Test Bank for Negotiation and Dispute Resolution, Beverly DeMarr Suzanne De Janasz

Test Bank for Negotiation and Dispute Resolution,

Beverly DeMarr Suzanne De Janasz
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Complete and broad in coverage, NEGOTIATION AND DISPUTE
RESOLUTIONaddresses negotiations and dispute resolution in a wide
variety of settings. Because skill development is an important part of
becoming a masterful negotiator, concepts are augmented with numerous
exercises, activities, role plays, and self-assessments. By combining
theoretical foundations with experiential exercises, the book helps students
develop their ability to negotiate and resolve conflicts in both personal and
professional settings.

• Combines theoretical foundations and experiential exercises in a single

volume.
• Covers negotiation and dispute resolution in a single volume.
• Highlights the relationship between negotiating and resolving disputes.
• Explores how disputes can be resolved via negotiation and how
negotiations may result in disputes.
• Includes a complete set of experiential exercises and assessments.
• Provides students with numerous opportunities to practice their
negotiation and dispute resolution skills and better understand
themselves as negotiators.
• Gives students an opportunity to create a portfolio that documents their
progress.
• Includes Points to Ponder review material.
• Gives students an opportunity to pause to reflect and apply the material
to their own life situations and experiences as they progress through
each chapter.
• Includes Ethical Dilemmas in each chapter.
• Encourages students to focus on ethical considerations and
consequences of their decisions and is consistent with accreditation
agencies’ calls for addressing ethics across the curriculum.
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 AB
F . 111.—A and B, Case of Schistosoma japonicum. Severe infection
of three years’ duration. Ova very abundant in stools. Liver dullness
diminished. Spleen not enlarged. (From Jefferys and Maxwell.)

The course of the disease may be divided into 3 stages: the 1st,
that of urticarial, pulmonary and febrile manifestations, which lasts
about a month; the 2d, where ova begin to show in the small mass
of bloody mucus which may cap the stool, and finally the 3d stage
with cirrhosis of the liver, ascites, cachexia and death.
 In the 1st stage we have headache and an evening rise of temperature
to about 101°F. or 102°F. Shortly after the onset urticarial lesions,
which may be 2 or 3 inches in diameter, may appear and disappear on
various parts of the body.

The pulse rate is usually low. Very characteristic and early

manifestations are those of the pulmonary involvement. Here
oedematous patches may give the signs of crepitation and
consolidation to rapidly disappear and reappear in another part of
the lungs.
These pulmonary manifestations and the associated fever
frequently cause a diagnosis of broncho-pneumonia to be made. A
dry hacking cough appears early and with the fever, etc., may make
one think of tuberculosis. The urticarial lesions often cause a
diagnosis of ptomaine poisoning to be made. The blood
examination shows a marked eosinophilia, of from 30 to 60%.
The 2d stage shows more or less intestinal disturbance with at
times bloody mucus containing ova. The ova may not be present for
long intervals or may never be found. Where reinfection does not
take place the patient tends to recover but if exposure to infection
be kept up then the 3d stage sets in with rather marked dysenteric
manifestations, emaciation, anaemia, ascites, dropsy and a terminal
cachexia.
The bladder never seems to be involved in Japanese schistosomiasis.
The eggs, however may be carried to the brain and produce symptoms
of Jacksonian epilepsy.

L D

This consists in the search for ova in the centrifuged urine of

vesical bilharziasis or in the bloody mucus of the intestinal
manifestations of the disease. If one adds water to the urine the
ciliated embryo will be noticed to break out of the shell in a few
minutes and move about actively as if in search for some host.
The eosinophilia is of great diagnostic value and is usually
associated with an increase in the leucocyte count.
Fairley has introduced a complement fixation reaction in diagnosis,
using an extract of the livers of infected snails as antigen. The reaction
appears early in the infection but disappears in the later stages. It is a
group reaction as the livers of Bullinus answer for the S. mansoni
serum as well as for the specific S. haematobium serum.

Bathing should be allowed only in filtered water, there being an

absence of the infecting cercariae in such a supply.
Then, too, if a water which does not contain fresh water snails is
stored for three or four days the cercariae which might have been
present in the freshly pumped up water will have died out, such free
cercariae only surviving for about this period. The gastric juice will
destroy cercariae so that it would seem impossible for an infection to
occur by the alimentary tract atrium with the exception that cercariae
might bore their way through the buccal mucosa as well as through the
skin. The sterilization of the urine of cases of vesical bilharziasis and
of the faeces in other forms should be carried out where practicable. It
is now considered practicable to eradicate carriers of the infection with
antimony treatment.

The most important matter is to avoid places where the infection

is known to exist. If one must wade through infected waters the
body should be protected by canvas or other closely woven
garments.
 Of various treatments, having in view the destruction of the worm,
such as salvarsan, etc., none seem to have been of any value except
antimony.
Robertson has reported relief of symptoms from the administration
of 2 grains of thymol dissolved in half a drachm of benzine. The
treatment is continued for a few weeks. Others have not had good
results from this treatment. Local treatment is necessary in treating the
cystitis and prolapse of rectum. Operative procedures are indicated
where calculi exist.

The results obtained by treatment with tartrate of antimony

during the past three years justify us in considering bilharziasis as a
disease which has a specific for its cure. Almost all cases will yield
to a course of intravenous injections of from one-half to two grains
of the drug, commencing with the smaller dose. The drug should be
well diluted (25 to 50 cc. sterile saline). Some use a 1% solution but
the higher dilutions are safer from a standpoint of avoiding
phlebitis. Intravenous injections are made twice weekly and the
total amount of drug given during the course should rarely exceed
25 to 30 grains. For details see under treatment of leishmaniasis.
 CHAPTER XXIV

MINOR HELMINTHIC INFECTIONS

General Considerations
This is an infection with a trematode, Paragonimus westermanni
(P. ringeri) (Distoma pulmonale). It is rather common in some parts
of Japan and Formosa.
Arce has recently reported cases of
paragonomiasis in three Peruvians who had
been in contact with Japanese immigrants.
In 1880, Baelz found the ova in the
sputum of a case of haemoptysis in a
Japanese, as did also Manson in a
F . 112.—Paragonimus
westermanni: natural size; to left
Chinaman. Manson’s case subsequently died
showing ventral surface; to right and when autopsied showed in his lungs a
showing dorsal surface. (Braun after fluke which was responsible for the eggs
Katsuruda.) (From Tyson.)
seen by Manson. The fluke itself is a little
more than ⅓ of an inch (8 mm.) long and is
almost round on transverse section, there
being, however, some flattening of the ventral surface. The acetabulum
is conspicuous and opens just anterior to the middle of the ventral
surface.
The branched testicles are posterior to the laterally placed uterus and
the genital pore opens below the acetabulum. The branched ovary is
opposite the uterus on the other side.
It is rather flesh-like in appearance and is covered with scale-like
spines. The flukes are usually found in tunnels in the lungs, the walls
of which are thickened connective tissue. These tunnels result from
hypertrophy of the bronchioles. There may be also cysts formed from
the breaking down of adjacent tunnel walls. In addition to lung
infection with this fluke, brain, liver and intestinal infections may be
found.

The life history and mode of infection of man, further than the
miracidium stage, has been unknown until recently. If the eggs in
the sputum are shaken up with water and the water renewed from
time to time a ciliated embryo or miracidium develops after a few
weeks and, at this time if one presses on a cover-glass covering
some of these more mature ova, the miracidium will break through
the operculated extremity of the egg and swim about actively in the
surrounding water.

F . 113.—Sputum of man containing eggs of the lung fluke, greatly

enlarged. (After Manson.)
 Nakagawa has found that the miracidia infest certain fresh water
molluscs and become cercariae in this first intermediate host. From this
host the cercariae go to certain fresh water crabs and encyst in this
second intermediate host, either in the liver or in the gills. In Japan one
of these crab hosts, Potamon dehaanii, is eaten both raw and cooked.

Experimental feeding of puppies on

infected crabs brought about infection with
the lung fluke. It is thought that the fluke,
after leaving the cyst, goes through the
intestine to the abdominal cavity. Thence it
perforates the diaphragm and enters the
pleural cavity, finally penetrating the lung to
become encysted there. The lung is the
favorite site but wandering flukes may
invade other tissues and organs even
invading the central nervous system.
Besides man, dogs, cats and especially
hogs may be infected.

Symptomatology, Diagnosis and

Treatment
F . 114.—Paragonimus
The case is usually considered as one of westermanni; photograph from a
sexually immature specimen. (From
chronic bronchitis on account of the Tyson.)
occurrence of cough and morning
expectoration of a gelatinous sputum
which is usually brownish. It is popularly known as endemic
haemoptysis for the reason that after violent exertion, or at times
without manifest reason, attacks of haemoptysis of varying degrees
of severity come on. The signs on percussion are usually
insignificant while those on auscultation at the time of haemoptysis
are often marked. The symptoms often disappear for months to
again reappear.
 F . 115.—Anatomy of trematoda (flukes) of man. O S, oesophageal sucker. Ph,
pharynx. Oes, oesophagus. O P, genital pore. V S, ventral suckers or acetabulum. Ut, uterus.
Int, intestines. Ov, ovary. Sh G, shell gland. T, testicles. T G, yolk glands or vitellaria. Exc,
excretory pore.

The course of the disease is very chronic, often lasting many years.
As a rule the patient is fairly well nourished although recurring attacks
of haemoptysis may bring on a rather marked anaemia. Jacksonian
epilepsy has been reported as occurring in paragonomiasis, the ova
being found in cysts of the brain. There is some question as to whether
some of the reports as to paragonomiasis may not have been connected
with infections with Japanese schistosomiasis.

The diagnosis of endemic haemoptysis is readily made by finding

the operculated eggs in the more or less sanguinolent sputum. These
eggs are of a light yellow color and average 90 × 65 microns. One
often sees Charcot-Leyden crystals in the sputum.
 As prophylactic measures we should forbid uncooked crabs or
crayfish. The sputum should be sterilized.
The treatment is entirely symptomatic.

F . 116.—Ova of Clonorchis sinensis. After Bell and Sutton. (Jefferys

and Maxwell.)

This is an infection due to a trematode, Clonorchis endemicus

(Opisthorchis sinensis). It is also referred to as human liver fluke
disease. It is true that the common liver fluke of sheep, Fasciola
hepatica, may occur in man but such infections are rare, only 23
cases having been reported. Another liver fluke of ruminants is the
lancet fluke, Dicrocoelium lanceatum, but it is also unimportant for
man, only 7 cases having been reported.
Clonorchis infections are common in China and Japan, the fluke
being about ½ inch long by ⅛ inch wide. There is considerable dispute
as to whether we have a pathogenic and nonpathogenic Clonorchis; the
name C. endemicus applying to the former and C. sinensis to the latter.
Looss considered the nonpathogenic C. sinensis to be larger (13-19
mm.), to show pigment in its parenchyma and to have breaks in the
vitelline glands. C. endemicus was reported as smaller (10 to 13 mm.),
and without pigment or breaks in the continuity of the vitellaria.
The eggs of this fluke show slightly concave bending of the sides at
the operculated end and are about 30 × 16 microns. These flukes are
found within the thickened bile ducts and may be present in great
numbers. They may invade the pancreas as well as the liver.
These flukes are found in dogs and cats as well as man.

This fluke is supposed to produce most serious symptoms as

indigestion, swelling and tenderness of liver, bloody diarrhoea,
ascites, oedema and a fatal cachexia.
The course of the disease is insidious and chronic with periodic
improvement.

As a matter of fact, many physicians in China attribute very little

pathogenic importance to it. The disease is diagnosed by the
presence of the ova in the stools. The source of infection is
probably through the eating of uncooked fish.
Kobayashi has examined various molluscs and fish for trematode
larvae. He succeeded in infecting nine kittens and two cats by feeding
them with certain fresh water fishes whose flesh contained trematode
larvae. These fishes were found in districts where human distomiasis
was common.
 Further experiments by
Kobayashi have shown that the
larval flukes leave the cyst and
start for the biliary passages.
When the flukes are very
numerous the size is smaller.
Maturity is reached in four
F . 117.—Clonorchis sinensis. (Jefferys and
Maxwell.)
weeks. This investigator
believes that the primary
intermediate host is a mollusc
as cercariae found in these hosts are very similar to the larval forms
found in fish.
He does not consider that there are two species concerned in
Clonorchis infections, as he has found variations in continuity of
vitellaria in small as well as large flukes. Number of parasites present
influences size. Age influences pigment production.

Another human fluke, Opisthorchis felineus, inhabits the gall

bladder and bile ducts of man and it is stated that the infection is
quite common in Siberia.
It is also a parasite of cats and dogs.
Both Clonorchis and Opisthorchis have the testicles in the posterior
end with the uterus anterior. The testicles of Clonorchis are branched
(dendritic) while those of Opisthorchis show as two lobes. In
Dicrocoelium the lobed testicles are anterior to the uterus, which fills
up the posterior end of the fluke.

The mode of infection as well as the life history is not known but
is probably connected with the eating of raw fish.
The symptoms are similar to those caused by C. endemicus.
The fluke has two-lobed testicles as against the dendritic one of
C. endemicus.
 I D

The most important intestinal fluke is undoubtedly Fasciolopsis

buski. It is now thought that this infection is more common than
was previously stated. Goddard states that more than 5% of stools
examined in Shaohing, China, show eggs of this parasite. It is a
very large fluke with an acetabulum 4 times the diameter of the oral
sucker. It is characterized by a very long and prominent cirrus.
F. buski and Fasciola hepatica are much alike in size and outline.
The acetabulum of the latter is only 1.6 times the diameter of the oral
sucker and the alimentary tract shows branching which is best seen in
the cone-shaped projection of its anterior extremity. F. hepatica is a
liver fluke rarely found in man.
F. buski is found in China, Assam and India. It is a parasite of hogs
as well as man. The eggs measure from 80 to 120 microns, are nearly
colorless and have a thin shell with a very small operculum.

The symptoms are chiefly those of a chronic diarrhoea followed

by anaemia and wasting. The stool is light yellow in color,
exceedingly offensive and does not contain blood. Goddard thinks
that they live in the upper part of the small intestines.
The life history is unknown but Goddard states that fresh water
snails are much eaten by the people of Shaohing. Nakagawa notes
that the eggs of Fasciolopsis hatch in two to three weeks. The
miracidia penetrate various species of snails in which the cercariae
may encyst and infect pigs eating such snails. The cercariae may
also leave the snail and encyst on blades of grass, to later infect an
animal feeding on the grass, this latter method of infection
resembling that of Fasciola hepatica.
Noc has reported success with treatment with thymol and
Goddard with beta-naphthol.
 Other intestinal flukes such as Cladorchis watsoni, Gastrodiscus
hominis, Heterophyes heterophyes, and Fascioletta ilocana are of less
importance. Heterophyes is probably a rather common parasite but
owing to its very small size (2 mm.) has been generally overlooked at
autopsy.

S S

It was formerly supposed that a chronic form of diarrhoea in

Cochin China was due to an infection with the parthenogenetic
female of Strongyloides stercoralis. It is now known that the
parasite is widely distributed over the tropical and subtropical world
and that it rarely gives rise to manifest symptoms although some
observers regard it as capable of producing diarrhoea and more or
less anaemia.
 F . 118.—Ovum of Fasciolopsis buski. Bell and Sutton. (Jefferys and
Maxwell.)

F . 119.—Fasciolopsis buski. Cleared in glycerin. (From Jefferys and Maxwell.)

It seems to be capable of setting up quite an eosinophilia at the time

the adult female is penetrating the crypts of Lieberkühn, so that it is
probably of pathogenic importance.
 The parasitic or intestinal form (also known
as Anguillula intestinalis) is represented only
by females. These are about 1/12 of an inch (2
mm.) long and reproduce parthenogenetically.
They have a pointed, four-lipped mouth, and a
filariform oesophagus which extends along the
anterior fourth of the body. The uterus contains
a row of 8 to 10 elliptical eggs which stand out
prominently in the posterior part of the body by
reason of being almost as wide as the parent
worm.
They usually live deep in the mucosa and the
embryos emerge from the ova laid in the mucosa.
The embryos escape from the eggs while still in
the intestines, so that in the faeces we only find
actively motile embryos. The eggs, which are
strung out in a chain, never appear in the faeces
except during purgation. As they greatly resemble
hookworm eggs this is a point of great practical
importance.

In fresh faeces we find hookworm eggs and

Strongyloides embryos. The embryos are rather
common in stools in the tropics. These
embryos have pointed tails and are about 250 ×
13 microns. They have a double oesophageal
bulb. They are about 250 microns when they
F . 120.—A, Egg of
first emerge but may grow until they Strongyloides intestinalis
approximate 500 microns in the faeces. The (parasitic mother worm)
found in stools of case of
mouth cavity of the embryo of the hookworm chronic diarrhoea; B,
is about as deep as the diameter of the embryo Rhabditiform larva of
Strongyloides intestinalis
at the posterior end of the mouth cavity; that of from the stools. (William
Strongyloides is only about one-half as deep as
the diameter. If the temperature is low, below Sydney Thayer, in Journal of
Experimental Medicine.)
15°C., these rhabditiform embryos develop into
filariform embryos, which form the infecting
stage.
It has been demonstrated by Fülleborn that infection of man takes
place through the skin. If the temperature is warm, 25° to 35°C., these
embryos develop into the free-living form. In this we have males and
females, with double oesophageal bulbs, the male about 1/30 of an inch
(¾ mm.) long with an incurved tail and 2 spicules and the female about
1/25 inch (1 mm.) long with an attenuated tail. These copulate and we
have produced rhabditiform larvae, which later change to filariform
ones. At this time the length is about 550 microns. These start up the
parasitical generation.
For treatment thymol is usually recommended. Stiles speaks highly
of sulphur.
 CHAPTER XXV

TABLE OF IMPORTANT ANIMAL PARASITE

DISEASES
 P D

Parasite Defin. Intermediate Important Transmission and

host host reservoir pathogenicity
of virus
Entamoeba Man. Not required. Man-carrier Cysts in food or water. Flies
histolytica. stage (feces). may act as carriers.
Ingestive. Amoebic
dysentery.
Balantidium coli. Man (hogs). Not required. Man-carrier Transmission probably
stage (hogs). same as for E. histolytica.
Found in those having care
of hogs. Ingestive.
Balantidium dysentery.
Anaemia.
Lamblia (Giardia) Man (mice Not required. Man-carrier Transmission probably
intestinalis. and rats). stage (mice same as for E. histolytica.
and rats). Rat feces on human food
important. Ingestive.
Lamblia dysentery.
Giardiasis.
Spiroschaudinnia Louse (P. Man.(*) Man (blood). Cyclical development in
(Spironema) vestimenti). louse. Bite puncture
recurrentis, carteri, contaminated by crushed
etc. (louse group.) louse. Relapsing fever.
Spiroschaudinnia Tick (species Man.(*) Man (blood). Excretions of tick
(Spironema) duttoni, of contaminating tick-bite.
novyi. (Tick group.) Ornithdorus Tick fevers. Relapsing
or Argas). fever.
Treponema (pallidum Man. Not required. Man. T. pallidum. Usually
and pertenue). venereal. Syphilis. T.
pertenue. Flies or contact.
Yaws.
Leptospira Man (rat). Not required. Rat. Common infection of rats.
icterohaemorrhagiae. Present in blood. Excreted
in urine. Ingestion. Weil’s
disease.
Leptospira icteroides. Mosquito Man. Man (blood). Cyclical development in
(Stegomyia mosquito—12 days.
calopus) Inoculative. Yellow fever.
 P D (Continued)

Parasite Defin. Intermediate Important Transmission and

host host reservoir pathogenicity
of virus
Leptospira morsus- Man (rat). Not required. Rat. Man inoculated by bite of
muris. infected rat. Rat bite fever.
Trypanosoma Fly (Glossina Man. Man—game Cyclical development in
gambiense and species) animals? tsetse fly. Inoculative.
rhodesiense. (blood). Sleeping sickness.
Schizotrypanum Lamus Man. Man. Cyclical development in bug.
cruzi. megistus Inoculative. Brazilian
trypanosomiasis.
Leishmania Not surely Man. Man. L. donovani—Bed bug? kala-
(donovani, known. azar. L. infantum—dog flea?
infantum, and infantile leishmaniasis. L.
tropica). tropicum—biting insects?
Oriental sore; American
leishmaniasis.
Plasmodium Mosquito Man (with Man (blood) Cyclical development in
malariae, vivax (Anopheline schizonts). (with mosquito—12 days.
and falciparum. species) gametes). Inoculative. Malaria.
Rickettsia Man. Louse (P. Man (blood) Cyclical development in
prowazeki. vestimenti). louse. Bite puncture
inoculated by louse feces.
Typhus fever.
Dermacentroxenus Man (goats, Tick Goats and Excretions of tick
rickettsi. rodents, (Dermacentor rodents. contaminating tick-bite.
etc.). andersoni). D. Rocky Mountain fever.
venustus.
Bartonella Man. Unknown. Man (blood) Transmission unknown.
bacilliformis. Species of Phlebotomus
suggested. Oroya fever.

N .—(*) Some authorities give man as definitive host of Spiroschaudinnia (Spironema).

Diseases often classified as filterable virus ones of protozoal affinity are (1) Dengue. Cause
unknown. Transmitted by Stegomyia species. (2) Pappataci fever. Cause unknown. Transmitted by
Phlebotomus species. Other protozoal diseases are (1) Tsutsugamushi. Probably a protozoan.
Transmitted by Kedani mite. (2) Trench fever. Probably Rickettsia. Transmitted by louse.
 H D —T

Parasite Defin. Intermediate Important Transmission and

host host reservoir pathogenicity
of virus
Clonorchis Man (cats, 1st, snail (Melania Man. Not definitely known. Eating raw
sinensis. dogs and libertina)? and 2d, fish. Ingestive. Human liver
hogs). fish fluke disease.
Opisthorchis Man (cats 1st, mollusc. 2d, Cats and dogs. Man infected by eating raw fish.
felineus. and fish. Ingestive. Liver fluke disease.
dogs).
Fasciolopsis Man (pig). Possibly 1st, Hog. Not definitely known. Intestinal
buski. mollusc. Cercariae Distomiasis.
encyst on grass.
Heterophyes Man (dogs 1st, probably Dogs and cats. Not definitely known. Intestinal
heterophyes. and cats). mollusc. 2d, Distomiasis.
probably fish.
Paragonimus Man 1st, snail. 2d, crab. Cats, dogs and Eating raw crabs containing
ringeri. (dogs, hogs. cercariae. Ingestive. Lung fluke
cats and disease.
hogs).
Schistosoma Man. Snail (Bullinus). Man (urine). Bathing or drinking water
haematobium. containing cercariae.
Penetrative. Vesical bilharziasis.
Schistosoma Man. Snail (Planorbis). Man (feces). Bathing or drinking water
mansoni. containing cercariae.
Penetrative. Rectal bilharziasis.
Schistosoma Man. Snail (Blanifordia). Man (feces) Bathing or drinking water
japonicum. domesticated containing cercariae.
animals). Penetrative. Katayama disease.

N .—Rare trematodes of man are (1) Fasciola hepatica. Chiefly disease of sheep. Cercariae
from snail (Limnea) encyst on grass. (2) Dicrocoelium lanceatum. Chiefly disease of cattle. (3)
Heterophyes nocens. A very small intestinal fluke of man. (4) Metagonimus yokogawai. Another
very small intestinal fluke of man. Intermediate hosts: mollusc and gold fish. (5) Echinostoma
ilocanum. A rare intestinal fluke of the Philippines. (6) Two genera of Paramphistomidae—
Cladorchis and Gastrodiscus. Intestinal flukes.