SYMPTOMATOLOGY-^PROPtiYLAXIS 15^1 



Morbid Anatomy. — The body may be well nourished, but more 

 usually is emaciated and anaemic. Ulcers can be seen at times in 

 the axillae and groin, leading into diseased glands. The muscles 

 may contain abscesses. The pleura, pericardium, peritoneum, and, 

 more rarely, the meninges, show the chronic inflammations and the 

 non-suppurative lesions mentioned above. The lesions found in 

 the lungs are diffuse cirrhosis, bronchiectatic cavities, pneumonia, 

 and caseous abscesses, while those of the liver are cirrhosis, peri- 

 hepatitis, and abscess-formation. The typical lesions mentioned 

 above may be found in the spleen, pancreas, small and large intes- 

 tines, kidneys, bladder, epididymis, prostate, and in the choroid 

 plexus of the brain. 



Symptomatology. — ^As the invasion of the body is so generalized, 

 the symptoms are very varied. Musgrave differentiates four 

 varieties — the generalized, the thoracic, abdominal, and cerebral; 

 but there is nothing very characteristic about any of these types. 



In the generalized type there may be fever, enlarged lymphatic 

 glands, general muscular pains, and ulceration of the skin. 



In the thoracic type there will be cough, with the expectoration 

 of purulent or, more generally, blood-stained sputum, in which the 

 eggs may be best seen by the addition of a little o-i per cent, solu- 

 ttion of sulphuric acid. More rarely an adult parasite appears in 

 ^the sputum, which also may contain Charcot-Leyden and creatinin 

 crystals. The patient generally complains of pain in some part of 

 the chest. The physical signs may indicate broncho-pneumonia or 

 pleural effusion, which may be serous or purulent. 



In the abdominal form of the disease there are only the vaguest * 

 symptoms of dull, aching pains and tenderness, while diarrhoea, 

 appendicitis, epididymitis, or cirrhosis of the liver, may be demon- 

 strated by the usual physical signs and symptoms. When diarrhoea 

 occurs, the eggs may be found in the faeces. 



The cerebral type is associated with epilepsy, which may be 

 Jacksonian in character, while neuritis or paralysis may also be 

 present. 



The blood and urine have not yet been fully examined. Though 

 generally chronic, the course may be acute if complicated by septic 

 or other diseases. 



Complications.— The most usual complications are tuberculosis 

 and ent amoebic dysentery. 



Diagnosis. — -With the above symptomatology, it will be obvious 

 that the diagnosis depends entirely upon finding the eggs of the 

 parasite in the sputum, the faeces, the scrapings from the ulcers, 

 or the fluids obtained by puncture of a hydro- or pyothorax. 

 Suspicions as to the presence of the disease will be strongest when 

 cases showing any of the above signs occur in the endemic area. 



Treatment. — ^The treatment must be devoted to relieving indi- 

 vidual symptoms, but Musgrave recommends treatment by iodide 

 of potash. Removal from the endemic area is, of course, indicated* 

 Perhaps tartar emetic injected intravenously might do good. 



