﻿54 MUSGRAVE. 



sometimes a marked eosinophilia. Mixed infection in any type of lesion 

 may alter its histology very much, this alteration depending upon the 

 nature of the secondary invader. 



VIII. SYMPTOMATOLOGY. 

 A. GENERAL DESCRIPTION. 



The clinical observations upon this disease have been largely confined 

 to the symptoms of the pulmonary and cerebral types of the infection, 

 and for these a summary of the literature gives a satisfactory picture 

 of the disease as I have seen it. However, a study of the material upon 

 which this report is based shows the disease to be much more generally 

 distributed in the body than formerly it has been recognized to be, and 

 therefore it necessitates a more comprehensive clinical picture than any 

 which has previously been given. However, before taking up a con- 

 sideration of these special types more in detail, it is necessary to discuss 

 the general type of the disease in regard to its acuteness. Heretofore, 

 it has been considered as being almost wholly a chronic infection, but 

 some of my cases have shown a most acute and rapid course. 



Acute and chronic processes. — It is probably a fact that the true 

 and uncomplicated Paragonimus disease is always a chronic one, and 

 that the more acute processes are the result of some concomitant infec- 

 tion or complication. This has already been pointed out as probably 

 accounting for the rapid course of some of my cases and it is a condition 

 which needs more study based upon a larger material. However, it is 

 a fact that we must consider from a clinical standpoint at least some of 

 these cases as acute, and while this condition obviously would be more 

 likely to occur in a general infection, it surely may take place and in- 

 fluence the course and termination in some of the more restricted types. 



B. CLINICAL TYPES. 



After a careful study of the literature and of my own material, as 

 well as I have had opportunity to do so, it seems advisable to consider 

 the symptomatology under the following arbitrary clinical classification: 



(a) Generalized paragonimiasis. 



(b) Thoracic paragonimiasis. 



(c) Abdominal paragonimiasis. 



(d) Cerebral paragonimiasis. 



(a) Generalized paragonimiasis. — A full consideration of the gen- 

 eral infection would produce a composite picture of the other more local 

 varieties, which I have already given in the classification and therefore, 

 in order to avoid repetition, only those points in the clinical symptoms 

 which are not directly covered in the discussion of the other clinical 

 types will be noticed here. Some of the most interesting of these symp- 

 toms are produced by involvement of the superficial lymphatics and the 

 skin. Enlarged lymph glands are quite common among the people of 



