These findings cannot as yet be considered of diagnostic value.
Various Helminthological Infections.—In the earlier stages of ancylostomiasis and schistosomiasis we have a rather notable increase in the percentage of eosinophiles but with the advanced stages of these infections, with severe anaemia, the eosinophiles may even be absent.
One should always keep in mind the very characteristic and marked eosinophilia of trichinosis when such a blood finding is encountered. There is often a leucocytosis of 15,000 to 20,000 in this disease.
In the urticarial fever stage of Japanese schistosomiasis the marked eosinophilia is of great assistance in diagnosis. One trouble about attaching importance to eosinophilia in the tropics is the confusion which is difficult to eliminate and which arises from infections with the more common but less important group of intestinal parasites such as Ascaris, Trichuris, etc.
The eosinophilia-producing characteristics of many skin diseases must also be kept in mind.
CHAPTER XLVI
THE CIRCULATORY, RESPIRATORY AND LYMPHATIC SYSTEMS TOGETHER WITH ANAEMIA, HAEMORRHAGES AND OEDEMA IN TROPICAL DISEASES
The Circulatory System
Beriberi.—Almost as important in diagnosis as the weakness of the legs, with anaesthetic and oedematous areas, is the early palpitation of the heart upon the slightest exertion. Later on as the vagal degeneration becomes more prominent we have a loss of the normal cardiac rhythm, to even become embryocardial, together with dilatation of the right heart, pulsating jugulars and various blowing murmurs, which are propagated into the vessels of the neck. The pulse is weak and rapid and this combination of a tumultuous heart action and weak pulse is striking. Blood pressure is below normal.
Cardiac involvement is also a feature of ship beriberi as well as infantile beriberi. In the latter a marked hypertrophy of the right heart is characteristic.