﻿60 MUSGRAVE. 



sometimes rather difficult to distinguish, and the two infections may be 

 found co-existent in the same lesion. 



Amccbiasis complicated 3 of my fatal cases, and the two diseases have 

 been found together twice clinically. The association is particularly 

 interesting in case 1, where both etiologic agents were found together 

 in the multiple abscesses of the liver and in lesions in several other 

 parts of the body. 



It is probable that in intestinal paragonimiasis eggs would more readily 

 be found in a bowel already ulcerated by amoebae. The symptom- 

 atology of the two diseases, when the abdominal organs are particularly 

 involved by the Paragonimus, may be very similar and the double in- 

 fection easily overlooked. 



XII. PROPHYLAXIS. 



As has been pointed out by Stiles and Hassall, Looss and many other 

 writers, no satisfactory prophylaxis against this disease can be estab- 

 lished until the life cycle of the parasite has been elucidated. General 

 hygienic usages are recommended by most authors, these measures, for 

 example, being the use of cooked food and sterilized water and the 

 disinfection of the sputa of infected hosts. In addition to the lack of 

 knowledge of the complete life cycle of the parasite, successful prophy- 

 laxis is further inhibited by an ignorance of the complete list of the 

 hosts of the adult fluke in zones where the parasite is endemic and its 

 prevalence in these different species of animals. 



Practically all writers have assumed that the infection takes place 

 through the gastro-intestinal canal, and this is probably true, but it 

 seems that the question of possible infection through the skin should 

 also receive careful consideration. The frequent, extensive involvement 

 of the lymphatics and the role played by this system in the distribution 

 of the infection in the body of the animal host make it very important 

 that skin infection be excluded in considering the manner of entrance 

 of the parasite. The probable similarity between the life cycle of this 

 fluke and that of some others with known life histories, adds another 

 good reason for forbidding the use of uncooked food, particularly vege- 

 tables and water, in countries where the disease is endemic. For similar 

 reasons it seems justifiable jjarticularly to warn against the consump- 

 tion of uncooked fish, clams, crabs, oysters and other shellfish obtained 

 from local waters. From data brought out in this report it seems wise 

 to recommend not only the destruction of the sputum of infected human 

 hosts, but an equally careful disposition of the faeces and, in cases 

 where ulceration of the skin exists, careful disinfection or destruction of 

 the dressings should be a routine procedure. Finally, it seems that the 

 spread of the disease might be somewhat limited by the destruction of 

 as many of the lower animal bosts as can be discovered. In this country 



