﻿PARAGONIMIASIS IN THE PHILIPPINES. 25 



The gall bladder is large; it contains a considerable quantity of light-colored, 

 fluid bile, no parasites or eggs are seen either in the gall bladder or ducts. 

 Nothing abnormal is found in the portal vessels. 



Both kidneys are of normal size. They are very pale and soft, with nonadherent 

 capsules. The left kidney contains two subcapsular abscesses and one is seen in 

 the pelvis. The adrenals appear to be normal. 



The left psoas muscle contains an abscess with about 100 cubic centimeters of 

 matter having the appearance of anchovy sauce, in which hundreds of parasites 

 and eggs are encountered. There are a number of smaller abscesses in the pos- 

 terior abdominal wall, on both the right and left sides. 



The prostate gland and epididymis contain a few abscesses. 



The bladder appears to be normal. 



The entire large intestine is thickened, of a dark-slate color, and it shows a 

 number of hard nodules beneath its peritoneal surface. On section, numerous 

 ulcerations extending from the rectum to the caecum are found. These ulcers vary 

 in size from 2 millimeters to 10 millimeters. They bear no relation to the mesen- 

 teric border or to any other definite anatomic structure. Their margins are raised, 

 appear as if they were punched out, are rather hard, granular and sometimes 

 intensely congested; in other instances they are without congestion. The floor of 

 these ulcers is either in the submucosa or it extends down to the muscular layer. 

 They vary much in size, contain a dark-colored, thickened matter, together with 

 numerous ova and in one instance a parasite. 



The lower portions of the small intestine and appendix are similar to that of 

 the large, but the upper two-thirds of the small bowel is apparently free from 

 parasitic infection. 



The stomach and pancreas appear to be normal. 



A most striking general picture of this autopsy, as well as in the two preceding 

 ones, is found in the peculiar, dull-slate color of all the tissues involved in the 

 infection. This is particularly noticeable in the omentum, intestinal wall, and in 

 the other tissues of the abdomen. 



The abscesses referred to are of a peculiar appearance and are characteristic. 

 They vary very much in size, but the general appearance in every instance is the 

 same. There is a rather definite limiting cystic wall, of a dull-blue slate color, and 

 on section a dark material like anchovy sauce is found. In most instances these 

 abscesses contain either parasites or ova, or both. 



Case No. J/ (31995). — Jacksonian epilepsy, paragonimiasis of the bruin, Jungs 

 and abdominal organs; death, autopsy. 



The patient, a male Filipino, 30 years of age, was admitted to the hospital 

 with an epileptic seizure and lived about twenty-four hours, during which time 

 the attacks were repeated two or three times. Nothing is known of the previous 

 history of this patient except that he was in the hospital on two occasions during 

 the present year suffering from acute coryza. During his last illness there was 

 no fever, and the epileptic attacks were typical in every way of epilepsy major. 



Autopsy four hours after death : Body of a well-developed, well-nourished Fili- 

 pino man. Skin and mucous membranes appear normal. Two small, bleeding- 

 surfaces on the tongue, evidently from injury during his epileptic seizures. There 

 is some oedema of the lower eyelids and a very marked, chronic conjunctivitis. 

 The mucous membrane of the nose is also hypertrophied and oedematous. The 

 subcutaneous tissues contain a moderate amount of fat and are normal in appear- 

 ance; the subcutaneous lymphatics are not enlarged, except in the right axilla, 

 where there is moderate hypertrophy without any evidence of an acute process. 



