﻿58 MUSGRAVE. 



their outlines may be made sharper and clearer and the operculum may 

 be rendered more distinct by adding a small quantity of dilute sulphuric 

 acid to the specimen, or by running a drop or two of a 0.1 per cent 

 solution under the cover glass. The ordinary munipulations used in pre- 

 paring a specimen of sputum for examination for tubercle bacilli either 

 destroy the eggs or reduce them to an unrecognizable condition. Once, 

 in examining a slide for tubercle bacilli, peculiar appearing bodies were 

 noticed, which led to the examination of a fresh specimen and to the 

 recognition- of a case of paragonimiasis which had previously been unsus- 

 pected. This patient also had tubercle bacilli in his sputum. While in 

 several conditions Charcot-Leyden crystals are found in the sputum, they 

 are in this disease more numerous and constant than the eggs of the 

 parasite, and when seen in considerable numbers in a sputum from a 

 patient in regions where the infection is endemic, their presence should 

 lead to a closer investigation for Paragonimus disease. In the Philip- 

 pine Islands, and other endemic zones, examinations of fresh specimens 

 of sputum should be as much a part of routine as is the examination of 

 stained ones. 



Fceces. — Several times duirng the past year the presence of Paragoni- 

 mus infection has been discovered by finding the eggs in the faeces. In 

 one case the diagnosis was confirmed by an autops} r . In two of these 

 instances no eggs could be discovered in the sputum. Only a simple 

 cover-glass preparation is needed for the examination of the faeces and 

 the eggs are most quickly located with an AA objective and a number 

 ■i occular. The eggs are less numerous in the faeces than they are in the 

 sputum, and they usually are found only after persistent search. 



The primary lesions in the intestine are usually in the deeper layers 

 and the eggs probably do not appear in the fasces unless there are ideera- 

 tio'ns of the mucosa; this fact has been pointed out in the discussion of 

 the pathology of this disease. 



Ulcers. — Ulceration of the skin of a chronic type leading into deeper 

 tissues should indicate careful examination of the scrapings for eggs of 

 P. westermanii. 



Fluids and tissues removed by surgical operation in obscure cases 

 should be carefully scrutinized for eggs and parasites in zones where the 

 disease is endemic. This is particularly true in operations which require 

 the opening of the abdominal or pleural cavities. 



In explorator} r , diagnostic operations in the Philippine Islands, par- 

 ticularly upon the chest, abdomen, liver, scrotum or prostate, fluke infec- 

 tions should be kept in mind. The difficulty of distinguishing the egg 

 of P. westermanii from some of the other fluke eggs has already been 

 noticed in another part of this paper and need not be repeated here. 



While, as stated above, positive diagnosis can only rarely be made in the 

 living subject except by finding parasites or eggs, there are several subjec- 



