137 
because of some interesting particulars it contains.* The preserved 
material sent to me consisted of about 200 loose worms, and many 
others were still seen densely packed in the bile-ducts of some 
preserved pieces of liver. Among the loose worms there was again 
not a single specimen of the ordinary small variety, but all were the 
large form. I had thus, within a very short lapse of time, thrice come 
across a variety of the Chinese liver-fluke which I had never seen 
before, and in all these three cases this variety had been present 
alone, quite unmixed with individuals of the usual smaller variety 
I had not the least doubt that this new form would prove to 
be an independent species and that it would be easy to delimit it 
anatomically from its smaller congener. I was therefore soniewhat 
disappointed, when after a most minute and thorough comparison of 
the specimens with those 1 possessed of the small “ Disloma sincusi, 
1 could not, apart from the size of the body and the ratio of tin 
suckers, find any constant internal differential character between them. 
Even of the characters mentioned the last-named is by no means 
conspicuous, and I had almost made up my mind that the two varieties 
must be considered as one and the same species, when, on 
reconsidering all the factors involved, 1 came to the conclusion that 
* A CASE OF DISTOMIASIS OF THE LIVER AND THE DUODEN UM. 
Too-ting, a Chinaman, aged .25, was admitted to the British Hospital, Fort 
Said, on May ioth, 1906, suffering from Lumbar Abscess. He was landed from 1 
ship proceeding from China to England. The abscess was pointing in the lumbai 
region, posteriorly, 2^ inches from both the middle line of the back and the cre>t 
of the ileum. It was opened and about 300 grins, of bile-stained pus were 
evacuated. The walls of the abscess were explored and the transverse proce.-s of 
one of the lumbar vertebrae was found to be necrosed. But no connection could 
be found between the abscess and the liver. The cavity was washed out and 
stitched up. Subsequently a drainage tube had to be inserted, for the pus collected 
again ; but the man’s condition rapidly improved, and the wound over the site of 
the abscess healed completely. 
On June 21st, the man suddenly developed pneumothorax, affecting the lower 
part of the right side of the chest. As he was thought to be suffering from an 
abscess of the liver, this organ was explored again, but no pus was found. Oedema 
occurred over the lower part of the right side of the chest and still no pus could be 
found on exploration. The patient rapidly became worse, and died on June 25th. 
I ost Mortem. 1 he abscess in the lumbar region had healed completely. V 
reason for it could be found beyond the necrosed vertebra. 
Liver : 1 he liver was enlarged and contained numerous abscesses in both lobes 
I hey varied in size from that of a small pea to a tangerine orange. On sect.' :, 
the liver presented hundreds of liver flukes in the bile-ducts. The hepatic duct-, 
common bile duct, and gall-bladder all contained numbers of these flukes. 
1 hey were also found free in the duodenum, but not in the ileum. 
1 here were no flukes in the abscesses. 
No cause for the pneumothorax could be found, and no connection between it 
and the liver was apparent. All the other organs were normal. 
(Signed) F.dward Cvfkey, 
Medical Olficer, British Hospital, 
Port Said. 
