Complete Text (Part 21)

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Size — 70 to 100 microns by 50 to 70 microns. Pathology — Often found in connection with vari- ous types of diarrheal affection but may be found in persons without intestinal symptoms. It is capable of setting up a severe ulcerative colitis not unlike amoebic dysentery (Strong and Bowman) and se- vere anaemia (Barker). 279 Fasciola hepatica. other names — Distomum hepaticum, Distomum cam, Fasciola huinana, Cladocaelimn Tiepaticum, common liver fluke. ^i^e_20 to 50 by 8 to 13 millimeters. ^ize of egg — 130 to 145 microns by 70 to 90 microns. Pathology — Usual habitat is the gall ducts but is frequently found in the gall bladder, intestines, por- tal system, and subcutaneous cysts. Infection is rare in man (32 cases recorded). Mode of infection — The intermediate host is the snail of the genus Limnaea. Infection occurs in swallowing the encysted cercaria deposited on plants in marshes. Method of diagnosis — Finding ova in the feces. . SCHISTOSOMUM HEMATOBIUM. (Infection called Distomiasis and Bilharziasis) Other names — Bilharzia hematohia, gynecophorus, Distomum hem^atoMiim, Distoma capense, Thecoso- ma. Size of male — 12 to 15 mm. by 1 mm. Size of female — 20 mm. by 0.25 mm. Size of eggs — 0.16 mm. by 0.05 mm. Pathology — The parasites inhabit the blood of the portal vein, and the vessels of the pelvis, rectum and bladder. Mode of infection — Through drinking water and occasionally through the skin with a cycle much like that of the hook-worm. Egg cysts form in the mu- 280 05 ^"Z . O Cii rS aj e pq ..•2o".2 ^ o o M els to C3 Q 3 rt £3 >> c3 o d C3 • IS fi Sac </} Is o ? I ^ o CS S .s ^ © rt . o s S S "^ i«§s:^s.pi gSsg-s^g-^S E-I H H Eh' Q Q CS 02 g« O Q ao j- 5 =3 -^s S« s^ -ast: o s- o 281 ^ 5 oc 9 k ^•s -= e <» •- c o face ^ c S Cm if 282 cosa of the bowel and bladder, causing lieiuorrliagcs from either. S. hematobium S. joponicnm S. manisoni Paragonimus westermanii. This organism is a very frequent cause of he- moptysis in Japan. The eggs can be found in the unstained sputum which are j^ellow, operculated, and 77 to 102 by 40 to 75 microns in size. FiLARIA BANCROFT!. Size — 270 to 340 microns long by 7 to 11 microns broad. Pathology — These parasites and their ova cause obstruction of the lymphatics. They reach the gen- eral circulation bj^ way of the thoracic duct. Chyluria is a very frequent occurrence due to the rupture of the varicose lymph vessels of the bladder. Elephantiasis develops in the extremities due to lymph obstruction. Method of diagnosis — There is usually pain and fever with lymph tumor, elephantiasis, hematochy- luria, enlarged spleen. Examine the blood during the night for the parasites, for they appear in the circulation onlv at this time. Strongyloides stercoralis. Other names — Anguilhda intestinalis et stercor- 283 alis^ Leptodera, intcsfinaJis et stercondis, Pscudor- hahditis stercoralis^ Rhadonema strongyloldes, Rlia- donema intestinaUSy Strongyloides intestinalis. ^ize of egg — 70x45 microns. Forms : 1. Parasitic adults, rartliogenetic females Avhicli live in liuman intestines, 2.2 to 3 mm in size. Eggs indistinguishable from those of hookworm, but only the embryos are passed in the feces. Elggs develop into 2. Rhaditiform embryos, 200 to 400 microns in length, and in a few days these develop into 3. Free living adult males and females. Male .7 mm. and females 1 mm. in size. , The females pro- duce from 30 to 40 eggs, which develop into 4. Free living rhabitiform embryos, 220 microns long. When they attain the size of 550 microns they moult and change into 5. Filariform embryos having elongated cylin- drical esophagus. This is the infecting stage for man wliich occurs in much the same way asAyith the hook-worm, i e, through the skin or the mouth direct. In temperate zones cycles 3 and 4 may not occur. Method of diagnosis : 1. Finding the rhabitiform embryo (2) in the fresh feces. 2. Occasionally the eggs, strung together end to end and surrounded by a delicate tube are also found in the feces. Pathology — They live in the upper intestinal tract. Large numbers cause anaemia and diarrhea. 284 Trichinella spiralis. 8is!e of male — 1.4 to 1.6 mm x 40 microns. Size of female — 3 to 4 mm x 60 microns. Pathology — A disease especially of slaughter- house rats, but also of dogs, cats, hogs and man, an accidental host. There are three stages of the in- fection. In the first the cysts present in the con- taminated digested meat are digested and males and females develop. The females burrough into the mucosa and proliferate rapidly. In the second stage they enter the lymphatics and gain access to the circulating blood. In the third stage they stop for the most part in striated muscle in which they become encysted. A myositis develops. Symptoms of infection — 1 . Intestinal disturbance. In animals this is very severe. There is profound intoxication, a drop in the w.b.c. count with an associated drop in eosino- philes. 2. Tremendous inflammation of the muscles asso- ciated with fever, enlargement of the spleen, and an increase in the polymorphonuclear neutrophile and eosinophile count. Sometimes there occur as many as SO per cent, eosinophiles. There is pain on mus- cular effort. The muscles of the eye ball, the calves and the diaphragm are all tender. After the first acute symptoms the patient doesn't suffer, but he is doomed to harbor the parasites the rest of his life. Diagnosis — Never made by finding the parasite in the stools. They can be found in the stomach and 285 intestines. In the dog the parasites can be found in the blood within 5 days after the infection, and this is the most satisfactory method in man in the early stages, of the disease. A syringe full of blood is removed f roin a vein and is laked by the addition of 2-3 per cent of acetic acid. The laked blood is centrifugalized and the supernatent fluid is decanted. The sediment is then washed if necessary and again centrifugalized. Preparations ,are made from the sediment and are examined under low power. In the later stages of the disease the diagnosis is made b}' excising a piece of muscle, which is then em- bedded, sectioned and stained. Mode of infection — Eating improperly cooked pork contaminated with the parasite. Trichiuris trichiura. Other names — Ascaris trichiura^ Trichocephalus trichiuruSy Trichocephalus homhvh, Trichocephalus dispar, Trichocephalus mastigodes, whip-worm. Size of male — 40 to 45 microns. Size of female — 45 to 50 microns. Size of eggs—oi, by 33 jnicrons. Pathology— Thej live in the colon eepeeially in the caecum and rarely in the appendix. They are an infrequent cause of anaemia and diarrhea. Enor- mous numbers may be present without symptoms. Mode of infection — Eating food contaminated with the embryos. The eggs passed in the feces re- quire considerable time for development. They re- sist freezing for many months. Method of diagnosis — Examine the feces for the characteristic eggs. 286 Ancylostoma duodenale. Otlicr nanic.^— Old World hook-worm, Uncinaria (liwdcual'hs, Stiongylus quadyidentatns, Dochmius (luri/lostouiinH, Sclcrostoiiia duodenale, ^trongylus duodenal i-^, Doehniius duodmalis. Enropeau hook- worm. Size of male — S to 10 mm long. Size of female — 12 to 18 mm long. Vharacteyistics of head — Two pairs of strong c'ui'e(l ventral teeth. One pair of knob-like dorsal teeth. One pair of Aentral lancets. Size of eggs — 52 to 61 by 32 to 88 microns. Pathology — Thev inhabit the dnodenum, jejnnum "and ViplJer ilinm and cause severe anaemia through loss of blood and toxin formation. Ground itch is the local" lesion of -the larva. 'Modeyyfinff'dti'on—.- (a) Ingestion of unclean vegetables or contami- nated water. (bi Through the skin. Tlie larva bores through the skin of the feet and enters the lymph and blood stream. They reach the lungs and bore their way into the bronchi whence they are raised with the bronchial secretion and swallowed. Necator americanus. Other names — New World hook-worm, Umcaria americana, American hook-worm. Size of male — 6 to 9 mm long. Size of female — 8 to 15 mm long. Characteristics of head — A dorsal and a ventral pair of lips at mouth. Prominent dorso-median buccal teeth. Four buccal lancets. Size of eggs — 64 to 72 by 36 to 40 microns. Mode of infection and pathology — Same as for the Old World form. Method of diagnosis — Look for larva in the feces : 287 ; 1. By direct examination of the feces (40 per cent. yield). 2. By adding water to the stool and passing it through a series of sieves and then allowing it to settle and examining the sediment. 3. Increase specific gravity of the stool and cen- trifugalize. They are relatively light and come to the top where they can be secured. (55 per cent, yield.) 4. Cultural method. Put stool in petrie dish and enough water to keep moist. Make a well in the center filled with Avater. Examine the water in the well from day to day. (99 per cent, yield.) Parasites havitig eggs resembling hookworpi eggs : 1. Stroiigyloides stercoralis. Eggs infrequently passed in the feces. 2. Trichostrongylus instahilis (See Jour, A.M. A. December 23, 1916, Pg. 1908). The eggs of this worm are larger and have a tend- ency to point at one end and be flattened at the other. There are from 4 to 32 segments within the egg. 3. Haeinonchus coutortus. 4. Strongylus coutortus. ASCARIS LUMBRICOIUES. &ize of hiale : 15 to 25 cm. Size of female: 20 to 40 cm. Characteristics of head: It has 3 conical lips. Color: Grayish to reddish yellow. Size of eggs : 50 to 75 microns by 36 to 55 microns. 2SS Fertilized Unfertilized PaihoJogy. Tliev inhabit the small intestine, nsu- ally one or two being present. Occasionally large numbers arc found. While remaining in the in- te tine they rarely cause trouble, but when they wander up the common bile duct they often set up a pancreatitis and a hepatitis with liver abscesses. During anaesthesia they may be regurgitated, as well as at other times, and find their way into the air ])assage-\ Anaemia and intestinal obstruction are also caused at times by this infection. Si/hiptonis of infection : There are many. Itching at the anus, irritability, picking at the nose, rest- lessness, convulsions in children. A few worms may cause no symptoms. Mode of infection : The eggs are expelled in the feces and develop into embryos. These, when swal- lowed Avith contaminated drinking water or fruits, cause the disease. Eggs discharged in the feces are not immediately infective, but are only so after the development of the embryo. Method of diagnosis : Look for the eggs and worm ^ in the stools. There is usually an associated eos!- nophilia. TOXICORA CAXIS. Other names: Asca-iis canis, Ascaris liinil)ricns canis^.A^ckir-is^tereSy Ascaris caniculae, Ascaris cati, Asmris'tMciispiddta^ Ascaris felis, Ascaris loerneri, Ascmis inarginata, Ascaris aJata, Fusaria mystax. Si^e of male : 40 to 60 mm. long by 1 mm. thick. Size of female : 120 to 180 mm. long by 1 mm. thick. Size of egg : 68 to 72 microns. 289 Pathology: This worm is not uncommon and may be found accidentally in man. OXYURIS VERMICULARIS. other names: Ascaris vennicularis, Fusavia ver- micularis, Ascaris graecorum, pin-worm, thread- worm, seat-worm. Size of male : 3 to 5 mm. by 0.3 to 0.4 mm. Size of female : 10 mm. by 0.6 mm. Characteristics of head: Male has 6 pairs of papillae ; female has 3 small nodular lips. Size of eggs : 50 by 16 to 20 microns. Pathology: The early stages live in the small in- testine, where the^^ copulate. The males soon die and the females wander to the large bowel as far as the anus. They migrate from here and deposit their eggs in the skin about the anus and cause intense itching. The eggs lodge under the finger nails upon scratching, and often find their way into the mouth, causing auto-infection. The females may wander up the vagina, uterus, tubes or into the urethra and bladder. Method of diagnosis : Not readily made from the examination of the stools, but from the symptoms and the examination of the scrapings of the skin in the anal region, where the eggs are likely to be found. i 291 INDEX Abnormal myeloblasts , 216 Abscess, sputum in 144 Acetic acid in stomach analysis 115 Acetone. Frommer's test for 93 Gunning's test for 93 , Lenoble's test for 93 Lieben's test for ^ 93 Legal's test for 92 Achylia 109 Acids in the urine. Quantitative determination of 34 Variation of 33 Acidosis 91 Acute myeloid leukemia 242 Albuminuria. Albumoses 8 Bence-Jones protein 8, 14, 15 Definition of 7 Detection of 10 False 7 Nucleo-histones •. 8 Origin 7 Pseudo-globulin, etc 7 Salient features of functional disturbance 9 True 7 With renal lesion 8 Without renal lesion 8 With transient renal injury 9 Albumin. Heat and acetic acid test for 10 Heat and nitric acid test for 11 Heller's test for 11 Potassium ferrocyanide and acetic acid test for 12 Quantitative test for 12 Alkapton bodies in urine 44 Aleukemic lymphadenoses 239 Allen's theory of. diabetes 95 American hook-worm 286 Ammonia in urine 65 Ammonium sulphate test for globulin 13 Amoebic dysentery, stolls in 158 Amorphous phosphates and carbonates in urine 20 Amyloid disease, stools in 157 Anachlorhydria 109 Anemias. Acute hemorrhagic 225 Acute lymphatic 239 Blood picture in secondary 224 Chlorosis 228 Chronic hemorrhagic 225 General considerations of 223 292 Hemolytic 227, 245 Pernicious anemia 228 Secondary aplastic 226 Ancliylostoma duodenale 286 Anguillula intestinalis et stercoralis 282 Animal parasites. In sputum 131 In urine 27 Anisocbromia 205 Anuria 31 Aplastic anemia 250 Arnold's method of determining amount of chlorides in urine 48 Ascaris alata 288 " lumbricoides ; 287 canis 288 cati 288 felis 288 " graecorum 289 marginata 288 teres 288 " tricuspidata -88 *' vermicularis 289 " werneri 288 Avery's media for isolating influenza bacilli 143 Avery's method of determining type of pneumoco: us. . . 137 Bacilluria 26, 27 Bang's titration method for sugar 85 Banti's disease 245 Barlow's disease 251 Basophilic reaction in r. b. c 206 Bayne-Jones quan. determination of chlorides in the urine 50 Beef tape-worm 280, 281 Bence-Jones protein in urine 8 Character of urine in 15, 16 Nature of protein 15 Tests for 16 Theories of origin 15 Types of cases demonstrated in 14 Benedict's test for sugar 73 " quan. determination of sugar 85 Benzidine test for blood 40 Bial's method of detecting pentose in urine." 80 Bile pigments in the urine 40 Tests for Foam 42 Gmelin's • • • 12 Xakayama's 43 Rosenbach's moditication of Gmelin's 43 Smith's 13 Bilharzia hematobia 279 Bilirubin crystals in the urine 20 Blood. Bleeding time determination 195 295 I'oygiilatioji liiue (Iclenuination 194 Chart for special examination 197 Cleaning glassware for 159 Dust 182 Counting 183 Burger double counting chamber 186 Hayem's solution for 184 Red counts 185 Sing'le counting chamber 186 Requirements