﻿52 MUSGKAVE." 



The loose connective tissues, particularly in the subserous coat of the 

 bowel, and less frequently elsewhere, may sometimes be found infiltrated 

 with eggs without any decided change in the histology of the tissues 

 themselves (PL X, fig. 1) ; however, in a later phase of this condition 

 two changes begin to take place — a proliferation of connective tissue and 

 beginning round cell infiltration. As the connective tissue wall developes 

 in quantity, eggs may be surrounded by it, the proliferated cells increase 

 in numbers and eventually the next stage is recognized — cirrhosis — or 

 the lesion begins to break down and an abscess is formed. The early 

 changes above referred to are rarely seen in the liver, but the second 

 stage, with moderate cirrhosis by increase, particularly in the larger 

 bands of G-lisson's capsule, was present in one of my cases. After an 

 examination of many specimens I have found a few eggs in apparently 

 nonproliferating tissue of the liver. 



The histology of broncho-pneumonia, another nonsuppurative type 

 of lesion, does not differ materially from similar lesions due to other 

 etiology. The exact method of formation is difficult to explain, but 

 inasmuch as the two first stages of infiltration mentioned above are also 

 seen in the lung, and bearing in mind the part played by the lymphatics 

 in the distribution of the eggs, it would seem that the pneumonic areas, 

 at least in part, may follow some of the other lesions. 



Pneumonic areas sometimes become converted into the abscess type. 

 The amount of embolism and thrombosis in this disease is exceedingly 

 small. Lesions of the serous surfaces may be of the ordinary type, but 

 often they have certain distinctions. They are most numerous about old 

 adhesions, which may or may not be of Paragonimus origin. The adher- 

 ent surfaces when separated are rough, raised, often of a brownish color, 

 and contain eggs ; sometimes these lesions break down and abscesses are 

 formed. The histologic picture in these types shows a fibrosis, with very 

 moderate round cell infiltration. Here, as in the other types discussed 

 above, there is sometimes, but not often, a marked eosinophilia present. 



Tubercle-like lesions, particularly those very much like miliary 

 tubercles, have been mentioned by several writers. Miura states that they 

 correspond histologically with Virchow's "fibrous tubercles," the centers 

 containing eggs and often giant cells. These lesions have been consid- 

 ered the primary ones and all others the result of coalescence and 

 changes in the tubercles. 



Although lesions closely resembling more advanced tuberculosis are 

 often encountered in these cases, I have not seen the type of miliary 

 tubercle except in one case, and here the lesions were of true tuberculous 

 origin. To judge from the descriptions of some of the cases in litera- 

 ture, it would seem that mixed infections such as were present in this case 

 had been described. As has already been stated, eggs and tubercle bacilli 

 have been found together in more advanced types of lesions and, as is 



