VA RIETIES-^PROGNOSIS 



1593 



The cerebral type is exemplified by partial hemiplegia and slight 

 disturbance of speech after high fever, and associated with an 

 eosinophilia of about 50 per cent. Jacksonian epilepsy has also 

 been reported as due to this parasite. 



The urticarial fever is characterized by a remittent type of fever, 

 usually ranging at first from 99° to 100° F. in the morning to 102° 

 to 103° F. in the evening, and after a time from normal to about 

 100° F., associated with marked urticaria, followed by pale raised 

 blotches on the arms, trunk, and legs, and associated with a marked 

 urticarial rash. The fever lasts some weeks, and very closely 

 resembles malaria at first, because the daily fall of temperature is 

 associated with sweating. 



Complications. — ^The infection is generally complicated by the 

 presence of Trichuris tnchiura, Ancylostoma dtwdenale or Necator 



americamis, and Ascaris lum- ^ 



bricoides. Dysentery is a com- ' ' "^-^ 



plication which may occur and 

 prove fatal to the patient. 



Diagnosis. — ^The character- 

 istic signs are chronic painful 

 enlargement of the liver and 

 spleen, associated with ascites 

 and chronic irregular diarrhoea, 

 and marked eosinophilia (10 to 

 50 per cent.). A definite diag- 

 nosis is tobe effected by finding 

 the ova in the faeces. These ova 

 are large (o-i by 0-07 milli- 

 metre), oval, non-operculated, 

 laterally spined (75 per cent.), 

 smooth, and transparent, with 

 a double contour sometimes 

 showing a Miracidium, and 

 when kept in water for a short 



time give rise to a free-swimming ciliated Miracidium. These ova 

 are apt to be mistaken for Ascaris lumbricoides, or less likely 

 for an Ancylostoma ovum. The ova require to be looked for 

 carefully. 



Other points which assist in the diagnosis are the greatly exag- 

 gerated knee-jerks, the peculiar muddy complexion suggestive of 

 anaemia, the lack of leucocytosis (the counts in uncomplicated cases 

 being about 2,000 to 8,500 per cubic millimetre), and the emaciation 

 without obvious cause. 



Prognosis. — ^The prognosis is very bad, as the parasite directly 

 or indirectly leads to the death of the patient. The mortality is 

 not known, but Katsurada met with between thirty to fifty-four 

 cases every year for five years in the infected area in Japan, and 

 saw three to five deaths per annum, which he considered directly 

 due to the parasite — i.e., a mortality of about 10 per cent. — but 



Fig. 712. — Egg of Schistosoma 

 japonicum. 



(From a photomicrograph by J.J. Bell.) 



