﻿PARAGONIMIASIS IN THE PHILIPPINES. 51 



Kidneys. — The kidneys were included in the infection three times; the 

 lesions were mostly closely connected with the capsule, but in 2 there were 

 abscesses of the pelvis and in 1 the ureters were included in the affection. 



Urinary bladder. — This organ had Paragonimus abscesses in the walls in 

 2 cases. 



Scrotum. — The epididymis contained parasitic lesions in 3 instances; in 1 

 the infection extended through the inguinal canal to the abdominal lymphatics. 



Prostate gland. — The prostate was involved four times. The lesions were of 

 the abscess type and contained ova. 



Brain and spinal cord. — These organs were only examined twice. In one 

 instance there were Paragonimus lesions of the membranes of the brain, and 

 eggs were found in the choroid plexus. 



E. HISTOLOGY. 



The literature bearing upon the microscopic study of the disease 

 principally consists in the description of two types of lesion — the tubercle 

 and the bluish-colored necrotic abscess. 



The older literature is well summarized by Stiles and Hassall; since 

 that summary was compiled, some original observations have been made, 

 particularly by Katsurada. Looss has recently given another brief sum- 

 mary in Mense's handbook. 



I shall discuss the lesions under the same classification as that already 

 used in describing the gross pathology. They have certain points in 

 common. In all the strictly parasitic types of infection there is the 

 evidence of a slowly developing, low grade of chronic inflammation, with 

 constant effort at repair which is chiefly manifested in the extensive 

 proliferation of the connective-tissue framework, the new tissue being 

 deposited about the original lesion, gradually encapsulating it or in 

 some other manner tending to prevent its further spread. 



This is made most manifest in the fully developed cystic abscess 

 lesion, where the limiting wall is often very firm and thick. In other 

 types it is less evident and in some of the very early infiltrations of the 

 loose connective tissue with eggs it is entirely absent. 



Eggs or parasites are by no means constantly present in any variety of 

 the lesions. In the earlier forms the diagnosis can only be made by dis- 

 covering the presence of these bodies, for there is nothing else charac- 

 teristic about the lesions. The older ones and particularly those of the 

 abscess variety take on characteristics which should be diagnostic even 

 in the absence of eggs or parasites. Again, the greatest variation often 

 exists in the number of eggs or parasites in a given lesion, sometimes 

 the eggs are very numerous, and on the other hand, in an otherwise 

 exactly similar lesion they may be very scarce. Parasites when present 

 may range from one to many. More than 1 00 adult parasites were found 

 in a psoas abscess. 



The nonsuppurative lesions are of several types; however, some of 

 these are but later stages of others, but there are certain ones which 

 differ in formation as well as in their entire course. 



