21,6 Mendoza-Guazon: Schistosomiasis in the Philippines 558 
Lungs.—Groups of freshly laid ova in the wall of the cavity which is 
infiltrated with small lymphocytes, eosinophiles, giant cells, and polynu- 
clear leucocytes. The lung tissue and wall of cavity contained a great 
number of acid-fast tubercle bacilli. 
Spleen.—Marked fibrosis, eosinophilia, pigmentation, hyaline degenera- 
tion of the blood vessels, and minute tubercles which contained acid-fast 
bacilli. 
ANATOMIC DIAGNOSIS 
Anemia, secondary; hemorrhage, pulmonary; dilatation, heart; ulcera- 
tive and fibro-caseous tuberculosis, lungs; miliary tuberculosis, lungs and 
spleen; fibrosis, right pleura and Glisson’s capsule; chronic interstitial ne- 
phritis; parenchymatous degeneration, heart, liver, and adrenals; schis- 
tosomiasis, liver and lung. 
SIXTH CASE 
S. M., 27 years of age, Filipino, laborer, residing in Ermita, Manila, 
was admitted to the Philippine General Hospital on February 5, 1919, com- 
plaining of severe headache, moderate fever, and chilly sensation. Last 
November he had influenza. He had cough, fever for fifteen days, but 
no chest pain. The attack was not severe according to the patient, yet 
after the febrile period he felt weak and had to stay in bed until last 
January. Since this attack he has been coughing. Two days before ad- 
mission he had chills and headache. The duration of the chills was one 
and one-half hours, and afterward the headache was very severe. Patient 
states that he had frequent headaches before the present illness. He is 
able to sit up in bed, but cannot walk on account of his weakness. 
His eyes react well, the right has poor vision; both are congested 
and watery. There is slight rigidity and also tenderness in the right 
mastoid region. The liver and spleen are not palpable. Kernig’s sign is 
slightly positive, patellar reflexes are diminished, ankle clonus and Ba- 
binski’s sign are absent. He is conscious and irritable. 
February 11, 1919.—Patient tends to sleep; if asked the reason, he says 
that he feels well. At times he talks nonsense when asked if he is out 
ef his mind. 
February 12, 1921.—Patient was in good condition this morning, but at 
1 o’clock this afternoon he had sudden tonic convulsions, and expired shortly 
after. 
Laboratory examination—Urine negative for albumen and sugar, rare 
hyaline casts, and few red blood cells. j 
The temperature was 39.5° C. on admission; it became subnormal in 
the early part of the mornings and rose to 38° C. in the afternoons. 
Clinical diagnosis Influenza, with pneumonia and cardiac failure; urx- 
mia? 
Morbid anatomy.—Autopsy 6862. A well-developed, well-nourished Fili- 
pino male, adult. The left arm is more contracted than the right. The 
peritoneal cavity does not contain any fluid. Appendix is long and retro- 
cecal. Mesenteric lymphatic glands are enlarged and soft. The right 
pleural cavity is completely obliterated. The right lung is small, and the 
left is slightly voluminous. A triangular area in the anterior portion of 
the left upper lobe is held by fibrous adhesions to the thoracic wall. This 
portion is firm and fibrous and shows on section dilated bronchi and thick, 
fibrous tissue around each bronchus. 
