﻿46 MUSGRAVE. 



C. GROSS LESIONS. 



Bather liberal abstracts from the autopsy protocols in my eight fatal 

 cases are given in Chapter V of this report, and these findings are epito- 

 mized in Table Xo. 4. 



All the previously described lesions, as may be seen from a study of 

 these cases and of the literature on the subject, are found in these eight 

 and in addition new distributions and pathological processes caused by 

 the parasite are recorded. In three of these cases the distribution is 

 extensive enough to justify the term general infection: in two it is so 

 markedly predominant in the lungs that thoracic or pulmonary paragon- 

 imiasis would seem a proper designation in these instances; in one case 

 of epilepsy the term cerebral paragonimiasis would more clearly indicate 

 the nature and most active location of the processes. Whatever the loca- 

 tion or distribution of the lessions, there is always a great similarity 

 between them. 



These Paragonimas lessions have certain characteristics in general, 

 which are sufficient to make it possible usually to identify the mature 

 ones even Avithout finding the parasites or without using the microscope. 

 These characteristics are the color, general structure, contents and the 

 absence of evidence of active inflammation. 



The color of the lesions is a peculiar dull, bluish-slate, without evidence 

 of pigmentation, and it seems to be in part due to reflection from the 

 contents through the walls of the cyst, but this is not entirely the case 

 for, after opening and cleaning a lesion, some of this color remains in 

 the wall. 



The general structure of the mature lesion is that of a necrotic abscess 

 with a definite and more or less dense wall, which appears to be made 

 up of layers. The outer surface is intimately connected with the sur- 

 rounding tissues and the inner one is usually a smooth appearing 

 membrane, but it may give evidence of being granular. 



The contents vary but little. In addition to adult parasites, and eggs 

 which may or may not be present, there is a material resembling anchovy 

 sauce filling the entire cavity. At times (probably in mixed infections) 

 the contents may appear more like ordinary pus and again it may be 

 caseous and hardly distinguishable from a tuberculous lesion. It must 

 be remembered that such a double infection may be present. As a rule 

 there is an almost complete absence of the usual evidences of inflamma- 

 tion in or around these lesions. 



While lesions answering to the description given above are charac- 

 teristic, and while some of them may be found in even 7 case of the disease, 

 there are several important exceptions. These exceptions are so prom- 



