1 868 



INTESTINAL SCHISTOSOMIASIS 



of the rectum. Papillomatous growths may form in the rectum, 

 and can be distinguished from piles by their large number. They 

 may protrude from the anus, when the removal and microscopical 

 examination of a small portion will clear up the diagnosis. When 

 the lower part of the rectum is involved, much agony from tenesmus 

 and constant desire to defsecate is experienced. The rectal prolapse 

 becomes very distressing, as it has to be constantly replaced by the 

 patient himself, and as both the mucous membrane of the bowel 

 and that of the anus become much inflamed and irritated. 



In cases in which there is much sclerosis, with a scarcity or absence 

 of polypi, the dysenteric symptoms are not so marked. On the 

 contrary, the patient complains of constipation, not relievable by 

 ordinary methods, alternating with bouts of diarrhoea. 



Fig. 771. — Prolapse of the Rectum in Intestinal Schistosomiasis. 

 (From a photograph by Christopherson.) 



Schistosomic Tumours.- — When an emaciated patient in one of 

 the endemic regions is examined, one or more abdominal tumours 

 may be found in the region of the caecum or colon. These tumours,, 

 which are fairly hard, are somewhat movable, and are usually 

 elongated, with the long axis corresponding to the direction of the 

 long axis of the bowel in the region in which the tumour is lying. 

 The tumour, accidentally discovered, continues to increase in size 

 for months and years, while the patient becomes very emaciated, 

 and suffers from attacks of colic at times. 



Liver and Pancreas. — The liver may be found to be enlarged and 

 cirrhotic, the spleen also be enlarged, and there may be signs of 

 cirrhosis of the pancreas. 



If the patient removes from the endemic area, improvement will 

 take place; but if he remains, then no cure appears to be possible, 

 and he dies sooner or later from exhaustion. 



Blood. — The blood in intestinal schistosomiasis requires further 

 study, but it would appear that usually there is a marked anaemia, 

 with oligochromsemia, slight leucocytosis, and very slight eosino- 

 philia. 



