﻿56 MUSGRAVB. 



and pleurae were found to be involved. The number of eggs in the 

 sputum depends upon the extent and particularly upon the character 

 of the lesions. Just as is the case in tuberculosis, it is obvious that 

 more of the eggs will be discharged from bronchiectatic cavities than 

 from the equally important pneumonic areas. With this in view it 

 seems hardly likely that early diagnoses are probable in this disease, 

 and the need of repeated and careful search for eggs in the sputum of 

 suspected cases is also emphasized. Haemoptysis has not been a constant 

 symptom in my cases, at least while they were under observation, but in 

 one instance it was repeated and quite severe. In a country where 

 tuberculosis is so very general, haemoptysis would call attention to the 

 disease under discussion only in the absence of other tubercular symp- 

 toms. Charcot-Leyden crystals are at times quite numerous in the 

 sputum or again may not be observed at all. Other types of crystals, 

 such as those of creatinin are also sometimes present. When the pleu- 

 rae are extensively involved, with but slight or no extension of the disease 

 into the lungs, the chances of finding eggs in the sputum will be very 

 small and the diagnosis will then have to be made largely from physical 

 signs. The fluid from a Paragonimus empyema contains very few eggs 

 and therefore, when this is the case, aspiration of the pleural cavities 

 would often fail in furnishing a diagnosis. 



In two cases under my observation which had pericarditis, the mani- 

 festations were similar to those encountered where this disease is of other 

 etiology. 



The physical signs in thoracic paragonimiasis have a greater importance 

 than is usually ascribed to them. Bronchopneumonia, empyema, hydro- 

 thorax, etc., due to this infection show the same accurate physical signs as 

 they do in the similar conditions produced by other causes. In one clin- 

 ical ease the presence of an empyema with pericarditis led to a careful 

 examination of the sputum, and this determined the diagnosis. It must 

 not be forgotten that, particularly in Manila, tuberculosis will be found 

 associated with Paragonimus. 



(c) Abdominal paragonimiasis. — This term is used by me to include 

 the infection of any or all of the abdominal organs. 



The abdominal infection is usually a rather extensive one and will 

 hardly admit of a positive diagnosis without an exploratory operation 

 or the finding of the eggs in the faeces. Eggs are probably only found 

 in the faeces in the presence of ulcerative lesions in the bowel. In the 

 several cases which I have had the opportunity of studying there was 

 abdominal pain, mostly of a dull, aching character; in such instances 

 the abdominal walls may be rather hard and may show some tenderness 

 on pressure. In areas where the infection is endemic, hypertrophy of 

 the prostate, cirrhosis of the liver, chronic epididymitis or lymphadenitis 

 of doubtful etiology, should always lead to a careful study in which 

 fluke infections are taken into consideration. If there is tdceration of 



