first stage of a cirrhotic process. The capil- 
laries seem much distended. 
In the intestine I found the males near 
to the serosa; the females can reach the sub- 
mucosa. The eggs are found in smail groups 
in the mucosa at the base of the glands and 
also isolated between them, but sparsely and 
without indicating, how they reach the sur- 
face. The groups of eggs are surrounded by 
an infiltration not unlike a tubercle. Giant 
cells are formed exclusively arround or in- 
side of the empry shells. Eosinophilous celis 
are seen in the tissue and in the vessels. In 
older infections the eggs may also abonnd 
in the submucosa. 
On the lesions observed in man much 
has been written. The first writers did not 
distinguish between the two infections found 
in Egypt and most of the older or newer 
authours treat in preference of fatal cases 
where the infection was many years old. In 
such cases, in the sections the flukes may be 
rare or even absent. The predominant lesions 
are due to the eggs which exist in large, of- 
ten enormous numbers. Small lesions without 
great importance, when constantly repeated, 
lead finally to severe and extensive lesions of 
the most invaded viscera. 
Material from early stages is rare. Ho- 
wever, I have elements for describing them, 
using personal observations and others found 
in the litterature. 
Of macroscopical lesions the only ones, 
observed in more recent and not very severe 
infections, were a swollen spleen and medul- 
lary tumefaccion of the mesenteric lymph 
nodules, both very common in other disea- 
ses. The flukes are not seen in the mesen- 
teric veins and the best places to look for 
them are the trunk and the ramifications of 
the pcrtal vein. 
In older and more severe infections there 
are lesions of the liver which may look either 
like hypertrophic or like atrophic cirrhosis 
and may cause ascites and jaundice 14). The 
spleen which as a rule is free from flukes 
and eggs may be swollen or small. Of other 
organs only the intestine shows striking al- 
126 
terations. They may consist ina varying de- 
gree of general sclerosis and alterations of 
the mucosa, more apparent in the rectum and 
diminishing in proportion of the distance 
from it. The difference in localisation bet- 
ween man aud animals may be due mostly to 
gravitation. 
The histological alterations of the organs 
were studied in my material andalso in pre- 
parations received from Dr. J. RISQUES in 
Venezuela and compared with good prepa- 
rations oi infections with Sehistosomum ja- 
ponicum. Some were from human infection, 
made by Prof. CROWELL in the Philippines 
and others from domestic animals, received 
from Prof. AKANASCY. The infections were 
severe and the corresponding lesions were 
well accused. 
Individuals, who suffer from infection 
with Sch. M. beginning in early youth, may 
show few flukes in comparison with the 
enormous number of eggs, accumulated in 
the tissues, without the slightest probability 
of leaving them during the life of the host. 
They are more numerous in theliver and the 
wall of the intestine, but are found also, though 
in smaller number, in other organs, as the 
mesentery and its lymph glands, the pan- 
creas, the lungs and the brain. Like the eggs 
of Sch. japon. they are often found in the 
interstitial tissue of the viscera, independent 
of any celular infiltration ; they may be more 
or less calcified which points to their staying 
there for a long time. Such deposits are the 
cause of the sclerotic process, found princi- 
pally in the terminal part of the gut and in 
the liver, where they lead to a form of cir- 
rhosis, with or without splenomegaly, jaun- 
dice and ascites. 
The intestinal sclerosis impares the fun- 
tion and leads to obstipation. Though most 
pronunced in the rectum, it extends upwards 
and there are many accounts of thickening 
of the appendix, due to infiltration with eggs. 
It may even extend to the higher parts, though 
it does not call the attention of the observer. 
Macro— and microscopic lesions of the 
intestine where studied accurately by LE- 
