SUPPLEMENT 641 



enlargement is specially perceptible over the left lobe of the liver. 

 The patients maintain a proportionately good general state of health in 

 this state for a long time and may hope to recover. In severe cases 

 there occurs copious and generally bloody diarrhoea, also icterus. 

 The next stages are anaemia, emaciation, epistaxis, ascites, enlarged 

 spleen, and cachexia, to which the patient finally succumbs. In 

 general the course of the disease is very chronic and irregular; in 

 winter and spring there is generally improvement, in the summer and 

 autumn the patient gets worse. At post-mortem the bile-ducts are 

 enlarged and thickened, there is interstitial hepatitis with enlargement 

 of the liver, but not to such an extent as in hypertrophic cirrhosis. 

 After the initial enlargement contraction of the liver sets in, the 

 peritoneal coat and capsule proper of the liver become more or less 

 thickened in places. In the pancreas also dilatation and thickening 

 of the ducts occur, as well as interstitial inflammatory processes. 

 Obstructions in the portal circulation may lead to catarrhal changes 

 in the stomach. 



The diagnosis is based on ihe demonstration of ova in the faeces. 



As a radical treatment is still unknown, consequently it can only be 

 purely symptomatic. Prophylaxis consists in the prohibition of 

 drinking unboiled water or eating uncooked molluscs, fish, etc., of 

 canal water. Leaving the epidemic region may bring about gradual 

 recovery. 



BILHARZIASIS. 



Schistosoma haematobium. 



The symptoms of bilharziasis are manifested chiefly in the urinary 

 apparatus, and above all as hasmaturia, at the outset without any 

 special troubles. Later, however, it is accompanied by subjective 

 symptoms in the shape of feelings of pain, and of vague pains in the 

 perinaeum and lumbar region, and of burning in the urethra during 

 the passing of urine. All the symptoms are usually aggravated after 

 excesses in eating and drinking, and after considerable bodily exertion. 

 Another condition found, but not often mentioned, is lipuria (Stock 1 ) ; 

 the highest amount has been 2 per cent, fat in the urine. Stock found 

 6 to 20 per cent, of eosinophile cells in ten cases examined by him. 

 They appear to be increased, especially in the early cases ; Kautsky 2 

 also called attention to the excessive degree of eosinophilia, whilst 

 Goebel* expresses the opinion that a specific toxic action on the 

 organism generally is not developed in bilharziasis. Kautsky 4 assumes 

 a toxic anaemia as in the case of ancylostomiasis. English authors 

 also have called attention to the eosinophitia and to a considerable 



1 Stock, Lancet, September 29, 1906. 



- Kautsky, Wien. klin. Rundschau , 1903, xxxvi. 



3 Goebel, Arch. f. Schiffs- u. Tropen-Hyg., 1903, vii. 



4 Kautsky, Wien. klin, Rundschau, 1903, xxxv 



