive custody of his child.

Thus, from the whole multitude of versions to which the pinworms are dreamed, we have considered a certain averaged, generalized definition of this dream.