Handbook On The Prevention and Treatment of Schistosomiasis

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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
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lations
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personal
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systems
Studies
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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
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Milo D. Leavitt,
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Information contained in this publication in no way reflects the

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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
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
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 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
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,
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.
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
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
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 irrigating
for small
canals come from snail-infested
ing canals in turn are pathways
results
the hot summer
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
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
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
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
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.
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;
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;
(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:
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
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
Agrimonia
terrestris,
pilosa,
5 dr; Ingluvin,
1 oz; Salvia multiorrhiza,
3 dr; Glycyrrhiza,
3 dr; method
3-5 dr; Tribulus

of preparation
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.
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)
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

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

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
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 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
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
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

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
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
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;
should not be treated
typhoid
condition
foods supplied,
of symptoms.
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
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
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,
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
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
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
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-

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A project

For F~!II bv tlo Swwrintmdent

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

Study in the Health

serve the escalating

vide the U.S.

the type of medical

the completea study

of the best features

ing some of the complex

are part of the continuing

and named in memory

in his address to the Third

1963 as a great international

of the late Congressman

work cf the Fogarty

and the nations

two decades as Chairman

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

of internaand the Pan

States and abroad.

as the focus for the dissemination

of new and valuable

have grown and

an.1 engages in less formal

such as th e b:orld Health

also has the effective

hodies and by means of bilateral

and on the Visiting

Also being implemented

Many and varied

It is part of a series of trans-

They were translated

Handbook on the Prevention

have been investigated

and by its five-year-old

have been addressed

and have been reproduced

has been deleted

for the sake of brevity.

about this and other publicationr

to Dr. Joseph R. Quinn,

Information contained in this publication in no way reflects the

Snails in Rice Paddies

Snails in Reeded Areas

3. The Proper Treatment

Chin Shan County,

4. Safe Water Use and Personal

Pools for Water Use

Safe Water Use

Ova and Cercariae

Serum Oval Ring Sedimentation

of the Upper Alimentary

for Sending Cattle

Among Farm Cattle

Drug Dosage and the Course

B. Drug Dosage and Treatment

on the head and a ventral

where the female

and male fre-

The life span of an adult

Some of the ova follow

human beings and animals