﻿PARAGONIMIASIS IN THE PHILIPPINES. 55 



this country, and cases of so-called "glandular fever" and of "climatic 

 bubo" axe not uncommon; some of these, as well as certain of the so- 

 called "tropical ulcers/' may have their etiology in trematode infections. 

 The symptoms produced by glands infected with trematodes are not dif- 

 ferent from those of similar lesions of other etiology, and an exploratory 

 incision may or may not reveal the presence of eggs. 



The skin ulcerations have nothing characteristic. They are probably 

 secondary to the infected lymphatics beneath. I found eggs in the con- 

 tents of the ulcers in two of my cases, and the older and more advanced 

 ulcers have a slate-colored, overhanging margin. The lack of evidence 

 of acute inflammation about such ulcers is important. 



One of my fatal cases, while in the hospital, complained of muscular 

 rheumatic pains, and similar symptoms have been pointed out by other 

 writers; this is at least partially explained by the distribution of the 

 lesions, parasites and eggs in the muscular tissue. 



Fever, which has not previously been considered an important symp- 

 tom in these cases, was high in 4 out of 9 of mine and it probably will 

 be found to be a somewhat constant symptom in extensive infections 

 and in mixed ones which run a rapid course. 



(b) Thoracic or pulmonary paragonimiasis. — According to the 

 literature this is by far the most frequent type of the disease and loca- 

 tions of the infection other than in the thoracic cavity are considered to 

 be secondary to this primary focus. 



In two of my fatal cases and in two more of the clinical ones, the 

 lungs were not involved and in several others the older and more severe 

 lesions were surely present in the other organs. The pleuras, diaphragm 

 and other chest structures are so commonly, indeed almost constantly, 

 involved with the lungs that thoracic paragonimiasis seems to be the more 

 satisfactory term for this class of infection. 



The most prominent symptoms ascribed to this type comprise : Pains 

 in the chest; cough with occasional small haemorrhages, the sputum 

 containing eggs and according to Taylor and others sometimes an adult 

 parasite. The physical signs are usually considered as being slight. 

 Cough is a prominent symptom in most of these cases, but in one of 

 mine it was so slight as to attract but little notice. The nature of the 

 cough is as variable as that observed in tuberculosis, and the character 

 and appearance of the sputum has an equally wide divergence; both 

 depending largely upon the stage or nature of the underlying patho- 

 logical change and the amount of lung tissue involved, together with 

 the condition of the pleurae and heart membranes, this condition depend- 

 ing upon the presence or absence of fluid, adhesions, etc. I have also 

 convinced myself that the finding of eggs in the sputum in the average 

 case requires more time and care than is usually supposed to be the case. 

 Indeed, in one instance eggs were not found after several careful ex- 

 aminations made for this specific purpose, and yet at autopsy the lungs 



