21,6 Mendoza-Guazon: Schistosomiasis in the Philippines 555 
purely bacterial in origin? Fibrosis of the lungs is a common 
finding after influenza,(26) yet the presence of giant cells and 
eosinophiles indicates that the injurious agent which attracted 
them is not far away. 
SEVENTH CASE 
Clinical history.—T. A., 22 years of age, single, Filipino sailor, residing 
in Binondo, Manila; admitted to the hospital on June 30, 1921, complaining 
of fever, headache, and abdominal discomfort. The fever was of eight 
days’ duration; continuous and moderate in degree. Since the onset of 
the disease patient has had no desire for food; he suffers from constipa- 
tion at times, alternating with diarrhea. Patient is complaining of pain 
in the chest. He does not cough. On physical examination dullness is 
noted and crepitant rales heard in the base of the right lung. Similar 
rales are heard in the left interscapular region. Heart beats fast, without 
murmurs. Abdomen is distended and flatulent. 
July 2, 1921.—Patient is delirious. Abdomen is distended and tympa- 
nitic. Marked dullness at the right base with few occasional rales. Heart 
beats are fast, pulse is soft. At noon he passed a slightly coffee-colored 
bloody stool. 
July 3, 1921—Adbomen tympanitic and slightly rigid. Marked tender- 
ness in the right iliac region. At 3 p. m. had profuse bleeding from the 
gums. Bladder is distended. 
July 5, 1921.—Unconscious; respiration rapid and deep. Heart is gal- 
loping, but heart sounds are distinct and free from murmurs. Rhythm 
normal. 
Abdominal examination reveals nothing. 
Temperature varying from 38.5° to 39.5°. 
Urine, acid, albumen positive, slight sugar, some hyaline and abundant 
granular casts. Sugar probably due to hypodermoclysis with lactose. 
Feces, negative. 
Blood culture on July 6, 1921, was negative. 
Agglutination tests for Bacillus typhosus and for B. paratyphosus A 
and B were negative. 
Blood counts: Leucocytes, 6,000; neutrophiles, 52 per cent; small lympho- 
cytes, 36 per cent; large lymphocytes, 11.5 per cent; basophiles, 0.5 per cent. 
Clinical diagnosis.—Fever, typhoid; severe toxemia; pneumonia, hypo- 
static, bilateral; hemorrhage, intestinal. 
Morbid anatomy.—Autopsy 8470. The findings are those of typhoid 
with cedema and congestion of the lungs. 
HISTOPATHOLOGY 
Liver.—Hemangioma; focal necrosis, typhoid; large Schistosoma nod- 
ules without eosinophilic infiltration and few giant cells; in the mesenteric 
lymph nodes, Schistosoma nodules and focal areas of necrosis. Some eggs 
with giant cells are also seen in the periphery of the areas of focal necrosis 
due to typhoid. Marked cdema and congestion are seen in the sections 
of the lungs, but no ova. Sections of the other organs are free from ova 
and eosinophilic infiltration. 
ANATOMIC DIAGNOSIS 
Intestinal hemorrhage; acute ulcerative enteritis, acute lymphadenitis, 
acute splenitis, typhoid; schistosomiasis; hemangioma, liver. 
