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ki..:~;-;:.)OK

ON THE

PREI-ENTION

AND

TREATMENT

OF SCHISTOSO\lIASIS
1.4 translation

of a Chinese

-4 Publication
Geographic

John

of the

Health

E. Fogarty

publil:ation)

Studies

International

Center

for
Xdvanced

Study

in the Health

Sciences

1977

L.S. DEP.4PTMENT

OF HEALTH.
Public
National

DHEW

For F~!II bv tlo Swwrintmdent

EDUCATION,

Health

WELFARE

Service

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Publication

AND

of Health

No. iNIH)

77-1290

of Documents, U.S. Government Printing Office, WnshIngton, D.C. 25402

Other
China

Publications
Health

Studies

Geographic
John E. Fogarty

of the

Health

Project
Studies

International

Center

for
Advanced

Medicine
Topics

and Public

Health

of Study Interest

Republic

Peoples
Anticancer

Report

of Chinese
Republic

in the Peoples

in Medicine

of China:

A Bibliography

Study in the Health

Republic

and Public

of a Planning

Agents Recently

of China

Health

in the Peoples

Meeting

Sources on Medicine

of China:

Sciences

and Public

Health

in the

1960-1970

Developed

in the Peoples

Rcpubiic

of China-

A Review
Prevention

and Treatment

Standard

Surgical

Neurology
China

Illusirated*

As We Saw It

Herbal

Respiratory
An Economic
Republic

*Translations
quantities

Techniques,

Eye Diseases*

- Psychiatry*

Medicine

Chinese

of Common

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Research
Analysis

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Republic

of the Cooperative

of China

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of China

cf Chinese
only.

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produced

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in the Peoples

The Government
b::sis the national

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include

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An

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Taking

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of the American

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health-related

ing some of the complex


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of all health

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Such studies
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Island.

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in his address to the Third

National

1963 as a great international


to international

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and education

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for research

cooperation

John E. Fogarty

of Rhode

ad

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on World Health
in biology

and collaboration

for

in September

and medicine

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With Senator
the growth

center

in 1968,

by Mr. Fogarty

Conference

Inter-

established

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of the late Congressman

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dedicated

Institutes

work cf the Fogarty

and Health,

of Alabama,

Institutes

for nearly

Appropriations
Education,

Congressman

of Health

Fogarty

and the nations

two decades as Chairman


Subcommittee
and Welfare.

. ..

111

charted
medical

of the House

on the Departments

The many-faceted
flourished

The Center

American,

countries

American

ing scientists

Organization

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Public

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overseas

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Fellowship

Program,

is the Centers

the govern-

Japan, and the U.S.S.R.


cooperation

of internaand the Pan

exchanges

States and abroad.

medical

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Institutes

involv-

Similarly,

it shares its

of Health

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opportunities

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agreements

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tional

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Also being implemented


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Many and varied

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the Centers

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conferences

and seminars,

Program.

This latter

Frogram,

enterprise,

other

is this publications

for Prevention
on methods

section

on schistosomiasis

lations

of dccuments

health

care.

personal

to obtain
systems

Studies

of

against
patients,

on various

under arrangements

iv

Municipal

Lnstitute
sections

snails,

diag-

as well as a

It is part of a series of trans-

in other countries

of Commerce,

and Treatment

It contains

protection

of schistosomiasis

They were translated


the Department

designed

by the Shanghai

in farm animals.

published

of

Health

of the health-care

of Schistosomiasis.

and treatment

program

raison detre.

was published

of snail elimination,

by

Geographic

Handbook on the Prevention

and Treatment

nostic measures,

of Congress,

knowledge

titled

of Schistosomiasis,

by a continuing

a series of studies

comparative

This document,

have been investigated

and by its five-year-old

and disseminate
countries,

topics

or private

with
firms.

aspects

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the Library
Many of

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have been addressed

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the original
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documents

which

Inquiries
Studies

Program

graphic

i-ieaith

in limited
contained

has been deleted

to specialized
quantities

irrelevant

nonmedical

Some of

or nonscientific

for the sake of brevity.

should be directed
Program,

audiences

in this country.

about this and other publicationr

Studies

Chinese

4 Lhc Geographic

to Dr. Joseph R. Quinn,

Fogarty

International

Milo D. Leavitt,

Head, Geo-

Center.

Jr., M.D.

Director
Fogarty

International

Health

Center

Information contained in this publication in no way reflects the


q!Gtions of the Fogurty International Center, the National Institutes of Health, the Department of
Health, Education, and Welfare, or
any other agency of the Federal
Government.

CONTENTS

Page
CHAPTER

1.

The Schistosome

CHAPTER

2.

The Elimination

1.

of Snails

Snail Distribution,

A.

Activity,

and Colonization

Snail Distribution

B. Snail Activity

and Colonization

The Investigation

of Snails

A. Methods

10

of Snail Investigation

B. Questions

Regarding

the Investigation

of Snails
In.

Methods

12

A. Eliminating

Snails in Rivers

B. Eliminating

Snails in Irrigation

C. Eliminating

Snails in Rice Paddies

D. Eliminating

Snails in Fishponds

E. Eliminating

Snails in Marshland

River

Iv.

of Snail Elimination

Canals

and Grassy

Banks

F. Eliminating

Snails in Complex

G. Eliminating

Snails in Cities

H. Eliminating

Snails in Reeded Areas

Frequently

A.

Used Molluscicides

Sodium Pentachiorophenate

B. Antischistosome-67
C. Lime Nitrogen
D. Industrial

Wastes

vii

Environments
and Towns

22

Page

V.

Some Problems
Water

CHAPTER

of Snail Elimination

in Areas with
27

Networks

3. The Proper Treatment

of Manure

Safe Cesspools

A. Capacity

29

29

of Cesspools

B. Style of Cesspool
C. Advantages

II.

of Cesspools

Compost

A ~ rnaerobic
:erobic

emical

III.
\.

Compost
Compost

41

Treatment

Dipterex

B. Ammonia

Water

C. Lime Nitrogen
D. Wettable

Iv .

Methods

V.

Manure

666

of Proper

Treatment

Treatment

Chin Shan County,

Regulations
Shanghai

A. General
B. Ideological

Work

C. Sanitation

Members

D. Manure

Management

...

Vlll

of Manure

of the Fenyg-wei
Municipality

42

Commune,
43

Page

CHAPTER

I.

4. Safe Water Use and Personal

I.

Wells

B. Separate

Pools for Water Use

C. Drawing

Water

Personal

A.

CHAPTER

45

Safe Water Use

A. Digging

II.

45

Protection

from Midstream
58

Protection

Avoid

Contact

with

B. Prevent

Penetration

5. Methods

of Diagnosis

Stool Examinati.on

A.

Infected

Water

of the Cercariae

(Sedimentation

61

Hatching

Method)

61

Preparations

B. Procedure
C. Morphology
D.

il.

of Schistosome

Ova and Cercariae

Precautions

Serum Oval Ring Sedimentation

A.

Ova Suspension

3.

Serum

C. Test

ix

Test

69

Page

IrL

Proctoscopy

and Sigmoidoscopy

71

and Biopsy

A. Indications
B. Precautions

and Procedures
of Ova and its CU.lical

C. Differentiation
Significance

CHAPTER
I.

II.

ILL

6. Treatment

of Patients

75

Pretreatment

Preparations

75

The Selection

of ivledications

Schistosomiasis

Treatment

75

80

Antischistosose-846

B. Sodium Antimony
C. Furapromidum

Potassium

A.

Gallate

Methods

(Antimony-273)

(F-30066)

Antimony

Tartrate

of Tartar

B. Precautions

During

Emetic
Tartar

(Tartar

Emetic)

Emetic

Treatment;

and Treatment

of Toxic

C. Prevention

and Treatment

of Severe Cardiac

Caused by Tartar

D. Prevention
Toxic

Treatment
Concurrent

and Treatment

103

Treatment

Prevention

Arrhythmia

v.

for

Oral Medicines
A.

Iv.

and Methods

Emetic

of Tartar

Reactions

Toxicity
Emetic

Hepatitis

of Several Frequently
Diseases

Encountered

of Schistosomiasis

126

Page

A.

Principles

of Treatment

B. Preliminary

Suggestions

Several Concurrent
VI.

Treatment

A.

of Acute

Main Clinical

B. Important

in the Treatment

Diseases

of

of Schistosomiasis
131

Schistosomiasis

Manifestations

Diagnostic

Points

C. Treatment

of Chronic

Treatment

A.

Clinical

Manifestations

B. Differential
C. Methods

Diagnosis
of Treatment

D. Treatment

A.

CHAPTER

Pathological

Strengthen

the Leadership

7. Prevention

Methods
Among

II.

of Schistosomiasis

of the Upper Alimentary

C. Colonic

Among

I.

Treatment

143

Splenectomy

B. Bleeding

Ix.

of Complications

of Surgical

Methods

134

Schistosomiasis

Methods
Among

Changes

Tract

in Schistusomiasis

Role in Treatment

and Treatment

of Schistosomiasis
159

Farm Cattle

of Prevention

157

of Schistosomiasis

159

Farm Cattle

for Investigation

of Schistosomiasis

159

Farm Cattle

xi

-----

Page

A. Requirements

for Sending Cattle

Manure

for Examination
B. Manure-hatching

m.

Methods

Method

of Treatment

of Schistosomiaris
161

Among Farm Cattle

Iv.

A. Health

Examination

Procedures

B. Cattle

Not to Be Treated

Drug Dosage and the Course

A. Calculation

of Treatment

of Body Weight

B. Drug Dosage and Treatment


C. Determination

Side Reactions

A.

for Treatment
and Their

Side Reactions
Their

169

Treatment

of Tartar

Emetic

and

Management

B. Side Reactions
and Their

VI.

Course

of Drug Dosage

D. Requirements

V.

164

Work After

of Antischistosome-846

Management

Conclusion

xii

of Treatment

172

Chapter

I
THE SCHISTOSOME

The schistosome
mesenteric

the ovum,

is dependent

the miracidium,

The adult

the snail,

schistosome.

2, The female

Female

is slender

on the head and a ventral


surface

embrace

may extend

to fertilize

against

A female

plate

where the female

They

an oval

on the abdomen.

On

and male fre-

The life span of an adult

schistosomes

Some of the ova follow

the bloodstream

the miracidia

the intestinal
Generally

the cercariae,

reproductive

schistosome

the intestinal

The toxin
wall,

outside

human beings and animals

After

the miracidia

group together

on the surface

enter

they will die-in

the snail,

The mail.

of the water

emerge from

about

others

secreted

thus allowing

by
the

infested

with

(Fig. 3).

the ova, they frequently

(Fig. 4). If they are not able to

2 to 3 days.

The snail is an amphibian

soft-body

animal.

It is the intermedi-

ate host of the schistosome.

The shell of the snail has six to eight left-to-

right

are transverse

spirals;

outwardly

of a rice grain.
the screw
ova.

snail

there

and creeks.

streaks.

The shape is that of a small screw;


(Fig. 5). Each year a female

The snail likes to habitate


Decaying

plants

flow

of the body with

become

ova are found in the feces 1 month later

The miracidia.

will produce

into the liver;

wall.

canal and be excreted

after

cycle

the bloodstream

to enter the intestinal

in the ova may destroy

ova to enter
the feces.

and short.

over 10 years.

The ovum.
1,000 ova.

the ova.

are depicted

about 1 cm long, with

suction

in the male is a groove

The spread

(Fig. 1).

and male schistosomes

of a cc;cton string,

veins or

schistosome,

and long; the male, thick

suction

the ventral

the adult

and the cercaria

of the caliber

plate

and feeds on blood.

on the five stages:

are generally

quently

that lodges in the portal

veins of human beings or animals

of schistosomiasis

in Figure

is a type of trematode

The length

is about that

that is why it is called

snail can reproduce

over 100

in the dark damp weeds of the banks of rivers

are its main food.

Figure

1. The spread of schistosomiasis.

1. Schistosome
4. Snail

2. Ovum
5. Cercaria

3. Miracidium
6. Mesentery

-,. . _I^,.,;ELI
-...,1, ::_.,-r.,.. ...-.,,...7..,..r. -

Figure

3. Structure

of a schistosome

ovum.

2. Side spicule
4. Cilia

1. Esophagus
3. Blood and tissue cells attached
to shell
5. Hair-growing
cells
7. Head gland

6. Flame! cells and eliminating

Figure 4. Internal structure


schistosome
miracidium.

of a

tube

Thecercaiae.
of reproduction,
cercariae

A miracidium
tens of thousands

of the schistosome

ed on the surface

the miracidia

bodies;

and develop

cercariae.

(Fig. 6). The

They usually

the schistosome

is encountered,

the snail and develop

into adult

are produced

the ova are excreted

and when water

enter

two generations

are group-

edge.

the snail and roam in the water,


bodies,

of cercariae

of the five stages is:

in the human or animal


and animals

the snail and, after

are forked-tail

of the water

The relationship

beings

enters

schistosomes.

contains

the essential

requirements

struction

of any stage of the cycle

miracidia

the cercariae

to penetrate

This life

are hatched;

cycle

leave

human or animal
of the schistosome

for the spread of schistosomiasis.


will prevent

ova

in the feces of the human

into cercariae;

find opportunity

reproduces

De-

the spread of this disease.

Figure
1.
4.
7.
10.
13.
16.

5. External appearance and position


soft body of a snail.

Tip of shell
Prebody spiral
Mouth of shell
Width of shell
Crease of shell
Axis of shell
19. Tactile horn
22. External sheath
25. Accessary gland

Figure

2.
5.
8.
11.
14.
17.
20.
23.

Nuclear spiral
Body spiral
External lip
Internal lip
Height of shell
Liver
Mouth
Cheek

6. Morphology

of the

3. Posterior

body spiral

6. Spine of lip .
9. Base of shell
12.
15.
18.
21.
24.

of the schistosome

Umbilicus
Spiral
Eye
Foot
Intestine

cercarium.

of shell

Chapter

2
THE ELIMINATION

The snail is the only intermediate

OF SNAILS

host of the schistosome.

Elimination

of the snail in an area will stop the spread of schistosomiasis


is an important

step in the eradication

I. Snail Distribution,

A.

and therefore

of schistosomiasis.

Activity,

and Colonization

Snail Distribution

River

snails.

1 meter
level.

River

above or below

snails are mainly

water

level.

The snails are more densely

and less densely

populated

of the bank is greater,


the wider
creeks,

from

nearer

the water

In small rivers,

creeks,

streams,

full of wee&,

the distribution

distributed;

is sparse.

superficial

in rivers

with

more easily

limited

the less the slope,


and dead-end

large creeks,
with

fast-moving

winter,

level.

and tide-

slow-moving

streams,

is dense
poor soil, and

in all months

of

Snails may exist in

most of the snails sta; in the

The snails in irrigation

canals are mostly

distributed

the end of autumn

ditches

and elec-

in a line on the water

in the bed of the ditches

found during

and canals

and beginning

where

level.

they are

of spring

when

is at a standstill.

and mud bank snails.


to 1 to 2 meters

5 to 6 meters
by rivers,

in bitter

snails.

Some snails also exist

Field

Where the slope

Snails may exist under water

Except

and canal

irrigation

irrigation

level

layers.

Ditch
trical

to the water
level.

In rivers

the year, but most of them stay above water


soil levels.

that

and with rich soil, the snail population

banks, it is sparse.

shallow

found below

small creeks,

is dense; in large rivers,

reaching

on the two banks

the less the area of population;

the distribution

barren

They are rarely


populated

farther

the distribution.

and widely

distributed

from

near the irrigation

the gutters.

snails frequently

Snails in the rice fields

In fields

are distributed
7

gutters;

are most!.y

some may be found

and mud banks easily


in a flat

area.

flooded

Lake pool

snails.

Generally,

lakes and pools infested

with snails,

or pool communicating
distribution

with rivers

of treatment

ronments

At this time,

frequently

bamboo gardens,

brick

and tile piles,

in stone mounds;

gutters,

troughs

During

examination

cement

ditch-digging,

holes of frogs,

Basically,

ditches,

pools, low swamps,

in this pattern

other.

Sometimes,

B. Snail Activity

increase

by cattle,

wharves,
banks, banks

areas; along

rivers,

dams, and

to direct

ditches

of snails,

snail-infested

tombs,

water

into

and the space beneath

such places are railroad

gutters,

highway

close to the villages.


attention

should be paid

areas or spots created

farming

by

and to those easily ne-

of snail distribution

on the longitudinal
and electric

they are carried

may occur

is in the plains

or transverse

irrigation

of snail distribution

because

points

include

damp shadowy

gutters

and banks that are connected

factors

snail-infested

pattern

areas, mainly

irrigation

of snails in

and mud banks they include

gutters,

and pioneer

envi-

rats, crabs, and snakes.

the natural

network

a short period

elimination

tubes crossing

for the elimination


and isolated

and streams.

may be found in complex

tree roots,

along dikes, and dead-end

to the many cut-off


road building,

Other

The

In most places

along riverbanks

indentations

rice roots and rice stems.

Snail

snails.

of snails in these complex

and along fields

footprint

areas.

boat sheds, and fish storage

barns, cracks and holes in irrigation


and out of fields,

they still

In

of snails changes from

and sectional

environments

and canals they include

of rivers,

with

areas after

the distribution

elimination

of stone, bamboo stalks,

water

infested

is the key to the complete

Complex

glected

is a history

In ordinary

Nevertheless,

this whole area.

cracks

of the lake

snal!s.

areas to spotty

be found.

environments.

ditches

there usually
and streams

for snai: elimination,

?nd large flat

snails cannot

built

pools.

of snails in lakes and pools is the same as in rivers

Complex environment
linear

no snails live in stagnant

of

crossroads

canals and the lakes,


with

them (Fig. 7). The

may change and affect


by humans in their

that are not connected

with

each
daily

rivers

work,

or ditches.

and Colonization

activity.
or decrease

In different
of density

seasons the activity


in the superficial
8

of the snail and the

soil !i.e., snails in the deep

soil layer
changes

moving

towards

of weather.

the superficial

Activity

little

occurs.

of snail density

It becomes

Especially

from December

During

one year there

along riverbanks;

is higher
density

the density

the peak in the first

soil layer,

of snails increases

colonization.

is most active
lasts from

March,

to July,

April,

with

ova is damp, moist

able temperatures,

March,

April,

and winter

the

The investigation

The requirements
following

during

the water

canals systematically;
and suspected
after

environme:lts.

layer

of soil on river

level.

From these ova,


With suit-

to maturity.

these months

The snail appears in


that are therefore

to the elimination

then the elimination

will

of snails in water

and checking

fields,

network

areas

rivers

and

banks, or pools connected

with

Also, the distribuzion

of snails

attempts

must be examined

the end of winter

10

of snails.

be incomplete.

snaii-infested

of snail infestatinn.

banks should be peeled

most

of Snails

investigating

During

are the main

of the snail.

system;

elimination

and October

and growth.

The Investigation

is not clear,

ferent

ova

The most frequent

from hatching

and the elimination

for the investigation

changes

the year but

most snails are seen in June.

of snails is the prelude

If the investigation

throughout

The season for laying

May, September,

soil most often

IL

and their

less and

and becomes less in the

areas near water

colonization,

for investigation

the rivers

In spr;Jrg

snail may last 1 to 2 years.

for snail activity,

the superficial

are:

half year is in April

peak in May.

it takes about 2 months

of a mature

In sur-imary,

and May.

the highest

young snails may be seen in April;

suitable

very

increases

and October.

The snail may copulate

during

March

site for laying

months

in June, July,

to February,

in summer

in the deep soil layer

and

soil.

Snail

The life

whereas

to the

April,

of snails in the deep soil layer becomes

in the superficial

superficial

weaker

are two seasonal

and May and in the second half year in September


and autumn

in March,

and October.

and in November.

activity

vary according

of the snail is strongest

May and again in September


and August

soil layer)

off.

and early spring,


This procedure

in the difths grassy


not

only will

eliminate

nization

but also will

investigation

some snails and change the environment


facilitate

should include

the investigation
with

mutual

investigation,

self-investigation,

vestigation,

and investigation

A.

of Snail Investigation

Methods

1, A section

of a river

snails may be selected


fested

with snails,

infested

investigation.

in-

infested

If the river
as totally

with

is heavily

infested.

in-

Then the

by use of the step measurement

These methods

an area considered

or when deciding

whether

to make thorough

investigations.

3. In areas where

are also applicable

out two or three times.

to contain
with

snails,

If snails are found,


must be immediately

snail infestation

and autumn

unlikely

an area is infested

of snail infestion

in the spring

of farm

fixed-partnership

state and heavily

may be calculated
method.

the conditions

of

to other

environments.

2. In treating

environment

in a primitive

Methods

population.

then it may be considered

or rope measurement
heavily

by the entire

for special

area of snail infestation

of snails.

coordination

production,

of snail colo-

it is necessary

then the area and


recorded.

has not been found for 2 to 3 years,

of each year investigation


This procedure

snail infestation

will

still

consolidate

should be carried
the results

of snail

elimination.

4. Methods
and pools,
distribution

for calculating

snail-infested

1 m of bank length

areas are: on rivers, ditches


2
as 1 m . If it is found that snail

is considered
1
is less than 10 per rn& (even if only one snail is found),

then

it still

is considered as 10 m2. Over 10 m2 and less than 20 m2 is considered


2
as20m.
Using each 10 m2 as a basic calculating
unit, other calculations
can be derived.
whole

field

If snails are found in one section

is considered

In snail-infested
used to calculate

swamps

snail-infested

of a ricefield,

(each mou is equivalent

and grassy banks, the actual

the infested

area.

11

then the
to 666 m).

snail distribution

is

Furthermore,
igation

equal

distance

may be used to carry

of snail elimination.

out scientific

then all snails in the basket

number

of snails reflects

or evaluate

of snail-containing

the average

density

the snail density.

The calculation

Percentage
of baskets
with snails

No. of baskets with snails X 100


= No. of baskets investigated

the Investigation

Spring and autumn


When rivers
level.
ditches
fields,

are examined,

When rice paddy fields

complex

the center

have repeatedly
environments

attention

first,

then the field

of the fields.

been carried
for investigation.

III.

infestation,

A.

in different

out by different

and outlet

and edges of the


elimination

border

blank spots.

pro-

of two
Records

1.

of Snail Elimination

of snails in different

terrains,

of farm production,
methods

with

on the
of snail

snail elimination

definite

plans and procedures.

Snails in Rivers

are the main breeding

They are also important

sources

on

and kept by designated

seasons, on the change of conditions

and on the activities

Eliminating

Rivers

Methods

on the distribution

should be carried

to avoid leaving

is shown in Table

of snails.

should be centered

At the common

at all stages should be filed

An example

ditches

out, emphasis

of snail investigation

snail activities

is:

the inlet

In areas where

should overlap

Depending

formula

should be paid to the water

for snails,

areas, investigations

personnel.

The

of Snails

are examined

should be investigated

cedures

snails.

are the best seasons for the investigation

and ditches

and finally

baskets

of living

= Total no. of snails caught


No. of baskets investigated

Regarding

the results

If snails are found in the basket,

ft.

Average densiiy of living


snails (no./ft
)

B. Questions

of invest-

at each 10 m or 20 m distance,

and the number

to calculate

method

research

If a basket is placed

the size of the basket is 1 Chinese

should be counted

basket placement

places of snails in water


of snaii infestation
12

network

in irrigation

areas.
canals

Table

1. --Sample

Record

rivers,

Commune

Area
Name

originally

infested

(ft*)

-Date

investigation
Yr

Total

of

MO Day

Chart

of

ditches,

Snail

pools,

fields,

(suitable

for

banks)

Production

Brigade
1
Area

Investigation

team
2
Date

now infested

of

investigation

(ft2)
Yr

MO Day

Area

now

infested

(ft2>

and rice paddies.


elimination

Therefore,

in water

elimination.

ditch

areas.

of river

of chemicals

may be used.

combined

In areas with

of chemicals

immersion

sparse distribution

and killing

land with

in of rivers

construction

of water

are all good methods

1. Combined

by chemicals,
Efforts

irrigation

Methods

paring

carried

productivity

include

management

snail elimination.

environments,

killing

are effective.

all the snails above and below water

and outer layers

of the soil with

environments

as tree roots,

First
brick

one treatment.

plants,

level

thoroughly

and water

on the distribution

build dams and drain the water,

should be about 1 m below

is small or shallow,

clean

and tile piles,

low tide to build dams and stop the flow.

or utilize

The standard
the highest

the lowering

levei

of
small
for
of

may be determined

condition.

Spreading

chemicals.

an area 2 feet above the highest


(1 catty=500

the snail

out are as follows:

If the river

by the local

with

all of which

irrigation

the year.

of the

to eliminate

of complex

electric

the water

the density

of Snail Elimination

where snails may easily hide; depending

lowering

of

rivers

opening

wharves

tides during

Whether

the recontouring

Management of complex environments.


out such complex

the method

with

should be made to eliminate

The methods

soil or with a soil

the snail or coordinating

the soil, and immersion,

and in the inner

then a

to eliminate

that coordinate

These methods

with

along the bank may be used.


is high or low, coordinating

level

is inadequate,

and low density,

of snail distribution
the filling

snail

snail elimination

at the base of the bank can be dug and buried

strip.

of river

of snails is wide and dense

are ample,

If the supply

snails is the key to snail

There are many methods

In areas where the distribution

and when supplies


methods

network

elimination

Spread sodium pentachlorophenate


water

level,

gJ per 100 m.

14

within

using 20 g/m, i.e., 4 catties

Paring

soil.

Pare the soil 3 to 5 inches deep.

ing with

chemicals

Finally,

sweep all the loose soil into the water.

holes and cracks

first;

with

then pare from

chemicals

wait

at least 5 days before

to reenter.

Thorough

the top of the bank downward.


After

paring,

spread the

and then seal with soil.

Renmme t-he dam and let


tion,

Pare the area spread-

i.2 water.
removing

examinations

After

thorough

snail climina-

the dam and allowing

must be made before

water

removing

the

dam; if snails are found the dam should not be removed

before

eliminated.

This method

is best carried

to September

fully

the chemical

effects

utilize

2. Snail Elimination
River

to

on snail elimination.

by Ditchdigging

at Bed of

Bank and Soil Burying

This method
and soil burying.

of snail elimination
Generally

bed soil as fertilizer.

a. Build
the winter

out from April

they are

is also called

it can be coordinated

The method-is

bilateral

with

ditchdigging

dredging

of river-

as follows:

a dam and drain the water

to lower

dry season to expose the noninfested

the water

level

or utilize

area of the base of the

bank.

b. Dig a ditch
noninfested

areas.

near the center


erally

on each of the two sides of the base of the bank in

The noninfested

of the riverbed.

soil is piled on the side of the ditch


The width

and depth of the ditch

(gen-

1% feet wide and 2 feet deep) should be able to accommodate

snail-infested

soil pared from the riverbank.

c. Pare the soil 3 inches deep.


near the water

level,

the top of the riverbauk


the whole ditch
A 5-inch

layer

the

First

pare the heavily

and dump it into the ditch.


into the ditch.

with noninfested

soil

Then pare the soil from

Clean up the loose soil, and cover

soil lying

of soil is used which

infested

on.the

is then pounded

15

center

side of the ditch.

and hardened.

3. Snail Elimination

This method,
head,

is: utilize

water

level.

into the river

The snail-infested

strip is created,

which

soil is dumped

the grass should be frequently

prevented;

and if there is any collapse,

and making

of ditchdigging

into the ditch

and are not limited

First

drain

by Opening

the rivers

This method

5. Snail Elimination

This method

dumped over the ditch,

of the river.

Thus a stepping
water

soil from other places

pounded
cleared

the strip

and hardened.

In ordi-

and cracks should be


should be repaired

out in coordination

in time.

soil burying,

with

farm pro-

Rivers

dry, and pare the snail-infested


in adjacent

little

can be coordinated

Through

Pare the soil infested


the whole river

Then

by the season.

It is best to use this soil to fill


soil burying.

first.

at the bed of the riverbank,

a soil strip may be carried

4. Snail Eiimination

soil pared from

should be at least half a foot above the highest

nary times

cover

The depth of the ditch

the snail-infested

over for use, and the strip,

The methods

the

into a small dam to prevent

stream.

the center

a ditch

on the side of the ditch

When there is not enough soil, noninfested

may be brought

a dam to lower

is pared off layer by layer,

and spread 2 to 3 feet towards

or pulling

area of the base of the

is piled

This soil is built

to accommodate

the soil of the riverbank

ductivity

strip

in the noninfested

of the river.

should be sufficient

level.

elimination

soil removed

soil from dropping

the riverbank.

snail

dig a ditch

The noninfested

near the center


infested

also called

a Soil Strip

small tides and low tides, or build

First

riverbank.

by Making

with

Recontouring

with

water

and ditches,

Land

soil; pound and flatten

the snail, but also increases

land and does away with useless snail-infested

16

in

conservation.

snails to the base of the riverbank;

with noninfested

not only eliminates

streams

soil for 3 inches.

rivers.

then

out tht. soil.


the cultivating

6. Snail Elimination

Generally

by Immersion

this method

is suitable

ponds and pools where it is difficult


to lower

tha water

level.

and Killing

the Edge

for such wide surface

to build

in the area within

This procedure

i,- 0 effective

are better

method

in ivater

for the spreading

areas.

A thor xgh

nate snails is also an sffective

of eliminating

canals

out this project,

dug-up

conservation

noninfested

The distance
1 m to prevent
a collapse

between

irrigating

Use of chemicals

canal
to elimi-

in Old Canals

first

clear

off the grass on the bank,

Sweep and clean the area.

plan, dig new irrigating

soil to fil!

of sriails

with snails on both banks of snail-infested

into the bet of the canal.

the water

the

elimination

link in the elimination

method

Irrigat-

method.

1. Open New Canals and Fill

and pare off the soil infested

rivers.

consolidate

Therefore,

snails is to open new canals any &.-I in old ones.

In carrying

nfested

of snails to the rice pad-

canals will

in the rice paddies.

canal snails is an important

network

season.

Canals

of snails in the irrigating

of snail elimination

of irrigating

for small

canals come from snail-infested

ing canals in turn are pathways

results

the hot summer

of snail elimination

Snails in Irrigation

Elimination

dur+g

soil under the water

for soil paring.

The snails in irrigating

dies.

Sweep the loose

will soak the snail-infested

areas that are not suitable

B. Eliminating

level.

soil (3 inches deep) from the bank into the water;

along the b;i,:1-. The results


Spraying

or

(100 g for

1 foot above the water

then pare the soil from the top of the bank downward.
soil clean.

areas as

dams to block the flow

Spread sodium pentachlorophenate

each 10 m of riverbank)
Pare the snail-infested

Along

in the old canal.

canals nearby,

Following
and use the

Pound and flatten

the soil.

the old canal and the new canal must be at least

contamination

of the new canal should rain and water

of the new canal bank.

17

cause

2. Sodium Pentachlorophenate

Using sodium
be killed

to Eliminate

pentachlorophenate

Snails

(20 g for each m2), the snails will

in 3 days.

C. Eliminating

Snails in Rice Paddies

The snails in rice paddies come from irrigation


reach the rice paddies,
paddies.

Therefore,

farm workers
results

efforts

produce

and

rice paddy snails are the direct

become

of irrigation

are widely

they can multiply

canals;

infected

with

distributed

but are grouped

are concentrated

during

dures are energetically

carried

incessantly

sources

schistosomiasis.

canal snail elimination.

the proper

they
in the

from which

They also affect

Generally

chiefly

but after

rice paddy snails

in low marshy

areas.

season and elimination

out, it is not difficult

the

If
proce-

to eliminate

the

snail.

In the elimination
killing

method

Paring
of field

of rice paddy snarls, use of the chemical

is most effective.

field

ditches,

ditches.

The method

immersion

is as follows:

Pare off the soil on the surface

and spread this snail-infested

and edges

soil on the middle

of the

field.

Fill
Examine

field

water

within

water.

Cover

the area. surrounding

off possible
with

with

leaks to fulfill

and chemicals

about 3 inches
beforehand,

of water.

and block

that the soil must be covered

using chemicals.

using chemicals,

If the water

has leaked off

then the area must be reflooded

added.

Use of chemicals.

For each mou of rice paddy field,

7 ounces of sodium pentachlorophenate,


antischistosome-67
one-third

with

the rice paddy field

the requirement

for 3 days after

24 hours after

the field

with

of the chemical

spread the rest evenly

or a mixture

use 2 catty

of l-3/8

ounces of

6-7/B ounces of sodium pentachlorophenate.


on the water

on the field.

surface

After

18

of the field

using sodium

ditches,

Spread
and

pentachlorophenate,

one must wait

2 days before

antischistosome-67
rice sprouts

rice sprouts.

With the use of the

and sodium pentachlorophenate

can Le carried

Examine leaks,
out after

planting

mixture,

planting

of

out immediately.

and repair

snail elimination.

defects.

RE examination

If snails are found,

must be carried

>hey must be taken care

of quickly.

D. Eliminating
Fishponds

Snails in Fishponds
are frequently

of the fish during

;nfested

snail elimination

Use the method


soil or the method

of ditchdigging
of covered

of snail elimination

with snails.
is a problem

soil strip

pond for feedlng.

a few fish are returned

for a trial

staged

and sectioned

of the total

E. Eliminating

spraying

attention.

catching
One month

must elapse before

but if dead fish are seen, the


reexamination,
method

area should not exceed

ba&.

and Grassy River

Banks

in tSis kind of area should b,z coordinated

with

farm

productivity.

1. Recontouring

Small ditches
of land.

In the first

not to provide

the Land

and marshland

may be filled

2 years, it is best to cultivate

a new breeding

environment

19

methods

all the fish or turning

Each time the sprayed

area of the fishpond

the

Combined

with sodium pentachlorophenate

Snails in Marshland

Snail elimination

period;

snails.

If a few snails are found during

may be used as a supplement.


one-fifth

that should receive

to eliminate

may also be used after

must be changed.

the death

at the base of banks and burying

all the fish into another

water

Row to prevent

in during

recontouring

dry land crops so as

for the snail.

2. Digging

Fishponds

to Eliminate

Use lime to divide


the sections

depending

the grassy riverbanks

on the intended

each piece leave an empty


ment.

In building

ficial

snail-infested

intended
piling

first

the surface.

In paring

the superficial

fishpond

layer by layer,

Complex

environments

are also the most difficult


Elimination

1. Brick

pounding

should be covwith

1 m of deep

and hardened.

Environments

are the original

residence

of the snail.

areas in the investigation

methods

and

this soil, care must be

sui! and the top covered

Snails in Complex

of the

soil, a spade must be used

In transporting

These layers should be pounded

an embank-

1 foot of the super-

Both sides of the embankment

1 to 2 m of deep layer

F. Ehminating

They

and elimination

of

include:

and Tile Piles

When bricks
pick them clear

and tiles are not too numerous

and proceed

with

many, it is best to use chemical

method

is to combine

along riverbanks,

snail elimination.
immersion

are used, they must be used while


Another

dig up about

Then dig into the intended

up the whole block of soil.

layer soil.

Between

about 5 to 10 m) to build

this soil on top and on both sides of the embankment,

ered with

the size of

grassy soil and dump this soil in the middle

taken not to drop any snails.

snails.

into sections,

size of the fishponds.

space (usually

the embankment,

embankment.

hardening
to lift

the Snail

chemicals

When there are too

elimination.

the bricks

simply

and tiies

If chemical
are turned

and use river

sprays

over.

soil to seal and elimi-

nate thF snail.

2. Tree Roots and Bamboo Garden

Bases

Tree roots and bamboo garden bases that may hide snails should
be cleared.

Smooth and healthy

level should be preserved.


If they are really
should be removed

trees growing

If the roots grow wild,

useless and hinder


together

on riverbanks

with

the elimination

the root.
20

near the water

they should be trimmed.


of snails,

then they

3. Water Wharves

and Bridge

When the water


oughly

turned

level has lowered,

over and repaired,

and cracks sealed with


ports

or where paring

elimination

of snails

immersion

elimination,

soil.

cracks.

be placed

bank and continuing


be carried

Extension

with soil.

on complete

water

built

level

method

immersion,

extension

extension

banks, emphasis

of snails before

sealing

in the extension

Snail elimination

chemical

off

spreading,

may

or spraying.

and Towns

extension

can be very complex.

banks, water

bridges,

and chemical

immersion

Along

river-

and houses are

wooden poles and stone buttresses.

may be raised

Generally

elimination

the

used.

The

is:

1. First
bank.

with

buttresses,

with soil, chemical

the snail from hiding

In suburbs and towns the environment

frequently

of bridge

banks and brick

to breed and cause trouble.

banks, many connecting

wooden sup-

Banks

In fixing

elimination

will prevent

Snails in Cities

with

sprays.

in stone extension

out bv* chemical

G. Eliminating

the safety

Banks and Brick

This procedure

supported

out by sealing

or chemical

should be thor-

soil should be removed,

wharves

may be carried

by sealing

wharves

snail-infested

In water

The holes and cracks


banks may be fixed

water

of soil may affect

4. Stone Extension

must first

Buttresses

investigate

the high level of snail distribution

on the river-

If snails are found on the land along the bank, they must be elimi-

nated before

2. Build
highest

carrying

out this method

a dam during

snail distribution

3. Within

high tide; the top of the dam must be above the


line.

the sphere of 1 m below

spray sodium pentachlorophenate


swimming

above water

of snail elimination.

level

the highest

(10 g/m2),
after

flooding.

21

snail distribution

thus preventing

line,

the snail from

4. Introduce
level

water

into the river

to 10 cm above the highest

5. Evenly
on the water

above the dam, raising

snail distribution

line.

spread sodium pentachlorophenate,


surface

close to the bank.

spread the chemicals

in different

spread once in a short period


should be used to sprinkle

6. Generally

several

are only

The chemical-containing

of time.

this chemical

boats should

so that the chemicals

the edge of the bank several

out for at least 7 days before

H. Eliminating

15 g/m3 (15:1,000,000),

In long rivers

sections

the water

immersion

elimination

river

water

times.

should be carried

the dam is opened to drain

the water.

Snails in Reeded Areas

The breeding

environment

of snails in reeded areas is the same as that

in areas without

reeds; therefore

the methods

same.

from

to May of the next year is the time to

carry

However,

out snail elimination

During
lizing

September

this period

snail elimination

the 10 edges of reeded river

of thorough
be fulfilled,

snail elimination

first

so as to avoid injuring

IV.

Snail elimination

carbide

and chromate

higher

the temperature

characteristics

before

of these chemicals

come out).

to the reeds.

In uti-

crops, the requirement

before

the 10 edges must

cultivating

the crops of the 10 edges.

Used Molluscicides

in use include

lime nitrogen,

the better

are the

banks to cultivate

Frequently

compounds.

reed sprouts

is less harmful

drugs presently

ate, antischistosome-67,

A.

(especially

of snail elimination

sodium pentachlorophen-

and such industrial

In snail elimination
the results.

wastes as calcium

by chemicals,

An introduction

the

to the

follows:

Sodium Pentachlorophenate

Sodium pentachlorophenate
powdery

chemical.

It is irritating

is a light

brown,

water-soluble,

to human skin and mucosa.

22

flaky

or

Exposure

to sunlight

will

It is a contact

disintegrate
germicide

the chemical

and render

it less effective.

that can kill adult snails, juvenile

ova, and the schistosome

ova, miracidia,

snails,

snail

and cercariae.

1. Dosage of Sodium Pentachlorophenate

The dosage varies d:pending


used.

In warmer

weather,

in cold weather,

the immersion

the chemical

the chemical

of snail elimination

ing to the volume

method

along the bank edge, calculate


10 g of chemical
for the spraying
15 g/m.

when the temperature

canal,

Since this chemical

is above 2OC.

or pond.

according

toxic

to the length,
riverbank.

according

is highly

When
accord-

When using this method

of snail-infested

is calculated

The results

use 10 to 20 g/m3 of water

the amount

for every meter


method

should be lower;

should be higher.

is utilized,

of the river,

and the method

concentration

concentration

are better

killing

on the temperature

using

The dosage

to the area, using 10 to

to fish, it generally

should

not be used in fishponds.

2. Precautions

in Sodium Pentachlorophenate

a. In administering
covered.

the chemical,

Use a wooden stick

let the chemical

wet clothing

Snail Elimination

stay upwind,

to mix the chemical,


or contact

immediately

not the hand.

Do not

the skin.

b. If the skin or mucosa come into contact


rophenate,

keep all body areas

wash it off with

with

clear water.

sodium pentachloProperly

distribute

and store sodium pentachlorophenate.

c. In using sodium pentachlorophenate,


elimination

team or the commune

and show signs of lassitude,


temperature,
nation

if members

come into contact

extreme

they should immediately

thirst,

copious

with

of the snail
the chemical

sweating,

be sent to the hospital

and treatment.

23

and high
for exami-

3. Clinical

Manifestations

a. After
irritation

chemical

of Sodium Pentachlorophenate

contamination,

may been seen; the skin is slightly

red macules.

A few days later

healing

wiil

there

cause stinging
irritation

pain, lacrimation,

of the nasal cavity,

painful

locally

and exhibits

will be iocal desquamation,


Chemicals

blown

and conjunctivitis.
sneezing,

to quickly,

b. The main symptoms

the condition

and after

into the eyes will

Inhalation

and irritating

poisoning

causes

cough.

These symp-

concern;

but

may be prevented

of acute poisoning

The incubation

are not serious.


which

of skin and mucosa

mild and should not cause the patient

if they can be attended

after

there

be no pigmentation.

toms are frequently

which

symptoms

Poisoning

period

are lassitude

is generally

may show sudden changes.

and fever

several

hours,

The main symptoms

are:
..

Lassitude.

feels weakness
heavy.

the patient

even carry

When the condition

Profuse
Night

sweating

be entirely

progresses,

sweating.

is especially

Fever.

is nausea and vomiting.

heart

tality

may be unclear.

gishly

to light.

If proper

extremities

lassitude

becomes

prominent,

Symptoms

heavy work, now

Most patients

more and more severe.

and the clothing

copious sweating.

and bedding

and thirst

may read around


has become

system symptoms.

may

may also occur.

38C.

If there

serious.
In the early stage there

have anorexia.

and tespiration.

Pupils may be dilated


treatment

feel particularly

may experience

of restlessness

the condition

rate

suddenly

work and may even be bedridden.

The patient

Gastrointestinal

Increased

daily

The body temperature

it indicates

The patient

had been able to perform

out light

soaked wet.

is high fever,

symptom..

of the whole body; the lower

Whereas

he cannot

This is the earliest

In serious
and unequal,

is not given in time,

24

cases men-

and react
the condition

slug-.
will

rapidly
tion,

deteriorate.

There may be pulmonary

or acidosis,

finally

4. Treatment

Because
excreted

exhaustion

and death.

for Sodium Pentachlorophenate

Poisoning

sodium pentachlorophenate

rrom the body, the prognosis

deteriorate

in 24 hours.

and start proper


or with

taminants
lavaged

immediately.

further

should immediately

5% sodium bicarbonate.

fever,

in giving

replacing
sodium

wrapping

Drugs to lower

fluids,

salts.

Physical

the body with

Ingestion

methods

include

(finish

Oxygen

if necessary,

respiratory

and circulatory

treatments.

correction

Barbiturates

will stop sweating,


traindicated.
the liver

of acidosis

at
espec-

body temperature

calories.

inhalation

with

Ade-

Hydrocortisone
may be given,

functions.

Other

and supportive

this chemical

heat dispersal.

the acute stage, attention

(20 to 50 mg

drip in 2 hours).

and symptomatic

are synergistic

thus preventing

After

balance,

chlorpromazine

ill patients.

include

Skin con-

is aimed mainly

of lowering

may be -used in seriously

measures

with

should be

electrolyte

(ATP) may be given to supply

to maintain

stop contact

This treatment

5%) given intravenously

triphosphate

of poisoning

wet sheets and using fans and icepacks.

body temperature

in 500 ml glucose,

does not

of the condition.

and maintaining

and

one must be confident

Those suspicious

deterioration

dehydra-

metabolized

is good if the condition

can be washed off with soap and water.

lowering

nosine

is rapidly

in the treatment

of poisoning

to prevent

with

include

Therefore

procedures

early symptoms

the chemical

ially

ending with

edema, anorexia,

and atropine

All are strictly

con-

should be paid to protect

and kidneys.

.B. Antischistosome-67

Antischistosome-67,
successfully
paste-like

a new type of snail elimination

produced.

It contains

chloronitroamide

chemical,

has been

(50%) and is a brown

material.

1. Utilization
Snail elimination
20C.

The method

is ideally

effective

when the tt;,;berature

is the same as for sodium pentp.chlorophenate.

25

is above
For

the immersion
for weight

killing

method,

calculation,

of water

use 2 g/m

the same as below),

and for the spraying

The death rate of the snail is highest

use 2 g/mL.

(use the paste form


method

in 10 days.

2. Safety
This chemical
Within

has no special

odor

the dosage of snail elimination,

does not injure

of snails crawIing

upwards

In each m3 of water,

combine

ponds.

toxic

with

to prevent

the phenomenon

sodium pentachloro-

in rice paddies,

this I.

:hod is espe-

the snail from climtiing

to fish; therefore

The rice paddy water

tosome-

water

killing,

has to be taken into account.

antischistosome-67

in 1:5 proportion

b. It is highly

for immersion

out of the water

(because of the shallow

suitable)

to rice sprouts.

in the Use of Antischistosome-67

a. In using antischistosome-67

cially

to the skin.

it is safe for humans and animals,

the crops, and is harmless

3. Precautions

phenate

and is not irritating

upwards.

it should not be used in fish-

that has been treated

with

antischis-

also should not be used in fishponds.

c. After
precipitation.

storing

for some time,

Therefore

antischistosome-67

when this chemical

may show some

is used, it should be thoroughly

mixed.

C. Lime Nitrogen

Lime nitrogen
has a calcium
frequently
killing

carbide

calcium

cyanamide.

odor, and is alkaline.

used as a basic fertilizer,

It is a black powder,

It is a chemical

and is also a chemical

fertilizer,
capable

of

snails and snail ova.

Lime nitrogen
snails.

is also called

is often

used in the immersion

To each mou of snail-infested

cm) depth of water,

use 25 catties

method

rice paddy field


of lime nitrogen

26

to kil.1 rice paddy

with 4 inches

mixed. with

water

(10
and

sprinkle

evenly

into the field.

ditches

smoothly

on three surfaces,

into the chemically


immersion

At the same time pare the surrounding

treated

and then dump the snail-infested

field.

When the temperature

for 3 days will provide

1. Precautions

is above 20C,

good snail elimination

effects.

in the Use of Lime Nitrogen

a. After
rice sprouts.

soil

using the chemical,

wait

at least 3 days before

It should not be used in fields

already

growing

b. Lime nitrogen

can also poison and kill

c. Lime nitrogen

should not be stored for long.

planting

crops.

fish.

It should be stored

in dry, sealed places.

d. Lime nitrogen
operator

is poisoned,

constriction,
ical,

there

toxicity

dermatitis

must be stressed

wastes

and cracking

during

When the

tinnitis,
with

chest
this chem-

of the skin.

There-

its use.

such as calcium

carbide

can be used in snail elimination.

and sprinkle

evenly

eljminatinn
- -I--.-w-va.

m**rt
..a....

by the population

with

i-w--l=*IIIVIYCZ

lI.11Le

coordination
teams.

massive

production

snail elimination

in Areas

of extermination

complex,

and water

a specialized

Snail elimination
conservation.

may be started

27

efforts

Because the distribution

team must be organized.


farm

and mix with

Networks

the snail is very broad and the environment

be coordinated

Use 1 kg/m2

of Snail Elimination

and the specialized

and part-time

and chromate-containing

over the area.

With Water

off-seasons,

of dizziness,

If the skin comes into contact

V. Some Problems

time

humans.

Wastes

Industrial

Snail
i-e-_

against

may be symptoms

etc.

may be localized

D. Industrial

water,

there

vomiting,

fore protection

compounds

has certain

of
full-

also must
During

in coordination

the
with

recontouring

of the land, collection

tion canals.

During

carry

out repeated

of fertilizers,

and repairing

the busy seasons of farming,

the specialized

investigations

and extermination.

snail elimination

must maintain

high standards,

should be carried

out to prevent

outside

and causing

recontamination.

tween

Hsien,

where

elimination

several

commune,

and brigade,

is completed,

to eliminate

reexamination

years.

28

team can

At the same time,

and preventive

snails being brought

Close cooperation

of irriga-

measures
into the area

must be maintained
dead corners.
should be carried

beIn areas

out for

Chapter

3
THE PROPER

Proper

treatment

of manure

of schistosomiasis.
manure

diseases.

water

and eliminate

of manure

are:

Proper

three methods

safe cesspools,

compost,

ova and prevent

treatment

ova and prevent

in farm production

At present

tion environments.

link in the elimination

the schistosome

sources.

hookworm

It is also beneficial

OF MANURE

is an important

Its purpose is to kill

from contaminating

can also kill

TREATMENT

of manure

intestinal

infectious

and in improving
for the proper

and chemicals

sanita-

treatment

to kill

and eliminate

ova.

I. Safe Cesspools

Safe cesspools
The three-pool
utilizes

and two-septa

the fact

ova 1.06, ascaris


urine

solution

manure

fermentation

gravity

ova 1.14) is greater

are sealed tightly.

by the ammonia

stagnant

produced

is produced
Under

condition,

pool, a 20-day

the use of fertilizer

each section

must have a minimal

ing manure,

manure-producing

is more concentrated,

The following

cesspool:

capacity

pool,

manure-producing

Tha
a.._ second pool should have a 2-day manure-producing

and the third

number

dilution

formula

the daily

average

urine,

and water

of persons times

and
when

of manure

by fermentation.

pool must have at least a lo-day

bigger.

manure

the ova sink down and are killed

The first

zaritw\I,.
-L

This style

by fermentation

a certain

of Cesspools

first

cesspools.

ova 1.20, hookworm

than that of the mixed

Capacity

(if it is a double

style

in use.

of ova (schistosome

(1.02) and that ammonia

and a rather

ova-sinking

style pools are presently

the specific

and urine

and urine

A.

are also called

capacity.
the third

is used to calculate

manure-producing

the rumber

of days, divided

of the pool (volume).

29

5-day capcapacity;

In areas where

pool may be made


the capacity

capacity

to clean the nightstool)

capacity

of the

per person

(includ.

of 2 kg times

the

by 1,000, will

be the

X no. of days = cesspool

2 kg X no. persons
1,000
Example:

A certain

of a safe cesspool

production

is needed.

capacity

team has 150 members;

The capacity

for the first

(m3)

construction

pool should be:

2 kg X 150X 10 days = 3 m3
1,000
The second pool should be l/5 of the first,
be twice

that of the first,

or 0.6 m3; the third

pool should

or 6 m3.

An oblong shape is better

for a cesspool,

and it should not be too wide.

This makes it easier to cover.

B. Style Of Cesspool

Three-pool
pool is first
will

retain

and two-septa
retain,

style.

The function

second sink, third

the manure

sediment

which

sediment

the manure

in the second pool is more diluted


safe:

very few or no ova.

Ideally

the width

to be determined

cilitate

construction,

retain:

the first

pool

most of the ova and make

and the ova sink downward;

to sink down; third

and length

First

contains

the manure

ova continue

ferment

safe.

of this type of cess-

second

and moves slowly,

the manure

sink:
and the

in the third

pool has

the depth of the pool should be about 1.6 m,

the distance

by the existing

of the septum

conditions.

between

To fa-

the first

and

second pools should not be less than 0.5 m. The hole should be made 40
cm upwards
pool),

from the bottom

and it should be 20 cm high and 30 cm wide.

holes at the same level.


and third

The hole in *he septum

pools may be created

10 cm) from

the top, making

way is only a short distance


acity

of the pool (about one-fourth

to store manure.

Double first-pool

by omitting

them alternately

It is best to open several

wa!!

to the third

from the top, giving

the third

Required

material

style.

This type of cesspool

(Fig. 8). First

the second
(about

pool.

This path-

pool more cap-

may be found in Table

two-septa

use one part,


30

bet:veen

two pieces of bricks

this the pathway

and second pools of the three-pool,

the depth of

divides

2.

the first

style into two parts and uses


fill

with

manure

for about

Table

2.-- Material
Style

Needed
Safe

for

Cesspool

Fermentation
(For

Ova-Sinking

Reference)

Required
Used by

Capacity

no.

1st

of

people
Less

than

100-150

150-200

200-250

wall
pool

100

2nd

(M3>
3rd

pool

pool

pool

tile
tube

tile
tube

tile
tube

tile
tube

lo

Construction
of pool

8-5

brick

(PC.1

The length
tiles

(3)
The diameter
iron sheets,
or heavy
nothing.

Cement
(bag)

Sand

Broken

Steel

Tile

brick

rod

tube

(ton)

(kg)

(PC.1

Brick
Mixed

cement

1,700
a-

16
16

2.4
2.4

3.3
5.3

18
18

2
2

Brick
Mixed

cement

2,200
--

20
20

3.0
3.0

4.9
7.4

26
26

2
2

Brick
Mixed

cement

2,700
--

25
25

3.8
3.8

6.0
9.3

33
33

2
2

Brick
Mixed

cement

3,200
--

30
30

4.5
4.5

7.5
11.3

41
42

2
2

Note:
(1)
The proportion
of sand paste mixture
needed
is 1:3 (cement:sand);
the proportion
for the construction
wall without
brick
is 1:3:5
(cement:sand:broken
bricks).

(2)
insufficient,

Material

of the tile
tube is ! m; the internal
and ceuent can be fixed
at the opening
of the steel
rod is 6 mm. Expenses
copper wire are used as substitutes.

to construct
and paint
the brick
of the pool top, pool bottom,

diameter,
23-30
of the tube.

cm.

If

the

length

no01
and
is

may be lowered
if bamboo tubes,
useless
Picking
broken bricks
for use costs

(4)
Two kinds of casspool
construction
are:
"Brick
construction"--the
pool wall
is built
with bricks;
'mixed
cement construction"-the pool wall
is built
with cement mixture.
There is
no difference
in the construction
of the pool top and pool bottom since cement mixture
is used for
both.
Construction
expenses are lower in "mixed cement construction,"
but the construction
process
is more difficult.

Figure

8. Fermentation
ova-sinking
style cesspool
(double first pool style) (unit: cm).
2. Opening to remove manlure
sediment
4. Half brick wall or mixed
cement wall (7 cm thick)
6. 1st pool
8. 3rd pool
10. Opening to pour in manure

1. Plane figure
3. Brick
5.
7.
9.
11.

stand

Opening to release manure


2nd pool
Covering board
Alternate
opening to pour in
manure

1. Cross section G-septum 3-pool


style)
3. Opening to alternate
pouring
in manure
5. Mixed cement pool top
7. 2nd pool

2. Water-sealed
opening to pour
in manure
4. Opening to remove manure
sediment
6. 1st pool
8. 3rd pool

1. Cross section (oblique inserted


tile tube style)
3. Obliquely
inserted tile tube
(take place of 2nd pool)

2. 1st pool
4. 3rd pod

32

2 months,
on fixed

then use the other part for the next 2 months.


dates will

give each part sealed storage

at least 2 months,
This style

will

not only killing

eliminate

schistosome

Thu5 alternating

of manure

sediments

for

ova but aiso hookworm

the need for chemical

tre&tment

ova.

of the manure

sediment.

insert

tile

tube (barrel)

septa, three-pool

style,

style.

use an obliquely

angle of the tube and the septum


procedure

into the first

pool stool by stool,

of manure

cesspool.

(Fig.

9).

Others.
accessible

A latrine

crocks

sinking

style

manure

must be removed

may also be ci.ti,structed.

rivers
crocks,

separately

latrines

boats to periodically
all these require

three-pool

populated

to the principle
to construct

areas,

of first
the ova-

that are connected,

sediment

in the first

crock

fermentation

and

the attention

safe cesspools

the areas to manage

stools (Fig. 11). Boatmen

into cesspools

more boats travel,

and in which
collect

dense, large,

or separate

and private

or safe latrines

stools

in sparsely

sealed to allow

is quite

Concentrate

where comparatively

to wash their

a two-septa,

chemicals.

must pour the manure

cesspools,

If a large

on top of a safe cesspool

The manure

., ore the population

of public

to construct

According

effect.

with

is poured

or if the pool is

(Fig. 10). The more crocks

frequently,

or treated

the manure

the second pool, but

the ova to sink.

is not available,

crocks

than 45O. This

If the manure

safe, use three crocks

the ova-sinking

In towns

allow

may be constructed

may be utilized.

second sink, third

The

even if the second pool has a capacity

it will still

When material

ova killing,

material.

then it is better

retain,

the better

of cleaning

is poured into the pool at one time,

used by many people,


style

tile tube instead.

wall should be greater

of the construction

of less than 2 days manure,

fishermen

inserted

not only can omit the process

also can save part

amount

In the second pool of the two-

when coming

manure

manure

33

In

personnel.

for the boatmen

and urine.

may also be organized.

of designated

to laud.

there should be manure

on the banks especia!ly


to pour their

and

Special

However,

Figure

9. Diagram

of safe cesspool

and latrine.

1. Plane figure.
2. Small size water reservoir
(with
a three catty volume dipper, used to wash away manure
after using water-sealed
squatting seat). 3. Door.
4. Men. 5. Women. 6. Step. 7. Urinal.
8. Watersealed urine entrance.
9. Water-sealed
manure groove.
10. Water-sealed
squatting seat. 11. Clear water
pool. 12. Turbid water pool. 13. Water-sealed
opening
to pour manure.
14. Alternate
opening for manure
entrance (when one part is in use, seal the other unused
part with mud). 15. 1st pool. 16. 2nd pool. 17. 3rd
pool.
1. Cross section.
2. Men. 3. Women. 4. Watersealed squatting seats. 5. Water-sealed
opening to
pour manure.
6. Alternate
opening for manure entrance.
7. Water-sealed
urine entrance.
8. Water-filled
manure
groove (with movable covered board). 9. Cesspool.

34

Figure

10. Three-crock

five-section

safe manure

stored

1. Cross section.
2. Water-sealed
opening to pour
3. Plane figure.
4. Mud-sealed
covgr. 5. (
to remove manure.
I nanure.

11

igure 11. Cross section diagram of safe cesspool


and manure fluid.
Removal device used in Chang-I
Town, Chin Shan County.
1. Work shed. 2. 1st pool. 3. 2nd pool. 4. 3rd pool.
5. 4th pool. 6. 5th pool. 7. Valve. 8. Calculating
ruler.
9. Manure fluid removal pool. 10. Manure
fluid removal. tube. 11. Manure collecting
boat.

35

crock.

Utilizing

the water-sealed

in manure

is constructed.

of ammonia,
principle,
opening

principle,

It can prevent

thus preserving

a water-sealed
under

a water-sealed

the squatting

each defecation,

use water

Then the manure

will

of the fertilizer.

for incoming

urine

Using the same

and a water-sealed

seat may also be constructed


(about 3 catties)

follow

the water

for pouring

flies and foul odor and evaporation

the quality

opening

opening

(Fig. 12). After

to wash the manure

into the trough

leading

down.

to the safe

cesspool.

C. Advantages

of Cesspools

A safe cesspool,
managed,

if it is constructed

not only will

and prevent
collected

growth

kill insect

I f flies,

and improve

is solid and firm

alternate

and hookworm
processes
third

nitrogen
manure

water.

use according

After

the quantity

of fertilizer

The cesspool construction

After

to regulation,

passing through

in the first

After

matter

O.l%),

practical

will kill schistosome

the fermentation

the manure

is mostly

and ova-sinking
fluid

in the

has been through

decomposed.

representing

The ammonia

cesspool

an increase

use, the people evaluated

at it one sees clear water,

after

pool,

over 95%.

This kind of manure


sediment

sediment

above 0.2% (in the open-air

it is below

Looking

The manure

sanitation,

and second pools, the ova in the manure

the organic

crock,

by saying:

The manure

be decreased

is maintained

effectiveness.

of fertilizers.

effectiveness.

fermentation,

and properly

environmental

but also will increase

effect.

periodic

in the first

Fertilizer

to standard

and may be used for a long time.

ova.

pool will

ova, improve

the quality

Ova elim.ination
after

according

fluid

is suitable

ova elimination

fertilizer.

36

and in the
of fertilizer

the third

pool

using it turns it to ammonia


for secondary

by sealing

fertilizing.

is a good primary

.- -- _.

Figure 12. Diagram of water-sealed


opening und.er
squatting seat used in Chang Chin Commune,
Ka-tine County (unit: cm).
1. Cover over observation
2. Manure groove

opening

37

(ordinarily

sealed)

II.

Mix human and animal


sediment
terial

ova, ascaris

will produce

not fulfill

generally

and aerobic

manure,

with

wet mud.

Well-piled

1 week.

high temperature

An-

and does

ova elimination.

weedy grass, and other

manure

which is likely

that cause decomposition

principal

methods

1. Half-Fit

material

Thoroughly

bacteria

of aeration

with

human and animal

mix them (it is best to add some


to produce

of organic

generally

heat),

matter

and pile up. The

are aerobic.

Compost

sunlight

in summer.

and small bottom

like a basin.

soil dug up is piled

around

high and against

The diameter

the opening

to a height

of 70 cm.

On the two opposing

dig two slanting

ends of the groove,


reaching

a width

to the outside

6 to 10 cm above the level of the land, thus preventing


entering.
twigs

In making

the pile,

first

a large toy,

of the base is 2 m. The muddy

with

from the bottom,

the wind, avoid-

Dig a pit about 1 m deep, with

and wall of the pit, dig a crossed groove

wall upwards

Three

are used.

Choose a site that Is comparatively

or slender

composts.

weedy grass, and grain

of around 65OC after

does not produce

at a 7:3 proportion.

horse or swine

from

in win-

Compost

Use garbage,

ing direct

The time

and 2 to 3 months

used are anaerobic

a temperature

the requirement-of

B. Aerobic

in summer

pile them up; and seal tightly

compost

manure

methods

ova, hookworm

fly pupae, and maggots.

mix human and animal

stalks of plants;

aerobic

bacteria,

by bac-

Compost

Thoroughly

composts

to kill schistosome

is about 1 month

The two common

and used wine

the heat (50C to 70C) produced

ova, pathogenic

A. Anaerobic

weedy grass, garbage,

and fermentation

needed for compost


ter.

manure,

into a pile, utilizing

decomposition

Compost

tie the stalks

On the bottom

and iepth

of 20 cm.

grooves

on the

of the mud mound,


water

and rain

of corn or sorghum

into a fence! shape and lay them over the crossed groove
38

of the base and slanting

grooves

of the crossed groove.


pile protrudes
finally

Then pile in the compost

a 10 cm thickness

has a small exposed surface

temperature;

thus facilitating

Aeration

The principle
the compost,
with

On a circular

depth and width


small
groove,

erect

and aeration.

15 cm.

trve must be recorded


is no problem.
the pile.

an aeration

In piling

into the pile;

making

After

daily.

attention,

certain

air cannot

having

of the +I

the compost,

pull

in the early
water

composi-

the temperature
increases

and moip

daily,

at several

then there

places on

a wooden rod may be stuck

it and observe

human manure

At the same time the covering

in the middle

take readings

is not available,

degree of dampness,

for

use corn stalks or

of the materials,

If the temperature

1 day remove

or dilute

both grooves

particularly

rod is damp ?nd hot to the hand, the condition


hot, then water

dig a groove

completing

the compost,

Using a thermometer,

after

sealing

system.

the compost,

to the proportion

If a thermometer

After

up

aeration.

good composts,

After

and

Compost

out the bamboo tube to allow

tion,

its water

While piling

to form &shape.

leaving

a heavy bamboo tube.

stage, should be given

of com-

The temperature

above.

dig a + shape mud groove,

In making

maintain

decomposition.

to cross over the + shape groove;

twigs

This method

base of about a 2 m diameter,

about

the

for 5 to 6 days (Fig. 13).

bamboo sticks

3. + Shape Aeration

in the middle

of mud.

is the sl?me as described

use heavy

until

Compost

mud, pull out the bamboo,

water;

layer by layer,

and can easily

complete

can reach 70C and be maintained


2. $Shape

communication

Shape it into the form of a bun, and

out of the opening.

seal it on top with

posting

of the wall to maintain

the end of the rod.


is normal.

If it is dry and

should be added to maintain

which is necessary

for bacteria

If the

colonization.

mud should not he too thin so that cold

enter.

39

Figure
1. About

13. Cross sectian

of half pit compost

1.7 m.

2 m. 3. About

2. About

20 cm.

III.

If a large quantity

Chemical

of manure

may be used in manure

crocks

Treatment

is needed for fertilizer

or cesspools

The chosen chemicals

should not lower

should be inexpensive

and harmless

quickly,

for fast action

the fertilizer

to the crops.

chemicals

ova elimination.

effectiveness.
Common

They

chemicals

in

use are:

A. Dipterex

(39 11) (Phosphorus

According

to the weight

of l:lOO,OOO--to

of the manure,

10,000 catties

and stir thoroughly.

within

24 hours.

the time must be prolonged


tively

kill hookworm

fluid.

Due to the difference

actual

effective

Water

Ammonia

water

of ammonia

ova will be killed


is prolonged

C. Lime

add 2 oz of 3911 (5O%)--

above ZOC, all schistosome

When the temperature

is below

To effec-

ova, add 6 oz of 3911 (50%) to 100 catties


of concentration

of manure

of 3911, when in use the

must be calculated.

containing

20% ammonia

To each load (about


water.

20C,

is a common

100 catties)

With the temperature

in 24 hours; with

fertilizer

of manure

used

fluid,

add 1

above ZOC, schistosome

the temperature

below

20C,

the time

to 2 days.

Nitrogen

Lime nitrogen

(calcium

To each load of manure


:his mixture

fluid

cyanamide)

of water.

is a nitrogen-containing

add 2% to 3 oz of this chemical.

can kill schistosome

soil in 24 hours.
amounts

fluid

from 48 to 72 hours to be effective.

concentration

B. Ammonia

catty

of manure

add 3911 to make a proportion

With the temperature

ova will be killed

in rice paddies.

Compound)

ova and hookworm

If used as a fertilizer,
However,

to the seeds or sprouts

rod-like

fertilizer.
After
larvae

stirring,
in the

it should be diluted with equal


\
even at that concentration
it may be harmful

of cabbage

and colza.

41

D. Wettable

666 (6%)

To each load of manure


After

stirring

the mixture,

90% of hookworm
highly

IV.

Methods

use broken

safe cesspools,
bricks,

and c&ment,

Before

constructing

personnel,

struction,
may affect

bottom

bottom

the setting
collapse

during

and water

on a downward

is already

Treatment
the individual.

or leakage.

digging,

drained

of mixed

and to empty

cloudy

their

material,

The quality

If water

until

team.

but convenient

stools.

Before

according
ready;

to

and expe-

good day for conweather

that

must be guaranteed

is found seeping

from the pool

well must be dug beside the pool


the mixed

cement

poured

into the

hardened.

of manure

directly

Study and establish

It should be strictly

over

choose the site

days or freezing

cement.

then a diverting

day and night

soil).

cement

slant,

Choose a comparatively

and try to avoid rainy,

to prevent

pour mixed

the cesspool,

should be designed;

organized.

one can also

three-mixed

the size of the cesspool should be calculafed


The style

In

of the houses of the production

to go to the latrine

the population.
rienced

called

as model plates;

It must be on high land, far from wells,

construction,

Work in accord-

besides using bricks

to the basic distribution

for the inhabitants

of Manure

and basic methods.

Use door board or brick pieces

according

disease.

and simplicity.

(commonly

the
has

using local material

sand, and cement

to make the pool walls.

during

of fertilization

of hookworm

of Proper Treatment

(6%).

It can kill over

On the farms,

this method

of self-reliance

the environment,

constructing

in the soil.

in the prevention

the principle

ance with

larvae

666 powder

immediately.

seasons for hookworm,

advantages

Utilize

add 3 oz of wettable

use as fertilizer

rod-like

infectious

significant

fluid,

carried

subsequently

summarized,

consolidated

and improved.

concerns

the welfare

a reasonable

out and periodically

system

for all to follow.

examined,

so that the work of manure

42

of the group and

and experiences

treatment

will be

In the work of a sanitation


cleaning

cannot

must maintain
chemicals

be stopped
cleanliness

to kill

flies

to the maintainance

the weather,

the stool

A sanitation

member

of cesspools

and latrines

and periodically

and repair

Commune,

no matter

for 1 day.

Furthermore,

and maggots.

V. Manure

A.

member,

of cesspools

Treatment

frequently

attention

use

must be paid

and latrines.

Regulations

Chin Shari County,

of the Feng-wei

Shanghai

Municipality

General

Elimination

of schistosomiasis

It is a widespread

and difficult

schistosomiasis
manure

task.

schistosomiasis

Leaders

to render
and other

manure

personnel

B. Ideological

Leaders

of the people.

in all ranks must put antitheir

role.

safe is an important

diseases and improving

We must see that the leaders

responsible

the health

work on the agenda and strengthen

treatment

people.

safeguards

Proper

task in eliminating

the health

level

take this task seriously

of the

and that

are designated.

Work

understand

from the two ranks of the brigadew and production


teams must
the significance
of manure treatment
and carry out plans and

inspections

so that the work of manure

solidated
with

Educate

and improved.

manure

monthly

treatment,

meetings

for sanitation

treatment

and select

the outstanding

bought

into

pools to guarantee

C.

Sanitation

Select

members.

seasonally,

in carrying

outside

commune

and every family

of manure

be examples

treatment

sanitation
out manure

the pool.
that

exchange

Forbid

the manure

will be constantly

members

to become

should support
Inspect
mutual

members.
treatment.

experiences,
Cadres should
Forbid

use of manure

concerned

this work.

and judge

pouring

in the first

con-

Call

the work
and judge
lead and
manure
and second

is safe.

Members

enthusiastic,

the poor and peasant

conscientious,

hard-working

classes to be sanitation
43

people

members.

who are from

Their

appointments

should be discussed
members

and approved

are not changed

1. Be responsible
to commune

Sanitation

by the accountant;

daily;

3. Be responsible

kill

are to:

Distribute

manure

of loads of manure

and reported

for their

sanitation

used

to the accountant.

own lots should be recorded

are needed.

in pouring
maintain

and cleaning
cleanliness

that manure

the fermentation,

4. Be responsible

duties

of manure.

The number

using manure
no tickets

2. Be responsible

guarantee

by tickets.

On principle,

Their

at convenience.

group should be recorded

members

once or twice

peers.

in the management

members

by the collective

by their

stools.

Clean the latrines

and sanitation.

is not used in the first

ova killing,

and second pools;

and sedimentation

in using chemicals

in the cesspools

of manure.

and latrines

to

maggots.

D. Manure Management

The +andard
production,
manure

for issuing

stool-washing

The ccjllective

issued to (:ommune

an investment

are returned

members

by members,

an investment

are issued.

allotment

It is considered

team.

an investment

Commune
Tickets

members,

by that member.

an investment.

44

month

members

is valued

In treating

the crocks are evaluated

In the first

to commune

and excess

Each load of manure

over to the production

by the member.

the 40% manure

and recorded.

that are issued monthly.

to the production

and turned

of

Each load costs 0.50

are good only for that month,

crocks of commune

priced,

to 250 catties

crop

water).

at 0.50 yuan and is considered

quality,

of rice is entitled

use 40% and pay by tickets

the manure

by the estimated

group uses 60% of the manure.

yuan, is considered

tickets

is calculated

An area of 100 catties

(including

members

manure

by

team, and considered


of using safe cesspools,
is withheld

and no tickets

Chapter

SAFE WATER

Safe water
prevention

use and personal

of infections

caria.

Safe water

change

of habit

education

USE AND PERSONAL

protection

use and personal

protection

of the population

significance

the elimination

are important

of humans and animals

carried

of safe water

of schistosomiasis

good.

schistosome

is filtered
Drinking

through

use and personal

hygiene.

from rivers

and creeks,

crocks,

by

diseases.

method

morning

and retained

lands.

Wells should not be built


used to dry salt.

and pools, water

a simple

for the people

and conform

No latrines,

barns, or garbage piles should be nearby

banks, or land formerly

Next

tract

is compar-

the spread of infection

at sites convenient

to seek water

plates;

to avoid

in low marshland,
In areas where

sources are rich and are suitable


sources is: in the evening

cover them over at several

turn them over for inspection.

drops, it means that there is water


water

of health.

Use

can prevent

paddy fields,

quality.

a few bowls or porcelain


ground.

in

Well sites should be on high land at some distance

animal

the water

are many rivers


On farms,

protection

of Well Site

to sanitary

in garbage

the

Therefore

layers of soil and its quality

and intestinal

Wells should be built

affecting

with

and daily life.

and the safeguarding

well water

cercariae

1. Selection

manure

are concerned

cer-

Wells

Well water
atively

in the

out to let people understand

I. Safe Water

A. Digging

measures

by the schistosome

in production

must be conscientiously

the important

PROTECTION

underground;

drops, the more the underground

water.

45

places

If there

there
for wells.
use
on the

are water

the more the number


This condition

is caused

of

by evaporated
surface,

water

forming

temperature

seeping

a mist,

tile

Cement

in segment

kinds of cement
the proportion
sections

downward,

barrel

use stones, sand, and cement

well.

First

over fixed

molds;

by segment

erials

to build

are waterproof

of construction

materials

and are joined

of cement,

needed for well

cover,

well.

Two

Therefore

The three upper

in a bugle fashion.

The upper open-

opening

has an inner

diameter

sand, and stone is 1:3:5 (i.e., one

are not waterproof;

The proportion

tile barrel

is also different.

three parts sand, five parts stones).


all sections

and put these

and nonwaterproof.

of 51 cm; the lower

The proportion

Wells

then dig the well

the cement

tile barrels

cm throughout.

drops under the low

of Different

ing has an inner diameter

part cement,

into water

to the ground

for the Construction

are waterproof

of 100 cm.

and rising

and evening.

to make the well barrel


barrels

soil layers

and condensing

of morning

2. Requirements

through

From the fourth

their

of materials

inner

is 1:1:5.

diameter

is 100

Quantities

well rim, and well baseboard

section

of mat-

may be found

in Table 3 (Fig. 14, Fig. 15).

Pour the proportionally


of lubricating
it firm

oil before

while pouring.

pouring

should be lengthened).
it.

Then sprinkle

filling

After

water

come out easily);

up, use a layer

After

hammer

of cement

and

to cover

the

about 8 hours it can be taken out.

and then the outer

first

into the mold (smear a layer

tlrree parts sand) about 3 cm thick

top, and make it smooth.


layer

material

so that it will

just before

sand (one part cement,

the inner

mixed

(in bad weather

it is removed,

on it four to five

Remove

the setting

time

use wet grass bags to cover


times per day for 7 days.

After

15 days, it is ready for use.

Instruments

utilized

in well digging

are:

one short-handled

spade;

one wooden or iron gourd: one piece long rope to haul mud; one bucket
or other

container

pole for carrying;

to haul mud; one piece of thick


three

pieces of bamboo

water-draining

instruments.

well is detailed

in Figure

The procedure
16.

4b

rope, 6 in long; one long

to make a triangular
for digging

a cement

frame:

and

tile barrel

Table

3. --Material

For Each Well Cover,

Well Rim, and Well Baseboard1

Material
Cement
Name

(catty)

Sand
(catty)
12

Well cover

Needed
Stones*
(catty)

8(

size of
watermelon
seeds)

Steel

rods3

Price

(catty)

(yuan)

1.2

1.00

Well railing

15

45

50 (2,4,6)

1.0

3.50

Well baseboard4

25

80

70 (2,4,6)

3-4

3.50

1
For size of well cover, well rim, and well baseboard, refer to
wellcover
styles,
refer to Figure 15.
Figure 14. For well railing,
2
Trade specifications
of stones are given in parentheses.
3
Discarded iron sheets, heavy wire, or bamboo tubes may be used
instead of steel rods.
4
Each well baseboard is made of two half circles.

36
.
Explanation
o Each section 40 cm high
o Wall of well 6 cm thick
o Internal diameter each
section
(a) upper opening 51 cm
lower opening 67 cm
(b) upper opening 67 cm
lower opening 83 cm
(cl upper opening 83 cm
lower opening 100 cm
(d) upper and lower
opening all 100 cm

Figure

14. Simple

1. Well cover.
4. Well barrel.

drawing

of cement

tile barrel

2. Well railing.
3. Waterproof
5. Water penetrable
section.

48

well.

section.

Figure

15. Diagram

of well railing

and well cover.

1. Well railing.
2. Well cover. 3. Cement crane
for cover. 4. Previously
imbedded iron rod. 5. Latch.
6. Prepared opening

1
1.2m

Figure

16. Diagram

for procedure
tile barrel well.

of digging

cement

(1) On the site chosen, draw a circle 1.2 m in diameter;


(2) Follow the drawn line and dig perpendicularly
downward;
(3) In the dug-out mud pool, lower three sections of
nonwaterproof
barrels; (4) One person should enter
the well and dig out the earth from the center to the
periphery.
When the mud under the last section of
the well wall is dug out, the barrel automatically
sinks
down. When the upper section sinks to slightly above
ground level, put on another section; (5) After all the
nonwaterproof
sections have been lowered, digging
must continue to allow the barrel to sink in for another
two sections; (6) Prepare to place the well base. Dig
a mud pool at the bottom of the well with a small
upper opening and a large lower base, so as to place
two half-circle
well baseboards.
Now dig out the mud
below the barrel, so that the barrel will sink down
and rest on the baseboard; (7) Finally put in the three
waterproof
sections and the well rim. After the filledin mud has become hard, the well stand can be constructed.

50

Brick

well.

Ordinary

wells are made with


of the opening

bricks

specially

are usually

made well bricks

the diameter

of the opening

3 ft, the digging

may extend

sand layer

level).

or if water
lowered

(e.g., in the Shanghai

evenly

and firmly.

using mud to fill

upper part of the well wall


and sand mixture
dirty
After

railing

with

from leaking

5 in of cement

over it).

Connections

must be sealed tight

Simplified
basically

hammer

between

the first

circle;

water

made smaller,

then use cement


well stand,

well.

is:

of barrels

have
cover

to smooth

well,

of construction

but this type

(a) Select

flat

well is planned,
circle

the two circles,

This groove

After

an upper opening

well

in.

(cl Draw another

(also the model mold).

even

and well railing

This method

tile barrei

The method

on the ground;

(e) Make the number

forms

and easy
clear ground
first

draw

7 cm out
making
the bed

that each ring should be

5 cm smaller

than the lower

that are required,

(f) Finally

well is made.

The materials
sand, and broken

cement

the well stand (first

(d) Dig up the soil between

each with

chimney-shaped

quality

heavy rainfalls

from seeping

barrel

On the

This procedure

the water

several

it tight;

that is 7 cm wide and 30 cm deep.

for the tile barrel

opening;

after

soil (Fig. 20); (b) If a 90-cm-diameter


circle

be

or lime

a groove in the ground (Fig. 19). It is simple

a 90-cm-diameter

a groove

the wall.

the well wall,

to avoid dirty

to make, and the cost is cheap.

from

be dug up clearly

put the premade

is the same as that of the cement

firm

12 ft below

should immediately

in, thus making

wait until

cement tile

is made by digging

with

or smooth

loose soil; then build

mixture;

to

The well wall should be made round

the well wall is completed,

the surrounding

almost

(441 to 6 ft), it is best to use cement

over the well opening;

hardened

cannot

every

in all around while it is being built.

to seal the cracks

water

digging

When

(6 to 9

Digging

area it is usually

is seeping up, then the well baseboard

and smooth,

better.

for 6 in; continue

inward

When the mud and sand mixture

and placed

prevents

may be smaller

(9 to 10.5 ft).

ft); when the soil is loose, it may be bigger

ground

(Fig. 17, Fig. 18). The size

of a well must depend on the degree of soil looseness.

the soil is compact,

the moving

used, but in some places

for this primitive

bricks

(slightly

larger

cement

mixture

well are cement,

than broad beans).

51

Add water

to

Figure

of Chuan-Sha
17. Diagram of connection
County model well bricks.

1. Chuan-sha
3. Well brick.

Figure

County model well brick.


2. Cm.
4. Model box to make well brick

18. Layers

1. Layer.
2. Diameter
used around. 4. Ft.

of well built
of inner

52

with
wall.

well bricks.
3. No. of bricks

2
Figure

19. Setting
primitive

1. Well opening.

of the tile barrels


cement well.

2. Well base.

3. Section.

for a

4. Cm.

-----me
--s-u--Figure

1. Ground

20. Diagram of digging soil to prepare


the model bed of tile barrels.
surface.

2. 80 cm.

53

3. 90 cm.

4. 30-50 cm.

these materials
roilnd

in 1:2:6 proportion,

bed. Wait about

the tile barrel

and mix well before

can be removed

of the barrel

90 cm; otherwise
cement

for use.

The tile barrel


well site.

to work (but the inner


it will be difficult

baseboard

Mud well.
constructed

digging

In areas without

a long-blade

is:

knitted

(Fig. 22); (b) In di gging the soil, first


on the selected

the dipper.
a smooth

well site.

portion,

3 ft; and the base of the well,

firm.

If white,

of the well opening

of about 9 ft will

can be divided

ences of water
determined
to cover

level

at different

by the actual

conditions

ft long.

bucket

and damage the well wall.

mid-

will not easily

into three layers:

yellow

This soil is comparatively

collapse,

during

so another

digging,

site should

(e) The usual well depth

of the soil; (f) Stones are not used


cleaning;

(g) A broken-bottom

crock

an old pan may be used as a well

should be hung on a bamboo stick

Do not use rope, which

to remove

areas, the depth of the well should be

the well base to facilitate

(hj The water

and draw

depth of 4.5 to 6 ft; but due to the differ-

may be used to make the well railing;


cover;

This structure

soil or sandy soil are encountered

a water

bucket

the soil with

use the bucket

soil.

type of well constructed;

allow

bamboo for

should be 2 ft; the widest

2.5 ft.

it means this soil is loose and will easily


be chosen or another

a 9- to 12-ft

well should be dug into drum

soil; and green-purplish

powdery

three kinds of

must be pared off to maintain

collects,

The diameter

soil; greyish-brown

with

to dig; (c) The whole

(d) The soil generally

prepare

Then dig the soil, removing

shape.

collapse;

mud wells can be

use a 9-in rope as the radius,

When much water

it, and then continue

and some

weedy rope, and a water

The mud along the well wall


surface.

or cement,

(a) First

with

The

The base here should be set

spade connected

soil, a mud dipper

a circle

is safer.

well.

bricks

(Fig. 21). This method

instruments:

should not be less than

to dig the soil), which

in the same way as the one in a tile barrel

layer

A person can squat

diameter

tubes should be added.

then

for the lowest

should be made into two or three sections,

steel rods or bamboo

into the

10 days, and dig away the soil in the circle;

can be set on the ground at the planned


inside

pouring

may allow

Specifications

types of wells may be found in Table 4.

54

about

10

the bucket

to knock against

and material

costs of several

1.5 R8
t-l

----m---m
--I--m
---

Figure

21.

Cross

section

of mud

well.

1. Well opening
diameter
at ground level.
2. Height
of well railing.
3. Mud wall.
4. Depth of well.
5. Depth
of water.
6. Depth of base pool.
7. Well base diameter
8. Ft.

-1
Figure

1. Dorsal

22.

view.

3-

Instruments

for digging

2. Frontal

56

view.

3.

mud

well.

Dipper.

3. Management

After
wall

of Wells

construction

(except

of a well,

in a mud well);

is refilled,

then dram the well dry.

Wait 1 day before

fouud,

drain the well dry several

times,

the salty

contents

will

population,

things

After

times.

be installed).

personnel

well sterilization.

After

sterilization

for one-half

bactericidal

effect.

and used.

Maintaining

A common

for chlorine

method.

Collect

:o 6 drops of methyl
Compare
excess.

this with
Methyl

toluidine,
standard

toluidine

and shake.

Select

regulations.

See that

A community

water

should contain

A yellow

in a test tube, add 5


color

will

the amount

should be kept in colored


yellow

is the methyl

appear.

of chlorine
bottles

and

or turbid.

Pools for Water Use

convenient

clean environment
Other

the

excess will keep the

water

tubes to determine

solution

mobilize

excess measurement

5 ml of sterilized

should not be used if it has turned

B. Separate

Fully

excess is too high or not sufficient,

should be changed.

toluidine

taste will be diluted.

hour, the water

the dosage of chemicals

procedure

several

to manage and clean the well

this chlorine

If the chlorine

is

if bamboo or iron sheet pumps can

out routine

excess.

water

the soil is filtered

are not washed around wells.

and to carry

chlorine

If salty

and set up sanitation

Assign designated

the well

to each load of water

and the salty

should be used (it will be better

to wash the well

Wait until

using the water.

dug, kept,

discuss the matter,

stools and dirty

powder

decrease,

Wells must be properly

certain

use well water

and then add 2 g of bleaching

for sterilization.

bucket

first

pools with no snails and with


for drinking,

washing

pools may be used for washing

rice,

clothes

57

good quality

azcildwashing
and animal

water

vegetables.
drinking.

and

C. Drawing

Water From Midstream

Use bamboo
Draw

water

tubes or lead sheet to make water

from midstream

are no cercariae

usually

of a deep river

Avoid

Contact

In rivers,
duction

with

canals,

and daily

Personal

Infected

and banks that are frequently

livelihood

and are possibly

built,

bridges

water.

and others

wading

must change their

green fertilizer,

blockade

fishing,

Penetration

will

easily

result

tions should be taken.


and livelihood,

Clothing
preventive

to catch

If water

must be entered

two preventive

to collect
fishing

river

could

fish and crabs.

high and entering


cercariae,

the
precau-

because of production

measures

may be adopted.

Tools

are effective.

shoes, long rubber

Dissolve

soak the clothes

and trousers,

protective

may last for about 2 weeks.

58

boots,

antischistosome-67

100 ml of water),
effect

of people

by the schistosome

such as tung oil cloth

trousers

using tools instead

or seduction

is comparatively

in infection

the following

1. Use of Preventive

boatmen,

of the Cercariae

In areas where snail density


water

that easily

Fishermen,

as using long bamboos

take the place of man going into the water

B. Prevent

embankments

dug to drain places

tools or methods,

of pro-

precautions

communication

should be avoided.

Such methods

net fishing,

passed because

snail-infested,

put up, and ditches

Unnecessary

for work in the water.

there

Water

Roads should be repaired,

collect

because

Protection

should be taken.
temporary

for drinking

pumps (Fig. 23).

in this water.

If.

A.

drawing

and plastic
(2 g in

sun dry, and wear.

The

Figure

23. Diagram

of water-drawing

pumps.

2. ;Cubber piston.
3. Rubber
1. Outlet for water.
5. Cm. 6. Base of Wats>-.valve. 4. Inlet for water.
drawing pump.

59

2., Smear and Rub Protective

Chemicals

Smear and rub 15% linimentum


use 1 ml of 25% sodium alkyl
washing

phthalatis.

Then stir while


After

be ready for use.


be treated
tained

thorough

for 4 hours.

slowly

as substitute),

adding

mixing,

If immersion

must be repeated.

and shows sedimentation,

To prepare,
of synthetic

and dissolve

15 ml of linimenturn

the milk-like

the chemical.

phthalatis.

(i.e., the ingredient

All skin that comes in contact

by smearing

the application
paration

sulfonate

soap, or use 10% soap water

of water.

dibutylis

The protective

time exceeds
If the milky

dibutylis

protective
with

solution

infected
effect

the effective
suspension

in 04 ml

water

should

will be maintime,

then

is an old pre-

it should be shaken well before

60

will

use.

Chapter

METHODS

Thorough

of th- = sick patient

investigation

Methods

for schistosomiasis.
for the pathogen
immunological

of diagnosis

(stool proctoscope
diagnosis

OF DIAGNOSIS

may be divided

and Sigmoidoscope

(oval ring test, etc.).

examination

is the main method

examination

is poor in early mild infections,

but no longer
examination
patient
bitipsy

used.

and the effect

may make diagnosis


examinations

examinations)

in patients
cases.

of hypertrophy

and serum

on the farms,

with

stool

value of stool
chronic

Limitations

cases
of the

of the mucosa of the

In these patients,

cand serum immunological

examination

the diagnostic

infected

difficult.

of treatment

into:

At present

However,

in the area, and in newly


methods

is the prerequisite

clinical

and rectal

tests should be used to help

in the diagnosis.
I.

Stool Examination
Hatching

A.

Method)

Preparations

To carry
that

(Sedimentation

out the general

the cadres,

study.

class, and laboratory

to collect

team and brigade

and specific

methods

the stool specimen


scooped

used to carry

and collecting

out of the stool or manure

Using the production


charts.

Distribute

specimens,

chart

the important

sig-

them out.

should

Educate

it in a proper

to a sanitation

also be distributed.
61

instruc-

of stool collection
the people in preserving

container.

keep accurate

a doctor

Detailed

It should not be

crock to avoid an inaccurate

team as a unit,

two copies-one

of schistosomiasis.

must designate

and significance

and one to keep at the laboratory

of a specimen

take

and send stool specimens.

tions should be given about the purpose

requires

personnel

for the disease for the elimination

At the same time each production


member

properly

Every person should understand

of examination

or sanitation

of stool examination

the poor, the peasant

part in intensive
nificance

survey

laboratory

member

to register
Waterproof

examination.

registration

to collect

results.

stool

Three copies

blue ballpoint

pens

Carefully

may be used for copying.


one to two laboratories
collectively.

in each commune,

Choose a location

water is available.

check for mistakes.

accessible

Each laboratory

It is best to establish

so that instruments
to water

sources,

must be adequately

can be used
so that washing

equipped.

B. Procedure

1. Reception

Before

accepting

points:

production

cient,

and whether

a specimen

chart

than 20 g (size of a Ping-Pong


be rejected

and another

2. Opening

five

of stool is suffi-

quantity

If the stool quantity

is less

ball) or the stool is badly contaminated,

specimen

unwrap

to transfer

the specimen

is complete.

check the following

it should

collected.

Package

Carefully
Use a stick

name, whether

team, number,
specimen

for examination,

chart

the package,

and avoid keeping

the stool onto a copper

on the measuring

any paper pieces.

wire sieve or cloth,

and paste

cup.

3. Form Paste

Use a paste-mixing
wire sieve or cloth.

stick

A measuring

stir all of the speciman

cup filled

with

water

In using the latter

may be used to form the paste.


water

to evenly

added and the speed of the hand-stirring

or a teapot

method,

motion

on the copper
with

the amount

water
of

may vary according

to the stool hardness.


4. Change

After
or cloth

of Water

mixing

paste in the measuring

and let stand for 30 minutes.

and preserve

the sediment

(retain

of the cup).

Add clear water

Subsequently,

change water

cup, remove

Pour off the supernatant

about 5 cm of the mixture

again, and continue


every

the copper

20 minutes

62

until

to allow

wire sieve

stool water
at the bottom

sedimentation.

the supernatant

becomes

clear.

Generally

about three

changes are required.

natant

fluid,

avoid interrupting

the flow to prevent

5. Microscopic

(50-100X).

of the slide.

each having

the presence

positive

specimens

of the cup.

under a microscope

an area no smaller

They should not be too thick

if a batch shows positive

should demonstrate

in the bottom

slide, and examine

make two smears,

examine the slide, and record


ova.

loss of the sediment.

to suck up the sediment

smear on a covered

Usually

two-thirds

out the super-

Examination

Use a long pipette

Make a droplet

In pouring

or too thin.

of schistosome
microscopically,

than

Thoroughly

or other parasite
the same batch

hatchings.

6. Hatching

Pour the entire


flask,
Fill

sediment

and add clear water


to this height

ing.

Observe

of the measuring

to about 0.5 to 1 cm from the mouth

exactly.

the results

two or three times.

The time interval

H the temperature

for observation

is 30C,

the first

ob-

should be made at 4 hours; the second, at 8 hours; and the third,

at 12 hours.
Generally

If the room temperature

when cercariae

under examination
firmed

of the flask.

Put the flask into a 20C to 30C room for hatch-

depends on the room temperature.


servation

cup into a 250 ml Erlenmeyer

should be inspected.
In winter

room to avoid affecting

peratures,

thus missing

then observe

are seen in the positive

by two persons.

hatching

is 25C,

hatching

Findings

6 hours.

stage, the specimen

of cercariae

the observation
the activities

every

should be con-

should be carried
of the cercariae

out in the

by low tem-

the cercariae.

7. Washing

All instruments
Glassware
(cloth)

sticks

should be separated

to kill all ova.

slides should be boiled


pipettes

cleaned

should be washed three times and rinsed.

and mixing

and boiled

should be thoroughly

with

Washing
alkali

water

63

contamination.

The copper wire sieve


the glassware,

must be changed

to remove

must be sterilized.

from

to prevent

brushed,

frequently.

the oil and then wiped

Glass
dry, and

8. Registration

of Material

A designated

person

they are registered


and their

leaders

in time,

--I
-_-iu*i.ure

a light

and progress

must be notified

so that treatment

C. Morphology

must keep stool examination

noted in each unit.

--.vvuul

I- ---I
IS Vdl

color.

1- ,L,,,
111 aucLps,

7A
IX +m
LY 1nA
A.._

Cercariae

can be seen within


hard to recognize,
examination

Though

and has a double

tests

is oblong,

can be seen by the naked eye.


the flask neck, utilizing

their

They seldom change their

ova.

in size; but when they degenerate,


move in circles

of the stool.

usually

elongated

death.

The nearer

their

down to the flask bottom.

Only a few rise again to the flask neck, and at this

be paid.

The time of survival

temperature

ture.

at hatching.

Generally,

cercariae

nifying

Death

suitable

the cercariae

glass, or a small mouth

after

hatching

for hatching,

attention

depends on the
a high tempcra-

or neon light

If necessary,

with

use a mag-

may be used to suck out the fluid

examination

bugs.

64

must

most of the hatched

Under sunlight

can be seen easily.


pipette

they sink straight

bugs, so special

occurs soon in a room with

for over 24 hours.

drop on a slide for microscopic


water

of the cercariae

in temperatures

can survive

a dark background,

them for water

until

line.

death they are, the slower

time it is very easy to mistake

become,

around

They are

slightly

when they are approaching

and

straight

is encountered.

they become

white

gather

swim in a slanting

movements

speaking,

ova are com-

and greyish

cercariae

course if no obstruction

matter.

24 to 26).

semitransparent,

to actively

Although
it is

Generally

or mutated

ova (Figs.

The hatched
cilia

wall.

by dead tissue and dirty

immature

mature

in size, with

frequently

they are a very small proportion

will reveal

the cercaria

and frequently

to 80 microns

the shell of the mature

the ova are aasily recognizable.

uniform

hv
.-, 55

on the upper part of the oval shell,

seen because it may be obscured

Generally

positive

Ova and Cercariae

not easily

Further

These people

of the names of those showing

The oval shell is very thin

there is a small spicule

paratively

and see that

can be begun in time.

of Schistosome

yellow

results

to distinguish

the cercariae

and
from

11

12

13

li

10

16

15

17

20
Figure

24.

22
of schistosome

31
Morphology

1-5. Immature.
6-13.
mutated.
20. Mature
22. Entirely
calcified.

Mature.
mutated.
23. Ova

6.5

19

18

pcJ
ova.

14-19.
Immature
21. Dead cercaria.
in intestinal
mucosa.

qj?

10

14
13

la

Figure

25. Various kinds of frequently


seen parasite ova.

1. Clonorchis
sinensis.
2. Tapeworm.
3. Tapeworm.
4. Short shell tapeworm.
5. Whip worm. 6. Thread
worm. 7. Broad tapeworm.
8. Hookworm (immature).
9. Hookworm imaturej.
i0. Ascaris (fertilizedI.
11. Ascaris (unfertilized).
12. Fasciolopsis
(immature).
14. Paragonimus
Westermani.
13. Fasciolopsis
(mature).
15. Schistosome.

66

Figure

26. Several
mistaken

kinds of pollen that may be


for parasite ova.

clethroides.
1. Borage officinalis,
L. 2. Lysimachia
5. Papaver somniferum
3. Malvaceae.
4. Ficus religiosa.
8. Olaenlandia
(red poppy). 6. Pine. 7. Aster tataricus.
11. Rhodo10. Cauliflower.
diffusa (wild) 9. Violet.
dendron mettermichii.
12. Citisus scoporius.

67

Water bugs are not uniform


or greyish

white;

in size; some are dark green, greyish

and most do not refract

and some vibrate

in a spiral

suddenly

and backward,

forward

not swimming

fashion

in a straight

light.

Their

movements

or move forward

floating

are aimless,

by rolling.

about aimlessly,

brown,

They move

or circulating

and

line.

D. Precautions

1. Quality

of Water

On the farms using river


should be made to exterminate
nt~i only will

they be confused

spoonful

of water.

This method

bleaching

powder

chlorine

water

bugs.

for hatching,

When there

cercariae

with

Use bleaching

the capacity

in a small basin, add water,


and stir evenly

with

a rod.

are many water

bugs,

but also

the work efficiency.

powder

(about 0.4 g) of bleaching

varies

attempts

and cause mistakes,

speed and lower

of water bugs.

bugs; i.e., one level

it into the crock,

or well water

with

will slow down the observation

Elimination

water

to kill water

powder

of the water

in 240 catties
crock.

Put the

and stir into a thin paste.


After

30 minutes,

Pour

the excess

should be 0.7 to 1.0 ppm.

Dechlorination.
it to naturally
1:400,000
sulfate,

Chlorinated

dechlorinate.

sodium

In areas with

(in 240 catties

This water

waterworks,

excess is high, it may affect


chlorine

overnight

Another

of water

method

tap water

hatching

to allow
is to add

add 3 ml of sodium

can be used 30 minutes

thio-

later.

may be used; but if the chlorine

of the cercariae.

excess is above 0.3 ppm, the water

method

may be left

Then it can be used.

thiosulfate

a 10% solution).

water

Therefore,

if the

should also be dechlorinated

(see

above).

If the river
centration
0.03%.
alkalinity).

water

is turbid,

should not be too high.


The pH of water

it may be treated
Generally

most suitable

A pH 6.8 to 7.6 range will

alum, but the con-

it should be below

for hatching
not affect

68

with

0.02% to

is 7.4 to 7.8 (wea;:


hatching.

There is usually

no problem

with

the quality

of the water

to chemical

factories,

tamination.

In such cases other rivers

the results

should be paid to industrial

concentration.

the mere hatching

salt concentration

be used instead
water

water

is too high,

to change solutions
This procedure

hatching

can only

where

the

1.2% saltwater

during
will

may

sedimentation,

avoid

the hatching

Especially

in summer

using
of

of Stool Preservation

work the stool must be fresh.

kept too long.

In collecting

before

At the same time,


and fermentation
to freeze,

occurs.
will

proportion.

be examined

at least

the laboratory,

a stool is examined

For general
times.

surveys

in a mature

and the positive


in infectious

Therefore

the people

may rise
overnight

sediment

around

ovum combine

must be fully

mobi-

Test

a ribbon-shape

The metabolites

the homologous
69

rate

areas, stools should

test produces

the ovum.

with

reaction

examinations.

Serum Oval Ring Sedimentation

serum oval ring sedimentation

or iapeworm-shape

so the stool may be old.

do not leave the stool outdoors

to make sure there are three specimen

A positive

have to be

Stool Examinations

three

II.

procedures

be affected.

of times

are in direct

several

are held too long, the temperature

In winter

of Multiple

The number

reaches

if specimens

or hatching

3. Effects

stool specimens

the specimen

it

Even in other seasons it should not be

should not be kept for over 24 hours.

cariae

Generally,

chloride

too soon.

In practical

lized

con-

is high.

for the last change.

2. Effects

followed

of sodium

not in areas along the seacoast

if the room temperature


of clear

the concentration

will be suppressed.

of water

In summer

cercariae

waste water

should be chosen to avoid affecting

The higher

occur in low salt concentration,

clear

source is close

of hatching.

Salt
in water,

attention

used; but if the water

(specific)

of the cerantibody

of the serum to produce


Laboratory

reports

stages of the life


todes.

a fluorescent

ball shape.

show that species exhibit


cycle

The procedure

and do not produce

It is a highly

great

accurate

specificity

cross-reaction

test.

for the different

with

other

trema-

Dissect

after

is as follows:

A. Ova Suspension
1. Infect

the domestic

rabbit

with

about 2,000 cercariae.

40 to 42 days.

2. Use the intravenous


the liver,

infusion

and use scissors

method

to collect

the adult

worm.

to cut away the bile ducts and other

Remove

connective

tissues.

3. After

microscopic

tosome ova are present,


into tissue-grinding

4. Add saline
?2(! holes.

After

use normal

machine,

and filter
filtering

5, Co!!ect

the.filtrate

tion.

Change

the saline

tirely

clear.

6. Pour the sediment


trifuge

two or three

slightly

yellow.

through

proves

that large amounts

of schis-

to wash, and cut into pieces.

Put

grind into paste.

copper sieves with 40, 60, 80, 100, and

grind once more.

into

a 1000 ml conical

about every 30 minutes

into

the pointed

times until

saline

saline

and fully

This sediment

7. Use normal
200 ova/drop.

slide examination

to dilute

until

c+

for sediacnta-

the supernatant

end of a centrifugal

the sediment
contains

mezssmirg

is en-

tube, and cen-

in the tube bottom

becomes

pure ova.

the pure ova to a concentration

This is the ova suspension.

Preserve

4OC to 6OC. It may be used for 7 to 10 days.

70

of 100 to

in the refrigerator

at

B. Serum

Under semistarvation,
from

the capillaries

hemolysis

(slight

withdraw

2 ml of blood from

of the earlobe.
hemolysis

Separate

a vein or obtain

the serum after

blood

clotting.

Avoid

is not detrimental).

C. Test

1. Put a drop of the patients


a drop of ova suspension
Use a cotton

stick,

microscope

3. Standard
small amounts
and clearly

and immediately

incubator
(100X).

reaction

of spheroid

sediments.

from

are various

sediments.

are sediments,

chrysanthemum

petals,

showing

results

maintained
plicated,
symptoms

no matter
for a certain

this method
but repeated

supplementary

IIL

time.

+++I surrounding
different

(400X).

the ovum are

mentioned

infections

be used widely.

fluorescent,

++

surrounding

two-thirds

of the

shapes such as false feet,


++++ surrounding

the ovum

above.

(100%).

among acute infec-

With patients

Since the preparation

negative

diagnostic

remnants.

if they are cured or not, a positive

cannot

under a low-

surrounding

of the oval ring test are highest

tions (98% to 100%) and recent


been treated,

slide paraffin.

They are even, colorless,

or fungus branches.

shapes of sediments

4. The positive

pathological

(Fig. 27). +

stool examinations,

reaction

of antigen

However,

who have

in people

it still

will be

is quite
with

com-

clinical

is valuable

as a

test.

Proctoscopy

or Sigmoidoscopy

and Biopsy

A. Indications

Those patients
symptoms

with

a history

and signs but repeated

of contact
negative

71

Add

a 24 X 24 mm cover slip.

change to high power

other golden yellow

the ovum are process-like

Do not use oil.

for 48 hours, and then examine

If necessary

for positive

different

ovum surface

cover with

and seal all edges with boiling

2. Put in a 37C
power

serum on a clean slide.

with

infected

water

stool examinations

and with

should be

++

it

Figure

27.

Oval

ring

72

sedimentation

test.

examined

extensively.

although

a correct

Patients

having

They may have a positive

positive

a positive

diagnosis

of schistosomiasis

proctoscopic

examination

over a year also should be examined

B. Precautions

orrhoids

function

sigmoidoscopy,

impairment

and extreme

a suppository

oil.

Advise

evacuation

position

insertion
light,

the condition

remove

bismuth

subcarbonate

Before

or lies on the left

Insert

side.

the muscles

the scope into the

advise the patient

to relax).

push the scope forward

Remove

along the

of the mucosa.

a piece

of intestinal

tissue

about one-

of the intestine

about 8

Do not cut too deeply or tear the tissue.

5. The wound should be cauterized


with

severe hem-

is sufficient.

to constrict

the size of a rice grain on the dorsal surface

to 12 cm from the anal opening.

diseases

enema may be considered.

the patient

Under the sigmoidoscope


lumen and observe

mechanism,

the anal opening.

(after

4. If a biopsy is indicated,
third

bowel

is put in a knee-chest

anus for a few centimeters

~ktestinal

clotting

or saline-cleansing

the anus and expand

the probe.

for

weakness.

thorough

the scope with

surrounding

being treated

for those with hemorrhagic

with disturbed

proctoscopy,

3. The patient
Lubricate

after

made.

carefully.

should be postponed

and fissures,

2. Before

was never

test

and Procedures

1. Examinations
or liver

oval ring sedimentation

powder,

with

silver

nitrate

an antihemorrhage

(10%) or treated

powder,

to stop bleeding

by pressure.

6. On the day after


activities

or forced

7. If abdominal
exa- Gnat&z,
from

intestinal

examination,

the patient

should rest.

Avoid

vigorous

defecation.

pain, bloody stools,

the patient
perforation

fever,

should be observed
or hemorrhage.

73

or gaseous distension
to see if there

occur after

are complications

C. Differentiation

Tess
examine

the biopsy

tissue with

under a low-power

high power

to observe

guish whether
rectal

of Ova and Its Clinical

the construction

the ova are living

Mature ova (living


ish brown.

Mutated
thickened;

ova.

side).

They are called

degenerated
or

net-like

of the cercariae

in the ova to distin-

The ova frequentlv

The cercariae

structure,

recently

or slightly
ova.

can been seen.

No cercariae

outline,

or yellow-

in the ova is clear.

than living

ova; the shell,

yellow

smaller

white,

or dark yellow,

(grouped

on one

in the ova have

have decayed

The body is smaller

into a remnant

they are called

late-

mutated

mean there are living


if living

changes.

mature

of the disease must be carried

ova or ova shells are seen, it does not necessarily

schistosomes
or mutated,

who have never been treated

ova, and

ova are seen, it means that living

are in the body and treatment


mutated

than living

are in the ova, or only a few cell remnants

Some of them show degenerative

ova or recently

If late-stage

ova, no matter

yellow,

If the cercariae

or appear black or greyish

wa or wa shell.

the shell is thin.

schistosomes

light

If the ova are greyish

mutated

in

ova.

Immature

If mature

outline

the body is smaller

in the ova is clear

observed

under

kinds:

These ova are oblong,

into a mass, show an unclear

stage mutated

out.

oval.

Generally

outline

Then examine

or dead.

and the edges, uneven.

the cercariae

to look for ova.

are of the following

The shell is thin.

First

a cover slip on a slide into a thin sheet.

microscope

biopsy tissue usually

Significance

in the body; no treatment


are found in rectal

biopsy

is needed.

If

tissue of those

for the disease, it is best to begin a course of

treatment.

74

chapter

6
TREATMENT

OF PATIENTS

I. Pretreatment

Take the history,


purulent

and bloody

of work capacity,
hepatitis,

stools,

nephritis,

The physical
murmurs,

history

of psychiatric

physical

(venous

dilation

examination,

physical

condition

complete

records

for treatment

and age and whether

should be treated

should

should be taken (Table

5,

there are associated

treatment,

explanations

actively

diseases.
mTust be

and the patient

prepared

treatment.

IL

The Selection

of Medications

for Schistosomiasis

chronic
emetic

tions showing

symptoms,

3-day treatment

In patients

Treatment

may be used.

it is best to use the tartar

In acute infection
with

and Methods

oral drugs (antischistosome846,

infections,

273) or tartar

first.

The patient

should be made, based on the pa-

given.

orally

wall),

recorded.

for immediate

treatment.

and spleen enlarge-

of the abdominal

the body weight.

With those in no condition


The complications

liver

kept of heart

etc.

accurately

tients

With mild,

and records

telangiectasia

6). Recommendations

dis-

diseases.

rates,

Table

diseases such as

and neuropsychiatric

should be very thorough

extremities,

for schistosomiasis

concurrent

pulmonary

be naked and the weight

After

and condition

appetite,

as well as heart

measure, not estimate,

Accurately

ascites),

blood pressure,

jaundice,

edema of the lower

(such as fever,

there are various

tuberculosis,

rate,

of schistosomiasis

hematemesis,

examination

heart

ascites,

symptoms

and whether

eases, or a family

ment,

including

Preparations

with

fever,

concurrent

With more severe infecemetic

furapromidum
diseases,

75

antimony-

long-course

may be given

the selection

of a drug

76

Table

6. --Schistosomiasis

liver

Medication

for

course

Daily

mo.
dosage:

planned

total

enlarged
dosage

(days)

Time of treatment:
--

cm, spleen

I[:

treatment:
Started
day.
1-------- 2
9------ lo
17-P-P 18

Actual
3

yr. -dosage used


4

No.

wt
class -treatment diarrhea,

{before

enlarged

Record Chart

Family

Occupation

SexAgeType of schistosomiasis:

Name

dysentery,

Treatment

mo.

11

12

13

14

19

20

21--

22

Finished

day.
7
15-23--

8
16
24

kg
cm.)

Table 6 (continued)
Symptoms

;:

Before

treatment

During

treatment

no.

Month/day

Time

Nausea
Vomiting
Anorexia
Abdominal
distention
Diarrhea
Abdominal
pain
Liver tenderness
Dizziness
Headache
Vertigo
Blurred vision
Lassitude
Joint Pains
Insomnia
Skin rashes
Colored vision
Muscle spasm
Numbness/limbs
Heart rate
Heart rhythm
Progress note:
Summary of treatment:
Completed on schedule
temporary stop
completed with decreased dosage
stop treatment
and reason
Followups:
(included
improvement of symptoms and signs, recovery
capacity,
etc.

times
of labor

Dosage

Cumulative

dosage

should be based on the nature


is safe for cardiovascular

patients.

tuberculosis,

and chronic

hepatitis

course

emetic

tartar

drug reaction

may be explored

After

treatment

and improve

Oral antischistosome-846

of the complication.
In patients

with neuropsychiatric

in the recovery

stage, small-dosage

may be considered.

treatment

effects,

diseases,

Furthermore,

the combined

long-

to decrease

use of two drugs

(Table 7).

treatment

with

tartar

emetic,

antischistosome-846,

273, if reexamination

Shows that the patient

6 months

required

is generally

is not cured,

or antimonyan interval

of about

if the same drug is to be used for another

treat-

ment.
EL Oral Medicines

A.

Antischistosome-846

1. Indicated

or ascites

chronic

schistosomiasis

health

is good.

and spleen are enlarged,

and Powdered

Milk)

with

whose stool examinations

Patients

showing

and able to take part in ordinary

b. Patients
general

with

and whose general

whose liver

Tablet

for:

a. Patients
positive

(Antischistosome

with

no marked

are

late schistosomiasis
tenderness,

jaundice,

labor.

acute SChiStoSOmiaSiS after

improvement

of their

conditions.

2. Contraindicated

for:

or close relative

a. Tbe patient
tionst with

a history

b. Patients

of psychiatric

with

history

chasthenia,

and neurasthenia);

or frequent

attacks

of fainting,

(covering

two families,

three genera-

disease.

of epilepsy;
internal

neurosis

ear dizziness

dizziness,

80

or vertigo

(including
(Menieres
of unknown

hysteria,
syndrome);
origin.

psy-

--

Table

6 (continued)

Symptoms

Beiore

treatment

During

treatment

no.

Month/day

Time

Nau&a
Vomiting
Anorexia
Abdominal
distention
Diarrhea
Abdominal
pain
Liver tenderness
Dizziness
Headache
Vertigo
Blurrid
vision
Lassitude
Joint Pains
Insomnia
Skin rashes
Colored vision
Muscle spasm
Numbness/limbs
Heart rate
Heart rhythm
Progress note:
Summary of treatment:
Completed on schedule
temporary stop
completed with decreased dosage
stop treatment
and reason
Followups:
(included
improvement of symptoms and signs, recovery
capacity,
etc.

times
of labor

Dosage

Cumulative

dosage

c. Patients

who have recovered

or who are suspected


jaundice.

of having

In acute hepatitis

normai

liver

function

from hepatitis

hepatitis,

after

cirrhosis

a recovery

and labor capacity

within

the past year

of the liver,

of 6 months,

ascites,

a patient

may be treated

or

having

under strict

observation.

d. In patients
are not stabilized
nephritis,

with

(fever,

severe

acute or chronic

acute myocarditis,

anemia,

e. Hemorrhagic

added concurrent

heart

failure,

diseases that
acute stage of

etc.).

disease patients.

f. Women who are pregnant

or who have been breast

feeding

for less

than 1 year.

3. Dosage and Course

At present
milk powder.

there

are two forms

The antischistosome

the antischistosome-846
grinding

crystal

a small amount
846 crystal
ulating

tablet
powder

process and then pressing

g of antischistosome-846.
of

powder.

membrane

is smaller

is white

into tablet

After

high speed emulsification,


to form a powder,
powder

Because its absorption

and the course shorter.

0.25

to antischistosome-

it is treated
easily

by the gran-

absorbs moisture.

21 g of antischistosome-846

is better

Drug reaction

contains

is made by adding

gelatin

which

contains

and

by the air-current

Each tablet

milk powder

oil, sugar, and edible

method

granules

form.

vegetable

tablet

and is made by grinding

into minute

Antischistosome

Each 100 g of antischistosome


and 6.72 ml of oil.

of antischistosome-846:

than the tablet,

is basically

the dosage

the same as for

the tablet.

The dosages and courses are:

a. Antischistosome
highest

total

80 mg/kg/day;

continue

for 10 days; the

dosage, 40.0 g (Table 8).

b. Antischistosome
the highest

tablet:

total

dosage,

milk powder:
17.5 g (Table

50 mg/kg/day;
9).

continue

for 7 days;

Table

7. --Dosage

and Course Frequently


Treatment

Used for Various

Drugs in the

of Schistosomiasis
Method

of

Use
Highest

Drug form

Name of drug

Tablet
Milk powder
Antimony-2732

Oral
Oral

emetic

g)
g)

80 mg/kg/day
50 mg/kg/day

Course

dosage

10 days
7 days

40 g
17.5 g

Medium-speed

350 mg/kg

10 days

17.5 g

tab. oral
(200 mg)

400 mg/kg

15 days

20.0 g

Slow-melting

500 mg/kg

10 days

25 g

600 mg/kg
12 m&kg

15 days
3 days

tab.
Tartar

(0.25
(0.21

Dosage

total

oral

(200 mg)
Ampules (i.v.13

0.6 g (female)

Each ampule
with 1% 10
ml equal
0.1 g
Furapromidum7

Slow-dis-

(~-30066)

solving
oral

24-25 mg/kg4

20 days

1.4 g (male)
1.25 g (female)

to
22-24 mg/kg5
60 mg
(40-70/kg/day

tab.
(0.125

30 g
0.7 g (male)

g)

22-24 days6
14 days8

1.2 g

Table

CQ
w

7 (continued)

1
Use.indicated
in:
th; late schistochronic schistosomiasis
in gc$$
somiasis,
liver
and spleen enlarged with no mak!:$d te:&
without
jaundice
or ascites,
and z+ble to take part in tabor; acute schist
after general
,*$
'condition
improvement.
.
2
Use indicated
in:
chronic schistosomiasis
in fairly
good condition;
acute schistosomiasis
after fever subsided and general condition
improved;
late schistosomiasis
after general condition
improvement (no history
of ascites,
hepatbtis,
hepatic
function
fair).
'Used indicated
in:
chronic schistosomiasis
without
apparent anemia
or nutritional
disturbances,
without clear signs of liver
cirrhosis,
appetite
and labor normal, general condition
fair.
4
Use indicated
in:
more severe infection
or repeated treatment without
cure; acute schistosomiasis
after fever subsided, general condition
good.
5Use indicated
in:
acute, chronic,
or late repeated infections,
after
fever subsides but still
in weak condition;
late schistosomiasis
(or after
splenectomy)
with subsided ascites,
appetite
and general condition
impro\red,
hepatic
function
good; chronic or late schistosomiasis
in old age and weak
patients
with added diseases.
6
Small-dosage
long-course.
7
Use indicated
in:
acute schistosomiasis
or chronic schistosomiasis
with reinfection
and fever; late schistosomiasis
with fever,
if there is no
jaundice,
ascites,
liver
function
fair,
under strict
observation.
8
For reinfection
may extend to 21 days.

Table 8. Antischistosome
Tablet lo-Day Course Dosage Chart
(calculating
the lo-day total dosage of antischistosome-846
on the basis of 0.8 g/kg, the average daily dose is
0.08 g/kg) (0.25 g tablet)

I
Body wt .I

Total

dosage

Daily

(kg)
g

Tablet

--

11

:3
14
15
16
17
18
19
20
21
22
23
24
II
27
28
29
30
31
ii
34
35
36
37
ii
40
41
42
43
44
45
46
47
48

dosage

--

8.75
9.50
10.50
11.25
12.00
12.75
13.50
14.50
15.25
16.00
16.75
17.50
18.50
19.25
20.00
20.75
21.50
22.50
23.25
24.00
24.75
25.50
26.50
27.25
28.00
28.75
29.50
30.50
31.25
32.00
32.75
33.50
34.50
35.25
36.00
36.75
37.50
38.50
39.25
40.00

-<i 4

35
38
42
45
48
51
54
58
61
64
67
70
74

i
!
I

ii
83
86
90
ti
99
102
106
109
112
115
118
122
125
128
131
134
138
141
144
147
150
154
157
160

.-

4
5
5
5
5

4;
41

4
4

ii !
51

45
5
:

i
6

71

:i
8i
81

;
8
8

:iq

71
7j

7
7

8l

ti
91

t
8

ti
t
91 9
10 10
10 10
10 i

I
L

11
11
11
12
12
12
13
13
13
14
14
14
15
15
15
15
16
16
16

4 1

-,-- i 5

ii
101
10
PO 10
11 10
11 11 1
11 .*II i
12 i 11 1
12 ! 12 !

13
13
13
13
14
14
14
15

t
1
1
[

I
I

12
13
13
13
14
14
14
15

i: i .ii
16 16
16 j 16
; 16 1 16

a4

4
4
4
5
5
5
5
6
6
6
7

6171819
------

3;
4;
4;

31
4
4
4j
51

5;
4j
515

&j
5
61
5;
61 6
616

10

i
3!
4,
4j
41
5,
5

3
3
4
4
4
5

5
ii
6

f
6
6

8
8
8

t
9
ii
9
9
10 10
10 10
10 I 10
11 11
11 / 11
11 1 11
12 j 12

8
8
8
9

11 , 10 j 10
11 i ii
il
11 11 j 11
11 : 11 1 11
12 ,12

3
10
10
10
11

ii
11
11
12
12
12
13
13
13
14.
14
I4
15
15
15
16

3
3
4
4
d
5
5
6
6
7
7
7
8
8
8
9
9
t
10
10
10
11
11
11
12
12
12
13
13
13
14
14
14
15
15
15
16

Table 9. Antischistosome
Milk Powder 7-Day Course Dosage Chart
(calculating
the I-day total dosage of antischistosome-846
milk powder on the basis of 0.35 g/kg, the average daily
dose is 0.05 g/kg)

Body
wt

-_-

Daily dosage :
Total
dosage (g) I ,
(846 ba ic s$$;
/g z;k::
nto m.
mater&
I[milk
mat) gqwder
owder
I
--

fonv

Body
wt

--

Total
Daily dosage
.osage (g:
546 basic g (846 $wt 01 nto-ml
milk
k=s;f
naterial)
otider
Imilk
lewder
--

:onv

11

3.85

0.55

.,r, 62

6.5

31

10.85

1.55

7.38

18.5

12

4.20

0.60

32

11.20

1.60

7.62

19.0

13

4.55

0.65

33

11.55

1.65

7.86

20

14

4.90

0.70

2.28 Is 7.0
3.09
8.0
3.33
8.5

34

11.90

1.70

8.10

20.5

15

5.25

0.75

3.57

9.0

35

12.15

1.75

8.34

21

16

5.60

3.81

12.50

1.80

8.58

21.5

5.95

4.05

9.5
10.0

36

17

0.80
I
i 0.85

37

12.85

1.85

8.81

22

18

6.30

i 0.90

4.28

11.0

38

13.30

1.90

9.05

23

19

6.65

: 0.95

4.52

11.5

39

13.65

1.95

9.29

23.5

20

7.00

1 1.00

4.;6

12.0

40

14.00

2.00

9.52

24

21

7.35

1.05

5.00

12.5

41

14.35

2.05

9.76

24.5

22

1.10

5.24

13.0

42

14.70

2.10

10.0

25

23

7.70
8.05

1.15

5.48

14.0

43

15.05

2.15

10.20

26

24

8.40

1.20

5.71

14.5

44

15.40

2.20

10.44

26.5

25

8.75

1.25

5.95

15.0

45

15.75

2.25

10.68

27

26

9.10

1.3b

6.20

15.5

46

16.10

2.30

10.92

27.5

27

9.46

1.35

6.44

16.0

47

16.45

2.35

11.16

28

28

9.80

1.40

6.68

117.0

48

16.80

2.40

11.40

29

29

10.15

1.45

6.92

17.5

49

29.5

10.50

1.50

7.14

18.0

50

2.45
/ 2.50

11.64

30

17.15
17.50

11.9

30

Note: To facilitate
dispensing, a measuring tube
(or injection
tube) may be used to calculate the dosage.
For antischistosome-846
(2.5 g), pouring into the measuring
tube is equivalent
to about 30 ml.

85

(Body weight

over 50 kg should be based on a 50 kg scale to calculate

the dosage.)

4. Prevention

and Treatment

In carrying

of Side Reactions

out antischistosome-846

the side effects.

treatment,

one must not overlook

On the one hand antischistosome-846

sis, but on the other


fore in carrying

hand serious

out treatment

ever antischfstosome-846

side reactions

one must treat

treatment

are taken care of early,

schistosomia-

may affect

the body.

side reactions

promptly.

is properly

there is a marked

can treat

undertaken

decrease

ThereWhen-

and side reactions

of patients

with

delayed

reactions.
The side reactions
of treatment.

of antischistosome

In a few patients

be more severe because


after

the conclusion

occur mostly

they may continue

of added factors.

of treatment.

after

Depending

mild (patients

mild reactions

and can still

take part in labor) or severe

mental

the patients

disturbances

or rare reactions

should be transferred
must fully

with severe or prolonged

reactions.

a. Neuropsychiatric

Dizziness.

divide

early

side reactions

(patients

Treat

such as hemolytic

for treatment.

participate,

Aspects

exhibit
Additionanemia,

In the management

especially

in the few patients

of Side Reactions

at new acupuncture

points

(Ho-ku,

Feng-chih

Yin-tang.)

Herb medicine:
Angelica

appear

canno& work, and a few may even be bedridden).

of the case, the patient

Pe-hui,

or may

show short and relatively

classes:

with

treatment

on the degree,

into general

ally,

the course

Seldom do these reactions

may be divided

severe symptoms,

during

anamala,

Mix Eclipta

3 dr (one daily

alba, 1 oz; Lobelia

dose).

radicans,

Make into concoction

1 oz;

or syrup,

and

into two to three portions.

Others.

Vitamin

all be used (use recommended

B1, nicotinamide,
dosage).

86

and d-aminobutyric

acid may

Headache.

New acupuncture

points

(Ho-ku,

Tai-yang,

New acupuncture

points

(Tsu-San-li,

Pe-huil,

or use analgesics.

Lassitude.
yin-chiao)

or the above herb prescription

3 dr, and Agrimonia

pilosa,

Sight.

For blurred

ness, use vitamin

chiao,

Ho-ku,

Pe-hui)

Tract

Aspects

belladonna,

sodium

bicarbonate,

blind-

Shen-men,

San-yin-

New acupuncturepoints

(Tsu-

or the B vitamins.

points

(Nei-kuan,

Tju-san-

medication
given.

be investigated.

should be stopped

If there is gastric

If com-

and antispas-

pain, probanthine,

etc., may be used.

Side Effects

General

side reactions

skin rashes with

5. Prevention

also are treated

chlortrimeton,

and Management

a. Conscientiously

scientious

night

of Side Reactions

The cause should first

used; then anthelmintics

Two in time

to darkness,

etc.

medics

by treating

and use same as above.

(Nei-kuan,

New acupuncture

with bile duct ascariasis,

c. Other

univitatum,

681, etc.

Chung-kuan),

Abdominal pain.
plicated

points

abdominal distension.
Nei-kuan,

San-

or add nicotinamide.

Nausea, vomiting.
li, Tien-tu),

poor adaptation

or a form of alkali

Anorexia,
Cheng-sari,,

of preparation

New acupuncture

b. Alimentary

san-li,

visioq

A and D pills,

Insomnia.

adding Conioselinum

Method

1 oz.

Cheng-san,

carry

means discover

management

phenergan,

such as

etc.

of Severe Side Reactions

out two in time

side reactions

in time.

symptomatically,

Three

87

and three

in time and carry

keys means:

keys control.
out con-

the key of proper

selection

of patients

physical

examination.

before

treatment-obtain

Based on the indications

tosome-

and the patients

treatment;

the key of close observation

of side reactions-during
visits

and closely

condition,

contixme
pear,

actual

observe

patients,

the conclusion

But in a few patients,

aicohel,

or eating

which

If controlled

Therefore,

periodic

followup

gradually

and management

must make frequent

followup

become
fever,

daily

is the third

key.

the first

may

less severe or disap-

mental

trauma,

may become

these patients

within

for

for a few days, some patients

due to tiredness,

in time,

patients

about the patients

treatment

oily food, etc., the reaction

prolonged.

treatment

informed

of treatment,

do thorough

select

personnel

be fully
in time;

to have side reactions

carefully

during

medical

history,

for the use of antischis-

condition,

treatment

and manage reactions

After

detailed

usually

drinking

more severe or

recover

rather

month of treatment

soon.

completion

is very important.

b. Properly
safe medication

arrange

and reduce

should be rearranged
suitable

type of work and rest.


side reactions,

(avoid working

rest allowed.

Generally

in the afternoon

after

ment,

on the actual

depending

rest or only do light

taking

that necessitates

insomnia,

excitement,

(below

one-third

and darkened

for

the type of work

or on the water)

and

work may be done in the morning;

the drug.

After

condition

staying

completing

of the patient

of urine

bile duct ascariasis;

unstable

appetite),
indicating

by fever;
continuous

are:

rest

a course of treatduring

Severe fainting,

in bed; marked

complications

of normal

skin rash accompanied

impairment

light

polyphrasia,

trauma;

color

treatment

at high elevations

for discontinuation

dizziness

mental

during

conditions

medication,

work for a few days.

c. Indications

present

To provide

acute

somnolence

mental

of fever

state,

lassitude,
and severe

or slight

and infection;

nausea, or appearance

or

but clearly

severe anorexia
of yellow

symptoms

of toxic

abdominal

pain, such as complicating

false vision,

of vision.

88

colored

vision,

hepatitis;

sclera

diplopia,

generalized

and marked

d. The use of Chinese


treatment,
tried.

to treat

herb medicine,

side reactions

The following

should be advocated

prescriptions

i. With symptoms

in addition

to symptomatic
strongly

and widely

may be chosen:

of dizziness

and insomnia,

causing

general

lassitude:

Valeriana

officinalis,

1 oz; take 50 ml three

Zizyphus

3-6 dq mix in 300 ml water;

add sugar,

times daily.

vulgaris,

15-25 pieces;

fry until

fragrant

and grind

fine; add equal parts of sugar; take once every night.

Kadsura

sinensis,

M-3

oz; take 150 ml each morning

Eclipta
Conioselinum
japonicum,

dr; mix in 300 ml water;

radicans,

3 dr; Polygonum

5 dr; mix in 300 ml water;

Antischistosome
5 dr; Angelica
syrup; divide

anamala,
into

dr; Conioselinum

No. 1: Eclipta

5 dr; Ligustrum
and night.

radicans,

take 150 ml each in morning

3 dr; Triticum
4 dr; Lilium

seeds of Zizyphus
with

or

to ingest.

I-131 dr; glycyrrhiza,

1 oz; make into mixture

1 oz;

3 dr (1 days dosage); make into concoction

univitatum,

glut&rosa,

shell,

alba, 1 oz; Lobelia

4-6 dr; Anemarrhena

Glycyrrhiza,

4 dr; toasted

multiflorum,

vulgaris,

with 300 ml water;

Rehmannia

5 dr; oyster

take 150 ml each morning

two or three portions

Zizyphus

and night.

alba, 1 oz; Lobelia

univitatum,

add sugar,

sativum,

japonicum,

vulgaris,

89

I-l%

1.5-3

dr; make mixture

and evening.

1 oz; Jujube,
3 dr; Salvia

5 dr; Polygonium

300 ml water;

and evening.

asphodeloides,

10 pieces;

multiorrhiza
multiflorum,

take 150 ml each in morning

ii.

With symptoms

of dizziness

and lassitude,

causing

other

discom-

forts:
-4grimonia
300 ml water;

pilosa,

add sugar,

l-2 oz; Eucommia

vitatum,

radicans,

3 dr; method

schistosome

No. 2: Agrimonia

1 oz; Angelica

1 oz; Enonymus

anamala,

of preparation

alba, 1 oz; Radix rubide,

japonicum,

alba,
uni-

same as for anti-

glycyrrhiza,

pilosa,

pilosa,

4-5 dr; mix with

0.5-l

300 ml water;

sinensis,

oz; Jujube,

add

3-4 dr; Fresh

5-10 pieces;

mix with

and evening.

1 oz; Salvia

300 ml water;

With symptoms

japonicum,

and evening.

take 150 ml each morning

Agrimonia

with

4-5 dr; Angelica

3 dr; Agrimonia

300 ml water;

1 oz; Ligustrum

1 oz; make concoction

Salvia multiorrhiza,

iii.

1 oz; Eclipta

3 dr; Conioselinum

and medication

1 oz; take 150 ml each morning

terrestris,

pilosa,

and evening.

No. 1.

Eclipta

sugar,

1-2 oz; mix with

1 oz; take 150 ml each morning

Antischistosome
1 oz; Lobelia

ulmoides,

of lassitude

multiorrhiza,

4-5 dr; Tribulus

take 150 ml morning

and anorexia,

causing

and evening.

other

discom-

forts:

Ingluvin,
stir eveniy;

1 oz ground fine;

take 2 g three

times

add suitable

1 dr, in the abdomen;

suture.

the mud turns red and cracks;


into powder.

remove

orange peel to make tea to drink with

malt

Wrap with

and put Amomum


river

3-4 dr; mix with

regia,

2 pieces;

300 ml water;

xanthi-

mud; bake in fire till

the mud; take the toad, and grind

Take 0.5 dr (about 15 gI two to three

Juglans

of sugar, and

a day (1 oz equal to 30 g).

Use one large toad; do a laparotomy


oides,

amount

times daily.

May use

the powder.

yeast

5 dr; Rhaphanus

sativus,

3 dr;

take 100 ml three times per day.

90

Campauumaea
3 dr; Poncirus,
Salvia

pilosula,

2 dr; Cyperus

multiorrhiza,

3 dr; Atractylodes

rotandus,

4 dr; Corydalis

processed

ternata,

lances,

3 dr; Ingluvin,

3 dr; Curcuma,

4 dr; method

3 dq

of preparation

and dosage same as above.

Pinellia
speciosum,

tuberifera,

3 dr; Pachyma

3 dr; bamboo shoots,

1?4-3 dr; method


iv.

3 dr; orange peel, 1.5 dr; Glycyrrhiza,

of preparation

With symptoms

cocos, 3 dr; Nelumbium

and dosage same as above.

of iusomnia,

palpitation,

many dreams.

and

loss of memory:

Salvia
chinensis,

multiorrhiza,

1%3 dr; juniper

ml each morning

mix with

excited

take 150

Polygonum

(polyphrasia,

I-2 oz; Glycyrrhiza,

multiflorum,

2 dr; Juncus effurus,

add sugar, 1 oz; take 100 ml each night.

and hard to control

sativum,

etc.):

P-3 dr; Jujube, 4-6

3-8 dr; mix with 300 ml water;

take 100

times per day.

Triticum
Polygala

2-3 dr; Kadwra

300 ml water;

3-6 dr; Glycyrrhiza,

300 ml water;

Triticum

ml three

seeds, 3-5 dr; mix with

officinalis,

v7. Mentally

pieces;

tenuifclia,

and evening.

Valeriana
3 bundles;

3-5 dr; Polygala

tenuifolia,

sativum,

1 oz; Glycyrrhiza,

3 dr; Salvia multiorrhiza,

3 dr; Jujube,
3 dr;

method

10 pieces;

of preparation

and dosage same as above.

Agrimonia
terrestris,

pilosa,

5 dr; Ingluvin,

1 oz; Salvia multiorrhiza,

3 dr; Glycyrrhiza,

3 dr; method

3-5 dr; Tribulus


of preparation

and dosage same as above.

Powdered
of gastrodia

eleta,

centipede,

0.3 dr; powdered

0.3 dr; stir evenly

scorpion,

and take 0.3 dr three

91

0.3 dq powder
times per day.

To the above prescription,

add bird beaks and snake meat,

0.3 dr; take 1 dr three times per day.


e. 681 (form of alkali)
symptoms

of anorexia,

may be given;

treatment

insomnia,

etc; 681, 1 to 2 g three

10 to 20 days constitute

may be a burning

sensation;

also use injections


drip once daily;

continue

weakness,

once daily;

a few may have diarrhea

are used for patients

lassitude,

bedridden).

If necessary,

tion:

lassitude,

500 ml glucose

vitamin

and liver

with

main symptoms

with

should be hospitalized

of anorexia,

Every

with

dosage IS to 16 units),

ness of mouth),

morning

(hungry
usually

To stop medication,

regular

feeling,

first

potassium

insomnia,
liver,

is given

increasing
perspiration,

If there is difficulty

given intravenously;
usually

in eating,

then give glucose

lasts 20 to 30 days.

chloride,

1.0 g; for

and mental

daily

water,

organs)

These patients

by special

responsible

intramuscularly,
until

neuras-

depression

and endocrine

reaching

tiredness,

Stop injections

has gene into a state of semiconsciousness,


earlier.

of prepara-

ATP 20-40 mg;

of treatment.

insulin

give glucose

weak-

a course of treatment.

kidney,

and observed

about 40 units.

with

may be used for functional

other methods

for treatment

drip

is effective.

8-12 units;

treatment

Use

for intravenous

Method

1 to 2 weeks constitute

personnel.

of hypoglycemia

May

for infections

should be added.

damage.

insulin,

diseases of the heart,

that did not improve

there

acute severe reactions

use, watch

antibiotics

A, 50 units;

hypoglycemia

(not for organic

small

During

function

(10%); regular

drip once daily;

h. Insulin
thenia

with

drugs may be used in patients

B 6, 100 mg; coenzyme

intravenous

medication

(50%) for intravenous

use for about 5 days frequently

g. Calorie-synthesizing
ness, anorexia,

More than

or borborygmi.

100 mg added to 500 ml (5%) glucose

continuous
. .:.

main

for about 5 to 7 days.

infections.

hydrocortisone,

During

of 0.5 to 2.0 g in 500 ml glucose

f. Corticosteroids

or secondary

good effects.

with

times per day

a course of ,treatment.

half of the cases will show markedly

(general

may be used in patients

starting
the stage

palpitation,

dry-

2% to 3 hours later.

then congee.
then medication

If the patient
may be stopped

then 20 ml glucose

(50%) may be

and congee by mouth.

A course

In a few stubborn

92

cases, the dosage may be

increased

until

the patient

be extrasystoles,

or after

treatment

These should be treated

In combined

for the treatment

acid powder

tabict

and complex

symptoms,

of the above methods

(antimony-273)

powder.

The tablet

identify

for treatment.

is a kind of oral antimony

presently

to antimony-273.

and the medium-speed

Each delayed-dissolving
It requires
gastric

drug

secretion

mony-273.

It requires

iu artificial

gastric

and hard, easily

After

exposure

to heat,

Two types are the delayed-dis-

weighs

tablet

0.3 g and cont&ns

weighs

about 6 hours to release


and artificial

absorb moisture
the quality

or brittle,

they should be discards

types of tablets

were seen to be rejected


has already

200 mg anti-

over 95% of the main drug

drugs.

secretion.

They are greyish

in the air, and show moldy

becomes

and left

secretion.

intestinal

are slow-dissolving

200 mg anti-

95% of the main drug in

intestinal

in sealed containers

drug in the tablet

0.4 and contains

and artificial

Both types of tablets

the product

tablet.

tablet

secretion

white

gallate;

in use is made by adding

about 8 hours to release

Each medium-speed

speed tablets

will recover.

is the sodium salt of antimony

hard fatty

moldy

hypoglycemia.

of Drug

yellow

be stored

Most patients

may

of schistosomiasis.

is a milky

artificial

there

(Antimony-2731

gallate

Antimony-273

mony-273.

treatment

may be secondary

for multiple

Gallate

Sodium antimony

During

there

and use a combination

B. Sodium Antimony

solving

quickly.

treatment

these symptoms,

1. Nature

is semiconscious.

brittle.

Therefore

at dry and cool places.


Z. In clinical
in the stool,

been released.

93

they should
If they are

observations

both

but most of the main

The stool rejection

is much less than that of delayed-dissolving

spots.

tablets.

of mediumBesides,

there is also a type of adaptation


contains

10 mg antimony-273

tablet;

to provide

each tablet

weighs

the stimulating

0.12 g and

dosage of adapta-

tion method.

2. Selection

of Patients

Patients

are selected

3-day and 20-day


*the treatment

treatment

of chronic

after

if there is no history
and labor capacity

kidneys.

Patients

dosage is calculated
course,

tablet.

dosage is calculated

it is calculated

it is calculated

facility

liver,

and

should be established

In lo-day

treatment

In IO-day

treatment

course,

In winter,

the latter

dosage may be considered;

crease of dosage may be considered.

in 15-day

the total

in 15-day treat-

body weight.

as 50 kg. In considering

there should be flexibility


in children,

part of the treatment

in summer

according

and in patients
course,

5% to 10%.

94

or decrease

who had

increase

and in old and weak patients,


Increase

the

body weight.

course,

on a basis of 400 mg/kg

over 50 kg is calculated

conditions.
during

10 to 13)

on a basis of 600 mg/kg

the dosage and course of treatment,

around

of the heart,

on a basis of 350 mg/kg body weight;

All body weight

no reactions

selected;

on a basis of 500 mg/kg body weight;

Medium-speed tablet.

to the specific

and if the appetite

must be carefully

and Dosage (Tables

Delayed-dissolving

ment course,

for

for treatment.

3. Course of Treatment

usually

or hepatitis

When this drug is used, a medical

treatment

is used mainly

or in late schistosomiasis

should be given to the condition

in the commune

total

of fever

jaundice,

fair.

emetic

Its use may also be considered

subsidence

of ascites,
are still

attention

Antimony-273

methods.
schistosomiasis.

in acute schistosomiasis

special

in the way as those chosen for tartar

of
de-

of dosage is

Table 10. Antimony-273


Delayed-Dissolving
Tablet lo-Day Treatment Course and Dosage Table (total dosage 500 mg/kg body
wt. Each tablet contains 200 mg antimony-2731

Body wt
kg)

20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

10.0
10.5
11.0
11.5
12.0
12.5
13.0
13.5
14.0
14.5
15.0
15.5
16.0
16.5
17.0
17.5
18.0
18.5
19.0
19.5
20.0
ov.5
21.0
21.5
22.0
22.5
23.0
23.5
24.0

Daily

Total
no. of
tablets

Total
dosage
k)

5
5
5
5
5
5
5
5
5
6
6
6
6
6
6
6
6
I B
I 7
7
7
7
7
7
7
7
7
7
7
7
7

10

6
6
7
7
7
8
8
9
9
9
9
10
10
10
10
11
11
12
12
12
12
13
13
13
14
14
14
14
15
15
15

5
6
6
7
7
7
8
8
8
9
Q
9
10
10
10
11
11
12
12
12
12
13
13
13
13
14
14
14
14
15
15

5
5
5
6
6
6
6
7
7
0
8
9
9
10
10
10
11
11
11
12
12
I2
12
13
13
13
14
14
14
14

4
5
5
5
5
5
5
6
6
6
7
8
8
a
8
9
9
10
LO
11
11
11
11
12
12
13
13
13
14
14
14
-a

4
4
5
5
5
5
5
5
6
6
6
6
6
6
7
7
7
7
a
8
8
9
9
10
10
11
11
12
12
13
13

4
4
4
4
5
5
5
5
5
5
5
5
6
6
6
6
6
6
6
7
7
7
8
8
Q
9
10
10
10
11
12
-

4
4
4
4
4
5
5
5
5
5
5
5
5
6
6
6
6
6
6
6
7
7
7
7
7
7
7
I

.- --

.-

50
53
55
58
60
63
65
68
70
73
75
78
80
83
85
88
90
93
95
98
100
i03
105
108
110
113
115
118
120
123
125

no. of tablets

7
7
7
8
8
9
9
9
10
10
1.0
10
10
11
11
11
11
11
11
li
11
11
11
11
11
11
11
11
11
11
11

7
8
8
9
9
9
9
10
10
10
10
11
11
12
12
12
12
13
13
14
14
14
14
14
15
15
15
15

15
-

Note: First day take drug three times: one tablet aftexeakfast; two tablets after lunch; the rest of daily dosage after supper.
Thereafter the daily dosage may be taken in two to three divided
doses.
95

Table 11.
Course

Body wt
(kg)

Antimony-273
and Dosage
tablet

Total
Todosage I tal
no.
k)
tabs

-.

20
21
-22
23
24
25
26
27
28
,29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

12.0

12.6
13.2
13.8
14.4
15.0
15.6
16.2
16.8
I 17.4
/ 18.0
1 18.6
19.2
19.8
20.4
/: 21.0
1 21.6
j 22.2
22.8
33 4
24.0
24.6
25.2
25.8
26.4
27.0
27.6
28.2
28.8
29.4
30.0

60
63
66
69
I
72
75
78
81
84
87
90
93
96
99
102
105
108
lil
114
117
120

123
126
129
132
135
138
141
144
147
150

Delayed-Dissolving
Tablet 15-Day Treatment
Table (total dosage 600 mg/kg body wt, each
contains
antimony-273
200 mg)

Daily
1
-

5
5
5
5
5
5
5
5
5
6
6
6
6
6
6
6
6
-6
7
I

2
5
6
6
6
6
7
7
7
7
8
8
8
8
9
9

3
5
5
6
6
6
6
7
7
7
7
8
8
8
8
9

4
--

I
5
I --.-

5 5
5 5
5 5
6 5
F 6
6 6
6 6
7 6
7 7
7 7
7 7
8 7
8 8
8 8
8 8
9 8
9 9
9 9
10 9
10 10
, 10 10
i 10 10
11 10
11 11
11 1 I.
12 11
12 12
12 12
12 12
13 12
13 13

no. of tabjets
-

--

---

--

.-__

6 713
m--w
4
5
5
5
5
5
6
6
6
6
7
7
7
7
8
8
8
9
9
9
9
10
10
10
11
11
11
12
12
12
12

4
4
4
4
5
5
5
61 6 5
63 6 6
6 6 6
6 6i 6
7 61 6
7 7 6
7 7 6
7 7 5
8 8 7
8 8 7
8 8 7
8 8 7
9 8 7
9 9 7
9 9 8
94 8
10
9 9
10
91 9
10
4
4
5i
5
5!
5/
51

11

4
4
4
5
5
5
5

91 g

11

10

11

10

12

10

10

12

11

10

12 11 11

10 11 12 13 j 14 15
-__ -- I ---II-

4
4
4
4
4
.;I
5
5
5
5
6
6
6
6
6
6
7
7
7
7
7
7
7
7
7
8
8
8
8
8
9

3/3
4
4
4
4
4
5
5
5
5
5
5
6
6
6
6
6
7
7
7
7
7
7
7
7
7
7
7
7
8
8

3
4
4
4
4
4
4
5
5
5
5
5
6
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
7

3 f 3
3
3
3
4
4
4

5
5
5
5
5
6
6
6
6
6
6
7
7
7
7
7
7
7

5.
5
5
5
5
5
G
6
6
6
6
6
6
7

/ 3
3
3
/ 3
3
4
i, 4
4
4
4
4
4
4
5
5
5
5
5
5
5
6
6
6
6
6
6
6

Note:
First day take drug three times:
one tablet after breakfast;
two tablets after lunch; the rest of daily dosage may be taken in two or
three divided doses.
96

Table 12. Antimony-273


Medium-Speed
Tablet lo-Day
Treatment
Course and Dosage Table (total dosage 350 mg/kg body wt. Each
tablet contains 200 mg antimony-2731
Total
dosage
(i$

Body wt
(kg)

20
21

1
;

7.0
7.4

, Total
rcle9fs

-.

j
j

35
37

22
23
24

j
I

7.7
8.0
8.4

39
40

25

8.8

44

26
27
28
29
30
31
=3
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

;
9.1
j
9.4
1 9.8
/ 10.2
10.5
10.8
/ 11.2
j 11.6
I 11.9
I 12.2
i 12.6
/ 13.0
13.3
-~.
14.0
; 14.4
14.7
/ 15.0
j 15.4
j 15.8
1 16.1
16.4
16.8
17.2
17.5

1
\
:
;
:

,
I
I

46
47
49
51
53
54
56
58
60
61
63
65
67
08
70
72
74
75
77
79
81
82
a4
86
88

42

1
I
i
j
1
j
j

3
3
i 3
I 3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
2-*
3
3
3
3
3
3
3
3
3
3
3

--

2
_--_

5
5
5
6
6
6
6
6
7
7
7
7
8
8
9
9
9
9
10
-4!3

5
5
5
5
6
6
6
6
6
7
7
7
7
8
8
8
9
9
10

;;
10
10
10
10
10
10
10
10
10
10

10

10

11
11
11
11
11
12
12
12
12
12

Daily

no. of tablets

--

4
5
. -- __
4

5l

51

5
5
5
5

5
E
..I

6
6
6
6
6
7
7
7
7
8
8
8
9
9
10
10
10
10
10
11
11
11
11
12
12
12

6
6
6
6
7
7
7
7
7
7
7
7
7
8
8
9
9
9
10
10
11
11
12
12

4
4
1. 4
4
5
5
5
6
6
6
6
6
6
6
6
6
6
6
6
6
7
7
8
8
8
8
8
8
9
9
10

3
3
3
3
3
4
4
4
5
5
5
5
5
5
5
5
6
6
6
6
6
6
6
7
7
7
8
8
8
8
a

5
5
5
5
5
5
6
6
6
6
6
6
6
7
7
7
7
7
7
8

4
4
5
5
5
5
5

5
5
5
6
6
6
6
6
6
6
6
7
7

take
Note: First day take drug three times; after breakfast
the adaptation
tablet of the second dose; after lunch take one mediumspeed tablet; after supper take two medium-speed
tablets.
Thereafter
the daily dosage may be taken in two to three divided doses.
97

2
2
3
3
3
3
3
3
i
3
3
3
4
4
4
5
5
5
5
5
,5
5
5
5
5
6
6
6
6
6
6

Table 13. Antimony-273


Medium-Speed
Tablet 15-Day Treatment
Course and Dosage Table (total dosage 4Oc! mg/kg body wt. Each
tablet contains antimony-273
200 mg)
Body w
kg)

Total
dosage
(g!

20
21
22
23
24
25
26
27
28
29
30
31
32
33
3
35
36
37
38
39

46
7
8
9
50

8.0
8.4
8.8
9.2
9.6
10.0
10.4
10.8
11.2
11.6
12.0
12.4
12.8
13.2
13.6
14.0
14.4
14.8
15.2
15.6
16.0
P6,4
16.8
17.2
17.6
18.0
18.4
18.8
i9.2
19.6
20.0

Daily

TO-

no. of tablets
-

tal

no.
tabs

40
42
44
46
48
50
52
54
56
58
60
62
64
66
68
70
72
74
76
78
80
82
84
86
88
90
92
94
96
98
100

4
4
4
4
4
5
5
5
5
5
5
6
6
6
6
6
6
7
7
7
8
8
8
8
8
8
9
9
9
9
9

4
5
------

4
4
4
4
4
4
5
5
5
5
5
5
6
6
6
6
6
6
7
7
7
8
8
8
8
8
8
9
9
9
9

433322
443332
444333
444433
444443
444444
444444
544444
554444
555444
555544
555544
555554
655554
665554
666555
666655
666655
666655
766655
776655
777655
777765
877765
8 8 ?
888776
888776
888876
888886
988886
998886

1C 11
-

2
2
2
3
3
3
3
3
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
5
5
6
6
6

2
2
2
2
3
3
3
3
3
4
4
4.
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
6
6

Note:
First day take drug three times; after breakfast
take the second
of the adaptation
tablet; after lunch take one medium-speed
tablet;
after
supper take two medium-speed
tablets.
Thereafter
the daily dosage may
be taken in two to three divided doses.
98

15
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
dose

Medication.
divided

The tablets

doses, taken

with

lets are taken twice

Adaptation

of stimulation

increase,

tablets,

they usually

taking

This method

will

total

dosage is given

medium-speed

cause fewer

before

tion tablets

tablets

is begun.

twice:

three

necessary

with

an empty

tablets

the amount

of water

it is better

taken is not limited.

the daily

dosage should be decreased

and Management

taking

high; therefore

should be watched

(sodium

degree

glutamate-pyruvate

eral condition

antimony-273,
during
for.

adaptasupper),

Adapta-

only a small amount


No water

or food

a certain

tract,

taking
tablets

The daily

con-

accomplishing

adaptation

tablets
tablets,

should be gradually
but the qeed
At this time

dosage should be flexibly

With more severe reactions,

or the drug stopped

for observation.

of Reactions

the antimony

content

the course of treatment,

In a few patients,

of liver

supper)

to give adaptation

After

of the patient.

adaptation

40 mg.

the order of 1, 2,4 tablets.

based on the reaction

may be a slight

to antimony-

(3 hours after

with one tablet,

starting

managed

is rather

then

tablets

breakfast,

stomach;

or delayed-dissolving

should not exceed

a. After

bedtime

the gastrointestinal

In children

each medication

4. Prevention

tablets);

(3 hours after

In using medium-speed

3 hours after

to stimulate

of increase

liver

bedtime

times in doses of 10, 20, and 40 mg.

increased

take

than if the

1% hours, so that the drug can reach

of adaptation.

the medium-speed

i.e., first

usually

may be used to wash them down.

should be taken within

the purpose

reactions

for treatment,

once just before

should be taken with

(1 tablespoon)

centration

supper.

or delayed-dissolving

gastrointestinal

20 mg, and once the next morning

of water

of treatment;

can adapt gradually

20 mg just before

treatment

are given

tion tablets

and after

all at once.

are given once:

the night

breakfast

may be taken after

tablets

tract

In using delayed-dissolving
tablets

When the tab-

dosage (use adaptation

so that the gastrointestinal

273.

meals.

are taken after

is used at the beginning

a very small amount

daily in two to three

2 hours after

one or two more tablets

method

gradually

warm water

daily,

On principle,

supper.

may be ingested

enlargement

transaminase)

changes in the

taking

and tenderness;
becomes

is good, if there is no markedly

99

after

elevated.

decreased

in the liver

the drug there


the SGFT
If the gen-

appetite,

and if

the liver

enlargement

and tenderness

do not gradually

then the drug may be continued

under strict

also nausea, vomiting,

decreased

and if liver
especially

markedly

enlargement
with

and tenderness

the appearance

drug should immediately


for management

(refer

cardiac

arrhythmia,

tachycardia,

rate caused by tartar


include

flattening

changes

will

a. During

closely

b. During
given

to liver

marked

c. During
do not take wine,

cessation

be taken

hepatitis).

managed,

Adam-Stokes

it

syndrome.
heart

the electrographic

changes

of T-wave.

These

emetic.

medical

quickly,

the period

frequent

and tenderness.

If the patient

accurately

to help in conquering

the course of treatment,

of appetite,

The patient

and condition

personnel

personnel

himself

lassitude,

notices

and cooperate
the disease.

attention

Examinations

of medication

do not eat large amounts

measures

precautions

abdominal

100

distension,
area, then

instituted.

and within

7 days of conclusion

of fatty

food (such as fat meat),

are the same as for 20-day

treatment.

should be

should be made

or pain over the liver

and active

must make

must also be

and do not take part in heavy labor or work on a high elevation

d. Other

it may cause

of the drug.

examinations.

his feelings

he must be examined

measures

Treatment.

enlargement

decrease

then the

or in a few cases, inversion

and careful

two to three times.

hepatitis,

If poorly

treatment

the course of treatment,

the medical

in severity,

to the heart;

including

are same as tartar

During

to report

with

after

reactions

close observations

toxic

lassitude,

are the same as for the disturbed


During

of T-wave,

5. Precautions

persuaded

heart rate,

emetic.

disappear

c. Other

and active

or bradycardia.

and management

and general

and toxic

on antimony

in severity,

If there are

to increase

is to a degree also toxic

also could cause a disturbed


The prevention

continue

of jaundice

to section

b. Antimony-273

observaticns.
appetite,

be discontinued,

increase

tartar

or on water.

emetic

6. Followup.
Elimination
is concluded,

there is still

the drug which


there still

of antimony-273

still

nation

has certain

effects

or hepatic

must watch

patients

return

toxic

center

conditions

are found during

with

with

reinfe-:tion

be normal.

as diarrhea

If reac-

should be paid to rest and

may take place.

Witi

will

or chronic

is markedly
recent

schisto-

Usually

after

the drug is taken for

drop below

38C;

after

and fever.

e lowering

and nigh:. sweating

ment of these symptoms

that furapromidum

acute schistosomiasis

5 to 7 days, the tern1 rature


will

1 to 2 days after

(F30066)

in patients

somiasis

Within

of medication,

use for many years has proven

effective

and rest for 2 to

7 days of cessation

and attention

Clinical

exami-

they should

there

C. I uapromidum

physical

examination,

Within

so that early recovery

of

personnel

should make home visits.

be taken care of immediately.

nutrition

Medical

of medication,

personnel

amount

If care is not taken,

A complete

should be advised.

should be no heavy labor,

large

reactions.

for such reactions.

home, medical

tions or abnormal

Even when medication

on the body.

must be given at the conclusion

3 days at the treatment

slow.

in the body a comparatively

may be cardiac

and the patient

is rather

of temperature,

general

will also be markedly

establishes

10 days it usually

good conditions

symptoms

improved.

such

The improve-

for worm destruction

and treatment.

1. Indications

Mainly
or chronic

indicated

reinfections

if there is no jaundice
taken under strict

for patients
with

or ascites

acute schistosomiasis

In recent
and the liver

schistosomiasis
function

is fair,

with
with

fever

fever,

it may be

observations.

2. Dosage and Treatment

The daily

fever.

with

Course

oral dosage is calculated

per kg of body weight;

in adults,

on a basis of 60 mg (40 to 70 mg)

2 to 4 g per day divided

101

into

four doses.

To decrease

alimentary

tract

reactions,

adaptation

in the early stages, such as 1 g for the first

dosage may be given

day (0.25, four times

2 g for the second day (0.5, four times a day); increase


times

a day) on the third

rhea,

etc.

be extended

is 2 weeks; in severe infections

and the recommended

not appear to cause damage to the heart


vomiting,

abdominal

or liver.

pain, diarrhea,

used are intestinal

melting

is very rare.

camphor

may be given for abdominal

compound

3 to 5 days the symptoms


be given for muscular

will

spasms.

schistosomiasis

with

decrease.
In patients

and somnolence

accompanied

of the extremities
schistosomiasis

excitement,

with hepatitis,

marked impairment

may also occur.

If mental

and intravenous

glucose

be given.

Sedatives

symptoms

will quickly

abnormality

or glucose

occurs,

in saline

abate and disappear

who

manifested
behavior,

of patients

mania,

or tremor
with

acute

the above reactions


the drug should be stopped;

with sodium glutamate

may be given to patients

may

cirrhosis,

tendon reflexes

condition,

after

function

Abnormal

In a small number

who are in poor general

liver

of liver

and polyphrasia.

of

or sedatives

disturbances,

by hyperreactive

may occur.

or tincture

tablets

spasm.

(each tablet

pain and diarrhea;

Calcium

are

muscular

tablets

of belladonna

take the drug, there may be neuropsychiatric


by loss of memory,

The main reactions

delayed-dissolving

Tincture

dosage does

and paroxysmal

0.125 g). Vomiting

or recent

it may

and Management

This drug has a low toxicity,

Presently

pain, diar-

to 3 weeks.

3. Side Reactions

nausea,

to 3 g (0.75, four

day if there is no severe abdominal

The course of treatment

a day);

with
without

mania.

may

Most of the

consequence.

4. Contraindications

The drug should not be given to patients


ulcer

bleeding,

vious jaundice,

psychotic
ascites,

diseases, nephritis
or impaired

liver

102

with a history

and liver

function.

cirrhosis

of peptic
with pre-

5. Precautions
This drug is rapidly

destroyea

m the body, the blood level

and the usual dosage is not satisfactory


symptoms

have markedly

antimony

improved

as a anthelmintic.

After

and the temperature

drugs or antischistosome-846

is low,
the patients

approaches

normal,

should be used as anthelmintics

for treatment.
IV.

Properly
treatment

selected

Tartar
themselves.

emetic

observe

comparatively

tartar

emetic.

created
little;

chronic

without

signs of hepatic

gynecomastia,

cardiovascular

diseases,
appetite

in the elimination

reactions.

schistosomiasis

history

telangiectasia,

is to a certain
of

This method

We
may

patients:

or nutritional

without

by the people

severe in 3-day treatment.

and manage patients

anemia

b. Patients

normal

with

is a method

are generally

the following

a. Those with

and with

treatment

and age, constitute

and is fast, good, and inexpensive

be used to treat

or ascites;

condition

dosage and

Treatment

production

Reactions

marked

Emetic)

basing suitable

physical

3-day treatment

It affects

schistosomiasis.

without

(Tartar

Treatment

effective;

must strictly

Emetic

Tartrate

objectives,

in successful

of Tartar

Three-day

degree

treatment

measure

Methods

I.

Antimony

course on the patients

an important

A.

Potassium

who are in fair general

disturbances.

of jaundice,
cirrhosis

and ability

or other

103

hematemesis,

extremities,

associated

to work.

c. Women who are not menstruating.

hepatitis,

(such as enlarged

edema of lower

nephritis,

health

spleen,

etc.);

without

severe diseases;

d. Women who have breast


physically

fed for over 10 months

in good condition.

The dosage an& treatment


dosage is calculated
is divided

into six to seven injections,

emetic).

The interval

The highest

between

In older,

phvsica:ly

50 kg,.&

total

total

morning
After
=ez$

body weight.

one injection

Each injection

be less than 5 hours.


_.. --

course is shown in Table

on the basis of 12 mg/kg

one in the afternoon.


tartar

and who are

14. The total

This dosage

in the morning

and

should not exceed 0.1 g (10 ml 1%

dosage is 0.7 g given over 3 to 4 deys.

and afternoon

injection,

injections

should not

2 hours of rest in bed are mandatory.

and female

patients,

dosage should be calculated

if the body weight

is above

on the basis of 50 kg; and the

0 seven injections.

years proves
paratively
reactions.

Tat.&

&&tic

long-course

dose, long-cou&!treatment

good results

treatment

infected

tartar

But it should be noted

that the long-course

the total

heart

dosage large,

rate and toxic

Medical

personnel

mediate

treatment.

Tartar
infections

recent

emetic

of the colon,

health

liver

than in 3-day treatment.


reactions

is mainly

early and give im-

indicated

of hepatitis,

may also be used in patients


repeated

who had fever

treatments

lowered

with

is good.

104

dura-

such as disturbed

and spleen enlargement,

history

need it.

is of extensive

for severe
poor development

etc.), in young people or in children

(without

who were not cured after


schistosomiasis

treatment

small-

weak and cannot

e complications

not less severe

20-day

emetic

but who urgently

treatment

must be able to discover

schistosomiasis

The treatment

treatment

and therefor

hepatitis

(such as marked

or granuloma

emetic

less severe

many poor and peasant

or are physically

take the short-course

treatment

with

or tartar

may be used to treat

class persons w@\bta,heaviiy

tion,

that long-course

with

ascites,

chronic

chronic,

hematemesis).

schistosomiasis

and those with


furapromidum,

with

acute

if th.?ir general

Table. 14. Tartar Emetic Dosage- Distribution


Table
5-Day Treatment
for Chronic Schistosomiasis
Body wt
(kg;

Total
dosage (ml)
(1% sol)

18
19
20
21
23
24
25
26
27
29
30
31
32
33
35
36
37
38
39
41
42
43
44
45
47
48
49
50
52
53
54
55
56
58
59
60
61
62
64
65
66
iii
69
70
70

--

3
3

3
4

:I

::

I 44

t
No.

15
16
17
18
19
2Q
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
4s
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60

44

4
4
4
5

5
5
5
5

;I
5i
51
6
6
6
6
6

5
6
6

7
7
7

7
8
8
8
8
9
9
9
9
10
10
10
10
10
10
10
10
10
10

10
10
10

7
7
7
7
7
8
8
8
8
8
9
9
9
ii
10
10
10
10
10
10
10
10
10

10
10
10
10
10
10
105

I
I

Injection
; 4

in

No.
! 5

---

-6
ml :uer dose .il% .so:1)
--

3/
3
4 I
4
4
4
4
5
5

3:
3
3
4
4
4
4
4
5

551 1

x
S

ti5/
6

:
6
6
6
6
7

i
7
7
7

7
7

8
8
8
8
8
9
9
9
9
9
10
10
10
10
::
10
10
10
10
10
10
10
10

7
7
7
8
8
8
8
8
9
9
9
9
9
10

10
10
10
10
10
10
10
10
10

10
10
10

--

3)
3
3
3
4
4
4
4
4
5
5
5
5
5
6
6
6
6
6
7
7
7

3
3
3
3
3
4
4
a
4
4
5
5
5
5
5
6
6
6
6
6
7
7

7
8
8
8
8
8
9
9
9
9
9

7
7

10
10
10

10
10
lo
10

T.

I
f

8
8
8
8
9
9
9
9
9
10
6
7
8
10
10

5
5
6
5
6

10
10

10
10

10

10

8
9

10

10

10

10

10

10

Small-dosage,

tartar

emetic

long-course

treatment

is mainly

indi-

cated in the following:

a. Patients
somiasis

with

promidum

with

a history

of reinfection,

or prednisone,

b. Those with
or after

acute schistosomiasis

splenectomy,

and the liver

after

and the physical

chronic

fever

after

and general

associated

of symptoms,

to section

diseases after

if the general

on treatment

e. Women 6-months
In women

who have breast

condition,

treatment

for the breast-fed

by fura-

has subsided

condition

have improved

is fair.

d. Those with

(refer

schisto-

weak.

ascites

c. Those in old age, weak, and poor physical

and control

recent

ia controlled

state is still

schistosomiasis

if the appetite

function

or chronic

with

of the disease

has already

no pregnancy

be given.

improved

diseases).

fed for 10 months

can usually

treatment

condition

of associated

pregnant,

condition.

complications.

and who are in good physical


If arrangements

baby and rest can be guaranteed,

can be made

treatment

may be

given sooner.

Dosage and treatment


(Table

15, Table

one injection
to exceed
condition

course for the to-day

16) are calculated

per day (refer

on a basis of 25 mg/kg

to dosage distribution

1.4 g. In young healthy


or in patients

with

on the basis of 24 mg/kg

treatment

women

chronic

ta.blel,

total

and men in a weaker

schistosomiasis,

of body weight,

of body weight,

the total

calculate

dosage not
general
dosage

dosage not to exceed

1.25 g.

When small-dosage,
depending
diseases,

on the general

condition

age, and sex, calculate

mg./kg of body weight.


to 24 days.

Evenly

1.2 g. A two

long-course

ends larger

emetic

of the patient,
the total

If necessary

divide

tartar

severity

dosage on a basis of 22 to 24

the total

smaller

106

is used,

of the associated

the course may be prolonged

the dosage, with


and middle

treatment

method

to 22

dosage not exceeding


of dosage distribution

Tzble

-Body
iig)

z-t

II
Cc!.a1
I to;age(ml)

21

22
23
24
25
26
27
28
29
90
31
32
33
34
35
36
37
X8
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56

Injection no.
1
1 1 2 13 14 i 5 1 6-7 1 8 1 9 ~1~~11~12)13~14~15(16~17~~~~1~~2~

i
20

Tartar Emetic Dosage Distribution


Table
in 20-Day Treatment
(25 mg/kg body wt)
15.

(1% sol)
-50
53
55
58
60
s3
65
68
70
73
75
78
$0
83
85
88
90
93
95
98
100
103
105
108
110

113
115
118
120
123
125
128
130
133
135
138
140

I3
4
4
4
4
I4
4
4
4
5
5
5
5
5
5
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
7
7
8

8
8
8
9

3
4
4
4
4
4
4
4
5
5
5
5
5
5
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
7
7
8
8
8
0
8

3
3
4
4
4
4
4
4
4
4
5
5
5
5
5
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
7
7
8
8
8
8

3
3
3
4
4
:
4
4
4
4
5
5
5
5
5
6
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
8
8
a
8
I

,3
3
3
4
4
4
4
4
4
4
4
4
5
5
5
5
5
6
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
8
8
8
I

No. ml per dnse (1% sol1


3
3
3
3
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
8
8
107

3
3
3
3
3
4
4
4
4
4
a
4
4
5
5
5
5
5
5
5
5
5
5
6
6
6
6
6
6
7
7
7
?
7
7
8
8

3
3
3
3
3
4
3
4
4
4
4
4
4
4
5
5
5
5
5
5
5
E
5
6
6
6
6
6
7
7
7
7
7
7
7
8

3
2
3
3
3
3
3
4
4
4
4
4
4
4
4
5
5
4
5
5
5
5
5
5
6
6
6
6
6
6
6
7
7
7
7
7
7

--- _
2 2 2 2
2
2
2
2
2

3
3
3
3
4
4
4
3
3
3
4
4
4
4
4
4
4
4
5
5
5
5
6
6
6
6
6
6
7
7

2 2 2
2.2 2
2 2 2
2 2 2
2 .i? 2
2I 3 3 3
2 3 3 3
3 3 3 3
3 3 3
3 3 3
3 3 3
3 3 3 q
3 3 3 ;
3 3 3 4
3 3 3 4
3 3 4 4
4 4 4 4
4 4 4 4
4 4 4 4
4 4 4 4
4 4 5 5
4 4 5 5
5
4,515
5
455
5 5 5 5
5 5 5 5
5,5 5 5
5
555
5 5 5 5
5 5 5 6
5!66
6
5 6 6 6
6 6 6 6
6 6 6 6
6 6 6 6
7 6 6 6
. I

2
2
2
2
2
3
3
3
3

T
2.,3
3
4
4
4
4
4

4
4
4
5
5
5
5
5
5
5
5
5
6
6
6
6
6
6
6
I

2
?
;
2
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
6
6
6
6
6
6
6
6
6
I

3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
6
6
6
6
6
6
6
6
6
I

3 3
3 3
3 3
3 3
34
4 4
4 4
4 4
4 4
4 4
4 4
4 4
4 4
4 4
5 5
5 5
5 5
5 5
5 5
5 5
5 5
5 5
6 6
6 6
6 6
6 6
6 6
6 6
6 6
6 6
6 6
6 6
I r

2
3
3
3
3
3
3
3
8
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
6
6
6
6
6
6
6
6
7
7
7
L

Thble

16. Tartar Emetic


in 20-Day Treatment

Dosage Distribution
Table
(24 mg/kg body wt)
Injection

Body wt

kg)

Total
d osagc (ml)
(1% sol)
-----

.-:
1 I
9 :10~~~~2j13!14!15~16~17/18~19~20
I
i I
j 1

ljzi3j4j5/6/7/81

--I 51 iI I

-I

2
No. ml per dose (1% sol)

I
I
I
1
i
i
5
5
5

1.

31

74

51 5 , 11 1 i

32

77

5, 5, i .25 !

33

79

34

82

5 5

35

84

5, 5

36

86

5 5

I5 5 5
1;
I 15 5 5

67

89

6 6

;,

I5 5 j

38

91

6 6

j;

!6 5 5

39

94

6 6

ji

16 5 5 5 5 5

40

96

6 6

ii

/6 6 5

41

98

6 6

9i

6 6 6 5 5 5

42

101

6 6

fi

6 6 6

43

103

6 6

Ei

6 6 6

44

106

6 6

Ei

6 6 6

45

108

6 6

ti.

46

110

6 6

ti

47
48

!5 5 1
,I5 5 i

41

4I

1 1

4I

5 4

4L

5 i

5 5

4 4 4 4

4 4

4 4 4 4

4 4

5 5/

5 51

6 6 6
6 6 6

113
115
I

51
5
6i
fi

-i-

72

30

41

no.

1
1
1

I
.

I
,

4 14 4 5

I
4

I
I

4 4

5,

I
t

5i

5
5

5 5i

4 4

5i

5;

1I

6 6i

4t

4L

5i 5i 5 51

6 fi

4I

4I

5i 5i 5i

6i

6 Ei

ce5

F
.i

cci

cei

Lei

e
ci

7 6 f3 6 6 6

6 fi

e
.i

E
ci

cci

.ci

E
ci

I
7 7 i7 6 6 6

6 fi

.ci

C
.i

*ci

.Ei

.ci

E
.i

7 7 II7 6 6 6

6 f

\I:i

fi

.ti

ti

ti

fi

5
5

49

118

50

120

7 7 I7 7 7 6

6 I

.ai

r
.i

.ai

fi

tj

51

122

7 7 a 7 7 6

6 f

.15

1
.5

f5

f5

f5

52

125

7 7 7 7 i

5 'E I

I5

f5

i6

I5

I5 15

53

127

7 7 7 7 i

7 f

I6 6 I6 I6

6 I6 I6 I I6 I6

54

130

8, 7 7 i

7 i

I6 6 I6. I6 6 6

Iq I

CI

108

.L

.-

. I

II

I6 I6 6 6

m . I

in long-course

treatment

may be used; i.e., the 1st to 9th injections

the 14th to 20th injections

may be slightly

injections

so as to decrease

slightly

smaller,

But on principle

the difference
i to 2 ml.

should not exceed

cause of the weakness

larger

divided;

the larger

tract

reactions.

and smaller

long-course

dosages

treatment,

who may not tolerate

be-

drug reactions,

or the doses of the 1st to 10th injections

and the doses after

the 11th injection

6 ml per injection

It is safer not to exceed

and the 10th to 15th

alimentary

In small-dosage,

of the patients

the doses may be evenly


may be slightly

between

larger,

and

slightly

smaller.

in the male and 5 ml in the

female.

B. Precautions
of Toxic

During

Tartar

Emetic

Treatment;

Prevention

and Treatment

Reactions

1. Precautions

a. Take body temperature


injections).

once in the morning

and afternoon

should b e taken more frequently

The temperature

(before

if there

has been fever.

b. Before
and amount
symptoms,
of the heart

injection,

detailed

of food taken;
mental

attention

sta.te, thoughts,

rate and rhythm,

inquiries

should be made about reactions

should be paid to general


and mood; examinations

the sclera,

change of liver

subjective

should be made
size, and possible

tenderness.

c. Before

use, the ampules

or change of quality.

should be inspected

If the broken

ampule

for sedimentations

has been open too long, it should

not be used.

d. In S-day treatment,
slowly,

to avoid spastic

e. Before
should

be checked.

coughing

each injection,
After

the first

injection

especially

that could increase

fear in the patient.

the name of the patient

injection,

proper

109

records

should be given

and the do,;age

must be kept.

f. In long-course
the middle

treatment,

stage of treatment

according

to the change

h. After
observed

and the total

should be checked

tartar

occurs during

the late stage of treatment,

of treatment

for 2 to 3 days before

the patient

discharge.

to be hospitalized

for observations.

after

from

and work gradually

the hospital,

and Treatment

Experience

has proved

for and understand

(arrhythmia,
cardiac

toxic

care of, for the severity


general

reactions

severe.

If severe reactions

Reactions

rest, and

emetic

reactions

To prevent
must first

severe

be taken

interchange;

and if

they frequently

are taken care of in time and properly,

of Tartar

Emetic

reactions

become
they

tippear

treatment,

the 7th day and become

If they are not treated

tant factors

leading

Chung-kuan,

or Nei-kuan

after

Acupuncture

of Tsu-San-li,

sodium phenobarbital,

chlorpromazine)

vomiting,

in 20-day

become impor-

or oral atropine

patients

emetic

they frequently

may be performed;

then atropine

or belladonna
may be given.

(0.5 mg i.m.) should be given.

mental

depression,

should be discontinued

110

in

more severe on the 9th to 14th

arrhythmia.

If these are ineffective,


with persistent

and anorexia)

the 4th (ir 5th injections;

immediately,

to cardiac

(librium,

and Treatment

(nausea, vomiting,

usually

food, the tartar

reactions

may mutually

3-day treatment

and sedatives

have sympathy

conditions.

a. Gastrointestinal

days.

Reactions

entirely.

are not taken care of immediately,

may turn into milder

after

Toxic

then severe tartar

general

of reactions

resumed.

to the patiehts

can be prevented

reactions,

reactions

Rest should be taken

personnel

pay attention
in time,

hepatitis)

or heDatic

Emetic

that if medical

reactions

toxic

3. General

of Tartar

the patients,

are able to discover

injec-

should rest and be

Those with severe

should continue

2. Prevention

dosage corrected

for 1 to 2 days.

completion

discharge

emeti?

during

of weight.

g. If menstruation
tions may be stopped

body weight

and inability

and the patient

In
to take

observed.

Intravenous
given.

glucose

In patients

enlarged

liver,

emetic

with

on toxic

c. Auscultation

increases

indications

seen during

the first

may be vomiting

treatment

given

injection

should be carried

to avoid tachycardia

of 3-day treatstrain.

Decreas-

out for 1 minute

or bradycardia.

If the heart

or decreases

in the latter,

give atropine

rate

to below 45 beats

should be made to age and rate before

the drug should be considered.

sedatives;

tartar

can avoid or lessen the symptoms.


of the heart

(reference

discontinuing

sclera,

hepatitis,

and mental

to more than 100 beats per minute

per minute

by yellow

of toxic

and powerful

should be

hepatitis).

ing the speed of injection

injection

in saline

accompanied

should be discontinued,

In severe cases, there

before

vomiting

tenderness,

b. Cough is frequently
ment.

drip of 5% glucose

persistent

aud liver

treat..n&nt

(see sectio,

or intravenous

In the former

injection),
case, give oral

G.3 to 0.6 mg, two to three

times

per day.

d. Appearance
forerunner

of cardiac

suspended.

during

tartar

treatment

extrasystoles,

should be closely

atropine

then atropine

an2 sedatives

may be given.

and tartar

and further
become

devel-

less frequent,

If there are no changes,

(0.5 mg i.m.1 should be considered

should be administered;

(0.5 mg) and sodium

If extrasystoles

watched.

is frequently

emetic. should be ten ,porarily

(0.1 g i.m.1 should be given immediately,

then oral atropine

fluids

arrhythmia;

With frequent

phenobarbital
opments

of extrasystoles

once every 3 to 4 hours;

emetic

treatment

should be

discontinued.

e. Fainting

occurs

in a very small number

stage of treatment

during

injection

paleness,

cold skin with

pressure.

These symptoms

mental

strain,

the patient
intravenously.

afraid,

allowed

sweating,

to lie flat,

should be counseled,

and atropine

and lowering

immediately

111

After

sudden

of blood

who are under a


should be stopped,

(0.5 mg) and glucose

recover.

injections

in the early

along with

seen in patients

The injection

will quickly

and further

emetic,

bradycardia,

are mostly

or tired.

All patients

of tartar

of patients

given

that the patient

should be given with

the patient

lying

down.

treatment

If fainting
$;ould

occurs during

emetic

Therefore

injection

must be temporarily

with

may increase

in patients

and treated.

with

drugs as benedryl

10 mg) may bt! given three


suspended.

subsided

for 1 day, continuation

When low-grade

g. Severe dizziness,

drips of glucose

discontinued.

With fever,

edema, oral prednisone


emetic

without

of treatment

treatment

special

(5tem-

symptoms

has

may be considered.

constriction,

fear and uneasiness,

observed

sodium phenobarbital
may be given;

quickly

etc., may be given.

and feet are frequently

in saline

emetic

it should be lowered

treatment

and tartar

fever

thoracic

of Nei-kuan,

tartar

skin rashes, such antihistaminic

by angioneurotic

porarily

Acupuncture

emetic

nhenergan,

times daily,

of tartar

and the causes of fever

and tartar

hydrochloride,

and spasms in wrists

(above 37.5C),

by generalized

and skin rashes accompanied

reaction

is too high (above 39C),

or medicine,

is accompanied

the toxic

fever

suspended

if the fever

physiotherapy

If the fever

the

be discontinued.

f. Any cause of fever

found

the late stage of treatment,

during

hot summer.

(0.1 g i.m.),

attention

and intravencjus

should be paid to electrolyte

disturbances.

h. Other
joints

reactions

may be treated

methods,

sedatives,

rosis.

Therefore,

and prepared.

symptomatically,

of tartar
before

be injected
alcohol

locally

also may be used.

into

applied.

If redness,

and soreness of

to prevent

gentian

violet

infection.

may cause severe local pain and necthe blood vessel should be fully
of pain during

and examinations

If there is leakage,

may be applied.

the pus cavity

With. herpes roster,

complains

be stopped

to dilute

wet dressings

wet dressings

injection

If the patient

is in the vessel.

emetic

headache,

such as by using new acupuncture

and the lesion protected

tion should immediately


needle

dizziness,

and analgesics.

may be used locally

i. Leakage

including

swelling,
Injection

or 1% procaine

of pancreatin

112

saline

herb medicine

and suppuration

may help absorption.

the injec-

made to see if the

10 ml of normal

the drug, and Chinese


Acupuncture

injection,

exposed

or 95%

local

occur,

should

block

local hot

added to procaine

j.
tion.

iii treatment,

Chinese

medicine

may be used for local

Take 2 drams of fresh glycyrrhiza

with hot water,


After

put on gauze for local

about 30 minutes,

k. Another
(most painful
to 30 minutes

treatment

(needles

C. Prevention

When tartar

emetic

personnel

treatment

not in time,

arrhythmia

arrhythmia

results

of Tien-ying

Arrhythmia

Caused

occurs,

materials

it comes on very acutely.

not ready,

and emergency

Therefore

to prevent

medical

personnel

and manage severe

cardiac

at any time.

Manifestations

or within

arrhythmia

occurs chiefly

48 hours after

completion

are acute onset, paleness,

cessation

of breathing,

At the same time,

arrhythmia

(frequent

or disappearance

of heart

reach

fainting,

auscultation

flutter

rhythmia.

incorrectly

as hysteria,
emergency

113

Adam-Stokes

or weakening

and fibrillation).
at the same time patients
when medical

may have returned

should not rule out severe

of

shows cardiac

Sometimes

mal, but this condition

team may not give proper

convulsions

tachycardia),

arrhythmia.
rhythm

The clinical

(the so-called

ventricular

the scene, the cardiac

If diagnosed

spastic

and signs do not occur


toxic

the late stage of

of the heart

sounds (ventricular

should be tr <ated for severe

during

of treatment.

and cyanosis

extrasystoles,

Even if all these symptoms

the medical

points

pain disappears).

may be serious.

syndrome).

personnel

after

of Severe Cardiac

toxic

that may occur

manifestations
the limbs,

may be removed

are not alert,

Severe cardiac
treatment

or disappear.

decrease

Keep the needle in place for 15

aware of the symptoms

1. Clinical

adhesives.

Toxicity

If medical

must be fully

Ho-ku.

stir into paste

and fix with

is to use acupuncture

and Treatment
Emetic

application,

the pain may gradually

spot), Chu-chih,

by Tartar

ground into powder,

applica-

tartar

epilepsy,

emetic

to nortoxic

or general

treatment.

arfainting,

2. Preventive

Measures

Prevention
work.

has always been a key principle

To eliminate

severe toxic

reactions,

in carrying

out medical

one must grasp the following

two rules:

a. Before

starting

treatment,

should be made and a complete


the patients

condition

a thorough

physical

is thoroughly

study of the condition

examination

understood

performed,

so that

and a suitable

schedule

of dosage and course planned.

b. During
of reactions;

treatment,

analyze

of severe toxicity;

and compare

of bo&j temperature
comparatively

vomiting,

and anorexia

females
tartar

such as elevation

reactions

(frequent

decreased

or insufficient
arrhythmia

in hot
nausea,

urine,

rest during

and

the course

is much higher
in the estimation

who had more severe reactions

arrhythmia

complete
and glucose

in
of

For patients

the other patients

This point

should be carried
patients;

emetic

tartar

upon.

emetic;

there-

emetic

injections

must be emphasized.

Treatment

who have developed

from ordinary

of tartar

drugs for tartar

consequences.

may develop

must be insisted

and glucose in order to continue

of Emergency

that

suspension

of injections

are not detoxication

causes serious

gency treatment

and require

discontinuation

fore using atropine

arated

should be

reactions.

into severe cardiac

3. Method

early hints

factors

dehydration,

trauma

possible

or physical

this fact should be considered

For patients

frequently

tract

and development

Attention

factors

of infection

The rate of severe cardiac

emetic

Atropine

predisposing

with resultant
mental

discover

immediately.

severe alimentary

imbalance);

than males;

injections,

of various

the occurrence

them daily;

(complications

weather);

of treatment.

watch

and give treatment

paid tc the appearance

electrolyte

closely

severe cardiac

out on the spot.

avoid moving

so that emergency

e?ne-~-

They should be a?$-

them if possible,

treatment

114

arrhythmia,

and. transfer

can be efficienti):

sarried

out.

At the same time the mental

ed to in order to eliminate

state of other

unnecessary

In the course of emergency


must observe

and control

and changeable

bined treatment

measures

a. Ataopine
effective
effect
cular

on the heart,

mg atropine

It should be used first.


the heart

When severe cardiac

are no further

or the drugs stopped.

after

a regular

rhythm.

reappear,

intravenous

promazine
cardiac

dilantin
arrhythmia

of atropine,

there

and even mania.


injections

depending
red-

compounds.

Therefore

These conditions
amytal,

to appear after

then the use of isoproterenol

115

heart

can only maintain


to use the

injections.

After

such as unrest,

should be controlled

sodium phenobarbital,

If the heart

atropine

an increased

it is better

may be side reactions

with

and arrhythmia
Generally

usually

or subcutaneous

of sodium

continues

1. to 3 hours.

to maintain

rate,

can maintain

injections

dose by intramuscular

intramuscular

every

should be repeated.

maintenance

lucinations,

rate and rhythm,

should be flexible

of the heart

rate for 20 to 60 minutes.

use of atropine,

give 1.0 mg intramus-

it should be sufficient

an increased

repeated

1.0

to raise the heart

based on the heart

or subcutaneously

period;

2.0

at the same time

or subcutaneously

slowing

1 to 2 mg intravenously

rate for a longer

has occurred,

rate of about 100 to 120 beats per minute

If paleness,

given intramuscularly

ventri-

48 hours, then the dosage may be decreased

generally

ness of the skin and a heart

the vagus

rate and controlling

In 30 minutes,

attacks,

and is

It can remove

arrhythmia

The dosage of atropine

on the disease condition;

arrhythmia

or intramuscularly

1.0 mg may be given intramuscularly


are no attacks

must be used, and com-

intravenously;

rate to 1Oi) to 200 beats per minute.

If there

factors

and solve contraindications.

safe in treating

should be administered

If there

constantly

should be adopted.

mg should be given subcutaneously

cularly.

personnel

and predisposing

and techniques

thus increasing

rhythm.

medical

look for, analyze,

is comparatively

in most cases.

ectopic

treatment,

strategies

should be attend-

on their part.

the changes of condition

in the course of the disease;


Flexible

worries

patients

rate cannot

with
or chlor-

be increased

the use of a certain

should be considered.

hal-

and

amount

b. Isoproterenol
uloventricular

can stimulate

node and markedly

ventricular

ectopic

rhythm.

5% to 10% glucose

solution

venous drip (start


raise the heart

with

(or glucose

and gradually
and maintain

increase)

rhythm.

are:

the heart rate and rhythm

the drip, and prevent

to

a regular

drip a person should be assigned

the speed of the drip according

regulate

thus controlling

in sali;, (500 ml) for sl0v.v intra-

in the ilse of isoproterenol

record

rate,

The usual dosage is 0.5 to 1.0 mg added to

intravenous

close observations,

node and auric-

the heart

rate to 100 to 120 per minute

i. During

carefully

increase

a few drops per minute

Precautions

utes, readjust

the sinoauricular

every

to the heart

the needle from

to make

5 to 10 minrate and rhythm,

slipping

out of

the vein.

ii.
increased

If there are still extrasystoles,

to increase

the rate still


potassium,

cannot
fever,

the heart rate to about 130 times per minute.


be controlled,

acidosis,

looked for and measures


cardiogram

indicates

isoproterenol
arrhythmia

mental

then predisposing
excitement,

taken to quickly

them.
cardiac

still

If the electroarrhythmia,

be used or other

then
anti-

drugs added for use.


After

the arrhythmia

the normal

has been under control

level

decreased

until

for 24 hours,

the heart

for 2 to 3 hours and the rhythm

rate

maintained

then the drip may be discontinued.

iv.

While isoproterenol

time it increases
consumption,

causes (such as low

eliminate

and atropine

the speed of the drip may be gradually

regularby;

If

etc.) should be carefully

that it is a supraventricular

may be discontinued

iii.

approaches

the drops may be suitably

the force

increases

of myocardial

and the burden on the heart.

the heart
contraction,

should be paid especially

to ,older patients.

116

at the same

myocardial

If the heart

too fast and for too long, there may be myocardial

rate,

energy

rate is increased

damage.

Attention

v. Possibly
polyuria

due to dilatation

and interfere

drip infusion

with potassium

frequently

under close observatior

or bradycardia,

if the arrhythmia

or isoproterenol.

i. Dilantin

Consideration

can eliminate

coLtrolling

ventricular

ectopic

with

alkali

response

still

completing

rhythm,

rhythm

returns

Attention

should be called
and respiratory

with

ectopic

pulsation.

above dosage may be repeated


not exceed

If cardiac

once more.

and slowly

inject

When effective,

after

injection.

arrhythmia

The total

in

The dosage

to the fact that too fast an injection

suppressions.

myocard-

In adults use 3

water

10 minutes

caution.

effective

in 6 to 12 minutes.

within

block

between

and is frequently

20 ml of distilled

to normal

after

if there is conduction

the speed of conduction

the injection

the heart

drugs.

or should be used with

or supraventricular

(5%) diluted

intravenously,

should

be controlled

on a basis of 3 to 5 mg/kg of body weight.

to 5 ml dilantin

of

can be prescribed

cannot

However,

can decrease

ial fibers,

may cause

recurs,

the

dose in 1 day should

1.0 g.

ii.

Lidocaine

(Xylocaine)

a Id the speed of conduction


pressing

myocardial

they are contraindicated

is calculated

A long period

replacement.

drugs that lower

the use of atropine

this drug may cause

ion reabsorption.

This drug should not be dispensed

c. Other

cardiac

vessels,

causes low blood potassium.

be given io potassium

vi.

of renal

ectopic

rhythms.

to 20 ml glucose

venous drip,

and prolong

giving

once in 20 minutes
1 to 2 mg/minute.

action,

the refractory

given intravenously.

not cause a drop of blood pressure


has a sedative

mvocardial

The dosage is 1 to 2 mg/kg

(5%) and slowly

it can be repeated

can decrease

excitability

period,

of body weight,

proper

or suppression

so the doeage of sedatives

added

if it is effective,

or be added to glucose
Within

thus sup-

(5%) for intra-

dosage, this drug will

of cardiac

function.

and chlorpromazine

It
drugs

should be decreased.

iii.
effective
tricular

Preliminary

in ventricular
fibrillation,

clinical
extrasystoles,

use shows bromobenzyl


ventricular

The dosage is 3 to 5 mg/kg


117

amide to be

tachycardia,
of body weight

and vendiluted

in 20 ml glucose
nously.

(5%), taking

It can be repeated

a day.

about 10 minutes

three

With ventricular

times a day.

tion, nausea,

are not numerous,

intramuscular

extrasystoles,

and vomiting.

intrave-

include

injections

times

(dilution

100 mg may be taken orally


temporary

If these symptoms

blood press-e

occur,

attention

eleva-

should

hy-potension.

Experiences

to record

with

Side reactions

be paid to hypostatic

inject

once every 6 to 8 hours, not more three

It also can be maintained

not needed).

to slowly

with

the use of lidocaine

so they should be used with

and bromobenzyl

amide

care under close observation

the results.

4. First

Aid for Cardiac

Clinically

if cardiac

occurs,

minutes

cardiac

massage.

venously

Arrest

arrest

(disappearance

of pulse and heart

or seconds should not be wasted before


At the same time administer

(if an isoproterenol

iutravenous

of the drip should be increased

giving

sounds)

e,ktrathoracic

0.5 mg isoproterenol

drip is being given,

intra-

then the speed

or 0.25 mg be added to the infusion)

and

2 mg atropine.

A method
patient;

insert

of cardiac

massage is as follows:

a board under the shoulders

then a board need not be inserted).


side of the patient,
the sternum,
downwards,

placing

and steadily,
pushing

speedily,

and forcefully

time,

the wrists
attendant

is effective,

up quickly,

spiration,

artificial

taneously

carried

times of cardiac

respiration

massage,

with

artificial

respiration,

pulse.

inhalation

This motion

pressing

If the cardiac

If there is suppression

given.

breathing)

massage
of re-

Thould be simul-

or 1.5 g cytisme

Cardiac

(i.e., when air is

lungs, do not press on the chest).

118

Another

For each four to five

should be alternated

5 mg lobelin

down each

expand.

the lungs should be blown into once.

respiration

into the patients

After

(mouth-to-mouth

out and oxygen

massage and artificial


blown

pulse will be felt.

part of

presses perpendicularly

so that the chest can fully

may feel for the femoral

the femoral

stands on either

down for about 3 to 4 cm.

out about 60 to 80 times per minute.

medical

attendant

hands over the lower

is carried
lift

the head of the

and back (if it is a board bed,

The medical

the overlapped

the sternum

Lower

Simultaneous
may be given

intravenously.

If the patient

of isoproterenol
effective,

intravenously

and continue

0.5 mg isoproterenol

txacardially;

lactate

Over the whole


and mouth-to-mouth
disruption.

Except

arrest

(complete

arrest

the heart

arrest,

respiration

should be carried

fibrillation)

In those with

a comparatively

sodium

bicarbonate

will

through

attacks

arrest.

In patients

with prolonged

there are signs of cerebral


irregular

breathing,

treatment

cardiac

arrest

intracranial

carrying

time,

cardiac

cause tissue anoxia

and repeated

attacks,

if

of unconsciousness,

pressure,

then dehydration

should be used.

Drugs

Sedatives

and chlorpromazine

drugs may calm the central

lower

the tension

irritations

of the vegetative

that disturb

excitability

of the myocardium.

of atropine

as mental

the unrest,

used sedatives

the patient,

nervous

system,

and mania (while

be taken to eliminate

are:

119

lower

such toxic

and external
them),

the

reactions

using sedatives,

to search for the internal

and measures

nervous

decrease

and may possibly

They also can control

excitement

should be made simultaneously


causing

The

in those with repeated

and Chlorpromazine

external

of arrest

injection).

5. Sedatives

system,

out

(5%) in a intravenous

edema such as deepening

and increased

on without

long period

intravenous

should be increased

cardiac

con-

should be given to corrF&

dosage of sodium bicarbonate


and prolonged

or in-

massage

while

time give 100 ml sodium bicarbonate

drip or 40 ml (1 M) sodium lactate

in-

(5%) and 40

extrathoracic

or ventricular

attacks,

If still

beat returns,

when it happens for a very short

acidosis.

(the first

chloride

massage should not be interrupted

measures.

acidosis

massage.

drips.

course of cardiac

other

or with repeated

After

intravenous

artificial

Cardiac

and metabolic

give 10 ml calcium

intravenously.

to give isoproterenol

cardiac

give 0.5 mg

may again be given intravenously

at the same time

ml (1 M) sodium
tinue

does not respond immediately,

attempts
factors

Frequently

a. Amobarbital
4 to 6 hours.

(amytal)

Effective

(0.25 g) given intramuscularly

time is rather

b. Sodium phenobarbital
6 to 8 hours.

Action

once every

short.

(0.1 g) given intramuscularly

is comparatively

slow; effective

once every

time,

comparatively

long.
c. Chlorpromazine

and promethazine

(25 mg) each given intramuscularly


for intravenous

drips,

attention

(Wintermin

and phenergan)

once every 4 to 6 hours.


should be paid to possible

When used

fall of blood

pressure.

d. Dilantin

(methidin)

intramuscularly.

The action

drugs may be considered


contraindicated
ratory

solution
amytal

period,

long.

when other drugs cannot bring sedation


and in patients

These

but are

with signs of respi-

failure.

calm a patient

drugs may be used:

to 25 mg chlorpromazine
slowly

(25 to 50 mg each) given

is fast; and the effective

in old age and anoxia

To rapidly
lowing

and promethazine

intravenously;

who is maniacal

3 to 5 ml paraldehyde
diluted

with

intravenously.

given intravenously

intramuscularly;

10 ml of distilled

or 0.1 to 0.2 mg socium

to be given slowly

amytal

water

with pulmonary

12.5

in glucose
and sodium

of respiration;

and bronchial

the fol-

to be given

diluted

Both paraldehyde

may cause suppression

should not be used in patients

and restless,

they

diseases or

in older patients.

The main purpose


is to quiet

the patient,

of using sedatives

but not too much.

and chlorpromazine

The injections

drugs

should be given

once every 3 to 4 hours based on the need (the dosage and time interval
for medication
conditions).

varies
Several

used simultaneously

with

different

patients

and is determined

drugs may be used alternatively


to avoid causing serious

of respiration.

120

results

by existing

but should not be


such as suppression

6. Supportive

Treatment

a. Replacement
Infusion
fluid

of fluids

and electrolyte

reactions;
infusion

it also allows

glucose

a small amount
renal

function

on other

is normal,

conditions

corticosteroids
is present

tartar

supply nutrition,

emetic

excretion,

and relieve

solution

sodium

(10%).

should be limited

sodium bicarbonate

The daily

(5%) in normal
solution

chloride

with

the amount).
to avoid causing

depending

Hypertonic

glucose

hypocalcemia.

(5%) or sodium lactate

and

should be added

the dosage may be increased

to about twice

toxic

If the urine is voluminous

4 to 6 g of potassium

deficiency

chloride

maintain

general

intravenously.

of 2000 to 3000 ml of glucose

(5%), or compound

of glucose

(if there is potassium

of Acidosis

drugs to be given quickly

a total

solution

and Correction

can promote

balance,

may include

saline,

of Fluid

and

If acidosis

(1 M) intravenous

drip may be administered.


b. Quick-energy

Medicine

These subst,ances
provide

energy,

vitamin

Bl and B compound

Prescription

in myocardial

function

and utilization,
recovery.

one to two times per day.

They

In addition,

may be given intramuscularly.

compounds:

500 ml

chloride
B6

8U
1.0 g
50-100 mg

Adenosine

triphosphate

Coenzyme

Hydrocortisone

Administer

sugar metabolism

insulin

Potassium
Vitamin

fluid,

for quick-energy

10% glucose
Regular

can promote

and are beneficial

may be added to the infusion

and Inosine

20-40 mg
50 u
25 mg

300 to 400 mg of inosine,

daily.

121

intravenously,

: to 2 times

c. Oxygen
Oxygen
arrested

for a long period,

7. Tartar

should be yi I -~a.led when the heart

inhalation

Emetic

with

anoxia

Detoxication

and Excretion

Sodium dimercaptosuccinate

can promote

and is useful
cardiac

in preventing

arrhythmia

be considered.

further

occurs

At first

soon after

normal

saline,

Before

or 5% glucose

solution

rashes,

lassitude,

headache,

soreness

it should not be heated;


dissolving

emetic

excretion

If severe

injection,

toxic

its use may

may be given slowly.

Then give

three to four times.


in distilled

water,

and made into 5% to 10% solution,


for 10 to 15 minutes.

and nausea.

of the limbs,

the solution

it should be colorless

emetic

use it is dissolved

intravenously

may cause dizziness,

tartar

may be repeated

form.

is given slowly

tartar

2 g intravenously

This drug is in powder

present.

damage to the heart.

1 g every 4 hours; this procedure

which

and cyanosis

has been

etc.

Other

Rapid injection

side reactions

are skin

This drug is not very stable;

should be freshly

prepared.

or pink; if it is muddy yellow

After

or turbid,

it should not be used.

8. Predisposing
Patients
affected

Factors

with repeated

of cardiac

attacks

by many predisposing

factors,

a. Fever is an important

factor

which

arrhythmia

are frequently

should be investigated

and

eliminated.

Antibiotics
treated

should be given if infection


concomitantly

body temperature

be considered,
permit,

to cardiac

arrhythmia.

is present.

High fever

should be

or pharmaceutical

means to cause the

to fall rapidly..

b. If repeated
drugs to combat

by physical

predisposing

attacks

arrhythmia,
and rapid

of cardiac

then the possibility

correction

an electrocardiogram

arrhythmia

accordingly

occur even after


of hypokalemia

carried

out.

should

If conditions

may be made to help in the diagnosis.

122

using

c. Other

predisposing

vomiting;

pharyngeal

or urinary

retention

catheterization,
too frequent
ditions

factors

secretions

family

of stomach

visits,

strong

should be corrected

sedatives

causing

and Nursing

An emergency
patients

with

treatment.

emergency
and their

the situation.

be instituted
neously

quickly,

various

the fluid

supplied.

must be kept.
intake

Maintain

to prevent

should be given easily


Mentally

digested

clear patients

During

emergency

caffeine,

and other

used with

care.

out

but calm,
discuss

procedures

can be carried

must

out simulta-

must be paid to the course of the


rate and heart rhythm;

to the heart

and the amount

conditions.
infections.

frequently.

should be encouraged

oral, ocular,

If the patient

to combat

for these patients,

123

in

and calories

so that life-saving

Maintain

drugs that may cause cardiac

Record

of electrolytes

food in small quantities

treatment

In carrying

treatment

free flow in one or two veins,

complicating

stimulations

They must constantly

of the heart

and output

all external

a unit

during

must be enthusiastic

emergency

Listen

emetic

out instructions

should be limited.

but orderly.

Close attention

may be given under emergency


hygiene

carrj

personnel

Various

to take care of

carirc and observation;

visits

and to the examination


records

catheter

for nursing

so that all procedures

in good order.

condition,

detail

medical

work must be intense

and analyze

A retention

caused by tartar

and properly

and the family

treatment,

and mania,

arrhythmia

The room should be kept quiet,

should be avoided,

These con-

overexcitement

unit should be organized

The unit is responsible

of shift.

etc.

drugs,

retention.

cardiac

must be on post at all times,


change

noises,

During

such as

Care

treatment

severe toxic

irritating

and mania,

of irritating

drugs should be increased.

may be used in the case of urinary

9. Observation

irritations

tube, injection

light,

nausea and

excitement

or external

immediately.

or chlorpromazine

acidosis;

obstruction;

caused by atropine;

insertion

metabolic

are:

drugs
and nasal

can eat, he

and frequently.
disease confidently.

adrenalin,

arrhythmia

digitalis,

should be

Generally
special

after

nursing

closely.

the heart

The patient

may be discharged

recovered

should be hospitalized

longer,

and Treatment

1. Clinical

Manifestations

The patient
anorexia,

hepatitis
suffers

ance of jaundice,
examination

Emetic

occurs during

and yellow
fever,

jaundice,

coma, etc., which

Toxic

discharge.

Hepatitis

or marked

even without

atrophy,

are signs of hepatic

attacks

out after

may be present.

Severely

hepatic

carried

condition

nausea and vomiting,

enlargement

hepatitis.

ascites,

with repeated

be observed

the late stage of treatment.

and headache

and signs are present


as toxic

should

One or two days before

sclera.

may show hepatic

should be treated
increased

of Tartar

for 72 hours,

his general

and close followups

usually

chills,

above symptoms

Patients

from severe persistent

lassitude,

still

only after

for 10 days.

Prevention

Toxic

has been normal

care is not needed, but the patient

has completely

D.

rhythm

marked
the appearPhysical

tenderness.

jaundice,

affected

the case

patients

generalized

If the

may show

bleeding,

delusion,

cellular

failure.

hepatic

damage due to tartar

2. Prevention

The occurrence
usually

of severe toxic

occurs in patients

function,

with

or it may occur

alimentary
in time.

tract

during

reactions

Therefore

calculated,
to prevent

hepatic

tartar

emetic

disease or poor hepatic


treatment

when severe

have taken place but injections

It may also occur

not properly

previous

when the treatment

and the liver

not discontinued

course and dosage were

could not tolerate

severe reactions,

emetic

the following

the treatment.

precautions

must

be taken:

a. Before
conscientiously
calculated.
to whether
as jaundice,

treatment,
performed

In selection

selection
and treatment

of treatment

in the past or present


lassitude,

of treatment

anorexia,

must be

courses and drug dosage properly

objectives,

there

objectives

attention

were symptoms

abdominal

124

distension,

should be paid

of hepatitis
nausea,

such

edema,

fever,

etc., or signs such as yellow

and tenderness
wall,

ascites,

of the liver

treatment

of severe or continuous

active

and spleen,

telangiectasia,

distended

enlargement

veins of the abdominal

edema, etc.

b. During

symptoms

sclera,

occur,

the patient

must be watched

nausea, vomiting,

discontinue

and marked

injections,

observe

for the appearance

anorexia;

the patient,

if these

and institute

treatment.

3. Treatment

If toxic
analyze

Methods

hepatitis

occurs,

medical

changes of disease conditions

personnel

must investigate

and adopt a combination

and

of treatment

methods.

a. Immediately

stop tartar

emetic

treatment.

b. If there is nausea and vomiting


orally,

and medicine

then 1000 to 2000 ml of glucose

intravenously
given).

each day (appropriate

solution

amounts

At the same time large amounts

C should also be administered.


solution

and compound

chloride

of potassium

of compound

solution

be taken

(10%) should be given


salt should be

vitamin

With severe vomiting

sodium

cannot

B and vitamin

and anorexia,

alternately

glucose

may be given

intravenously.

c. If the condition

is serious,

with

corticosteroids

such as hydrocortisone,

may be added.

The dosage for prednisone

for about
intravenous

1 week.
drip.

Hydrocortisone,
If necessary,

be added intravenously

intestinal

bacteria

They may also be beneficial

dexamethasone,

prednisone,

etc.,

is 20 to 60 mg per day orally

quick-energy

compounds

daily

or inosine

for

may

Bl intramuscularly.

antibiotics

and decrease

and severe jaundice,

100 to 200 mg, may be given

and vitamin

Broad spectrum

high fever

(tetracycline,

the toxic

in lowering

effect

neomycin9
of bacteria

the blood ammonia.

125

can suppress
on the liver.

Tf there
tremor,

are indications

hyperreactive

ment the protein

of hepatic

tendon reflex,

coma such as delusion,

and amnesia,

intake

should be decreased;

2 to 3 g s-aminobutyricum,

or 20 g agrininum

solution

(10%) for :atravenous

dicated,

and sedatives

are present,

small

be given with

drip.

should be carefully

amounts

vitamin

besides the above treat-

and 23 g sodium
hydrochloride

Ammonium

are contrain-

When bleeding

transfusions

K and coagulants

glutamate,
added to glucose

compounds

chosen.

and frequent

flapping

tendencies

of fresh blood may

such as benzoicum,

6-aminocaproi-

cum, etc.
d. When sodium dimercaptosuccinate
excretion
liver.

of tartar

emetic

is promoted,

combines
decreasing

Use of this drug may be considered

the course of tartar

emetic

ment of arrhythmia

for method

V. Treatment

emetic,

hepatitis
after.

occurs during

Refer

to the treat-

of administration.

Frequently

Diseases

Encountered

of Schistosomiasis

of Treatment

Concurrent

diseases refer

are encountered

hepatitis,

schistosomiasis

to the various

simultaneously

diseases most frequently


asthma,

tartar

the damage of the

if toxic

or shortly

of Several

Concurrent

A. Principles

treatment

with

with

drugs well,

treatment.

Therefore

of concrete

conditions

etc.

cardiac

diseases,

frequently

and can easily have toxic


remember:

and adopt Adaptable

the chronic

Due to the double effects

diseases, patients

one must always

diseases tnat

Generally

are neurasthenia,

arthritis,

and the associated

weak, do not tolerate

schistosomiasis.

encountered

nephritis,

acute or chronic

are physically

reactions

Concrete

and changeable

of

during

analysis
strategy

and tactics.

1. Selection

of Time for Treatment

Treatment
or during

should not be considered

acute attacks

be given only after

of chronic

recovery

concurrent

or after

during

acute

diseases.

concurrent

diseases

Treatment

should

the disease is under control.

126

2. Selection

of Drug for Treatment

Selection

of antischistosome

of the associated
(including

disease.

antimony-273)

are cardiovascular,
using tartar

drugs should be based on the nature

If diseases are neuropsychiatric,


should be the treatment

antischistosome-846

emetic,

generally

antimony

of choice.

long-course

be used, the dosage and course based on the body weight,


state,

and condition

condition,

of the concurrent

a course of recuperation

be instituted;

and treatment

B. Preliminary
Diseases

disease.

in the Treatment

drug.

method

should

in weak general

treatment

given after

of Several

In

sex, age, physical

In patients

and symptomatic

of schistosomiasis

Suggestions

If the diseases

should be the principle

the small-dosage

drugs

should

improvement.

Concurrerit

Of Schistosomiasis

1. Neurological

Diseases

Neurasthenia, delayed reaction to antischistosome-846,


In these diseases, tartar emetic 20-day treatinternal ear dizziness.
ment or small-dosage
medical

personnel

heart-to-heart
their

long-course

treatment

should show more concern

talks with

them, and increase

may be used.

During

about the patients,


their

confidence

treatment
have close

in overcoming

diseases.

Epiiepsy
antiepilepsy
attacks,

and cerebral

treatment

tartar

emetic

ment may be used.


and observe

and Adam-Stokes

with such drugs as dilantin.


ZO-day treatment

During

closely.

type of schistosomiasis.

treatment

Distinction

syndrome

127

long-course

to give antiepilepsy

must be made between

caused by tartar

emetic.

give

When there are no

or small-dosage
continue

First

epilepsy

treatdrugs,

attacks

Psychiatric
during

diseases.

an interval

of no attacks.

may be chosen according


treatment,

After
within

ZO-day treatment,

150/100

treatment

cardiac

antischistosome-846
complications

treatments

of the patient.

During

supervised.

with

hypotensive

mm Hg, patient

small-dosage

During

with

may be given

or short-course

condition

treatment

continue

treatment,

and in the neart.

vascular

drugs,

In hypertension

has been stabilized,

may be considered.

of renal and cerebral

and anti-

to use hypotensive

diseases, if the condition

treatment

drugs and blood

may be given tartar

long-course

and note any changes of blood pressure


complicated

treatment

System

maintained

schistosome-846.

Long-course

should be closely

Hypertension.
emetic

emetic

to the existing

the patient

2. Cardiovascular

pressure

Tartar

The patients

with

disease should not be treated

for the time being.

Abnormal cardiac
systole.

These patients

If there

are no organic

quent,

tartar

emetic

treatment,

dilantin

made of change

rhythm.

The most common

should be treated

heart

long-course

treatment

or sedatives

of cardiac

treatment.

diseases,

may be given orally,

rhythm,

dosage long-course

treatment

active

or myocarditis,

3. Respiratory

During

and close observations

With patients

with

rheumatic

and con-

should be the main drug for

active

rheumatism,
tartar

may also be considered.


treatment

and myoczrditis
emetic

small-

With cardiac

failure,

should he postponed.

System

Chronic bronchitis,
If there have been no recent
treatment,

are not fre-

rhythm.

and with good disease stabilization,

rheumatism,

is extra-

antischistosome-846.

may be considered.

antischistosome-846

When abnormal

are not present

with

heart diseases and the extrasystoles

Organic heart diseases.


genital

mainly

symptom

then tartar

emetic

bronchial
attacks

asthma, pulmonary edema.

or +he symptoms

ZO-day treatment

128

are controlled

or small-dosage

after

long-course

treatment
During

may be used.

treatment,

attention

to prevent

secondary

of marked

insufficiency

tation,

dyspnea,

ically.

Treatment

symptoms

respiratory

infections.

Patients

of cardiopulmonary
after

light

of schistosomiasis

day treatment

with

functions

with

(absorption

and who have palpi-

work should be treated

the

be controlled

In tuberculous

stage and calcified

tartar

20-

if pulmonary

tuberculosis

symptoms

or exudative

pleurisy.

In tuberculous

pa-

not to use antischistosome-846.

System

pain and peptic

ulcer.

treatment

Active

may be given

treatment

given immediately.

Hepatitis.

Patients

with a definite

with

tartar

emetic

treatment

of acute hepatitis,

but whose disease was mild and short,


liver

method.

in a patient

functions

but with-

for over a year,

dosage long-course

and signs and with normal

or perforation

long-course

may be considered

and proper

of hepatitis,

function

small-dosage

During

postponed.

history

liver

or anti-

of symptoms.

a hemorrhage

treatment

and signs and with normal

may be treated

control

should

emetic

should be noted,

with

should have their

Patients

Tartar

after

any change of the disease condition

6 months

manifestations

symptomatically.

treatment

with

Small-

a history

who is without

for 6 months,

and who

and takes part in heavy labor.

Bile duct ascariasis,


are no attacks

emetic

should be postponed

overt

strong,

symptoms

Treatment

schistosome-846

out symptoms

stage),

without

treatment

by diet and treated

within

patients

antituberculosis

Gastric

cholecystitis,

of these diseases,

tartar

treatment

may be considered.

ascariasis

and whose stool examination

mintics

only after

At the same time,

4. Alimentary

is young,

energet-

may be used.

it is better

symptoms

warm and

complications

should be considered

tuberculosis.

should continue.

history

may also be chosen.

have improved.

and in remission,

tients

treatment

should be paid to keep the patients

and cyanosis

Pulmnary

is active

Antischistosome-846

should be given before

gallstones.

emetic

To a patient

schistosomiasis
12?

or antischistosome-846

with

reveals

If there

a history
sscaris

treatment.

of bile duct

infestation,

anthel-

5. Urological

System

Nephritis.
In patients
function

Treatment

with

chronic

nephritis

and good general

treatment

should be postponed

condition,

may be considered.

examinations

tract

urinary

routine,

treatment

active

tartar

During

symptoms,

emetic

normal

small-dosage

treatment

frequent

infection.

With disappearance

and good renal

or small-dosage

long-course

renal

long-course

routine

should be made and any change of the condition

Urinary
normal

without

in acute nephritis.

urinary

noted.

of symptoms,

functions,

tartar

emetic

treatment

msy be given.

20-day

6. Others

Arthritic
tartar

emetic

treatment

pain,

any existing

conditions

anthelmintics

and iron taken orally.


may be carried

out after

improvement

of upper respiratory
meningitis,

emetic

patients
safety

general

tract

pneumonia,

the other
fore during

infection,

fever,

and other

on the other

class wholeheartedly,

treatment

patients

with

medical
enter

malaria,

diseases.

Wait until

have recovered;

then

may be given.

concurrent

diseases,
plan.

the one hand, the schistosomiasis

hand attention

during

dysentery,

should be the key to a treatment

disease and improvement


treatment,

feverish

and the patients

schistosomiasis

must be considered-on

be treated;

or antischistosome-846

should not be treated

typhoid

condition

foods supplied,

of symptoms.

or antischistosome-846

In treating

emetic

is hookworm

Schistosomiasis

these diseases are under control


tartar

nutritious

tartar

During

symptomatically.

cause of anemia

should be given,
with

are stabilized,

may be used.

should be dealt with

Treatment

Acute infections.
epidemic

treatment

On the farm a frequent

First,

attacks

When such conditions

or antischistosome-846

Anemia.
disease.

arthritis.

General
should

should be paid to treatment

of the patients

personnel

health.

of
There-

must serve the poor and peasant

the wards frequently,

130

general

the

pay attention

to the

patients,

and examine

and observe

them closely.

shows signs of further

development,

becomes

attacks,

then antischistosome

or discontinued,

and appropriate

VI.

Acute
inated

treatment

schistosomiasis

areas who come into

contact

It may also occur in patients


reinfected

with

a large number

severe symptoms
bined result

with

of the toxin

suspended

among inhabitants

chronic

water

of noncontamfor the first

schistosomiasis

of schistosome

of adult

or leads to acute

Schistosomiasis

with infected

and signs of high fever,

disease

be given immediately.

of Acute

is seen mostly

more severe,

must be temporarily

treatment

Treatment

If the concurrent

who become

cercariae.

enlarged

liver,

Clinically

irritation

that cause tissue damage and are also due to the lack of immunity.
period

for acute schistosomiasis

symptoms

of the acute stage occur,

when the schistosomes


The pathological
emboli

are mature

basis for symptoms

they usually
and laying

The

about 40 days.

correspond

When

to the stage

ova in the portal

system.

and signs is .he formation

of ova

abscesses in the organs.

A. Main Clinical

Fever.

Manifestations

Intermittent

Occasionally

fever

is most common

there may be continued

Gastrointestinal

tract.

pain, diarrhea,

and watery

contain

purulent

mucus.

Enlarged
more marked

bloody

liver

and spleen.

on the left

or irregular

stools.

Most patients

The consistency

degrees of tenderness

and percussion

enlarged

spleen.

There

131

fever

next.

fever.

distension,

In a few patients

lobe.

may have a slightly

and remittent

There may be abdominal

dominal

different

is usually

the

etc., are a com-

worms and ova and mechanical

incubation

time.

the stool may

have enlarged
is soft.

pain.

There

ab-

livers,
may be

Some of the patients

may also be slight

tenderness.

In severely

Others.

of weight;

50%.

patients

there may be paleness

and loss

in a few there may be edema and ascites.

Blood Picture.
increase

affected

The most significant

of eosinophiles,

In seriously

usually

ill patients

peripheral

between

blood change is an

15% and 30%; some may exceed

if the eosinophiles

are decreased,

the resist-

ance is very low.

Change of hepatic

function.

degrees of elevation.
within

normal

B. Important

Contact.

Serum globulin

The SGPT may be slightly

Diagnostic

Points

History

of contact

with

Blood picture.

Acute
fever,

Percentage

stool

hatching.

test occurs rather

schistosomiasis

liver

but most are

infected

water

during

in those who used to live in noninfectious

Symptoms. Fever, enlarged liver,

mentation

elevated,

limits.

season (especially

Positive

may show various

the infectious
areas).

tenderness.

of eosinophiles

Positive

markedly

reaction

increased.

of serum oval ring sedi-

early and may be used for early

should be distinguished

abscess, septicemia,

tuberculosis,

from malaria,

diagnosis.

typhoid

etc.

C. Treatment

The principles

of treatment

Improvement of symptoms.
and then improve

the symptoms

for acute schistosomiasis

First

control

and general

132

high fever
condition.

are:

and toxemia,

Treatment of pathogen.
select
plete

drugs to treat

After

the pathogens,

improvement
to accomplish

of general

condition,

the objective

of a com-

cure.

1. Mild

Form of Acute

With low fever,


general

condition,

treatment

no apparent

furapromidum

regimen

the stool hatching


or tartar

Schistosomiasis

a short duration,

(F300661 should first

and when the body temperature


should turn negative.

emetic

small-dosage

must be carried

toxemia,

out during

long-course

Moderate

or high fevers,

symptoms

tolerate

enlargement

a. First
symptoms.

decreased

are improved,

and furapromidum

b. If low-grade
or butazolidin

attention

fever

the fever
are ACTH,

furapromidum

After

the body temperature

ment,

antischistosome-846

ment may be used to treat

the fever.
sweating

is lowered

may be gradually

Corticosteroids

after

should not be
infections.

is used, then
In using antipyretics,

leading

to exhaustion.

should be paid to the appearance


returns
or tartar

to normal
emetic

the pathogen.

133

the

hydrocortisone,

the temperature

may be added to lower

attention

cannot

and alleviate

should be paid to secondary

persists

Generally

If the patient

then corticosteroids

should be paid to avoid excessive

In using butazolidin,

will be present.

After

substituted.

poor general

may be done:

to lower

They are all effective.

toxemia,

the fever.

used corticosteroids

used for too long, and attention

aspirin

to lower

use corticosteroids

and the symptoms

Close observations

of general

tenderness

then the following

Commonly

or prednisone.

with

should be used first

furapromidum,

the treatment.

Schistosomiasis

furapromidum

After

has become normal,

treatment.

Form of Acute

and liver

be used.

If not, use antischistosome-846

2. Moderate

health,

and good

of edema.

and there is general

small-dosage

long-course

improvetreat-

3. Severe Form of Acute

Symptoms
anemia,

Schistosomiasis

are high fever,

malnutrition;

with severe

or jaundice,

such as maintaining

adequate

a,.ld blood transfusions

calories,

may be given.

and general

recovery,

long-course

treatment
VII.

Chronic

to work.

mostly

of long duration

Because

program

of Chinese

internal

medicine

A,

Clinical

herb medicine,

to work.

stools,

fever,

etc.

Frequent

lobe), spleen,

meacal

and Western

who

per-

medicine,

and

of the disease and possible

com-

of late schistosumiasis

may note eJargement,

of loins and thighs,

signs are enlargement

purulent

type).

findings

blood cells (WBC) and platelets

function.
134

it.

is hard and the surface,

are severe disturbance


Laboratory

(mainly

wall.

or below

and pain over the spleen (ascites

the symptoms

bloody

of the liver

veins on the abdominal

the consistency

abdom-

and a decreased

may also have diarrhea,

and visible

are not uni-

In the late stage of the disease symptoms

hematemesis,

ment (dwarfism

liver

Chinese

spleen may reach the level of the umbilicus

(huge spleen type).

of white

weakness

Some patients

ly there are indentations;

frequently

of the disease,

stages, the patient

soreness,

ability

ascites,

Schistosomiasis

the disease and adopt a combined

manifestations

the early

inal distension,

enlarged

small-dosage

and are on the verge of losing their

in the duration

the clinical

of the left

emetic

Manifestations

During

form.

oral furapromidum

and surgery.

Due to a difference
plications,

hydrocortisone

the poor and the peasants

of the complexity

sonnel must use all means tr analyze

and vitamins

the pathogen.

of Chronic

affects

measures

body temperature

or tartar

may be used tc treat

have severe infections


ability

normal

wasting,

supportive

improvement,

antischistosome-846

schistosomiasis

Active
electrolytes,

attaining

The Treatment

marked

With high fever,

After

After

etc.

fluids,

should be taken.

may be given daily intravenously.


or predniaone

ascites,

toxemia;

type).

of growth

frequently

(hypersplenism)

The
Frequentsmooth

are anemia,
In children

and develop-

show decrease
and change of

B. Differential

Chronic
rhosis.

Diagnosis

schistosomiasis

The differences

are not as marked

are:

seen; liver

serum albumin
from several
capacity

distension,

cirrhoses;

telangiectasis,

or portal

lassitude,

hepatic

enlarge-

palm, and gynecomastia


mild;

SGPT is usually

above 2.5 g percent.

years to more than 10 years,

cir-

and anorexia

the degree of splenic

damage is comparatively

is frequently

with necrotic

are

normal;

The disease may last

and a certain

degree of labor

can be maintained.

Chronic
the liver,

schistosomiasis
tuberculous

C. Methods

be strived

peritonitis,

can usually

with

Early

weak constitutions,
medicine

be indicated

to remove

small-dosage

the spleen;

treatment

of sodium

with

Ascites

condition,

of

Chinese

Treatment
infections

Intermittent

Surgery

Chinese
may
tartar

of hepatic
should

cir-

aim at

and complications,

use of diuretics

is only one means of improving

to promote
the symptoms.

Medicine

of chronic

schistosomiasis

described

in Chinese

medical

Through

combined

improvement,

is a manifestation

The ascites

Soong dynasties.

In pa-

may be given.

eliminating

and water

treatment.

ascites.

general

should

huge spleens or

and ascites,

function.

function.

with

long-course

and after

of liver

the liver

1. Treatment

emetic

long-course

the general

and maintaining

disease

carcinoma

etc.

Patients

should be used to eliminate

rhosis and decompensation

elimination

from

of the pathogen

hematemesis,

Symptomatic treatment.
improving

cysts,

treatment

schistosomiasis.,

stand tartar

and Western

emetic

ovarian

of pathogen.

for in chronic

dwarfism

should be differentiated

of Treatment

Treatment

tients

confused

abdominal

as in the other

ment is more marked;


rarely

is easily

centuries

is similar

literature
of practice,

135

before

to the dropsy
the Tang and

it has been proved

that

Chinese

medicine

has a certain

degree of effectiveness.

is abundant,

and it can be obtained

source of medicine

If ascites
effective.

is properly

Clinically

diagnosed

condition

is fair;

of urine;

urine

mental

coated

and dilute;

extremities

Treatment

allows

diuretic

etc.

radicans,

Desmodium

to ascites

ling-San

No. 1 prescription

is a patent

powder

brew (see appendix

for listing

pale or yellowish
watery
teeth

with

or loose stools;

the tongue

marks and coated

white

is slightly

are:

medication

or ascites

plantago

No. 2 prescription.

major,
powder,

Wu-

is a stomach

contained

in patent

exhaustion),

and chilly,

has cold limbs,


with

tonic

drugs).

the patient

is pale or thickened

but watery;

Use

for half a month,

Wei-ling-tang

(positive

edema, is tired

is felt;

gourd, or mole cricket

of constituents

In Yang hsu type of ascites

tongue

herb medicine

after

medication;

distention

herb medicine.

styracifolium,

improvement

the general

of the spleen and kidney.

or Chinese

and Chinese

If there is no marked

change

function

prescriptions

Simple prescriptions
Lobelia

or nonexistent;

and there is no change in pulse.

some simple

is marked,

abdominal

and white;

normal

can be

are good; there is no increase

no marked

is slight

treatment

into five types.

ascites

state and appetite

is clear

edema of lower

type although

the

locally.

and classified,

the disease may be divided

In the most common

In addition,

appears

and has

the edge showing

the pulse is slightly

weak or

slow.

The purpose
Use Fu-kuli

li-chung

and cinnamon
chin-kuli

is to warm yang

wan, a patent

that is used to restore

shen-chi

ing properties;

wan, a patent

Wu-ling-San;

The ascites
are:

of the treatment

symptoms

sloppy appearance;

medicine

pill containing

constitutional

medicine

and clear water.

balance

pill with

aconitum
(see appendix);

kidney/energy,sestor-

etc.

of the Yin hsu type (negative

red cheeks and internal

136

heat;

exhaustion)

dry mouth

and throat;

hot palms and soles; easily


poor intake
coating;

and feeling

thready

excitable;

of distension;

scanty

shiny red tongue

and red urine;

with little

or scaly

and fast pulse.

The purpose

of the treatment

exhaustion.

Use Angelica

a tonic

etc. (see appendix).

pill;

constipated;

sinensis

is to support
blood tonic

J&A and overcome

pilbHo-che

ta-tsu

wan,

In the depressed
is mentally

depressed;

and is thirsty;
shiny

type of ascites,

has dry mouth

the patient

and bitter

appears ashen;

taste; has a restless

bleeds from gums and nose; has poor appetite,

abdominal

yellow

fever

skin; shows marked

or red urine;

abdominal

distension;

has coarse or oily tongue

coating;

fever

has tight

and

has cloudy,

and has fleeting

and fast pulse.

Treatment

liver.

aims are to clear the fever

Use Wans bezoar

detoxication;
powdered

heart-clearing

use Hsiao-yu
artemesia

pill

and detoxify

to clear the fever

sari to clean the liver;

and szu-ling

and clean the

and artemesia

and for

use compound

of

brew for jaundice

(see

appendix).

The patient

with

exhaustion

cheeks and sunken eyes, muscle

type has dried-up

wasting,

He is very thin and looks like a skeleton;


*

ed; he is slow to answer questions;


is shiny like a mirror
bounding

and slow.

The purpose
Shih-chuan
a visceral
compound;

nails,

his appetite

he has little

There is also disappearance

of treatment

is to improve

a lo-constituent

and energy-restoring

tonic
pill;

high

and scanty

hair.

is normal

or decreas-

control;

his tongue

bladder

or dried up; and his pulse is thready

ta-pu wan,
tonic

faulty

appearance,

and weak or

of body flesh.

respiration
pill;

Hsiang-sha

and blood.

Vu-chung
lu-chun

I-chi
wan,

Use
wan,
a patent

etc. (see appendix).

In patients

with

various

prescriptions

or Chinese

Prescriptions

that cause diarrhea

types of ascites,

herb medicines

may be alternately

to eliminate

137

the above simple

water,

diuretic

used or added.

due to severe

gastrointestinal
At present

reactions,

they are rarely

2. Combined

effective

results

medicine

immediately.

Increased

(refer

the abnormal

medicine

Medicine

herb medicine

diuretics

am! Western

Yang hgu type is usually

With a history

wan, a patent
to improve

diuretics

medicine

alone

good.

The

disease or has a history

warm

During

the ascites

(Dialectics)

is comparatively

(see appendix),

the anemia,

treatment).

herb medicine

by bookworm

care.

of time

should be given at

of the Disease

of hemorrhage,

should be used with

are added.

for a long period

to Western

The prognosis

the normal

can be accomplished.

type, use of the Chinese

complicated

and Western

diuretics

diuretics

and Identification

cure the ascites.

clear or

are used to support

and Western

7 to 14 days (refer

for H to

without

of Chinese

and sodium usually

treatment)

In the common

herb medicine

medicines

should be taken continually

b. Classification

of hemorrhage.

Chinese

of Western

functions,

of water

of every

can usually

and Western

who has received

Chinese

excretion

an interval

neously

Chinese

should be given a combination

to dialectic

fa-wu

with

or one or two regimens

and correct

or second time given.

Methods

Any patient
1% months

the first

used.

Treatment

a, Treatment

Chinese

are only effective

type of Chinese

treatment

if San-ferg

or iron are given simulta-

will usually

subside.

The prog-

nosis is also good.

The Yin hsu and depressed


postnecrotic

or portal

In the Yin hsu type,


tively

long.

cirrhosis

care.

If Chinese

ments for exhaustion,


to clear

the fever,

medicine
wait until

detoxify

Western

the toxin,

has improved;

the yin

is poor.

develop-

should be used
and give replace-

or give prescriptions

and clean the liver;

138

with

compara-

is serious,

diuretics

is used to support
yin

function

the course,

type, the condition

is poor.

complicated

liver

is more persistent;

fever

ment is fast, and the prognosis


with

types are usually

or other infections;

the ascites

In the depressed

fever

wait until

the

depressed
method

liver

function

produces

effective,

has improved;

better

results.

Otherwise

but may even induce

In patients

with

treatment,

adopted.

to help respiration

condition.

These methods
Prescription

a. Plantago

major:

not only is in-

Chinese

medicine

of other

malignant

and Western

to help the liver;

and blood; give diuretics


will

medicine

use Chinese

depending

on the

cure the ascites.

References

Whole herb, dry 1 oz; fresh 3 oz; mixture.

b. Kochia

scoparia:

Whole herb, dry 1 oz; mixture.

c. Lobelia

radicans:

Whole herb, dry 102; fresh 3 oz; mixture.

d. Desmodium

e. Lycopus

f.

styracifoliam:

lucidlrs,

Powdered

Whole herb, dry 1 oz; fresh,

Cucurbitacea:

mole cricket:

and grind into powder;

This

coma.

type, the presence

Use Western

diuretics.

the treatment

out; and combined

medicine

APPENDIX:

hepatic

exhaustion

diseases should be ruled

then use Western

3 oz; mixture.

Each 5 oz; mixture.

Remove

head, legs, wings; bake until

2 dr per day divided

brown

into three doses,; take with

water.

Wu-1ing

Grifola

umbellata,

h. Ascites
3 dr; Paeonia
3 dr; Aralia
waxgourd
Poncirus

sari Consists
Alisma

of

plantago,

No. 1 prescription:
rubra,

trifoliata,

1 oz; Cucurbitaceae

cinnamon

cocos,

sticks.

major

(wrapped),

5 dr; Semen areca,

cordatum,

5 clr; peel of Chinese

1 oz; Aristolochia

1 dr; Hemerocallis
1 oz.; Pachyma

Pachyma

scoparia,

5 dr; Cynanchum
hispida,

lancea,

Kochia

3 dr; Plantago

papyrifera,
Benincasa

Atractylodes

flava,

5 dr; Lycopus

debillis,

1 dr; toasted

2 dr; Demodium

cocos peel, 3 dr; Calamus

139

lucidus,

styracifolium,
root,

2 dr;

Capsella

bursa,

angularis,

1 oz.

i. Ascites
japonica,

1 oz; Akebia

quinata,

No. 2 prescription:

1 oz; Elephantopus

Glechoma

hederaceae,

1 oz; Lobelia

3 dr; glycyrrhiza,

Euphorbia

scaber,

helioscopia,

5 dr; Ardisia

5 dr; Campanumaea

1 oz; Hypericum

radicals,

0.5 dr; Phaseolus

japoicum,

1 oz; Ajuga decumbens,

pilosula,

1 oz;

1 oz; Pyrrosia

lingual,

1 oz; Agrimonia

pilosa,

1 oz.
j.

Cinnamon-Aconitum

Atractylodes

lancea,

tonic pill:

Zingiber

Campanumaea

officimale,

Aconitum

pilosula,

glycyrrhiza,

fischeri,

Cortex

cinnamoni.

k. Kidney/energy
japonica,

Cornus

plantago,

Aconitum

1. Angelica

processed

officinalis,

Rehmannia

bark of peony root,

fischeri,

sinensis

hiroshimanus,
peony root,

Pill:

Cortex

Atractylodes

lancea,

Dioscorea

Pachyma

co@os, Alisma

cinnamoni.

blood-building

Horse glue, Paeeonia

glutinosa,

pill:

Angelica

sinensis,

Astragalus

alba, Rehmannia

glutinosa,

bark of

Pachyma

cocos, Cyprus

longus,

Euonymus

japonicus.

m. Ho-&e
bistorta,

Pachyma

alba, Atractylodes
glycyrrhiza,

cocos, Grifola

coptidus,

sari relaxant
lancea,

compound:
umbellata,

bidentata,

pill:

compound

pill):

Euonymus

japonicus,

Campanumaea

Rehmannia

Polygonum

pilosula,

Tortoise

gadeniae,

Scutel-

glutinosa.

Bezoar,

Curcuma

Fructus

longa, Cinnabar.

compound:

Pachyma

Zingiber

bistorta

lucidus,

heart-clearing

Radix

o. Hsiao-yao

p. Artemesia

Asparagus

cocos, processed

baicalensis,

mentha,

Achyranthes

japonicus,

n. Wans bezoar
laria

wan (Polygonurn

Phellodendron,

Ophinopogon
shell,

ta-tso

Angelica

cocos, Bupleurum

sinensis,
falcatum,

Paeonia
Folia

officinale.

Artemesia,

Atractylodes

AsYisma plantago.

140

lancea,

Pachyma

q. Artemesia

brew:

Artemesia,

r. Ten-precious-ingredient
lancea,

pill:

gardeniae,

Campanumaea

rhubarb.

pilosula,

Pachyma

cocos, glycyrrhiza,

Rehmannia

glutinosa,

Paeonia

alba, Conioselinum

univitatum,

Astragalus

sinensis,
Cortex

Fructus

Atractylodes
Angelica
hiroshimanus,

cinnamoni.

s. Pu-chung

I-chili

Campanumaea

wan:

pilosula,

hiroshimanus,

falcatum,

fresh Zingiber

Hsiang-sha

lancea,

xanthioides,

and energy-restoring

lancea,

glycyrrhiza,

orange peel, Cimicifuga


officinale,

lu-chum

Pachyma

Tonic

Atractylodes

Astragalus

t.

viscera

Aucklandin

foetida,

Campanumaea

tuberifera,

costus,

Aralia

edulis,

Bupleurum

Jujube.

wan pill:

cocos, Pinellia

pill:

pilosula,

Atractylodes

orange peel, Amomum

giycyrrhiza.

L,
u. Stomach
Atractylodes
cinnamon

tonic:

lancea,

Atractylis

ovata,

Pachyma

Magnolia

cocos, Grifola

hypoleuca,

umbellata,

orange peel,

Alisma

plantago,

sticks.

v. San-feng

Fa-mu

wan:

Atractylodes

japonica,

yeast,

processed

and pills;

take 1 to 2 dr twice

alum.

During
daily;

treatment

dissolve

pills

3. Supportive

in boilding

as compound

to promote

complications
may be given.

or other

becrest,

vitamin

mixtures

to ingest.

metabolism.
of infection,

primary

foci of pathological

changes),
general

diet, better

B and C. For protection

nutrition,

of the liver,

a short course of prednisone

With complications

After

a salt-free

roheparin,
glucorone, inosine,
12 p
With jaundice and low-grade fever but no

vitamin

(such as septicemia,

7 trol infection.
i

water

includes

use such drugs as glucose,


etc.,

medicine

Treatment

This treatment
such vitamins

use prepared

of infection

peritonitis,
antibiotics
improvement
141

urinary

(20 to 30 mg/dayl

or concurrent
tract

diseases

infections,

should be used vigorously


and control

of infection,

and other
to co;1-

the ascites
highly

can frequently

be stabilized,

and the use of diuretics

effective.

4. Treatment

with

Whether
ment of liver
ascites

Diuretics

diuretics

will be effective

ftmction.

In the ordinary

and no complications,

effective.

In patients

simple

with

tubule

actions

With jaundice,
function,

complicating

The use of diuretics


with

may also induce

hepatic

ascites,

the com-

are effective.

cachexia,

of diuretics

worsened

liver

are usually

poor.

coma, so they should be used

times per day 50 mg dihydrochlorothiazide

or 100 mg twice

sium chloride

an interval

supportive

or 100 mg twice

should be taken with

1 g potas-

Each course should last

If the effects

50 :Jg three

of aldactone

are not marked,


prolonged.

times per day

(40 mgl twice

daily

Then on the 2nd or 3rd day, add dihydrochlorothiazide


The regimen

of ethacrynic

but it also more easily


Potassium

is same as above.

acid is faster

causes hypokalemia.
chloride

course lasts 3 to 5 days.


rene or aldactone.

triamterene

or fine granules

chloride.

The action

may be given

should be given and the intervals

medication,

daily

may be given first.

times daily.

The medicine

of 1 to 2 weeks.

treatment

In combination

and potassium

daily.

110%) three or four times per day.

4 to 5 days, with
further

the effects

will be

that suppress distal

actions

and fever,

moderate

care.

Three
orally

or aldactone

ketoaldehyde

ascites,

a short-term,

course and marked

infections

and progressive

with

use of dihydrochlorothiazide

a longer

or neutralize

depends on the degree of improvepatient

bined use of drugs such as triamterene


renal

will be

During

than dibydrochlorothiazide,
The dosage is 25 mg three

(3 to 4 g) daily should be added.

It may also be used in combination


treatment

with

Each
triamte-

changes in the disease condition

should be observed.

142

5. Operation

Refer

D.

and Indications

to surgical

Treatment

for Portal

Decompression

treatment.

of Complications

1. Upper alimentary

tract

bleeding

usually

is due to rupture

veins of the esophagus

or fundus of the stomach.

sis and melena

Treatment

occur.

rest, transfusions,
pitressin

fluid

(or pituitrinl

replacements,

bleeding

(0.2 g) or 6-aminocaproicum

tary tract

the appearance
correct

of prodromal

venous potassium
the liver
toxic

prevent

the electrolyte

drip.

a three-tube

given,

bal-

and benzoicum
If these are

should be considered.

complications

fore one should actively

hematemesis,

bed

K, 20 units

(5%) for intravenous

blood transfusions

coma may be induced

bleeding,

absolute

vitamin

(2 to 4 g) used intravenously.

then surgery

2. Hepatic

by mouth,

intramuscular

or repeated

loon may be used for plugging,

In most cases hemateme-

nothing

added to 200 ml glucose

If there is excessive

not effective,

includes

of varicose

of -&ifections,
and eliminate

hepatic

imbalance,

chloride

by the use of diuretics,

and sodium

is not damaged.

and paracentesis.
predisposing

coma symptoms,
lower

upper alimen-

causes.

(For treatment

refer

With

one must quickly

the blood ammonia,

or potassium

There-

give intra-

glutamate.

to section

Make sure

on tartar

emetic

hepatitis.)

VIII.

Methods

of Surgical

Treatment

for Schistosomiasis

Schistosomiasis

hepatic

cirrhosis

to a huge spleen and rupture


veins causing
quickly

and their

hypertension.
the portal
prevent
relieve

bleeding

hypertension,

and gastric

Seriously

fundus

ill patients

function

improved,

so as to eliminate

At present

surgical

procedures

are used mainly

They may also help eliminate

of esophageal

and gastric

Operative

disruption

of gastric

coronary
143

varicose

ascites,

portal
to decrease
treat

fundus veins and bleeding,

procedures

include

leading

must be treated

hepatic

hypersplenism.

sion operations,

in portal

of esophageal

and ascites.

hypertension.
rupture

results

splenectomy,

veins, etc.

and
and
diver-

A.

Splenectomy
Splenectomy

of effectiveness

will relieve

hypersplenism.

in relieving

hematemesis

1. Preoperative

given

Examination

Besides a general

to a history

of schistosomiasis,

of the liver

examination.

history,
hepatitis,

attention

should be

hematemesis

Besides a general

degree of mobility

and the condition

of distended

should be performed

Laboratory

or melena,

abdominal

examinations

examinations.

blood.

the tender-

there is ascites,

Rectal

examination

masses, or stricture.

on the available

for the patient,

conditions

the following

labora-

Red blood cells (RBC), WBC, differential,

(albumin

d. Liver

tests:

function
cholesterol

glutamate-oxaloacetate

bilirubin,

Hb,

times.

time.

c. Serum protein

f. Routine

wall veins.

Depending

and coagulation

b. Prothrombin

e. Total

whether

to see if there are hemorrhoids,

bleeding,

cephalin

Observe

the size

may be made.

a. Rolltine
platelets,

examination,

noted.

of the spleen,

of the area and on the requirements

sodium

special

and the spleen should be carefully

ness, firmness,

test,

and ascites.

and ascites.

Physical

tory

degrees

and Preparation

History.
jaundice,

It also has certain

and globulin).

thymol

flocculation

turbidity
test,

transaminase

1 minute

stool and urine.

test, thymol

zinc turbidity
(SGOT).

bilirubin

Stool-hatching

144

test.

test,

flocculation
SGPT, and

g. Serum oval ring sedimentation


h. Fluoroscopy

of the chest and barium

i. Splenoportal

venography

operative

needed.

Generally

2. Indications

preparations.

brl-1,

of

K, B, and C, if

are not necessary

for anemic

patients.

exceeding

spleen with

marked

second degree.

hypersplenism

(WBC below 4,00O/mm,

80,000/mm3).

c. Ascites

disappeared

and Western

2 weeks.

and selection

for 0peratio;l

b. Enlarged

Chinese

in diagnosis

Supply vitamins

blood transfusions

a. Spleen enlargement

platelets

(helpful

meal study of the esophagus.

procedure).

Preoperative

ference

test.

medicine

No change of urine

or slabilized

after

(discontinue

all diuretics

volume,

treatment

body weight,

with

combined

and observe

or abdominal

for

circum-

should be seen).

3. Contraindications

a. Jaundice

for Operation

(total

b. Prothrombin

bilirubin

time,

above 1.5 mg/lOO ml).

40% below normal

c. SGPT and SGOT markedly

d. Progressive

The general
be considered

value.

elevated.

ascites.

condition

when choosing

of patients

the operative

145

of (a) and (b) above should


method.

4. Operative

Method

Anesthesia.
should be entered

Generally

extradural

anesthesia

or in a few complicated

is used.

If the chest

cases, endotracheal

anesthesia

may be used.

Choice of incision.

An abdominal

huge spleens and adherent

spleens.

incision

oblique

or a left

adhesions,

subcostal

a thoracoabdominal

Main procedures
explore

the extent

observe

the condition

sure.

artery

and remove

clamps

between
ligate

ligate

and veins separately.


close the abdomen

Divide

a retrograde
of adhesions.

During

first;

removed

will

decrease

In addition,

ligate

are widespread

long, curved
pedicle
to double

points;

subcapsularly

the splenic

to collateral

it will be easier

bleeding

or diaphragm,

for hemostasis,

by blunt

Attempt

dense adhesions

peritoneum

and preparations

injury

or

the splenic

for bleeding

so as to avoid massive

spleen and the posterolateral

rapidly

Use three

Try to ligate

adhesions.

it is best to first

When there

transfusions

ligament

artery
then

Operation

splenectomy,

blood

explore

Sever the splenic

examine

pres-

ligament,

Use heavy ligatures

pedicle.

Splenectomy for extensive


pedicle

the portal

the spletlorenal

pedicle.

organs,

in layers.

5. Precautions

splenic

measure

and colosplenic

Conscientiously

the abdomen,

the spleen and surrounding

at the porta.

the splenic

splitting

With widespread

entering

the spleen from the incision.

two clamps

and suture

may be used.

After

ligament

to clamp on the splenic

the first

a left upper rectus

If necessary

of the spleen.

may be used in all

may be used.

between

of the liver.

and pedicle

adhesions,

in...-ision

of operation.

Sever the gastrosplenic

the porta

Generally

incision

of adhesions

incision

dissection.

circulation

to stop bleeding

146

to tackle

artery

or perform

during

separation

between
with

the

the

adequate

the spleen may be


This procedure

and avoid massive

bleeding.

on the wound surface.

Coagulation
splenism

will

oozing

mechanism.

affect

the coagulation

of the wound surface

use suture

ligature,

to stop bleeding

be packed
static

with

mechanism,

electrical

cauterization,

after

powder

treating

iodoform

Frequently

and appropriate

amount

In giving

blood transfusions,

Splenic

pedicle.

experience

proved

bad reactions.

points,

the splenic

+Ae wound may

Then systemic

hemo-

be saved under

6-aminocaproicum,
also can be used.

effects.

leakage

blood.

to others

pedicle,

of pancreatic

are carried

of splenic
with

blood did not cause any

the same blood type also did

of blood source.
out on farms,

to their

juice

The resultsofseveralyears

This kind of transfusion

and can also solve the difficulty

avoid injury

infections.

that autotransfusion

according

With wide surface

fibrinogen

thus preventing

of splenic

not cause untoward

for surgery

protamine;

In handling

Transfusion

of splenectomies

is also effective.

Lives can frequently

the rate of subphrenic

Utilization

504 aerosol

fresh blood should be used.

to the tail of the pancreas,


and increasing

spoon cauterization

used drugs are benzoicum,


of ichthy

Surgeons

Locally

pressure.

hyper-

to widespread

to control.

oozing.

gauze tapes with

such measures.

leading

the main bleeding

drugs may be given profusely.

and marked

or coffee

from small areas of point

oozing,

function

that is very difficult

may be used; No. 25 hemostatic


massive

Poor liver

can save expenses

When a large number

the patients

blood type, so that splenic

may be organized
blood can be fully

utilized.

6. Postoperative

Postoperative
the recovery
enforce

bleeding

of the patients.

sterilization

scientiously

Care

Therefore,

and aseptic

and carefully

the usual postoperative


the following

and subphrenic

carry

abscesses will greatly

medical

techniques

during

out the operative

management

for major

two points:

147

personnel

must strictly

the operation
procedure.

abdominal

affect

and con-

Besides

surgery,

note

Postoperative
ing is mainly
hesions;

Bleeding

It may also occur

should be carried

pulse should frequently


observations

occurs

surface

or a collateral

within

out after

12 hours after

operation;

should be made and blood replacement


laparotomy

of ad-

the operaClose ob-

the blood pressure

With the appearance

bleed-

vessel missed

3 days, but this is less common.

be checked*

there is deterioration,

internal

wide oozing

mechanism;

usually

within

Postoperative

conditions;

of coagulation

operation.

servation

bleeding.

due to poor general

disturbance

during
tion.

internal

and

of bleeding,

given in time.

should be immediately

close

Once

performed

to

stop bleeding.

Postoperative
because

there

operation.

infection.

was a lack of aseptic

Usually

diagnosis

ness of left

tion of left

findings

diaphragm

the

The most common

coli.

The general

shadow,

and sometimes

Supersonic
They also estimate
culture

increased

examination

not serious,
antibiotics

of fluid.

tender-

state.

or effusion,

increased
density

eleva-

distance
of the local

are accurate

Diagnostic

procedures.

aspiration

and bac-

tests can be utilized.

irrigation

injected

marked

levels.

the abscess, if the toxicity

and the abscess cavity


Sectioning

fluid

increased

and localization

the amount

local

reaction

of movement,

and the diaphragm,

and drug sensitivity

In treating

shoulder,

of WBC and neutrophils.

of left phrenic

and limitation

the stomach

formed.

mainly
during

operation.

soreness of left

of an increase

findings

between

severe,

1 week after

angle, anorexia, and poor mental

costophrenic

c. Fluoroscopic

suitable

or sterilization

aureus or Racillus

high fever,

b. Laboratory

cemia

abscess occurs

for abscess follows:

a. Unrelenting

terial

technique

it occurs about

areStaphylococcus

pathogens

Subphrenic

is not severe and the septi-

of the abscess may be performed

into it.
large,

If the infection
then early

the 11 th rib to accomplish

148

is serious,

drainage

and

toxicity

.should be per-

extraperitoneal

drainage

is safer and allows


immediately

drainage.

search

After

the occurrence

of subphrenic

for the cause, and take appropriate

abscess

measures

to prevent

spread of infection.

B. Bleeding

Rupture
bleeding
portal

of the Upper Alimentary

Tract

of esophageal

fundus

is a frequently
hypertension.

ing can be stopped


bleeding

and gastric
encountered

If treatment

veins with

and most serious

saved.

first.

Medical

severe

complication

is given in time and properly,

and the patients

should be attempted

varicose

treatment

If it is ineffective,

of
most bleed-

to stop

then surgical

treat-

ment should be considered.

Medical

treatment

ing or if bleeding

1. General

is usually

for patients

stopped

at time of visit.

has practically

who have slight

bleed-

Treatment

a. Nothing

by mouth.

Bedrest.

b. Blood transfusions,
excessive

suitable

blood and plasma

fluid

replacements

transfusions

c. Use of antihemorrhage

(it should be noted

may elevate

drugs, vitamins

portal

that

pressure).

Kl and Kg, benzoicum,

6-aminocaproicum.

d. Use of pituitrin.
intravenous

drip, infused

20 units
within

added to 200 ml of glucose (5%) for

30 minutes.

If necessary may be repeated

once in 4 hours.

e. Oral antihemorrhage

powder.

At present

several

are in use,

such as No. 3, 8, 10, 202, and thromboplastin.

2. Plugging

With Triple

Tube and Double

a. If the blood pressure


or hematemesis

and melena

cannot

cannot

Sac

be maintained

be controlled

149

after

at or near normal
the above

treatment,

then plugging

Miller-Abbott
be used.

double

Before

volume

with a triple

tube and double sac or a remodeled

tube and single sac (more suitable

using this method,

examination

of the air sacs and for any leakage.

the patient
dicaine

during

placing

and an injection

should be lubricated
b. First
tube through
stomach

with

aspirate

plugged

cavity.

esophageal
After

and stomach
Inject

the cardia.

of the nostril.

sac.

Usually

Inject

pressure

the stomach

thrown

ferentiates

from
bleeding

c. Aspirate

fundus varices.

of bleeding,

is required.

The aspiration

if pressure

If fresh

of esophageal
Otherwise,
This method

it is
dif-

fundus or from the esophagus.

the blood in the stomach

the rapidity

applied

the cardia,

hematemesis.

to the esophagus.

of gastric

from the gastric

tape to fix

about 150 ml of air into

up, it proves that there is a rupture

a rupture

Now

is not immediately

blood is still

only bleeding

The

of resistance.

tube is pressed against

must be applied

Pass the

for 55 cm.

Use adhesive

should be made to see if there is still

and pressure

with

200 to 250 ml of air into

observations

varices,

of

The air sacs

there is no air.

there is a feeling

against

the tube on the skin outside

to the esophagus.

may be sprayed

(25 to 50 mg) be given.

into the esophagus

the sac, and pull the tube out until

the proximal

the suffering

oil.

sac is now in the gastric

the sac is already

To relieve

the two air sacs until

the nostril

should

should be made of the

of the tube, the throat


of phenergan

for children)

from the tube to determine

is effective,

and whether

tube may be used to aspirate

an operation

and to supply

nutrition.

d. If pressure
hours.

Applying

necrosis.

During

and retained
oil orally,

is effective,

pressure
removal

it is continued

for too long may cause mucosal

for 48 to 72
maceration

of the tube, the air sacs must first

for a few minutes.


and then slowly

generally

Make the patient

and

be emptied

take some lubricating

pull out the tube to avoid trauma

that may again

cause bleeding.

e. During
observation

the use of triple

tube-double

must be made to avoid rupture

150

sac pressure

method,

of the air sacs; slipping

close
out

of the tube can result


can result

in the loss of function

3. Surgical

Operative

Diversion
vein system
portal

in suffocation,

pressure,

a. Marked

tape

Methods

Anastomosis

of the inferior

thus decreasing

rence of ascites.

of the adhesive

of .air sac pressure.

operations.

to a branch

or a loosening

The following

of a branch

vena cava system

the alimentary

tract

contraindications

of the portal
should lower

bleeding

the

and recur-

should be noted:

cachexia.

b. Jaundice

(or bilirubin

c. Prothrombin

d. Elevation

above 1.5 mg/lOO ml).

time 40% below normal.

of SGPT, SGOT.

e. Progressive

ascites.

f. Old age.

Selection
has certain
pathy

rarely

of diversion

effects
occurs,

in lowering

of simple

not evident,

excision

multaneously.

pressure.

in splenorenal

splenorenal
of the gastric

When the calibers

not equal or the splenic

Splenorenal

Postoperative

so it should be the first

a. Some precautions
the effects

procedures.

shunt should be taken.

coronary

to lower

151

encephalo-

When

the pressure

are

veins may be performed

of the splenic

of the veins may be performed.

diversion

choice.

anastomosis

vein is too short,

anastomosis

vein and renal

then side-to-side

si-

vein are

anastomosis

b. Anastomosis

of the superior

vena cava may be used.

The choice

conditions

of the patients

procedure

is a side-to-side

of failure.

Artificial

diversion,

of procedure

and the operators


anastomosis,

but the rate of thrombosis

vein will

they cannot

The more ideal

is a frequent

cause

vessels may be used for bridge

is high.

Sectioning

anastomosis

in lower

of the inferior

to the superior

limb edema.

mes-

For these reasons

be used routinely.

c. Portacaval
lowering

result

depends on the actual

but tension

end-to-side

frequently

vein to the inferior

experience.

vessels or autogenous

vena cava and performing


enteric

mesenteric

pressure

shunt also is available.

and in treating

the rate of encephalopathy


the development

upper alimentary

complication

of this operation,

when the above methods

cannot

be less than 1.5 cm to decrease

Although
tract

is very high.

We advocate
be used.

its effect
bleeding

is good,

This problem

limits

the use of this procedure

The anastomosis

the occurrence

of

opening

of portasomatic

should

encephalo-

pathy.

Interruption

operations.

blood to the esophageal


of treatment

of bleeding

simultaneously

with

of the portal

vein with

to the gastric

coronary

splenorenal

with

of the short gastric


effects

Postoperative

I,

of the esophageal

shunt,

veins may be performed

interrupting
veins.

direct

It will

veins and to the esophageal


Performing

splenectomy

gastric

coronary

and prevention

meal examinations

incision.

152

veins and then to the


vein excision
of the blood flow

vein systems.

Thus it has

of recurrent

of most of the varices

or midline

the blood flow

bleeding.

of the esophagus

of vessels surrounding

upper rectus

communication

direct

coronary

causes interruption

vein and gastric

disappearance

b. Excision

coronary

the esophageal

in the treatment
barium

ment or entire

of gastric

splenorenal

anastomosis.

simultaneously

Make a left

from rupture

for the purpose

fundus varices.

a. The excision

certain

flow of the portal

azygos vein system is interrupted

and prevention

and gastric

The retrograde

show improve-

verifing

the stomach

this point.

may be used.

On the greater

curvature

side, ligate

the short gastric

sever and ligate


pancreas;
pylorus

and left

vessels on the posterior

on the lesser curvature


to the cardia

the vessels around

(left

effective

in upper alimentary

patients

of or prevent

ligation

neously

during

excision

vessels.

good method.

of gastric

solve

for bleeding

and not suitable

fundus

layers using No. 0 ligatures

compensation,

this operation

by direct

simultatract

bleed-

is performed

ligation.

and

It is only

part may be performed.

or esophagus directly
encephalopathy,
operation,

removes

Partial

the bleeding

part,

and is a comparatively
and some patients

of excision

in the treatment

Hepatic function

is performed

fundus veins gives poor short-term

There a.& also reports

satisfactory

5 cm from the cardia,

with upper alimentary

of bleeding

of diversion

with splenectomy

and sub-

the stomach.

But it is an extensive

fairly

About

layers

cases.

excision

has no complication

function

suitable

seromuscular

This procedure

In patients

emergency

of gastric

ing, with

and safe, is somewhat

condition,

of the gastric

but it can stop bleeding

e. Direct

neously

It is especially

of vessels surrounding

used in certain

it.

and may immediately

bleeding,

have had the spleen removed,

effects,

tolerate

veins are

tract

of the seromuscular

splenectomy.

d. Ligation

excision

sever and ligate

is simple

incision

the submucosal

long-term

the vessels from the

This operation

ill, in poor general

incision

ing who already


with

from the

if the subphrenic

of vessels may be performed.

make a circular
to ligate

wall coming

operations.

c. Circular
mucosal

and veins;

and its branches);

esophagus;

bleeding.

who are critically

for diversion

artery

the abdominal

they are also ligated.

gastric

arteries

sever and ligate

gastric

dilated,

the problem

gastroepiploic

of the gastric

cannot

fundus simulta-

of upper alimentary

tract

bleed-

results.

compensation.
we can divide

Based on the condition

upper alimentary

tract

of hepatic

bleeding

into

two types.

One type shows poor hepatic


by marked

ascites,

marked

jaundice,

function

hepatic
153

compensation,

coma! or prodromal

manifested
symptoms

of hepatic
tric

coma.

fundus

version

In this case, we perform

veins but retain

gastric

the spleen to avoid losing

ligation

of gas-

the chance of a di-

In patients

who already

have had the spleen removed,

of vessels surrounding

the stomach

plus circular

procedure.

excision

transabdominal

seromuscular

layers

and submucosal

ligation

incision

of the

of vessels may be

performed.

Another
jaundice,

type has with

good hepatic

In this case, perform

and no ascites.

plus splenorenal

shunt or splenectomy

of the stomach.

In patients

of surrounding

layers

emergency

superior

mesentery

anastomosis;

the selection

of an operation

diversion
gastric

operations
fundus

ligation

of surrounding

incision

ligation

of gastric

Otherwise

perform

vena cava anastomosis

based on the experience


fcr postsplenectomy
,f gastric

vessels

perform

of vessels.

vein and inferior

or excision

of different
bleeding

hospitals,

may be between

fundus and partial

excision

of

and esophagus.

At present
effective

plus circular

no

splenectomy

who have had a splenectomy,

and submucosal

or portacaval

compensation,

emergency

plus excision

vessels of the stomach

seromuscular

function

these two operative

in upper alimentary

methods

t;- ict bleeding.

are comparatively

These methods

used in the young with no marke#I disturbance

of hepatic

In the management

bleeding,

of upper alitI-:entary

procedure

is chosen,

the followi:-r:

to prevent

the occurrence

a. Give neomycin

measures

of hey,ritic

0.

tract

should be

or renal
no matter

functions.
what

should be taken in all cases

coma.

c; every 4 hours orally

or through

a stomach

tube.

b. Give 30 to 40 ml :,lagnesium
daily

orally

or through

a stomach

sulfate

(50%) one to two times

tube.

c. Saline enema dail J.

d. Use deammoniating
mate 23 g intravenous
or N-aminobutyric

drugs such as potassium

drip, once daily;


acid 2 to 4 g.
154

or use arginine

(sodium)

gluta-

acid 10 to 20 g,

C. Colonic

Pathological

Schistosomiasis
complication.

colonic

examinations

granuloma

Diagnosis

transverse

colon.

during

the operation

If it is confirmed
then local
If there

changes,

excision

mesentery

of multiple

and further

changes.

Carcinoma

1. Preoperative

operation,

granuloma

observations

full

diet,

and a liquid

3 days before

streptomycin

colon and
are stric-

a frozen

section

without

malignancy,

will be sufficient.

as carcinoma

in the mesentery

tract

examination.

symptoms.

of the

or base of the

Operative

are needed to detect

excision

any malignant

as follows:

Preparation

5. One week before


4 hours;

examiin the

When there

the stricture

of the colon is treated

a. Low-residue
before

colon.

then it is treated

does not cause intestinal

is difficult,

is found mainly

granuloma

of the mass to relieve

Occurrence

rectal

in the descending

it is best to perform

changes,

X-ray

is necessary.

to be schistosomiasis

are malignant

colon.

surgery

the rate of malignant

Digital

The pathology

next in frequency

encountered

by gastrointestinal

splenectomy.

It is rare in the ascending

tures or malignant

During

because

is made chiefly

and exploration

colon and rectum,

is also a frequently

carefully

should be made routinely.

sigmoid

every

in Schistosomiasis

It should be treated

change is very high.

nation

Changes

followed

by semiliquid

diet 1 day before

operation

operation

start

diet starting

3 days

operation.

sodium giutamate

change to or add neomycin

2 g every
1.0 g or

0,5 g, four times daily.

c. Three days before

operation

give vitamin

d. Three days before

operation

take liquid

evening.

155

injection.

paraffin,

20 to 30 ml,

e, Three days before


before

operation

low-saline

tion;

operation

give cleansing

enema, and retain

g. Preoperatively

correct

2. Surgical

Treatment

obstruction,

insert

stomach

anemia,

perform

of Carcinoma

a palliative

into an operation

operation,

a cecostomy,

cal operation

for carcinoma

carcinoma,
mosis.

operation.

perform

For left

anastomosis.

sverse colostomy

Radical

adhesions,

various

In carcinoma

adhesions,
dilated

adhesions,

and inflammation,

local

inflammation

of perforation.
and two-stage

determine

a tran-

on the colon,

of the colon is accompanied

Below

adhesions,

the stricture

separation

156

of

if there

excision

should

by stricture,
is markedly

the wall is edematous.

becomes

abscess formation,

should be performed,

and the prethe choice

a one-stage

All these are contraindications


operations

perform

of the carcinoma

or inflammation,

and possible

anasto-

colostomy.

of any position

thin.

colon

colon and sigmoid

the lumen above the stricture

and the wall becomes

when a radi-

For right

carcinoma

or inflammation

When carcinoma

When there are widespread

colostomy.

side-to-side

a transverse

The position

sence of strictures,

be attempted.

perform

colostomy.

is performed

or ileosigmoidal

colon

For descending

a transverse

For sigmoidal

operation.

are no strictures,

perform

or upper descending

operations.

a cecostomy.

of the colon is not possible.

colon carcinoma,

colon side-to-side

For right

or ileotransverse

This procedure

ileotransversa

operation.

obstruction.

perform

for acute

and a radical

ileostomy,

colon carcinoma,

Palliative

and dehydra-

of the Colon

may be divided

For tramverse colon carcinoma,


colon and sigmoid

give

tube and catheter.

hypoproteinemia,

O_oerat.im fm acute titestinal


carcinoma,

operation

B and C.

The types of surgery


intestinal

The night

an anal tube.

of operation

vitamins

Two hours before

enema.

f. The morning

and supply

give enema every night.

difficult;

with

there is the danger

to one-stage

resection,

3. Operative

Methods

Depending
methods

for Carcinoma

on to the different

of Different

positions,

Parts of the Colon

any of the following

may be used:

Carcinoma of the cecum, ascending colon,


The operative
hepatic

method

flexure

for carcinoma

is the same:

of the cecum,

a right

lectomy.

Because

by the midcolic

artery,

for carcinoma
ability

the whole length


a total

To allow
cessary

colon.

to mobilize

and left

Carcinoma of the left


and sigmoid colon.
Perform

Transabdominal

before

one-stage

tension,

of colon,

it is frquently

ne-

of the sigmoid colon and rectum.


and anastomosis

are possible.

first

If the

a preventive

co-

the carcinoma.

Carcinoma of the rectum.


operation;

is very important.

for all.

lostomy

resection

the vi-

descending colon,

of the mass is very low, it is safer to perform

abdominal-perineal

co-

of the colon.

position

and then resect

and

transverse

To determine

a left hemicolectomy

resection

colon,

colon is supplied

anastomosis

flexures

flexure

of the junction

Carcinoma

flexure.

must be performed

colon.

to be made without

the right

Perform

colectomy

of any part of the transverse

the anastomosis

ascending

of the transverse

transverse

of both ends of the intestine

and hepatic

hemicolectomy.

Carcinoma of the transverse

The following

of the rectum

(Miles

three

methods

operation);

are used:

Dixons

and Bacons operation.

IX.

Treatment

Strengthen

of patients

schistosomiasis.
anteeing

five

increased

The Leadership

is an important

It is also important

Role in Treatment

link in the elimination

in protecting

farm production.

157

work capacity

of
and guar-

Enthusiastically
with
health

these doctors
clinic,

as the backbone.

patients

and effectiveness,

treatment

be treated.

Organize

with

as a major duty.

or brigade.

Dispense
conveniently.

emergency

be responsible

severe reactions.

a treatment

health

clinic,

should consider

treatment

drugs to the household,


Early
treatment

for consultations

Draw on experiences,

treatment.

158

and chronic
units,

to;im
commune

treatment

Under the prerequisite

adopt the system of establishing

can receive

instructions,

The brigade

and Hsien peoples hospital

schistosomiasis

the commune

local doctors, and establish

train

of
of safety

centers

at

so the people

cases also should

make rounds and give

and management

of patients

and raise the standard

of

Chapter 7
PREVENTION

AND TREATMENT
AMONG

Prevention

and treatment

only keep the cattle


also an important

FARM

in eliminating

of measures

of manure,

tion of migration

Control
methods,

for production,

but is

of Schistosomiasis

Farm Cattle

is needed for the prevention

Besides actively
control

not

schistosomiasis.

of Prevention
Among

be control

among farm cattle

and is advantageous

I. Methods

asis among farm cattle.

CATTLE

of schistosomiasis

healthy

measure

A combination

OF SCHISTOSOMIASIS

treating

of water,

cattle,

elimination

of schistosomithere must also

of snails,

and preven-

of sick cattle.

of manure.

local

Prevention

should coordinate

fertilizer-collecting

methods,

farm production

and proper

control

of cattle

manure.

Control
by farm

of water.

cattle

In schistosomiasis

must be from

water

the snail has been eliminated.

Prevention

sources with

Use designated

must be treated

only after

treatment

locally

and cure.

areas, the water

used

no snails or in pools where

pools for water.

of movement of sick cattle.

schistosomiasis
cality

epidemic

Any cattle

sick with

and be sold or sent out of the loIn infected

areas, farm cattle

should

be kept in areas with no snails.

II.

Methods

for Investigation
Among

General
oughly.

investigations

General

be performed

investigation

in cooperation

of Schistosomiasis

Farm Cattle

must be carried

out conscientiously

for schistosomiasis
with

health

159

and thor-

among farm cattle

departments,

learning

from

must
each

other

and working

together,

and time and accomplishing

A.

Requirements

examined

the proper

three

through

quality

cattle

of the package.

sunshine

manure.

or drenching

tion with

not be used to fill

Completion

in human

may be used, but not paper used


fertilizer.

Establish

of farm cattle

manure

method

Each specimen

out general

transport

avoid

order.

the manure,

Red ink should

acomplete

system

of

schistosomiasis.

is still

examination

in lightly

of hatching

examination.

should be recorded

infected

The differences

special

to help in identifying

160

times.

areas, uncontami-

manure

is the same as

are:

the type of cattle,

If possible

three

for

to help in the diagnosis.

sick cattles

the card, include

tle, and name of the keeper.

the main method

should be examined

may be used for contrast

the procedure

1. In completing

During

The cattle,

and be in proper

the manure-hatching

manure

or seeping

Method

examination.

cattle

for obtaining

of the card must be done in consulta-

and registsation.

B. Manure-hatching

Basically,

The instruments

rain.

and registration

In carrying

and have it

in the card.

Investigation

At present

punctual

Obtain. 2 to 3 oz of manure

or chemical

and the card must all be checked

manure

of manure

the person who feeds the farm cattle.

investigation

a reliable,

There should be no leakage

Paper packages

farm chemicals

Complete records.

cattle

Designate

and quantity

should not be mixed.

for wrapping

nated

for Examination

(not less than the size of a ducks egg).

the manure

manpower,

times.

Pack and transport


daily

Manure

manure for examination.

Collect

material,

the objective.

for Sending Cattle

Send cattle
person.

thus saving equipment,

sex, age of cat-

characteristics
the cattle.

of the

2. The volume

of manure

3. The manure

sieve should be bigger.

40 holes/in

Sieve holes should be

2 (Fig. 28).

4. Thoroughly
requires

should not be less than 100 g.

wash and stir the manure

evenly.

Each manure

specimen

1 to 3 minutes.

5. Time intervals

for water

change for sedimentation

and 10 minutes.

If the supernatant

water

exchanges

may be increased.

20C,

1.2% saline

remains

In summer

turbid,
with

the number

a temperature

of
above

must be used to wash the manure.

6. In winter,

at intervals

each specimen;

fluid

are 30, 15, 10,

in summer,

of 2, 4, and 6 hours after


observe

cause of the large bulk of cattle


tion must be carried

1, 2, and 5 hours after

manure

out carefully.

hatching,

observe

hatching.

and the low ova density,

Each hatching

bottle

Be-

observa-

should be observed

for 2 to 3 minutes.

III.

Methods

of Treatment
Among

To accomplish

the treatment

Examination

If farm
first

cattle

standard

of treatment,

be delayed,

a. Obtain
feeding

decide

one must

and cattlemen.

a detailed

with

schistosomiasis,

they should

Then based on the conditions

if the cattle

should be treated,

and the

treatment

not given at all.

of the Health

and management

local veterinarians,

to be infected

examination.

or treatment

1. Main Items

successfully

Procedures

are found

be given a health

Farm Cattle

of schistosomiasis

depend on the poor and the peasants,

A. Health

of Schistosomiasis

Examination

history

of the sick cattle,

conditions.

161

their

habits,

and

Figure

28. Manure

sieve (unit:cm;

162

40 sieve holes/in).

b. A systemic
items

are:

ristalsis

body temperature,

of rumen,

condition

examination

diagnostic

mental

heart

state,

The chief

rate, heart rhythm,

appetite,

visible

pe-

mucosa,

and

Note if there is limping.

c. If necessary
other

respiration,

rumination,

of nutrition.

should be given to each cow.

perform

routine

blood and urine

examinations

and

tests.

d. In a cow the sexual

behavior,

pregnancy,

and nursing

conditions

should be recorded.

2. Normal

Physiological

Standards

a. Body temperature:
to 38C.

Heart

rate:

yellow

of Farm Cattle

yellow

cattle

37.5OC to 39C;

cattle,

40 to 80 beats/min;

buffalo

buffalo,

37C

40 to

60 beats/min.

b. Respiration:

10 to 20 times/min.

c. Rumen peristalsis:

d. Blood:
bilirubin

within

2 to 5 times/2

RBC 5 to 7 million;

min.

WBC 5,000 to 9,000; Hb above 5 g;

0.001 to 0.03 g.

e. Urine:

Protein,

sugar, ketone

for Delayed

Treatment

bodies,

urobilinogen,

hemoglobin;

all negative.

3. Reasons

a. Past the first

trimester

of pregnancy

of location.

b. Cow in heat.

c. Nutrition

below

50% of normal

163

values.

and within

the first

3 months

d. Abnormal

blood or urine.

e. FYesence of acute or chronic

B. Cattle

Not to Be Treated

Old and crippled


with

diseases..

serious

cattle

that have lost their

diseases that failed

to respond

ability

after

to work and those

treatment

should not

be treated.

IV.
A.

Calculation

of Body Weight

For accurate
ground

Drug Dosage and the Course of Treatment

measurement,

and with proper

measure

the length.

shoulder

to the ischial

value

obtained.

posture.

bone.

To measure
surrounding

the shoulder

bone.

body length

the chest circumference,

the chest at a point

During

extends

measurement

on a flat

and precisely

from

the tip of the

Both sides should be measured

and an average

record

the length

on the posterior

angle of

the tape measure

must be pulled

(Fig.29).

B. Drug Dosage and Treatment

Course

Drug dosage should be carefully


dosage for yellow
that

must stand up straight

Find the measure points

The diagonal

of one circle

tight

the cattle

for buffalo,

cattle

severe

is calculated

during

treatment,

more severe in old cattle

at a 350 kg maximum

reactions

among yellow

more severe in spring


than in younger,

the season, the treatment

must be considered

In the Shanghai

area, the

weight;

and

of Drug Dosage

than in buffalo,

Therefore

controlled.

17)

at 450 kg.

C. Determination

Generally

(Table

and analyzed;

and usually

objective,
veterinarians,

164

or winter

cattle

are more

than in autumn,
mild in calves.

and the treatment


keepers,

method

and leaders

must

Table 17.- Drug Dosage and Treatment


Actual
Name of drug
Antischistosome-846

dose

of drug

Course

Treatment
Daily dose

course

Method

Total dosage

0.2 g/ml

80-90 mg/kg

10 days

oral

800-900 mg/kg

0.2 g/ml

35-40 mg/kg

5 days

i.m.

175-200 mg/kg

0.23 g
per tab.
0.21 g/g

100 mg/kg

10 days

oral

oil solvent
(20%)
Antischistosome-846
oil solvent
(20%)
Antischistosome-846
tablet
Antischistosome-846
1
milk powder
Tartar

emetic2

Antimony-273
1

2
total

May give trial

0.01-0.03
g/ml
course with slightly

oral

2 mg/kg

3 days

i-v.

5-6 days

i-m.

2 mg/kg

lower total

of oral "846" oil solvent

1000 mg/kg
-

10-12

dose.

Total dose for yellow cattle not exceeding 1.7 g, for buffalo 2.2 g, daily
dose not exceeding 0.5 g; rest of dose inject on 4th and 5th day.

mg/kg

Figure

1. Shoulder
3. Diagonal

29. Tape ruler measurement


of cattle body,
bone [outline)
body length

2. Chest

Note: Calculation
of body weight
when stomach is empty.
The method
is as follows:

of parts

circumference

should be made
of calculation

Yellow cattle
body wt (kg)

=(chest

circumference)

2 X diagonal
10,800

body lenpth

(cm)

Buff alo body


wt (kg)

=(chest

circumference)

X diagonal
12,700

body length

(cm)

166

work together
point

D.

to determine

is important

the drug dosage for each sick animal.

for proper

Requirements

treatment

antimony
divide

calls

tablet

drug treatment,

into groups,

for ear;]

3. Strictly

adhere

safely

accurately

calculate

early.

dis-

Any change of disease conditions

and plan (especially

procedures.
with

and the method

during

pay attention

record

follow

in giving

card (Table

treatment);

drugs (note the quality

of preparation);

to safety

One must be

antimony

drug dosage and secondary

4. The treatment

and keepers;

and early treatment.

of drug, number,
injection;

points,

stages of the disease.

to the rules of medical

protect

With

should adopt small concentration

system of veterinarians

side reactions

by local

sent to each location.

the different

the on-duty

consultation

should be administered

packages

leaders

and treat

and prevent

able to:

treatment

in separate

2. Consolidate
cover

reactions.

for Treatment

1. Antischistosome-846
veterinarians

and to decrease

This

strict

asepsis

drugs.

18) and registration

must be kept

conscientiogus!y.

5. Medical
70% nursing

treatment
care.

Nursing

and help the sick cattle

6. Conduct

for sick cattle

study

consists

care must be stressed

classes for the schistosome


in nursing

in drinking

mental

sure is important

and appetite,

working;

b. On-duty
ment (night

duties

to decrease

reactions

veterinarian

personnel;

starting

care; note closely

state,

in the early prevention

a. One week before


or decrease

and

to early recovery.

raise the sense of responsibility


habits

of 30% treatment

urine,

the changes

and feces.

This mea-

of side reactions.

treatment,

the sick cattle

should stop

bulls should stop studding.

system

must be strengthened

should be assigned during

167

during

antimony

the course of treattreatment).

Nursing

z
u8

u
F-4
a
z
td

.
m

Qo

0
.-I

U
l-4

&
El
u

i
U
u.4

i!

..

s
P
W
U
1
*r(
u

u-4
0

c-4

fi

168

.
ii

care should be conscientious.

During

and antimony,

should drink a lot of water.

the sick cattle

water

should be given.

straw

on the ground;

treatment

with

antischistosome-846
In winter

warm

The barn should be kept clean and dry, with

much

the cattle

should be kept quiet.

cattle

should be kept cool, and in winter

warm.

treatment,

not to go into creeks, bulls and cows

it is best for buffaloes

should be in separate
injections

During

In summer

barns, bad-tempered

should be stopped,

the course of antimony

cattle

and treatment

should be kept solitary,

should be postponed

in cows

in heat.
c. After

treatment

.taking the cattle


nursing

perform

back to the production

care should be continued;

treatment.

a health

After

treatment

days; then the labor

Side Reactions

of Tartar

After

once more before


return

note any side reactions,

is gradually

V. Side Reactions

A.

team.

the sick cattle

capacity

examination

and give early

should not work for 20 to 30

increased.

and Their

Emetic

to the team,

and Their

Treatment

Management

1. Local Reaction

Slight
severe,

swelling

does not require

cold or hot compresses

severe pain, cold compresses


may be used.

In addition,

treatment.

If the swelling

may be used to eliminate


or procaine

a solution

hydrochloride

of glycyrrhiza

is more

swelling.

With

(0.5%) local block

powder

(20% suspension)

also may be used locally.

2. General

Reaction

a. Treatment

may be continued

is less than lC

and there

is elevated

lC

to 2OC continuously

of injection

may be considered.

supplied;

if necessary,

if the body temperature

are no other

normal

reactions.

If the body temperature

for 24 hours, then discontinuation

Adequate
saline

elevation

drinking

water

enema may be given.

169

also must be

b. In serious

muscular

should be discontinued,

convulsions

and the following

Sodium phenobarbital,
sulfate

10% hypertonic

saline

one may tie

muscularly

50-100 ml i.m. or i.v.

drugs, such as benadryl

then injections

reactions

once after

of tartar

emetic

of body

solution

(5%) intra-

with

atropine

sulfate

10 mg atropine

sulfate

hyperextension,

solution

and other sedatives

suddenly

or weakness

muscular

sulfate
repeat

Either

5%

(20%) intravenous-

may be given in this case.

symptoms

spasms, peripheral

of

coldness,

pulse expansion,

and

aid must be given in the form of 3 to 5 ml atropine


solution

(20%) intravenously

once;

(5%) intravenously.

In sick cattle
as adrenalin,

solution

sound, irregular

(5%); 200 ml glucose

1000 to 200 ml glucose

treatment,-

or intramuscularly;

drops to the ground with

of cardiac

first

when the

for a long time

should be discontinued.

severe convulsions,

difficultbreathing,

and continue

added to 100 ml glucose

If a sick animal

Generally

If necessary,

3 to 5 ml, subcutaneously

ly; or sodium phenobarbital

and are the

and 10 to 30 mg atropine

occur

injections

solution,

treatment.

or subcutaneously.

If extrasystoles

arrhythmia,

most frequently

or over 20 beats more than before

should be discontinued,

4 hours.

together

under tartar
caffeine,

In the use of atropine


watched

(0.5 mg/kg

sulfate

are encountered

should be given intramuscularly

mulants

treatment,

or subcutaneously.

rate is above lOO/min

sulfate

occur during

or 3 to 5 ml atropine

most serious reactions

arrhythmia

g i.m.

200-300 ml i.v.

antihistaminic

c. Cardiac

heart

injections

drugs be chosen for use:

of skin rash or urticaria

intramuscularly

tremor,

100 ml i.v.

solution

If symptoms

weight)

0.5-l

25% magnesium

50% glucose

and general

for; if the pupils

emetic

coramine,

sulfate,

become

treatment,

such cardiac

sti-

and digitalis

are contraindicated.

its side reactions

should be carefully

dilated,

170

then it should be discontinued.

If the rumen becomes


taken:
water

dilated

massage the left


for ingestion;

the rumen,
needle

measures

or use 15 g ichthyol

a needle with

and 100 to 500 ml saponated

stylet

cresol

should be

and 500 ml warm

may be used to aspirate

(1%) injected

through

the

to stop fermentation.

1. General

of Antischistosome-846

Alimentary

This reaction
anorexia,

constipation

of nux vomica,

and Their

of rhei,

taken orally

by decreased

peristalsis

The following

30 ml tincture

of the rumen,

drugs may be used:

of gentian,

10 ml tincture

once for 2 to 3 days.

add 500 ml water,

30-50 g charcoal

Management

Reaction

or loose stools.

5 g ichthyol,

300-500

Tract

is manifested

30 ml tincture

powder

g magnesium

take orally.

(or tablet)

sulfate,

once orally.

add 1000 ml or more water,

take

once.

100-200 ml sodium

50-80 g artificial

2. Liver

Toxemia

Liver

toxemia

mental

gag the following

abdomen,

if severe,

B. Side Reactions

orally

with

depression,

of feeding,

(10%) i.v.

salt, take orally

is manifested
indigestion,

distension

5% glucose

chloride

in normal

25% hypertonic

by yellow

diarrhea,

of rumen.

1000-2000

solution,

171

tinge

of visible

foul-smelling

Choose from

saline,

glucose

once.

stools,

the following

ml, i.v.

100-200

ml, i.v.

mucosa,
cessation
prescriptions:

Compound
weight

i.v.

vitamin

B and vitamin

of Excitement

When such symptoms

occur,

chlorpromazine

(2-3 mg/kg

of body

i.m.) may be used.

4. Elevation

of Body Temperature
.

Use antibiotics

and sulfonamides.

VI.

After

completion

investigate

changes

ability

after

Three

months

the effect
gative

of body

3, Symptoms

weight

C l-2 g or 2-3 mg/kg

Work after

of treatment,
of general

treatment,
after

of Treatment

close followups

health,

working

in order to determine

treatment,

of treatment,

Conclusion

capacity,
the final

use manure-hatching

and observe whether

for the test.

172

must be planned

to

and reproductive
effect

method

the manure

of treatment.
to reexamine

has turned

ne-