﻿PARAGONIMIASIS IN THE PHILIPPINES. 23 



The pancreas contains a number of the abscesses and is haemorrhagic for a 

 distance of about 5 centimeters from its splenic end. 



The Uver is enlarged, firmly adherent to all surrounding structures, very soft, 

 friable and studded with little, grayish, hard areas, particularly along the con- 

 nective tissue bands. A number of abscesses, mostly subcapsular, are found in 

 this organ. 



The gall bladder contains about 15 cubic centimeters of almost colorless bile 

 and the ducts are open. Its wall is much thickened, firmly bound down by adhe- 

 sion and surrounded and impregnated with abscesses. The scrotum, ejrididymis 

 and left testicle contain a number of these small abscesses and the prostate gland 

 is similarly involved. 



The wall of the large intestine is very much thickened and is surrounded and 

 infiltrated with abscesses. The mucous surface is free from ulceration, but shows 

 a number of the previously described cystic abscesses just under its surface. 

 This condition is most marked low down in the rectum and around the opening 

 into the appendix. The appendix itself is involved in its walls and also externally, 

 but not on its mucous surface. The entire small intestine shows the condition 

 found in the large one, excepting that the changes are much more extensive and 

 in several places in the ileum the abscesses in the wall have ruptured on the 

 mucosa, leaving ulcers with ragged margins. The fibrous adhesive bands asso- 

 ciated with broken-down cysts and abscesses in the mucosa of the bowel are very 

 extensive and in some places they apparently almost obliterate the lumen of the 

 bowel. The stomach is surrounded by a number of abscesses, but both its internal 

 surface and wall are apparently free from the infection. The abdominal wall 

 below the liver, on the right side, contains a knotty mass of abscesses several 

 centimeters in diameter and extending well down behind the kidney. 



Both kidneys are bound to a mass of proliferated tissue, abscesses and adhe- 

 sions, and both of these organs contain a number of abscesses like the ones which 

 have been described and which- are most numerous just under the capsule. 



The muscles of the calves of both legs and those of the thigh show abscesses 

 which are from 3 to 5 millimeters in diameter. 



The cerebrospinal canal was not opened. 



A microscopic examination shows parasites and eggs in the contents of many 

 of the abscesses, but not in all. The former are found in the heart, lung, kidney, 

 intestine, spleen and abdominal wall. Living parasites were extracted from the 

 pectoralis major muscle and some were found free in the abdominal cavity; these 

 were probably liberated by the rupture of some of the cysts during autopsy. 



Case No. 3 (32625). — Paragonimiasis, extensive infection with P. westermanii ; 

 aincebiasis of the colon; death; autopsy. 



The patient a Filipino, 50 years of age, has the following hospital record : 

 Admitted to hospital October 21, 1905, with a diagnosis of acute beriberi; on 

 October 23 he Mas transferred to the beriberi hospital; on February 23, 1906, he 

 returned to the prison hospital with a diagnosis of chronic diarrhoea. From 

 February 17 to 28 his temperature was 36°. 5 to 36°. 8, pulse 99 to 100. 

 stools 2 to 11 in twenty-four hours. No cough was noted. From March 1 

 to 31 his temperature was 36°.5 to 37°.3, pulse 98 to 101, stools 6 to 13 in 

 twenty-four hours. The diarrhoea was very persistent and not to be controlled 

 by astringents or enemas. From April 1 to 30 his temperature was 36°.8 to 37°. 2, 

 pulse 98 to 100; the severe diarrhoea continued during the month and microscopic 

 examination of the faces, on April 9, showed amoeba? and red blood corpuscles. 

 From May 1 to 31 the temperature was 36°.4 to 39°. The diarrhoea continued 

 and there was moderate cough, which was worse at night. A urine examination 



