﻿24 MUSGRAVE. 



on May 3 showed nothing abnormal and a sputum examination on May 29 was 

 negative for tubercle bacilli and for parasites or eggs. From June 1 to 30 the 

 temperature was 36° to 39°, the lowest point usually being during the early morn- 

 ing hours, but on a few occasions this relation was reversed. The cough became 

 much worse during this month and on June G there was a haemorrhage of about 

 100 cubic centimeters from the lungs. Examinations of the blood from this 

 haemorrhage and of the sputum between June 21 and 29 were negative for tubercle 

 bacilli and for parasites and eggs. On June 29 the stool still contained amoebae 

 and considerable blood and mucus was also noted therein. From July 1 to 4 the 

 temperature was 36° to 37°.2. Haemoptysis of about 500 cubic centimeters 

 occurred again on July 3, and an examination of this specimen was again negative. 

 Following this last haemorrhage the patient sank slowly and he died on the morn- 

 ing of July 4 with a clinical diagnosis of amoebiasis and sprue. 



Autopsy twelve hours after death : The body is extremely emaciated, the skin 

 normal, the subcutaneous fat very scanty, the muscles wasted and very pale and 

 friable. The superficial lymphatics are all enlarged. One, in the left groin, and 

 two in the right axilla are partially broken down and contain eggs of P. ices- 

 tcrmanii. A small, subcutaneous abscess at the back of the neck and another in 

 the left mammary region are noted. Both contain fluke eggs. Upon opening the 

 chest a number of dark, slate-colored, broken-down glands are found on the under 

 surface of the sternum ; a similar condition extends throughout over the parietal 

 pleura? on both sides. Both pleural cavities are obliterated by old adhesions, 

 and all tissues, including the lung, pleural and extra pleural structures contain 

 abscesses from 5 millimeters to 2 or 3 centimeters in diameter. Both lungs contain 

 numerous congested areas which on section resemble bronchopneumonia. In most 

 of these areas numerous parasites and ova are to be found. A number of the 

 bronchial glands are broken down and have the general appearance of the other 

 infected tissues. 



The diaphragm is thickened, adherent to all adjacent structures and contains 

 numerous abscesses of various sizes. 



The pericardial cavity contains a small amount of serous fluid and numerous 

 adhesions are present. Both the parietal and visceral serous surfaces are covered 

 with small, raised, dark-bluish or brownish congested spots which on section are 

 shown to contain ova; furthermore, there are at least two adult trematodes just 

 beneath the visceral pericardium, in the region of the right auricle. The heart 

 muscle is very brown, but no ova are found in its substance. 



The abdominal cavity contains large numbers of adhesions between the omentum 

 and the other structures. In several places large areas of the omentum are puck- 

 ered and brought to a central point of adhesion in the abdominal wall, and at 

 these places parasites or eggs are invariably found. The omentum in general is 

 thickened and contains numerous abscesses similar to those in other parts of the 

 body. 



The spleen is enlarged and adherent to the diaphragm and abdominal wall. It 

 contains a number of superficial abscesses, which show both parasites- and ova. 

 On section it is rather firm, bloodless and without increase of pulp. Xo abscesses 

 or parasites are found in the deeper portions of the organ. 



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

 intestine and contains numerous subcapsular abscesses. The organ is rather 

 firm and on section shows some increase in the interstitial tissue, from which 

 ova are to be isolated, but no abesess exists within the parenchyma of this 



