﻿PARAGONIMIASIS IN THE PHILIPPINES. 27 



cysts in other organs, the double infection in the lungs would probably not have 

 been discovered. Many of the tuberculous lesions show a bluish color, similar 

 to that constantly observed in those due to Paragonimus infection and it is 

 worthy of note that one cavity contains both tubercle bacilli and an adult 

 P. westermanii. 



The Paragonimus lesions in the pleura:, diaphragm and abdominal organs 

 are similar to those described in the previous cases. 



Case No. 6. — Paragonimiasis of intestine, omentum, pancreas, diaphragm, 

 abdominal lymphatics, and left pleura; chronic beriberi; death; autopsy. 



The patient, a native male about 40 years of age, was admitted to hospital for 

 chronic diarrhoea, which he stated was of long standing; he also said that he 

 had suffered from acute beriberi about eight months before the time of his 

 admission and that he was still suffering from this disease. Death from 

 exhaustion and intestinal haemorrhage occurred five days after he came under 

 observation. On admission, the patient complained of great weakness, diarrhoea, 

 and partial paralysis, principally involving the lower extremities. There was no 

 cough and no pain in the chest. Emaciation was very great and anosmia pro- 

 nounced. There was moderate atrophy of the lower extremities and all the 

 reflexes were absent. 



Autopsy nine hours after death : Paragonimus lesions similar to those 

 already described under the other cases are found in the intestinal wall, 

 the peritoneum, omentum, mesenteric lymphatics, diaphragm, small intestine 

 and left pleura. No such lesions are observed in the lungs, although a most 

 careful search was made, and these organs are normal, excepting a moderate 

 congestion and oedema. The left pleura, particularly on its parietal layer, is 

 moderately infected and this condition is more marked toward the base of the 

 chest, this infection apparently being continuous with the lesions along the 

 diaphragm. The most advanced lesions are found in the abdominal cavity, 

 and particularly in the omentum, where some of the slate-blue cysts 10 to 15 

 millimeters in diameter are observed. 



Lesions other than the specific and definite cysts due to Paragonimus infec- 

 tion are as follows: Moderate, fatty degeneration and passive congestion of the 

 liver; slight increase in the size of .the spleen with some fibrosis and perisplenitis; 

 moderate cirrhosis of the kidneys and old, healing amoebic ulcerations of the 

 colon. 



As is true of the other cases studied, parasites or eggs are found in many, 

 but not in all the cysts. 



Case No. 7. — Intestinal, omental, and lymphatic paragonimiasis, acute dysen- 

 tery and chronic parenchymatous nephritis ; death; autopsy. 



Practically nothing is known of the clinical history of this patient. The most 



interesting feature of the case is the complete absence of lung or other thoracic 



'lesion, in the presence of a well-defined Paragonimus infection of some of the 



abdominal organs. There are two typical lesions due to P. loestermanii on the 



under surface of the diaphragm, on the left side. 



Case No. 8. — Paragonimiasis of the left lung, pleura and superior surface of 

 diaphragm; acute generalized tuberculosis ; death; autopsy. 



The interesting features of this case are as follows: The parasitic lesions are 

 confined to the thoracic cavity; they are associated with tuberculosis and the 

 similarity between some of the tuberculous and the Paragonimus lesions is 

 striking. The bluish color of the parasitic abscesses is less marked than in the 



