﻿PARAGONIMIASIS IN THE PHILIPPINES. 49 



I have pointed out in previous papers in respect to tuberculosis and 

 amoebic dysentery. 



Course and termination of the lesion. — The several types of departure 

 from the earliest point of infection have been described, and all of these 

 may be found in a case of extensive infection at the same time. The 

 secondarily infected, or mixed lesions, and the process of healing which 

 is sometimes seen may also be considered here. 



Mixed lesions. — These probably occur quite frequently and they may 

 be of several kinds. In one of my cases many of the abscesses in the 

 liver and other organs contain amoeba; and Paragonimus and in two others 

 the intestinal lesions were of this double infection. In addition to this, 

 bacteria have been found, and while this subject has not been sufficiently 

 investigated, it is probable that this type of mixed infection is of great 

 importance. In case 2, which apparently pursued a very rapid course, 

 numerous bacteria were found in the Paragonimus lesions and in one other 

 the abscesses of the prostate were more of a pysemic nature than they were 

 of a parasitic type, although the trematodes and the bacteria were present. 

 It would seem that what at first appeared to be a single infection and 

 which seemed to establish for the parasites the capability of inaugurating 

 an acute process, probably constituted in reality a double one, and that 

 the evidences of the more acute inflammatory changes were due to the 

 bacteria present. 



Healing to the extent of complete disappearance of all evidence of the 

 former infection probably does not take place, but by encapsulation and 

 other connective-tissue hyperplasia the lesions may become inactive so 

 as to produce no further disturbance. I have several times seen areas of 

 old, bluish scar tissue which, from the amount of contraction present, 

 probably resulted from what formerly constituted rather extensive, 

 Paragonimus lesions. 



D. SPECIAL GROSS PATHOLOGY. 



It seems advisable at this point, after discussing the general patho- 

 logical anatomy and the lesions of this infection, to introduce a brief 

 explanatory resume of the pathological findings which are shown in 

 Table No. 4. 



The conjunctivitis noted in 2 of the 8 cases was probably not due to the 

 fluke infection. In one of these, a careful microscopic examination was not 

 made and in the other such examination did not show ova. Similar types of 

 sever* conjunctivitis, largely of the Koch-Weeks variety, are of very frequent 

 occurrence among the prisoners from which much this material was obtained. 



Skin lesions, consisting of ulceration, were present in 2 out of 6 of the fatal 

 cases. These ulcers in each instance communicated with diseased lymphatics 

 and their characteristics have already been given. 



Lymphatics. — Both the subcutaneous and deeper lymphatic glands suffered 

 in at least 5 out of 7 of the 8 fatal cases. Their involvement is much more 

 extensive and important than is indicated in the literature of the subject. In 

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