84 
assured that they are quite different from the Egyptian form S. hama- 
tobium. 
Here it is only necessary to say that the worms are characterized by the absence 
of the ciliated warts on the integument, which are a marked feature of S. hamato- 
bium. Minor anatomic differences are the size of the worm [average 10.43 milli- 
meters (Katsurada)], the length of the vas deferens, and the lobular character 
of the testes. 
The eggs are smaller than those of 8. hamatobium, have blunter ends, and no 
spine. 
A complete comparison of the Chinese and Japanese worms and of their ova will 
be found in Stiles’s paper. 
The description of the clinical symptoms of the disease “Katayama” 
must, for the present, be taken from the Japanese reports, since in neither 
Catto’s nor my case was there any opportunity for clinical study. 
Katsurada was able to examine from 30 to 54 cases every year while 
stationed in the infected district, in which his residence extended over 
about five years. He observed but few deaths (three to five annually) 
which he considered were directly due to the parasite, but he regards the 
indirect mortality as much higher. Defective physical development is 
the rule in affected children. Diarrheea is usually the first symptom to 
be noted, while anemia and ascites generally follow later; however, the 
most striking feature is the shape assumed by the trunk. The hypogas- 
tric region seems to shrink, while the epigastric enlarges, a transverse 
furrow forming directly above the umbilicus, so that the general appear- 
ance of the abdominal region is that of an inverted gourd. Dilatation of 
the epigastric region and of the lower part of the thorax was noted even 
in patients whose liver and spleen were not much enlarged. ‘The com- 
monest symptoms are an initial increase in the size of the liver, followed 
by a decrease, a secondary enlargement of the spleen, a muco-sanguinous 
diarrhoea, severe attacks of ascites, and progressive anemia. - Katsurada 
found the ova of the parasite under discussion and also those of T'rico- 
cephalus dispar, Uncinaria, and Ascaris lumbricoides in the stools of his 
patients. 
Yamagiwa described (1890) a case of Jacksonian epilepsy in which he found - 
ova in certain nodules in the brain. These ova were similar to those now 
known to occur in “Katayama.” At the time Yamagiwa first reported his case 
he considered these ova to be those of the lung distome, but he now believes 
himself to have been dealing with Schistosoma japonicum. 
In Catto’s case the right lobe of the liver extended for a distance of two fingers’ 
width below the costal margin and the left lobe a hand’s breadth below the 
sternum. The spleen was enlarged. 
My case occurred in a native Filipino who had not been out of the 
Islands and who at the time of his death was in Bilibid Prison. He died 
suddenly of a terminal bacterial infection in the course of intestinal 
amcebiasis and uncinariasis. The liver was not enlarged, but the spleen 
was somewhat increased in size. 
