LUNG FLUKES 299 



crassum. F. rathouisi is now considered to have been a shrunken F. buski, as it 

 seems to be anatomically similar to F. buski, Kwan's fluke reported from Hong 

 Kong, was possibly F. buski. 



Heterophyes heterophyes (Cotylogonimus heterophyes). This exceedingly 

 small fluke (2 X 0.5 mm.), which can be recognized by its small size (less than ^2 

 inch long) and large, prominent acetabulum, was formerly supposed to be rare. 

 The oral sucker is much smaller than the acetabulum. The elliptical testicles lie 

 at the extreme posterior end. Cuticle has scale-like spines. The eggs are 30 X I7M- 

 Very characteristic of this genus is the large sucker-like genital pore just below and 

 to one side of the acetabulum. Looss has shown that it is quite common in Egypt, 

 he having found it twice in Alexandria in nine autopsies. The parasites occupy the 

 ileum. It is common in dogs. 



Echinostoma ilocana (Fascioletta ilocana). This is a small fluke, about Y inch 

 (6 mm.) long. There are two massive testicles in the posterior part of body. The 

 acetabulum is prominent and about 5ooju in diameter. This fluke has a ring of 

 spines around the anterior extremity. Ovary anterior to testes. Genital pore 

 anterior to acetabulum. The egg of this small fluke is quite large (ioo/i) and has an 

 operculum. These trematodes were found by Garrison in five natives of Luzon, 

 P. I., after treatment with male fern. 



LUNG FLUKES 



Paragonimus westermanii (Distoma ringeri). In certain parts of 

 Japan and Formosa it is estimated that as many as 10% of the inhab- 

 itants may harbor this parasite. 



It is also common in China, and recently many cases have been reported in the 

 Philippines. Dr. Stiles states that around Cincinnati, Ohio, there was at one time 

 quite a heavy infection among the hogs, so that it may be that certain cases diagnosed 

 in man as pulmonary tuberculosis are paragonimiasis. 



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 Y$ 

 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 6s/z. 



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 



