HEPATIC HISTOMATOSIS. 
At least five species of parasites have been reported in connection 
with hepatic distomatosis in man; all are members of the family 
Fasciolidae. 
Clinical diagnosis. — Make microscopic examination of fresh, 
unstained feces for eggs; also, examine sputum and urine for eggs, 
as the ova in pulmonaiy and venal distomatosis may be discharged 
per anum; hence, finding eggs in feces without excluding distomatosis 
of lungs and veins may lead to error in diagnosis (see pp. Id, 49). 
Symptoms. — Best studied for epizootic distomatosis caused by 
Fasciola hepatica in sheep: (1) Period of traumatic inflammation of 
liver, symptoms may be indefinite, no eggs in feces; (2) period of 
anemia, positive diagnosis may be made by finding characteristic eggs 
in feces; (3) period of emaciation, atroph}" of liver; (4) period of 
emigration of flukes. For more detailed discussion in English, see 
Stiles (1898, pp. 29-57). 
Ta}4or (1884, pp. 48-57) gives the following symptoms for infection 
of man with f>pistliOTc]iis sinensis: 
The dwellers in these villages are attacked irrespective of age, sex, or physical con- 
dition. Young children are among the sufferers. When one in a family is found 
infected, several members of the family generally present the same symptoms in a 
greater or less degree. In this respect this disease offers a contrast to Endemic 
Hpemoptysis. A very large ratio of the inhabitants of the villages mentioned are 
victims of the parasite. Some native practitioners place the estimate at 1 in every 
7, while others make it as high as 1 in every 5 of the whole population. 
Symptoms and course . — One of the first and most prominent symptoms is the enlarge- 
ment of the liver, followed, attended, or preceded by diarrhoea. At first the diar- 
rhoea is irregular and intermittent, the attacks gradually become more frequent and 
lasting longer, till, after a period of from 2 to 5 years, there maybe hardly any inter- 
val between them. The stools, which may or may not he dark and bloody, some- 
times reach 12 in a day. In some cases bloody diarrhoea becomes after a time 
almost constant, while in others blood appears in the stools only at irregular inter- 
vals. The liver continues to increase in size, though at times it apparently dimin- 
ishes temporarily. There may be occasional tenderness over the hepatic region, or 
more or less constant pain. Jaundice, sometimes intermittent, is a frequent symp- 
tom. There is generally a dark ashen discoloration of the skin. The temperature 
varies between 99° and 100.5° F., or may remain normal. The pulse, though gen- 
erally about normal, frequently rises to 85° or 100°. After a time anasarca, likewise 
intermittent, appears and affects the legs especially. Ascites is also very likely to 
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