COM PLICA TIONS—TREA TMENT 



Urine. — In cases uncomplicated with the presence of S. hcBma- 

 tohium there is no albumer, no sugar, and no ova in the urine. 



Schistosomic Fever. — Flu in 191 1 reported that Schistosoma 

 mansoni could give rise to an illness resembling katayama disease. 

 Archibald has also called attention to the fact that intestinal 

 schistosomiasis caused by 5. mansoni is capable of producing a 

 fever associated with splenomegaly, enlargement of liver, a poly- 

 morphonuclear leucocytosis and lymphocytosis, together with a 

 diminution or absence of eosinophiles. The absence of eosinophilia 

 was constantly noted in intestinal schistosomiasis in contrast to 

 urinary schistosomiasis when the reverse holds good. Two cases 

 treated with an autogenous vaccine of the predominant coli organisms 

 present in the stools derived benefit and lessened the symptoms 

 of intestinal toxaemia. 



Urticaria has been noted by Lawton, who reports also presence of eosinophilia. 



Complications. — A case may be complicated with urinary bil- 

 harziosis, ankylostomiasis, and other intestinal parasitic diseases. 



Diagnosis. — The diagnosis must be made by finding the charac- 

 teristic lateral-spined eggs in the faeces. 



Prognosis. — The prognosis is unfavourable. It must be noted, 

 however, that in some cases the parasite does not give rise to any 

 distinct pathological symptoms for a long time. One of us has 

 observed in Uganda several natives with eggs of S. mansoni in their 

 faeces, although they were apparently in good health. The stools, 

 apart from the eggs of the worm, were normal. 



Treatment. — Christ opherson has recommended the intravenous 

 injection of tartar emetic (antimonium tartaratum). He gives 

 J grain dissolved in 20 minims of distilled water, and diluted with 

 two volumes of normal saline at the time of use. The dose is in- 

 creased by I grain every other day until 2 grains are reached, and 

 this dose is continued until 30 grains in all have been injected. 

 In children he began with J grain for a boy of ten years. Care has 

 to be taken to avoid acute or chronic antimony poisoning, and the 

 maximum dose for a boy of ten is given as i grain, for an adult 

 2 to 3 grains. The drug appears to have a cumulative actiom 



Christopherson's results have been confirmed by Low, Taylor and 

 others. 



Filix mas may be administered with the purpose of eradicating the worms, 

 and symptomatic treatment may be carried out as mentioned under Urinary 

 Bilharziosis. Madden advises an enterotomy and a cleaning out of the bowel, 

 when a tumour can be felt, and a Whitehead's operation may be done to relieve 

 the rectal symptoms , Vincent has suggested that large in testinal irrigations of 

 a solution of sodium hypochlorite (8 to 10 per 1,000) should be given, and 

 other authorities tannic acid enemata {3 per 1,000). Some authorities recom- 

 mend the intravenous or intramuscular injections of salvarsan, and others the 

 use of emetine. 



Prophylaxis. — This is based principally on Leiper's work. Filtered 

 water should be used for all personal purposes. If this is not possible, 

 tap-water should be stored for forty-eight hours before use, as 



