﻿20 MUSGKAVE. 



familiar with the appearance of the various lesions, I am confident that- 

 similar material has passed through my hands unrecognized many times 

 during the last seven years, and identical experiences have probably oc- 

 cured with others. It may safely be stated, to judge from the wide local 

 distribution of my cases, that trematode infections are fairly common 

 among the natives of these Islands and that the infection has been 

 endemic here for many years. 



V. MATERIAL. 



The material upon which this report is based consists of 17 cases with 

 S autopsies. Abstracts from the protocols follow and the summaries 

 of the findings and the analyses of the lesions and symptoms will be 

 taken up under the appropriate headings furnished in the outline. 



Case Xo. 1 (3091S). — Paragonimiasis and amorbiasis of the Jungs, pleuree, 

 diaphragm, omentum, peritoneum, spleen, liver, intestine, lymphatics, prostate, 

 bladder and abdominal wall; death; autopsy. 



The patient, a Filipino prisoner, was under observation in hospital for one 

 week, suffering with high fever, 30° to 40°, severe cough, pains in the chest, 

 and some dyspnoea. There was severe head-ache, mild delirium at times and 

 insomnia. The bowels were constipated, the abdominal wall rigid, and tenderness 

 was complained of over the entire abdomen. A blood examination showed nothing 

 abnormal except a moderate polymorphonuclear leueocytosis. The sputum was 

 negative for tubercle bacilli, but on the morning before death a few trematode 

 eggs were found. The stool contained many amoebae, blood cells, and mucus and 

 a few eggs similar to those in the sputum. 



Autopsy two hours after death : Emaciation and anaemia marked, severe con- 

 junctivitis of left eye; old, bluish-colored ulcer in the right axilla, which on 

 section connects with broken-down lymphatic glands. The eggs of P. westermunii 

 are found in this ulcer. The superficial lymphatics are all moderately enlarged 

 and those in the groins markedly so, and this enlarged chain extends down into 

 Scarpa's triangle. The scrotum is enlarged and on section the epididymis contains 

 Paragonimus cysts which apparently are continuous through the inguinal canal 

 to the abdominal cavity. 



The subcutaneous tissue is scanty and dry, the muscles soft, pale and coarse. 

 A small Paragonimus cyst is observed in the left pectoralis major and another in 

 the abdominal wall just above the symphisis. Upon opening the chest a number 

 of the small bluish Paragonimus cysts are found on the under surface of the 

 sternum and on the exposed pleura? and pericardial membranes. Both pleural 

 cavities contain a considerable quantity of fluid, filled with stringy masses and 

 ftocenli which settle to the bottom upon standing. The pleura-, particularly the 

 viscmal layers, are much thickened. The pleural surfaces are covered with many 

 of the cysts and even external to the parietal pleurae these lesions are found. There 

 are several small areas of chronic obliterative pleuritis and Paragonimus lesions 

 are numerous in the fibrous tissue forming the adhesions. Both lungs show a 

 moderate bronchitis, particularly of the larger tubes, but no eggs or parasites are 

 found in the bronchi and no definite bronchiectatie cavities can be located. There 

 are numerous areas of bronchopneumonia throughout both lungs, the largest near 

 the pleural surfaces; many of these pneumonic areas are not to be distinguished 

 from such lesions in other diseases of bacterial origin, while others, on section, 

 have a necrotic center containing material like anchovy sauce and often, but not 



