21,6  Mendoza-Guazon: Schistosomiasis in the Philippines 541 
cedemas and urticarias, pains in the abdomen, generally in the 
upper part, cough with evanescent areas of pulmonary dull- 
ness, diarrhoea or constipation, marked eosinophilia, and often 
mental depression. The second stage is marked by enlarged 
liver and spleen, with a heavy feeling in the upper abdomen, 
marked eosinophilia and some anzmia, loss of weight, slight 
degree of fever at some particular time of day, passage of 
blood-streaked mucus containing the ova in the stools, more 
or less tenesmus and straining at stool, sometimes diarrhea 
or constipation. A man generally gets better after several 
weeks or months in this stage, but may go on to the terminal 
stage after from three to five years, especially if reinfected 
several times. The terminal, or third, stage is marked by 
cirrhotic liver, sometimes enlarged, sometimes shrunken, as- 
cites, cedematous extremities, marked emaciation, anzemia, weak- 
ness, passage of blood and mucus in the stools, and sometimes 
a little fever. The man may die of exhaustion or of some 
terminal infection. ; 
As the ova do not appear in the stool much before the third 
week, the diagnosis in the first-invasion stage rests largely on 
the probability of exposure, the typical rash, the high evening 
temperature with attendant constitutional symptoms, the morn- 
ing feeling of comparative well-being, and, last but perhaps 
more important and constant, eosihophilia. The ova may ap- 
pear in the stool once, and not again for a comparatively long 
period of time. The incubation period, according to Lanning, 
is about twelve days. 
Houghton,(17) in his notes on infection with Schistosoma 
japonicum, classifies the clinical symptoms as follows: 
(a) Typical cases with enlarged liver and spleen, hydroperitoneum, and 
blood stools, 40 per cent. 
(b) Cases showing only splenic enlargement with or without blood in 
the stools, 27 per cent. The eosinophilia in these cases will differentiate 
them from malarial cachexia or other condition. 
(c) Cases with cerebral symptoms and a high grade of eosinophilia. 
He says that the cerebral lesion of his only case does not prove its connec- 
tion with the flukes, but Tsunoda has recorded a brain involvement and 
thinks it is conceivable that a high pyrexia might stimulate the passing of 
- great numbers of ova into the blood stream, to be swept outward and lodged 
as emboli elsewhere. 
(d) Cases negative, except for marked eosinophilia, 25 per cent. The 
discovery of the trematode infection was incidental in these cases, and these 
make bad surgical risks, for the relative increase of eosinophile cells is at 
the expense of the polynuclear neutrophiles, presumably diminishing the 
power of this bodily defense against bacterial invasion. 
