XII, B, 4 Hilario and Wharton: Echinostoma ilocanum 205 



of Zambales, we believe, is not to be questioned. The fact that 

 all our cases came from that province tempts us to assume that the 

 parasite may be just as prevalent there as in Ilocos Sur, which 

 is the locality established by Garrison on the basis of the fact 

 that all his cases were obtained from there. In this connection 

 further work on geographical distribution of the fluke may show, 

 in the face of the conflicting findings as to locality, wider fields 

 of distribution than is even now suspected. 



REPORT OF CASES 



Case 1. — I. F., female, 20 years old, born and living in San 

 Felipe, Zambales, entered the School of Nursing July, 1916. She 

 is moderately well nourished, but very pale. She complains of 

 constipation, headache, and occasional dizziness. Blood exami- 

 nation shows 65 per cent hemoglobin, 4,300,000 erythrocytes, 

 8,600 leucocytes, 78 polymorphonuclear neutrophiles, 20 lympho- 

 cytes, 8 polymorphonuclear eosinophiles, 4 large mononuclears. 

 In October, 1916, in the routine examination of the stool, a 

 moderate number of ova of Echinostoma ilocanum was encoun- 

 tered. After giving a dose of oleoresin of male fern, 8 worms 

 were obtained, in apparently poor condition. On January 21, 

 1917, the treatment was repeated and the stool was collected 

 in a dish containing 10 per cent formalin. Five worms in ap- 

 parently good condition were passed. Of these only one exhibited 

 cuticular spines. The specimen was fixed in formalin solution. 



Case 2. — T. M., female, 21 years old, native of, and residing in, 

 San Antonio, Zambales, entered the Philippine General Hospital 

 as a probationary student -in the School of Nursing on July, 1916. 

 She is well nourished and well developed, but somewhat pale. 

 She complains of occasional headache, sometimes stomach ache, 

 regularly slight constipation, and irregular menses. Blood exam- 

 ination showed 85 per cent haemoglobin, 5,400,000 red blood cells, 

 11,600 leucocytes, 78 polymorphonuclear neutrophiles, 15 lym- 

 phocytes, 6 large mononuclears, and 1 eosinophile. In Novem- 

 ber, 1916, the examination of the stool showed rare ova of 

 Echinostoma, as also a few eggs of Ascaris and Trichuris. She 

 was given a treatment of male fern. After a careful examina- 

 tion of the stool no worms were found. On January 21, 1917, 

 another dose of male fern was administered, and the stool was 

 directly received in a solution of formalin. Three worms were 

 recovered. 



Case 3. — (Case 47963) P. C., 38 years old, female, married, 

 born and living in Cabangan, Zambales, admitted to the Philip- 

 pine General Hospital for enlarged abdomen. She is fairly well 



