MTIOLOG y~5 YMPTOMA TOLOGY 



1 591 



In the Philippine Islands one case has been reported by Woolley 

 as occurring in a Filippino who had never left the islands. 



etiology. — ^The cause of the disease is Schistosoma japonicum 

 Katsurada, 1904, which is spread hy Blandfordia japonica, in which 

 the worm develops into cercariae which penetrate the skin. The 

 vertebrate reservoirs are cats, dogs, and pigs. For description of 

 the worm see p. 590. 



Pathology. — ^After penetrating into the skin the parasites enter 

 either veins or arteries. In the former case they pass to the right 

 heart and hence to the lungs, at the bases of which they collect, 

 and then, passing through the mediastinum, diaphragm, and liver, 

 reach the portal system. Sueyasu, in 1916, obtained complement 

 fixation with the blood of immune animals. 



Morbid Anatomy. — On opening the 

 abdomen, signs of old peritonitis may be 

 seen, the appendices epiploicae being 

 matted together, and at times there are 

 also signs of old pelvic peritonitis. The 

 liver is cirrhotic and less than its normal 

 size, and its surface is studded by 

 nodules, usually larger than those of 

 alcoholic atrophic cirrhosis. Glisson's 

 capsule is thickened, and shows much 

 connective tissue with round-celled in- 

 filtration, in which lie the ova of the 

 worm. 



The small and large intestines and 

 appendix may be thickened, and their 

 mucosa is swollen and hypersemic, and 

 shows patches of ulceration and necrosis, 

 and, in addition, papillomata, resembling 

 those of bilharziosis. The eggs may also 

 be found in the mesentery and in the 

 mesenteric glands, the wall of the gall- 

 bladder, the pancreas, the walls of the mesenteric vessels, and the 

 pylorus. The adiilt worms may be found in some of the veins of the 

 portal system, especially at the bifurcations of the sm.aller mesenteric 

 vessels. 



In addition, the eggs may be found in fibrous and round-celled 

 infiltrations in the lungs and in the brain. This infiltration often 

 takes the form of nodules. 



Symptomatology. — ^The early symptoms of the disease may be 

 slight, or perhaps it may begin with attacks of fever, with urticarial 

 rashes, in which there is marked eosinophilia, and this may be 

 associated with cough, scanty expectoration, some impairment of 

 resonance over the bases or other parts of the lungs, with fine 

 crepitant rales on deep inspiration, and a diminution of the breath- 

 sounds. 



About two years later there are diarrhoeic or dysenteric symp- 



FlG. 



•II . — Schistosoma 



japonicum Katsurada. 

 (After Manson.) 



