SUPPLEMENT 639 



PARAGONIMIASIS. 



Paragonimus ringeri. 



The disease produced by the lung fluke is specially endemic in 

 Japan, also in isolated parts of China, Formosa and Korea. The 

 fact that the lung-fluke disease is most frequently found in mountain- 

 ous districts (Katsurada 1 ) is worthy of special attention. The onset 

 of pulmonary paragonimiasis is generally insidious (Looss 2 ) ; generally 

 the only symptom is a slight cough, occurring at first at longer, and 

 later at shorter intervals ; it is accompanied by the expectoration of 

 discoloured sputum, frequently blood-stained. Though now and 

 then severe haemorrhages result, up to the present no case has been 

 established in which they have been the direct cause of death. 



Examination of the thorax frequently fails to reveal anything 

 abnormal. Inouye 3 states that the most frequently observed changes 

 consist in retraction of the thorax and in a contraction of its infra- 

 scapular portion. Scheube" 4 repeatedly observed that the one side, 

 presumably that which harboured the worm, moved less freely than 

 the other. The physical changes are not uniformly spread over the 

 whole lung, but are localized. The disease may come to a standstill 

 for long intervals and then set in again, lasting on the whole from ten 

 to twenty years. In addition to paragonimiasis of the lungs, cysts are 

 frequently found on the eyelids, which occasionally extend deeply into 

 the orbit and hinder the movements of the eyes. Post' mortem, cysts 

 the size of hazel nuts containing one, two, or three adult worms 

 are found in the lungs, and in addition, not uncommonly there exist 

 pulmonary emphysema and bronchiectasis. Besides being present in 

 the lungs and in the eyelids, the parasites have also been found in the 

 pleura, the liver, the intestinal wall, the peritoneum, the cervical 

 glands, and in the scrotum, without actually occasioning any actual 

 symptoms in these tracts. 



The most dangerous locality is in the brain. Otani, 5 Inouye, 6 

 Yamagiva, 7 and recently also Taniguchi, 8 have found post mortem 

 the worms and their ova in tumours of the brain, or, in areas of 

 softening in cases of Jacksonian epilepsy ; in Taniguchi's case the 

 eggs were found in masses in the inflammatory areas of softening. 

 In the nineteen cases of paragonimiasis of the brain collected by 

 Inouye, the following symptoms were observed : general convulsions 

 on eight occasions, unilateral convulsions on six occasions, convul- 

 sions with paralysis on the same side and hemiplegia, five times each ; 



1 Katsurada, Ziegler's Beitr. z. path. Anat., igoo, xxviii. 



2 Looss, " Handb. d. Tropenkrankh.," von Mense, 1905, i. 



3 Inouye, quoted by Looss. 



4 Scheube, " Die Krankh. d. warm. Lander," 1896. 5 Otani, quoted by Looss. 



6 Inouye, quoted by Looss. 7 Yamagiva, quoted by Looss 



s Taniguchi, Arch. f. Psych, u. Nervenkrankh., xxxviii. 



