pahasitic diseases of the liver. 



297 



points by starting from the vena cava, is not admissible. In the 

 first stage of distoraiasis we observe sometimes apoplectic deatli, 

 due undoubtedly to cerebral embolism produced by young fluke- 

 worms which have penetrated into the arterial circulation (Gerlach). 



The fluke-worms begin to leave the liver at the time of reaching 

 sexual maturity, a condition which occurs within about three weeks, 

 as stated by Leuckart. Gerlach has asserted that emigration takes 

 place from nine to twelve mouths after ingestion — that is to say, 

 toward the months of June or July. Pech and Friedberger have 

 found in the fall and winter numerous fluke- worms in the gall- 

 bladder and in the duodenum (in the large intestine they are 

 digested very quickly ; they are, therefore, never detected in that 

 organ). According to Thomas, the duration of the fluke-worm's 

 life varies from one to several years (six years in one case). 



Pathological anatomy. The main alterations are found in 

 the liver ; they difler mainly according to the period in which they 

 are observed. In most cases the left lobe is first aflected (Falk). 

 The liver is more or less hypertrophied ; its weight may have 

 doubled or trebled ; its edges are rounded and its coloration has 

 changed ; the appearance of the latter is at times very close to 

 porphyry ; upon a yellow, gray, or dirty yellowish-brown ground 

 we observe dark red or dark reddish-brown spots, which are round, 

 linear, or ramified, and which are irregularly distributed. The 

 surface of the liver is coarse, irregular, covered with filiform or 

 membranous neoformations, which sometimes join the liver to the 

 diaphragm very closely (perihepatitis). We observe quite often, 

 in the capsule, openings of the diameter of a pin-head or a millet- 

 seed, through which trickles a bloody dirty matter, or which is 

 filled with a worm's head. When performing an incision upon 

 their surface in the liver we often find, immediately below the 

 capsule, a more or less considerable quantity of young fluke-worms 

 located in grooves or in sinuous passages. The lymphatic ganglions 

 which are located upon the hilum of tjie liver are tumefied and 

 œdematous. 



On section we see variable alterations of the biliary canals and 

 hepatic parenchyma ; there are many lacunar, chambered spaces of 

 a very irregular form, and full of a clammy, bloody, red-brownish, 

 or grayish matter, formed of red globules and leucocytes, also of 

 hepatic cells having undergone fatty degeneration, broken-down 

 tissue, and fluke-worms in an imperfectly developed stage. The 



