﻿26 MUSGRAVB. 



The muscular tissues are rather coarse and quite pale in color. Both pleural 

 entities contain a small amount of cloudy, serous fluid and a number of chronic 

 adhesions, these adhesions being diffuse over the visceral surface and collected in 

 points of attachment on the parietal surface. At these points of attachment, along 

 the ribs, are found a number of slate-colored, cystic abscesses which, on section, 

 are typical of those already described for paragonimiasis. Both lungs are rather 

 voluminous and there is a marked bronchitis of all of the larger and medium sized 

 tubes. In the left lung there are several areas of bronchial pneumonia due to 

 P. westermani/i. Xo parasitic areas are found in the right lung. 



The visceral and parietal layers of the pericardium are adherent in several 

 places and, on separation of these adhesions, there are a number of raised, 

 brownish, granular patches which contain eggs of the parasite in question. The 

 heart muscle itself is firm and normal in color and no lesions of the endocardium 

 are found. 



The abdominal cavity is free from adhesions, except around the duodenum, where 

 there is a mass of old adhesions surrounding a post-peritoneal abscess which 

 leads well above and behind the left kidney; this contains about 50 cubic 

 centimeters of material resembling anchovy sauce and a number of adult parasites 

 and eggs. No direct connection between this abscess and any of the organs 

 can be established. 



The spleen is of normal size and consistency and no evidence of disease in 

 it was discovered on section. 



The liver is slightly cirrhotic and the gall bladder and bile ducts are moder- 

 ately distended with fluid, which microscopically is free from any abnormal 

 elements. No abnormal changes were found in the kidneys, bladder, or other 

 of the pelvic or abdominal organs. 



The intestine unfortunately was not opened. 



The membranes of the brain are thickened and adherent in many places; 

 bound in these adhesive masses are cystic parasitic abscesses similar to those 

 of the pleural cavity. The choroid plexus is coarse and granular, slightly 

 bluish, and a few eggs are found in its substance. The brain substance itself 

 appears to be normal, with the exception of moderate congestion near the cortical 

 surface. No distinct abscess cavity was found in this organ. 



Case No. 5. — Pulmonary tuberculosis; pulmonary pleuritic, diaphragmatic, 

 omental, intestinal and lymphatic paragonimiasis ; death; autopsy. 



Practically nothing is known of the clinical history of this case; the patient 

 continued to perform his duties to within about twenty-four hours of death, at 

 which time he first came under observation; no microscopic examinations were 

 made during life. When admitted to the hospital he was very weak, moderately 

 emaciated, was coughing considerably and complained of pains in his left chest 

 and abdomen. There was an active diarrhoea and a slight elevation in temper- 

 ature. 



Autopsy eight hours after death: Pulmonary tuberculosis and a rather 

 extensive infection with P. westermanii are found. The tuberculosis involves 

 the bronchial glands and the upper lobes of both lungs. Some of the lesions 

 consist of caseous areas, from 2 to 5 millimeters in diameter, and there are also 

 several tuberculous cavities of about equal size, and one 10 millimeters in 

 diameter is found in the apex of the left lung. Very few miliary tubercles 

 are encountered. 



The Paragonimus lesions of the lungs are very much scattered, as are 

 the tuberculous ones, and they so closely resemble the cavities of tuberculosis 

 that had it not been for the more extensive distribution of the Paragonimus 



