1592 



RATA YAM A DISEASE 



toms, with or without fever, and the presence of the ova in the 

 fseces. Associated with these symptoms are abdominal pains, en- 

 largement and tenderness of the liver, the hypogastrium shrinking, 

 and the epigastrium enlarging and giving rise to a characteristic 

 abdominal appearance. At the same time the d37senteric symp- 

 toms cease, and an irregular chronic diarrhoea sets in, with motions 

 containing much undigested food, and associated with dyspepsia. 



In course of time the preliminary enlargement of the liver may 

 cease, and the organ may begin to shrink, but in any case the spleen 

 becomes tender and enlarges, ascites appears, and the patient 

 becomes steadily weaker, more and more anaemic, emaciated, and 

 incapable of mental or physical work. The average of three differ- 

 ential blood-counts by Peake is as follows: Polymorphonuclears, 

 56-6 per cent. : mononuclears, 13-2 per cent. ; lymphocytes, 15-6 per 

 cent.; eosinophiles, 14-1 per cent., but the eosinophilia may reach 

 50 per cent. Attacks of fever may occur nightly, otherwise the 

 temperature may be subnormal. The vascular, respiratory, nervous, 

 and urinary systems are usually normal. If, however, the ova affect 

 the lungs, there may be signs of bronchitis, broncho-pneumonia, 

 and fibrosis; and if the brain, those of Jacksonian epilepsy. In 

 children the development is stunted. Death may result directly 

 from the action of the parasite, or be due to some intercurrent disease. 



Lanning distinguishes three stages in the disease, viz, : — 

 Initial Stage. — This lasts three to six weeks, and is characterized by high 

 afternoon temperatures, with slow pulse-rate, evanescent oedemas and urti- 

 carias, pains in the abdomen, especially in the upper part, diarrhoea or con- 

 stipation, marked eosinophilia, and often mental depression. 



Second Stage. — During this stage the liver and spleen are enlarged with 

 anaemia ; there is loss of weight, slight fever at times, and the passage of blood- 

 stained mucus, associated with more or less tenesmus and straining, and 

 either diarrhoea or constipation. The characteristic ova can be found in the 

 motions. 



Third Stage.- — ^This may or may not be present, and then only after three 

 to five years, and especially if frequent reinfection takes place. It is charac- 

 terized by cirrhosis of the liver, which may be enlarged or shrunken, ascites, 

 oedema of the extremities, emaciation, anaemia, weakness, passage of blood 

 and mucus in the motions, and a little fever. 



Termination. — Death may occur from exhaustion or some terminal infection. 



Varieties. — ^Houghton recognizes the following types of the 

 disease: (a) Typical cases, with enlarged liver and spleen, ascites, 

 and blood in the motions; {b) cases with only splenic enlargement, 

 and with or without blood in the motions; (c) cases with cerebral 

 symptoms and marked eosinophilia, to which may be added — 



(d) urticarial fever, with marked eosinophilia in the early stages; 



(e) cases only showing eosinophilia, often associated with some other 

 concurrent disorder; (/) latent cases showing ova in the motions, 

 but no bodily disturbance. 



The splenic type, when present without blood in the motions, 

 may give rise to difficulties of diagnosis, which may be cleared up by 

 an examination of the blood and fseces. The eosinophilia in these 

 cases is from 25 to 51 per cent. 



