BILHARZIASIS 251 



It is popularly known as endemic haemoptysis on account of the accompanying 

 symptoms of chronic cough and expectoration of a rusty-brown sputum. After 

 violent exertion, and at times without manifest reason, attacks of haemoptysis of 

 varying degrees of severity come on. The characteristic ova are constant in the 

 sputum and establish the diagnosis. The fluke itself is a little more than 1/3 of an 

 inch (8 mm.) long and is almost round on transverse section, there being, however, 

 some flattening of the ventral surface. The acetabulum is conspicuous and opens 

 just anterior to the middle of the ventral surface. Eggs about 90 x 65 /*. 



The branched testicles are posterior to the laterally placed uterus and the 

 genital pore opens below the acetabulum. The branched ovary is opposite the uterus 

 on the other side. 



It is rather flesh-like in appearance and is covered with scale-like spines. The 

 flukes are usually found in tunnels in the lungs, the walls of which are of thickened 

 connective tissue. There may be also cysts formed from the breaking down of 

 adjacent tunnel walls. In addition to lung infection with this fluke, brain, liver, 

 and intestinal infections may be found. Musgrave was the first one to call attention 

 to the frequency of general infection with this parasite (paragonimiasis) in the 

 Philippines. He found it in seventeen cases in one year. The life history, beyond 

 the stage of miracidium, is unknown. 



Another fluke which has been reported from the lung is Fasciola gigantea (very 

 similar to F. hepatica). This was coughed up by a French officer who had been in 

 Africa. 



BLOOD FLUKES. 



Schistosomum haematobiuin. Flukes of the circulatory system 

 are of great importance in Egypt, South Africa, Japan, and the West 

 Indies. The disease is named bilharziasis after Bilharz who in 1851 

 first associated the parasite and the disease. 



It seems probable that there are at least three human species, differentiated 

 principally by the appearance of the egg. In the blood-fluke disease of Egypt, 

 (S. haematobium), the parasite chiefly infects the bladder and the egg has a terminal 

 spine. The terminal-spined ovum is also found in the rectum and in the faeces. In 

 the West Indies, as shown by the reports of Surgeon Holcomb from Porto Rico, 

 rectal bilharziasis is rather common. In these cases the egg is practically always 

 lateral-spined. Looss thinks that the lateral-spined egg is the product of an unfer- 

 tilized female S. haematobium. These flukes differ from other human flukes in 

 possessing nonoperculated eggs as well as in having the sexes separate. The adults 

 of this species, the S. mansoni, are scarcely, if at all, to be distinguished from the 

 S. haematobium. Leiper has recently noted a difference in that the male of S. 

 mansoni has 7 testicles as against 4 for S. haematobium. With S. japonicum, the 

 name of the Eastern species, there is not only the difference that the eggs are without 

 spines, but, in addition, the skin of the adult parasite is not tuberculated, as is the 

 case with the other two species. It is slightly smaller, the acetabulum projects more 

 prominently, and the lower part of the male infolds more markedly than in S. 



