tainly the products of their metabolism are 
poured into the circulatory system of 
their host 10). They are however diluted and 
carried along when the circulation is free, as 
in the larger, veins. The blood, absorbed by 
the schistosoms, is their only alimentation 
but it is not so much that in moderate infec- 
tions, it could not be easily. substituted For 
this reason anemia is no help for recogni- 
sing the infection. People often attribute diar- 
rhoea to the parasitism of worms and some 
authors, amongst them GONÇALEZ — MAR- 
TINEZ, consider it as a symptom of the in- 
fection of Sch. Mansoni, According to my 
experience, it is only a frequent complication, 
as in other worm diseases and in chronic 
cases one finds habitual constipation which 
is explained by the sclerosis of the intestine. 
In recent cases the number of stools is ge- 
nerally not increased. 
JESUS-RISQUES called attention to un- 
defined pyrexy ofuncertain origin which may 
be attributed to Sch. Mansoni infection 11). 
I was present at the autopsy of a pati- 
ent infected by these parasites who succum- 
bed to a not very characteristic pyrexy. This 
subject is worth considering. It is already 
proved that acute and recent infections of 
Sch. Japon. may cause fever which is often 
acompanied by eruptions somewhat resem- 
bling urticaria. 
There is another symptom, which in my 
experience, is more frequent and which may 
be explained, taking into account the anato- 
mical observations made in patients, infected 
by Sch. japonicum and M. pulmonalis. 
These patients often complain of gjddi- 
ness which I attribute to the embolism of 
the blood flukes or their eggs. 
Some patients, who were accustomed to 
bathe frequently in ponds, told me; that 
they felt itching afterwards. Even the name 
of two of the ponds, we visited, refer to the 
itching. Though this symptom may not be 
considered pathognomonic, tt always gives 
a pretty sure indication of infected water 
and leads us to expect penetration of cerca- 
riae, which causes irritation, as is well seen 
n the experiments on white rats 12). 
124 
There is a series of symptoms, observed 
only in cases of intense or often repeated 
infection, which concern the intestine and the 
liver and which are explained by the anato- 
mical lesions, observed in those organs. 
These, however, depend rather on the 
eggs than on the worms, the eggs being 
deposited in the tissues, as we shall see in 
the pathological anatomy. The symptoms of 
the liver and intestines are, however, not very 
characteristic and may be found in many 
other affections; so their value depends 
on the exclusion of other complications or 
accidental diseases, observed in infected indi- 
viduals who, in some places, form the majo- 
rijy of the population. The frequency of cer- 
tain symptoms might be demonstrated by 
statistics but in this line nothing has been 
done in this country 13). 
Sanguinolent mucosities may be attribu- 
ted to Sch. Mansoni, if there are many eggs 
and no amoebae. Icterus, hepato-and sple- 
nomegalia, retraction of the liver and ascites 
are also suspicious symptoms when there is 
no probability of other etiology. 
Eosinophilia is observed in schistosoma- 
tosis as in other forms of helminthiasis, 
without being of much importance for diag- 
nostical purposes, as the greater part of the 
patients have also other worms. It is rather 
by an examination of the fecal matter than 
by one ofthe blood that a reliable diagnosis 
may be obtained, excepting only cases of 
quite recent infection. 
The other affected organs do not furnish 
any clear symptoms. In the first phases of 
their evolution, the worms probably pass 
through the pulmonary circulation; some not 
very characteristic manifestations, such as 
bronchitis and cough, may be due to them. 
The pancreas is often affected; it is advisa- 
ble therefore to seek for indications of gly- 
cosuria, which has not yet been done syste- 
matically. 
Besides the attacks of giddiness, nervous 
perturbations are observed which may be 
due to schistosomatosis; these are lapse of 
memory, want of energy, feeble comprehen- 
