If it be asked what were the symptoms produced, I can only furnish such few and hitherto unpublished particulars as the missionary himself supplied. I need hardly say that he was a highly cultured and intelligent gentleman, since only such persons are chosen for missionary work in China.
From inquiries made by me on the 29th of January, 1875, I learnt that they left Ningpo in November, 1872, and travelled thence 130 miles into the interior of the country. In the following September, or about ten months subsequently, the missionary was attacked with diarrhœa, which persisted until expulsion of some of the parasites had occurred. According to the patient’s statements this result, so far, was entirely due to his having been placed on a milk diet; this course of treatment having been recommended by Dr Henderson, of Shanghae. The patient himself always suspected the presence of intestinal worms of some sort or other, although a Japanese doctor laughed at the idea of such a thing. Some other doctor treated this missionary for parasites, administering both male-fern and santonine without effect.
It was not until several months had elapsed that his wife was attacked with diarrhœa. In both cases there was more or less flatus. The motions were white, and there were other indications implying that the liver was affected. Later on, symptoms of indigestion, with heartburn, set in and became very severe. Streaks of blood appeared in the fæces, but there was no dysentery. For the most part these symptoms were attributed to the effects of climate.
When, in the month of February, 1875, I saw the missionary a second time, professionally, I found that all the old symptoms had returned. He had a foul tongue, the surface of the body was cold, he felt chills, and the pulse, though regular, registered ninety-six to the minute. Indigestion, nausea, headache, and diarrhœa had reappeared. Notwithstanding these febrile symptoms, so satisfied was the patient himself that all his ailments were entirely due to the presence of parasites, that I felt inclined to take the same view of his case. Accordingly my attention was principally directed to an effort for their expulsion; and in this view I ordered an aloetic pill followed by a castor-oil emulsion. This having no effect, I subsequently prescribed aloes and assafœtida pills, followed by scammony mixture. The action of the latter drug did not occasion griping, but, although efficient, led only to negative results. I should mention that in the patient’s judgment none of the vermifuges administered to him at any time had exerted any influence in the expulsion of the flukes. He was still thoroughly impressed with the notion that the milk diet, ordered by Dr Henderson, was the sole cause of their expulsion.
As even a missionary could not live by milk alone I insisted upon a more substantial diet. The milk, indeed, had occasionally been supplemented by Liebig’s extract of meat and by light farinaceous food. When I last saw him neither he nor his wife had passed any more flukes, but they did not feel satisfied that no more guests remained. Somewhat improved in general health, the missionary resolved to go back to his duties in China. I expressed my fears, however, that his strength would prove unequal to the work.
From the size and almost leathery texture of the two flukes which were in the first instance submitted to my notice, I at once recognised the species; but as they were spirit-specimens, I requested that if any more examples were obtained they should be sent to me in the fresh state. Fortunately others were brought in a few days, when, from an examination conducted whilst they were still fresh, I was able to make out several details of structure which had hitherto escaped notice. Altogether I secured seven specimens, three of them being in a mutilated condition. In what way these mutilations (as shown by my dried specimens) occurred I have not been able to make out, either by personal observation or by questioning the bearers. Two of the parasites look as though portions had been carefully excised near the centre. The new facts I have gleaned were derived from the examination of two comparatively small specimens, one of which, dried, has, by Prof. Rolleston’s desire, been deposited in the anatomical department of the University Museum at Oxford. When I took occasion to bring some of the new specimens under Mr Busk’s attention, he at once recognised them as referable to the species he had long ago discovered.
The earliest literary notice of Distoma crassum appeared in Dr Budd’s classical treatise ‘On Diseases of the Liver;’ and in it the author correctly stated, from data supplied by Mr Busk, that these human flukes were “much thicker and larger than those of the sheep,” being, it is added, from “an inch and a half to near three inches in length.” The longest of my recent specimens, however, scarcely exceeds two inches, whilst the smallest and most perfect (the one at Oxford) measures less than an inch from head to tail. The greatest width of my broadest specimen is little more than half an inch, or 9/16″. None of the twelve examples that I have examined approach the length of three inches; but Mr Busk assured me that, judging from his recollection, some of his specimens were even longer than that. I fear, nevertheless, that the estimate given in my Synopsis is somewhat exaggerated; at all events it is so for average specimens.
Fig. 2.—The large human fluke (Distoma crassum) a, Oral sucker; b, intestine; c, cæcal end of same; d, reproductive papilla; e, uterine rosette (the folds of which are not branched); f, one of the folds (in profile); g, vitellarium; h, hernial protrusion (the result of an injury to the specimen); i, upper testis; j, streaks or layers of seminal fluid which have escaped by rupture and assumed a branched appearance; k, lower testis uninjured (but slightly altered in outline from flattening); l, ventral sucker. Magnified 2 diameters. Original.
The new anatomical facts made out by me bear reference principally to the reproductive apparatus. What else I have observed is for the most part confirmatory of the statements made by Mr Busk. In particular, his brief account of the position and character of the digestive organs was not only confirmed by my earlier examinations, but is now re-verified. In the representation given in my ‘Introduction’ I showed in dotted outline two large organs which I supposed to be the testes. I distinctly observed radiating lines proceeding from the centre in each; but I could not discover the slightest trace of any limiting border to either organ. I now found in the same position two nearly circular flattened masses with clearly defined limits (i, k). No doubt could be entertained as to the testicular character of the lower organ (k). In the original drawing I further indicated the presence of a third and much smaller globular mass, which I termed the ovary; but what I supposed to represent this organ in the particular specimen from which the accompanying illustration was drawn turns out to be merely a hernial protrusion resulting from injury (h). The radiating, broad, and branching seminal ducts are beautifully distinct in one of my specimens, forming the most attractive feature of the parasite’s organisation (k). In consequence of injury to the specimen which is here drawn, the upper testis (i) displays no seminal tubes. I made out the female reproductive organs with more completeness. In the outline drawing given in my introductory treatise I had indicated the probable position of the uterine folds; reducing the organ to the simplest expression of what I concluded must obtain in the normal condition. My conjecture was perfectly correct. The uterus consists of irregularly folded tubes, which, though here and there apparently branching from a central tube, are in reality folded evenly upon themselves. The oviduct can be distinctly traced to its outlet in the reproductive papilla, which, as usual in true Distomes, is placed in the middle line, immediately above the ventral sucker. In my examination of Mr. Busk’s original specimens I could not find the slightest trace of vitelligene organs; but in my fresh examples I not only obtained proof that these organs were largely developed, but that their limitations could be fixed with accuracy (g g). They consisted of two large elongated masses, one on either side of the body, occupying about two thirds of the entire length of the parasite. Their yolk-vesicles were distinctly seen; but the main efferent canals were only here and there traceable. Clearly, the position and character of the yolk-forming glands of this large human fluke are quite unlike those of any of its congeners. This fluke is a remarkably fine species, and, when viewed in the fresh state with a powerful pocket-lens, presents a most striking appearance. I did not observe any cutaneous spines. I found the eggs to present an average long diameter of about 1/200″, by 1/330″ in breadth. They are therefore somewhat smaller than those of the common fluke. In the specimen preserved in the Hunterian Museum there was complete evidence of the presence of an excretory outlet at the caudal extremity; but I did not succeed in finding any trace of the water-vascular system higher up. I have no doubt, however, that it exists.