8 
whether there exist in the United States species of snails which can 
serve as intermediate hosts; and. second, whether these snails actuaily 
become infected by persons harboring the parasites. From the fact 
that snails are necessary for the propagation of at least some of the 
trematode maladies of man. it is apparent that cases of infection are 
more likely to occur in rural districts than in cities. In other words, 
they are more likely to occur in the practice of a class of physicians 
who as a rale do not use the microscope as an aid in diagnosis and 
who. therefore, will not recognize the exact nature of the malady. 
CLINICAL CLASSIFICATION OF TREMATODE INFECTIONS 
(DISTOMATOSIS). 
Trematode infection is usually spoken of as distomatosis. The name 
is derived from Distonia, which has been used by many authors to 
designate a collective genus in the family Fasciolid^e. As a generic 
name, iJistoma is now suppressed, its species having been distributed 
in a large number of well-dehned genera, but the term distomatGsis 
may be conveniently retained (at least until the zoologic nomenclature 
becomes more settled) to designate infection by digenetic trematodes. 
Distomatosis may aflect dilferent parts of the human body, as follows: 
Ophthalmic distomatosis: Very rare: diagnosis only by ophthalmo- 
scopic examination, or after operation . or on autopsy : treatment sur- 
gical: caused by JZh/n>5-f<9//? (p. l'2)r^\\^Agamodistoinu)n (p. Id). 
Cerebral (Jacksonian epilepsy): Usually in connection with 
pulmonary distomatosis: diagnosis symptomatic and by micro- 
scopic examination of sputum: no specific treatment: caused by 
Paragon imus (p. 14). 
Pidrnemary distermatosis (parasitic hemoptysis): Diagnosis by micro- 
scopic examination of sputum: no specitic treatment: caused by 
Para (jemimas (p. 14) and Pasciola (p. 18). 
Ilejjatic distomatosis : Diagnosis bv microscopic examination of feces: 
no specific treatment: caused hy Pasciola. Pi croceeJi urn. and Opis- 
thorchis (p. dO). 
Pancreatic distomatosis : Occasionally occurs with hepatic infection: 
caused by OpisthorchU (p. 30). 
Intestinal distomatosis : Diagnosis by microscopic examination of feces: 
treatment with thymol, or same anthelmintics as for tapeworms: 
caused by Fascwlopjsis. lleteropehyes. and Gastrodiscus (p. 39). 
Yencd distrrmalosis (bilharzian hematuria): Diagnosis, microscopic 
examination of urine and feces: treatment, male fern (Q: caused 
by Schistosoma (p. 49). 
CLINICAL DIAGNOSIS. 
The clinical diagnosis of distomatosis should be made by microscopic 
examination of the sputum, urine, and feces. Xo special technique is 
required. Examine the fresh unstained excretions under a medium 
