Parasites of the Spleen. 371 



Symptoms. The symptoms vary with the organ invaded by 

 the parasite. 



(a) Lung Invasion. This is the common seat of the parasite, 

 and especially near the root of the lungs, the cyst opening into a 

 bronchium. The phenomena begin imperceptibly and encrease 

 gradually, a slight cough leading to a brown or reddish expector- 

 ation, resembling that of acute pneumonia, but easily distin- 

 guished by the absence of fever, and by the presence in the sputa 

 of myriads of the characteristic elliptical ova of the trematode 

 (sometimes 12,000 daily). Spitting of blood is common or 

 occurs later and can be roused by voluntary coughing. The 

 rusty or bloody expectoration at first proves intermittent, with 

 intervals of su.spension, but later with extension of the disease it 

 becomes constant, together with the cough and considerable dis- 

 comfort. It has been largely mistaken for tuberculosis but mi- 

 croscopic examination of the sputum corrects this error. The 

 expectoration, at first scanty, as well as intermittent, tends later 

 to become profuse and constant, and bleeding more frequent, ten 

 or twelve ounces being often ejected in a few hours. It is always 

 aggravated by violent exertion. Slight cases may continue for 

 ten or twenty years with comparatively little discomfort, but with 

 a more extensive infe.stment there is hurried breathing, dyspnoea 

 on slight exertion, anaemia, weakness, prostration, oedema, and 

 more frequent and profuse haemorrhages. In the early stages 

 auscultation and percu.ssion give little or no morbid indication, 

 but in case of extenisive invasion, there are blowing sounds, mu- 

 cous or gurgling r^les, wheezing, and areas of lessened or abol- 

 ished resonance. Even in advanced cases it is rare to find any 

 marked elevation of temperature. 



(b) Liver Invasion. The presence of the fluke in the liver 

 has been noted by Yamagiwa, associated with cirrhosis, ascites 

 and other .symptoms of the cirrhotic degeneration. Unless be- 

 trayed by coincident invasion of the lung, or by the detection of 

 the elliptical terniatode ova in the faeces, a correct diagnosis is 

 unlikely. 



(c) Brain Invasion. One such case is reported from Japan 

 by Otani' associated with infestment of the lungs, and one by Yam- 

 agiwa, without record of lung infestment. Both showed more or 

 less local paresis, and Jacksonian epilepsy, clonic spaisms in cir- 



