CONDITION OF THE LIVER IN SCHISTOSOMIASIS. 225 



Catto in their accounts of the ova of Schistosomuiu japoiiicum. They 

 were studied in comparison with a section of the liver from Catto's case, 

 which shows ova of a similar appearance. 



III. PATHOGENESIS OF THE CIRRHOSIS OF THE LIVER. 



It is clearly evident that in this case the liver was the organ to bear 

 the brunt of the infection, the invasion of the intestinal walls bejng 

 of but secondary importance to the lesions in the liver. In this respect 

 the findings here are in accord with those hitherto reported in cases of 

 this malady. In the earliest Japanese writings on the disease, the latter 

 is described a,s a peculiar cirrhosis of the liver due to a parasite, while 

 Ivatsurada, in his original description, speaks of it as an affection of the 

 liver both of man and of cats. In the case described by Catto, the extreme 

 enlargement of the liver and spleen was noted during life, while at 

 autopsy, although there were marked changes in the other organs, espe- 

 cially in the large intestine, the cirrhotic condition of the liver was 

 perhaps the most striking feature. In Woolley's case, the first to be 

 described in the Philippine Islands, the liver was smaller than normal 

 and markedly cirrhotic. In both of these instances numerous ova were 

 found in the perivascular tissues of the liver, where they apparently 

 caused a marked hypertrophy of the connective tissue. In two of three 

 cases reported by Dr. Logan in China, enlargement of the liver was a 

 prominent feature of the malady while in all three, oedema of the legs 

 and ascites were present, possibly clue to hepatic diseases. This list in- 

 cludes all the reported cases that have come to our knowledge, and in 

 practically all of them changes in the liver have been found either clinic- 

 ally or by post-mortem examination. 



The pathogenesis of the cirrhosis in these cases is difficult to estab- 

 lish. A moderate increase in the interlobular tissues might be due to 

 the presence alone of the ova, but how can we account for the destruction 

 of whole lobules in the presence of but a very few ova ? The anastomosis 

 of the blood vessels within the lobule is so free that it is difficult to see 

 how the ova, acting as emboli, could produce this result, but Katsurada, 

 according to Stiles, believes this to be the explanation of the cirrhosis, 

 although he speaks also of a toxin which he thinks is elaborated by the 

 worm and which plays a part in producing the liver changes. 



IV. COMPARISON OF INFECTION WITH SCHISTOSOMUM JAPONICUJI AND 

 SCHISTOSOMUM HAEMATOBIUM. 



Let us contrast the pathology of the above case with that encountered 

 in Bilharzia infections. Madden, in his excellent monograph on Bilhar- 

 zia, devotes a score of pages to the pathologic anatomy of the intestinal 

 and urinarjf tracts, and in four lines disposes of the liver with the state- 

 ment, "Kartulis and Symmes have described a periportal cirrhosis as 

 having occurred in this disease." Scheube says that the ova have been 



