TKEMATODA 31 



states that he had been suffering from { fever ' for the last two 

 months, at first intermittent in character, but for the last seven 

 days more or less continued. He is much emaciated and reduced 

 in strength. Complains of pain on pressure over the liver and 

 spleen ; the latter can be felt much enlarged, reaching down- 

 wards to nearly the level of the umbilicus ; the lower border of 

 the liver, however, can only just be felt below the ribs. Tem- 

 perature on evening of admission 101 F. Conjunctivas are 

 anaemic, but not jaundiced. Has also a little bronchitis. The 

 fever continued with slight remissions for ten days (January 4th, 

 1876), the highest diurnal temperature (in the afternoon) vary- 

 ing from 103 to 104 F.; it then abated, but dysentery set in. 

 He began to pass six or eight stools in the twenty-four hours, 

 attended with much griping, and containing varying quantities 

 of blood-tinged, gelatinous mucus. These became more frequent, 

 in spite of treatment, during the next three days, and on the 

 8th of January he was manifestly sinking ; passed his evacua- 

 tions into the bedclothes, became cold and collapsed, and died 

 in this state that same evening. 



" A post-mortem examination was made on the following 

 morning, thirteen hours after death. All the organs of the 

 body were found more or less ansemic, but exhibited nothing 

 remarkable with the following exceptions. The lungs towards 

 their posterior margins and bases were dark, but still spongy 

 and crepitant. The spleen was found greatly enlarged, heavy ; 

 capsule tense and stretched ; substance soft, reddish brown, 

 irregularly pigmented ; weight 1 Ib. 13 oz. The liver was of 

 about normal size ; its surfaces smooth, the capsule slightly 

 hazy looking. Hepatic substance firm, but abnormally dark, 

 and the bile-ducts particularly prominent and thickened. 

 Numbers of small distomata escaped from the incisions made 

 into the organ, and could be seen protruding from the dilated 

 biliary canals. The gall-bladder was filled with thick greenish- 

 yellow bile, measuring about an ounce and a half, but contain- 

 ing no parasites, and no ova even could be detected on micro- 

 scopical examination of this bile and of scrapings from the 

 lining membrane of the gall-bladder. The cystic duct was 

 free from obstruction. The condition of the common choledic 

 duct could not so well be ascertained, as the liver had been 

 removed from the abdominal cavity before anything extra- 

 ordinary had been detected in its condition, but, so far as it 

 could be examined, it was found patent ; the duodenal mucous 



