8 
skin are about the size and shape of grains of rice. When they first appear 
there is an itching produced. The cyst is filled with a clear watery fluid in 
which is found the small worm. In a few days a cyst wall is formed, sur- 
rounding the worm, which lies in a jelly or slime like substance. After weeks 
or months the cyst wall becomes firm, and surrounds one or more worms. In' 
some cysts I have found as many as three worms. In the course of a few 
months the cyst wall breaks and there is nothing left but, sometimes, a blue 
spot showing a small hemorrhage; after this is absorbed, there will be only 
a spot of indurated tissue to mark the place. The places that have been in- 
fected the longest appear as a mass of indurated skin and fascia closely con- 
nected so that the skin can be picked up only with the mass of worm and tissue. 
Patient is now 48 years old. He came to Florida in 1872 from Minnesota 
and settled with his father on a point on the Manatee River, now known as 
INlanns Point, which was accessible to fish and oysters. 
When 23 years old, while hunting in the woods about 11 miles from the coast, 
he noticed a small pimple on the left shoulder, which attracted his attention 
because of the itching. He thought the skin had been punctured by a thorn. 
He squeezed the lum]), from which came a small flat worm about i^-inch wide 
and f-inch long. One year after the first appearance on the shoulder, he 
noticed four or five small lump§. on his chest ; these he opened with a knife 
and he picked out the same kind of worms ; these swellings also had produced 
an itching sensation. Patient was then living as fisherman on Sarasota Bay. 
While fishing, patient’s diet consisted of smoked and dried fish, raw oysters, 
scallops, and clams. Up to five or six years ago he was a robust, healthy 
specimen of manhood, but lacked energy. At present he has a tired expression, 
has less energy, and becomes exhausted after little exertion. 
From the photographs (figs. 1-2) you will see enlargement of the left breast 
and shoulder ; also of left groin and lumbar r0gi6n. Spleen and liver are 
enlarged. 
The infection is slight on the right side. 
Patient has a wife and five children, all of whom are healthy. 
There probably was another case similar to this a few years ago in this 
county. I have been trying to obtain a history of it, but have failed thus far. 
The man moved from here to California, where he died. The report was that he 
was eaten up with worms before he died. — Extracts from letter, August, 1907. 
Japanese case . — The patient was a Japanese woman, Yae Tanaka by name, 
resident in Tokyo or immediate vicinity. Before her marriage to a dealer in 
old furniture she was a weaver, “occupations which place her decidedly in the 
lower class of society.” 
At the age of 33 years, in the spring of 1904, she visited the University Hos- . 
pital at Tokyo for treatment for left inguinal hernia, entering the surgical 
wards of Dr. J. Kondo. This hernia was traceable to the presence of parasites 
in the region of the ligamentum poupartii. In addition to the hernia, she pre- 
sented a peculiarly swollen condition of the integument, which bore scattered 
spots of acnelike appearance. This abnormal condition extended over nearly 
the entire body, except on the face and upper extremities ; it was most prom- 
inent on the left thigh, which was greatly swollen and presented very much 
the appearance of elephantiasis, although the skin and underlying 'tissues were 
quite soft, so that they hung down by their own weight and could be grasped in 
a flaccid mass by the hand. 
When 25 years old the patient had a tapeworm, the species of which is not 
known. The dermal affection was first felt when she was 31 years old, so 
that at time of entrance to hospital it was of about two years’ standing. It 
had given no particular trouble beyond that imposed upon motion by the 
