TREMATODES 611 



turn. The patient's general health is not materially impaired; but there is 

 danger of fatal hemorrhages. The diagnosis is determined by the demon- 

 stration of.the ova. The ova of the distoma may, according to Yamagiva and 

 Otani, be carried to the brain, and there give rise to serious disease. 



No special therapy is known as yet. But it seems advisable that persons 

 infected by distoma should leave the regions where these are found in order 

 to avoid further infection. 



The distomum spathulatum, Leuckart, 1876, or distomum sinense, Cob- 

 bold, 1875, is very common in man, and also in the cat, in China and in 

 some parts of Japan. 



This parasite is reddish, almost transparent, flat, 10-18 mm. long, with 

 pointed anterior and posterior ends; the skin is smooth. The suctorial disc 

 of the mouth is larger than that of the abdomen; the latter is situated at 

 the line of the first quarter of the body. The oval eggs, 0.028-0.03 mm. long 

 and 0.016-0.017 mm. broad, are encapsulated, and gradually become black. 



The parasites are generally found in large numbers in the bile-ducts, but 

 rarely in the stomach and in the intestines. They produce severe clinical 

 disturbances. According to Baelz, the trouble begins with enlargement of the 

 liver, and a sensation of pressure and weight in its region; this is accom- 

 panied by a morbid appetite. After some years the nutrition becomes defec- 

 tive, and uncontrollable diarrheas make their appearance and later become 

 hemorrhagic. Gradually dropsy, ascites, and anasarca develop, and the pa- 

 tients finally succumb with severe cachectic phenomena. The autopsy shows 

 the walls of the gall-bladder and bile-duct studded with cyst-like sinuses the 

 size of a nut, which often contain numerous parasites. The sinuses communi- 

 cate with the bile-ducts. The liver is enormously enlarged but of normal 

 color. The tissue in the neighborhood of the parasitic foci is atrophied. The 

 ova of the parasites are always found in the feces. We know but little regard- 

 ing the development of the parasite, only that the ovum while in utero 

 develops a ciliated miracidium. The young forms of the parasite probably 

 live in mollusca. In later stages of development they must reach the intestinal 

 tract of man with raw vegetable, and possibly also with animal, food. 



The distomum conjunctum, Cobbold, 1859, has been found, so far, only 

 twice, in individuals in India who had succumbed to severe dysentery. 



Distomum felineum, Kivolta, 1885, sive distomum sibiricum, WinogradofE, 

 1893, deserves special mention. 



According to its contractions, its length is 8-18 mm., and its breadth 

 1.6-2.5 mm. The parasite, according to Braun, in fresh condition, is of a 

 reddish color, almost transparent, flattened, and pointed at the anterior end; 

 the skin is not weaponed. The suctorial discs are of almost equal size. The 

 pharynx is immediately adjacent to the suctorial disc of the mouth; the 

 esophagus is as long as the pharynx. The intestinal shanks, which do not 

 branch out, extend to the posterior end of the body, and are filled with dark 

 brown, granular masses. The eggs are oval, and have a lid which is sharply 

 defined; the length is 0.02-0.03 mm., the breadth 0.011-0.015 mm. 



The parasite Winogradoff, which until 1892 was only found in the cat, in 

 that year was noted to be a very frequent parasite of man, being present in 



