﻿22 MUSGRAVE. 



broken down lesions are also present. The Peyer's patches are slighty swollen 

 but appear to be free from the parasitic infection. 



The large bowel in general presents a very similar picture to the small in- 

 testine, but in addition there is quite extensive amoebic ulceration extending from 

 the caecum to the rectum. 



The cerebrospinal canal was not opened. , 



Case Ko. 2 (31508). — Paragonimiasis, acute general infection, with death 

 after eight dags in the hospital ; autopsg. 



Nothing is known of the previous history of this patient beyond his statement 

 that he had never been ill before. He was sick in hospital for about eight days 

 before death with high fever, cough, and rapid, shallow respiration, abdominal 

 pains and severe diarrhoea ; he constantly complained of headache. The abdomen 

 was moderately distended and exquisitely tender in the region of the gall bladder 

 and over the descending colon. There was considerable difficulty in urination. 

 Expectoration was abundant, and sometimes tinged with blood, but upon micro- 

 scopic examination no tubercle bacilli or eggs were found in the sputum. 



Autopsy four hours after death : The general nutrition is very good and slight 

 jaundice of the conjunctivae is visible. A macular skin eruption is noted over the 

 lower extremities, abdomen, and flexor surfaces of arms. The muscles are soft and 

 exceedingly pale. The pectoralis major muscles are very coarse, pale, and contain 

 a number of small, dark spots about 1 to 3 millimeters in diameter. From 

 one of these spots an adult P. westermanii was extracted. The lymphatics in the 

 axilla are moderately enlarged and some of them congested. 



The left pleural caritg contains about 750 cubic centimeters of a yellow, 

 flocculent fluid with long, tenacious shreds of tissue. Both the visceral and parietal 

 pleurae are studded with raised, soft, dark-bluish colored, cystic abscess-like bodies 

 which, on section, contain a reddish-brown granular matter. Scattered through 

 the left lung are a number of areas of bronchopneumonia : on section most of these 

 show one of the above-described cysts, surrounded by pneumonic areas, but in other 

 instances the areas resemble those of ordinary bronchopneumonia. On the right 

 side the general condition is similar to that on the left, but the lesions are much 

 more extensive the entire lung being so completely filled with these pneumonic areas 

 that it appears to be almost solid. There is marked bronchitis. Ova, but no 

 parasites are found free in the bronchial secretion. 



The pericardial caritg contains a small amount of normal-appearing fluid and 

 both the visceral and parietal serous surfaces show bodies similar to those found 

 in the pleural cavities. Over the surface of the heart itself (PI. I) are many 

 little, raised, brownish, granular bodies varying from 1 to 3 or 4 millimeters in 

 diameter; these are somewhat hard, surrounded by congested zones and follow 

 closely in their distribution that of the vessels. On section, the heart muscle is 

 found to be very friable and pale, but it contains none of the bodies already men- 

 tioned. Both the upper and the lower surfaces of the diaphragm are studded with 

 these small, dark, cyst-like bodies. The diaphragm itself is very much thickened 

 and contains a number of abscesses within its substance. 



The entire abdominal caritg is almost obliterated by a mass of adhesions, and 

 dark, bluish cystic abscesses, varying in size from 1 millimeter to 15 or 20 mil- 

 limeters in diameter, are seen in great profusion. The surfaces of the intestine are 

 everywhere adherent. The omentum is thickened and filled with abscesses. The or- 

 gans of the pelvic cavity are so bound by adhesions and contain so many abscesses 

 that they can only be removed with a knife. 



The spleen is enlarged, soft, and studded both on the surface and internally with 

 small cystic abscesses similar to those found in the other organs. The pulp is 

 exceedingly soft, dark-red in color, and there are numerous small areas of intense 

 congestion corresponding to the Malpighian bodies. 



