REFERENCES 



1643 



Sambon's suggestion that the ova pass into the drinking-water, and 

 so to man, may be correct. It is possible that the eggs hatch in the 

 alimentary canal, and that the larvae then pass into the organs. 



Pathology. — The larvae are found lying coiled in cysts in the liver 

 and lungs. In due course these larvae become nymphas, which leave 

 the cysts and wander through the body, appearing in the lungs and 

 bronchi, causing bronchitis and broncho-pneumonia; in the peri- 

 toneal cavity, causing peritonitis; in the bowels, causing irritation. 

 Perhaps they leave the body by the faeces; perhaps, also, by the 

 sputum; but in any case they cause serious illness in, and death of, 

 the victim. 



Morbid Anatomy. — In opening the abdomen, the nymphae may 

 be found quite free in the peritoneal cavity, and may crawl up the 

 hands and arms of the pathologist. They may also be found in 

 the lumen of the ahmentary canal, in the mucosae, and thickness of 

 the wall of the bowel. The larvae may be seen encysted in the liver 

 and lungs. ^ 



In the cysts they lie in a curved position, with the ventral surface 

 on the outer aspect of the curve. The lungs show signs of bron- 

 chitis and pneumonia, and the peritoneum is usually chronically 

 inflamed, but not always. 



Symptomatology. — The symptoms of the early stages of the 

 disease are at present quite unknown, but the terminal symptoms 

 are emaciation and weakness, associated with attacks of bronchitis, 

 pleurisy, or other respirator}^ symptoms. There may be cavities 

 in the lungs, and the sputum may be offensive and may contain 

 the parasites, of which as many as 75 to 100 have been recorded 

 as being expectorated by a single patient. The liver is usually 

 considerably enlarged. 



Diagnosis. — The disease has often been mistaken for phthisis; 

 therefore any patient in the tropics suffering from the usual s^^mp- 

 toms of phthisis associated with enlargement of the liver may be 

 suspected, and the sputum and faeces carefully watched for the 

 possible appearance of the parasites. When a parasite is found, it 

 may not necessarily be either P. armillatus or P. moniliformis, but 

 is more likely to be some form found in some animal which lives in 

 the region where the patient resides or works. 



Prognosis. — The disease is generally chronic. The prognosis is 

 serious. 



Treatment. — There is no known treatment. 



Prophylaxis. — If the drinking-water is boiled or filtered, there 

 ought to be no danger of infection. 



REFERENCES. 



Broden and Rodhain (1907) , Annals of Tropical Medicine and Parasitology, 



p. 493, Liverpool. 

 Chalmers (1899). Lancet, i. (January 10). London. 



Sambon (1910-12). Journal of Tropical Medicine, London. (Series of 



valuable articles, not yet completed.) 

 Welch (1872). Lancet, ii. 703. London. 



