640 THE ANIMAL PARASITES OF MAN 



in Tanigtichi's case, attacks of cortical epilepsy, choreiform twitchings 

 in the right extremities, which gradually become athelotic. The 

 following were symptoms of rarer occurrence : paresis of the right 

 upper extremity, vertigo, dementia, and amnesic aphasia, disturb- 

 ances of vision. Paragonimiasis of the brain appears to arise by 

 embolism from a primary pulmonary lesion. 



The diagnosis depends upon the finding of ova in the sputa ; if 

 together witli ova in the sputa, cerebral disturbances make their 

 appearance, in all probability the cause is the presence of worms or 

 ova in the brain. 



The prognosis of pulmonary paragonimiasis is favourable ; on 

 the other hand, that of cerebral paragonimiasis is very doubtful. 



The treatment of the pulmonary lesion consists only in paying 

 attention to the general condition (good food, rest, cough remedies), 

 as all attempts to destroy the worms in the lungs by means of vermi- 

 cidal drugs administered internally or by way of inhalation have so 

 far been without result. The treatment of the cerebral lesion is 

 entirely hopeless. Trephining has been proposed for cases the con- 

 dition of which is more favourable, but it has not reached the stage 

 of performance. 



Prophylaxis consists in general management : cleansing and if 

 need be boiling of everything that is eaten or drunk. 



Clonorchis sinensis. 



According to our present knowledge Clonorchis sinensis is only 

 found in China and Japan ; even the post-mortem case reported by 

 Laspeyres 1 was that of an Asiatic sailor who w r as admitted into the 

 General Hospital St. George, Hamburg, in a moribund condition 

 with the clinical diagnosis of beri-beri. The bile-ducts are the usual 

 site of the parasite, though Katsurada 2 has found them also in the 

 pancreatic ducts. In addition, it is found not uncommonly in the 

 upper portion of the small intestine, especially in the duodenum, 

 also, though decidedly rarely, in the stomach. As these sites, however, 

 do not afford the conditions necessary to life, they are only found 

 here on their way out of the body of the host. 



The initial stage of infection with this fluke generally runs a 

 symptomless course ; in proportion as the worms multiply the 

 following symptoms are manifested : First there is a morbid sense of 

 hunger and irregularity in defalcation ; at the same time the patient 

 experiences a feeling of pressure and pain in the epigastrium and right 

 hypochondrium, or just a dull pain. Pressure increases the pain 

 considerably. The liver appears to be enlarged, sometimes the 



1 Laspeyres, " Dissert. Kiel," 1904. 



2 Katsurada, Ziegler's Beitr. z. path. Ana/., 1900, xxviii. 



