10 
tion: each patient is a native of the country in which the case was 
found, and in neither case is there any history given of the patient’s 
having visited the country of the other patient. 
Xatuke of the parasite. — A microscopic examination of the worms 
forwarded by Doctor Gates showed them to contain calcareous cor- 
puscles, hence the diagnosis of cestode infection was immediately 
established in this case on the same basis as was the diagnosis in the 
'Japanese case. The cestode in question is a larval form, without 
suckers on the head, and, as far as seen, without any primordium of 
genital organs. The most striking feature of the worm is its irregular 
shape, with tendency to proliferation by forming supernumerary 
heads. These characters immediately bring up for consideration the 
question as to whether the worm found b}" Gates is identical with the 
parasite recently reported by Ijima (1905) for Japan. As the Amer- 
ican and the Japanese parasites are very closely related, possibly 
specifically identical, it will be well to follow the two in comparison. 
In doing this it will be advisable to abstract Ijima's paper rather 
liberally, more especially since it is published in a journal not gen- 
erally accessible to dermatologists. 
The worm capsule of Ifimas parasite . — Ijima (1905, T-5) states 
that the worm capsules of various sizes occur in abundance in all 
parts of the subcutaneous tissues and less abundantly in the corium. 
The}^ were also observed in some numbers in the intermuscular con- 
nective tissue, but not in the muscles themselves, so far as such ob- 
servation could be made on parts incidentally exposed during the sur- 
gical operation. In the corium the capsule may be situated so close to 
the epidermis that the latter is externally raised into an acnelike ' 
prominence. On a piece of the preserved skin about 2 inches square, 
Ijima found at least four such prominences, which, as seen on the 
surface, appear smooth and less pigmented than the surrounding 
parts. Capsules so superficially situated might easily be ruptured 
by force applied through the skin from without. 
In shape the capsules are generally subspherical or ovoid. While 
the smallest of them are considerably less than 1 mm., others meas- 
uring 1 to 2 mm. or more are of quite common occurrence ; one of the 
largest seen was elongate, 2.5 mm. broad by 8 mm. long; another 
measured 3 mm. by 6 mm. The larger ^Capsules were found only 
in the subcutaneous parts, not in the corium. 
The capsular wall, consisting of a dense felt work of connective 
tissue fibers of the host, may reach nearly 0.33 mm. in thickness; 
in sections the capsules may appear not unlike a transversely cut 
blood vessel on account of the tough and compact looking wall; 
under a hand lens the inner surface of the capsule appears smooth; 
in some of the larger cysts the internal cavity is traversed by branch- 
ing trabecula ; microscopically the wall either shows no special limit- 
