﻿PARAGONIMIASIS IN THE PHILIPPINES. 21 



always, adult parasites or eggs of P. westermanii. in addition to tliese pneumonic 

 areas, both lungs contain many of the typical bluish Paragonimus cysts from 0.005 

 to 0.01 in diameter. 



The pericardial cavity contains a small amount of a slightly cloudy fluid. The 

 serous surface is dull in appearance and slightly adherent over the right heart; 

 showing through the visceral pericardium are a number of irregular, slightly 

 brownish, granular appearing areas similar to those described in case No. 2 (see 

 PI. 1). Eggs are found in these areas but none in the pericardial fluid. The 

 heart is of normal size and free from, valvulitis or other marked organic change. 

 The muscle is a little brown and coarse, but except just under the pericardium no 

 gross lesions are seen. 



The abdominal cavity presents a most striking picture, all visible tissues being 

 matted together and studded with the bluish-colored Paragonimus cystic ab- 

 scesses. In places where adhesions have been separated, for instance, between the 

 bowel surfaces or omentum and the abdominal wall, an area of bluish color of 

 equal size to the adhesions is left, and often small, necrotic areas with eggs and 

 parasites are exposed. Everywhere there is a moderate, subacute peritonitis, 

 light, dry, dirty-colored adhesions binding all the organs. Both the abdominal 

 and pleural surfaces of the diaphragm contain many abscesses. Similar lesions 

 are also found in the deeper structures of this organ. 



The spleen shows some perisplenitis and at the points where this occurs 

 superficial areas of infection with the parasites or eggs are A r isible. On section, a 

 moderate increase in the soft pulp is seen but no other change can be observed. 



The liver is of normal size but adherent to the abdominal wall, diaphragm, 

 intestine and other structures; the perihepatitis being due to the action of 

 Paragonimus. On section, the organ is soft and pale and contains many small 

 abscesses from 2 millimeters to 10 millimeters in diameter. These abscesses 

 closely resemble the multiple amoebic ones which are so often seen, but in others 

 the color and contents more closely resemble the Paragonimus cysts. Microscop- 

 ically, both amcebse and paragonimus eggs are found in some of these abscesses. 

 The gall bladder and ducts are large and distended with normal-appearing bile; 

 no parasites or eggs found. 



The kidneys are surrounded by many adhesions containing very many ab- 

 scesses of the Paragonimus type. Some of the lesions are subcapsular and others 

 are in the pelves of the kidneys and in the ureters. Both organs are somewhat 

 increased in size, soft and oedematous. 



The bladder wall contains numerous cysts and the prostate gland is also 

 involved. 



The pancreas shows a few cysts near its head, these being a direct infection 

 from the adherent structures. 



The appendix is bound down in a mass of adhesions and abscesses and its wall 

 is involved in the parasitic processes. The abdominal lymphatics are mostly 

 enlarged and soft, many containing characteristic abscesses with parasites and 

 eggs. 



The omentum is plastered to all the abdominal structures; it is thickened, 

 oedematous, and studded with the typical bluish abscesses. 



The stomach is not involved excepting at points of adhesion on its outer 

 surface. The walls are free from abscesses, and nothing abnormal is noted on 

 the mucous surface. 



The small intestine, from near its upper end to the esecum, is severely infected. 

 The Paragonimus lesions involve all of its coats, and are most severe in the 

 ileum and lower jejunum. The mucous surface shows typical cysts of various 

 sizes, some standing out well into the lumen of the bowel : ulcers resulting from 



