As regards the affinities of Distoma crassum, it is clear that this Trematode has little in common either with the liver-fluke of cattle and sheep (Fasciola hepatica), or the still larger species obtained by me from the giraffe (Fasciola gigantea). The simple character of the digestive tubes obviously connects it more closely with the lancet-shaped fluke (Distoma lanceolatum), the last-named parasite being, as already shown, an occasional resident in the human liver, where its presence, moreover, undoubtedly contributed towards the production of the fatal result.
In my remarks on the missionary’s diet it is hinted that the Ningpo oysters may have played the rôle of intermediary bearers to the parasite in question; and as tending in some measure to strengthen this notion, it should be borne in mind that Mr. Busk’s original fluke-bearer came from the east. It is not improbable that the Lascar host may have partaken of the same particular species of fish or shell-fish that the missionary and his wife partook of. Be that as it may, the frequency of the occurrence of Trematodes and their larvæ in marine mollusks is well known. According to Woodward, several species of oyster are sold in the Indian and Chinese markets. Thus, it would require the skill of a malacologist to determine the particular species of Ostrea to which the Ningpo oysters should be referred.
Mons. Giard is of opinion that the singular larvæ known as Bucephali attain sexual maturity in sharks and dog-fishes; therefore it is extremely unlikely that the Bucephali should have been in any way concerned in the infection of our missionary and his wife; nevertheless there remains the probability that these human bearers swallowed other kinds of Trematode larvæ when they consumed the Ningpo oysters. Moreover, if it should happen that none of the other larvæ occurring in oysters are capable of developing into flukes in the human territory, it yet remains highly probable that some one or other of the various encysted (and therefore sexually immature) Trematodes known to infest marine fishes will turn out to be the representative of our Distoma crassum. In this connection we must not forget that the flesh of the Salmonidæ forms the probable source of human Bothriocephali; and there is some likelihood that salt-water fishes, if not actually the primary, may become (after the manner explained by M. Giard) the secondary intermediary bearers of fluke-larvæ. At all events, I am inclined to look to the Ningpo oysters, or to some other of the various species of marine shell-fish sold in eastern markets, as the direct source of Distoma crassum; for, in addition to the bucephaloid cercarians, we have abundant evidence of the existence of other and more highly developed fluke-larvæ in marine bivalve mollusks.
In this connection I will only further observe that we possess very little knowledge of the parasites which take up their abode in the viscera of savages. This ignorance results partly from the fact that these untutored races, as proved by the statements of Kaschin and others, actually, in the matter of severe symptoms, suffer much less from the presence of intestinal worms than their civilised fellow-men do. The subject is worthy of further attention, but no one, so far as I am aware, has cared to institute the necessary inquiries in a methodical way. I strongly suspect that several of the human parasites which we now consider to be rare would be found to be abundant if by means of post-mortem examinations and other methods of investigation we could be made acquainted with the facts of helminthism as they occur amongst the raw-flesh and fish-eating savage tribes. Of course any person, notwithstanding the utmost care and cleanliness, as in the cases before us, may contract a noxious parasite; nevertheless, speaking generally, it may be said that the measure of internal parasitism affecting any given class of people bears a strict relation to the degree of barbarism shown by such persons in their choice of food and drink, and in their manner of eating and drinking. This statement, if true, is not destitute of sanitary importance; moreover, it applies not alone to ourselves, but also to all the domesticated animals that serve our wants. Cleanliness is just as necessary for their welfare as for our own.
In the spring of 1878 my patients returned from China. They had experienced fresh attacks from the parasite; moreover, one of their children, a little girl, was also victimised by the same species of fluke. Thus, in one family I have encountered three cases of fluke-helminthiasis due to Distoma crassum! One of the worms passed by the little girl per anum is now in my possession. It not only shows the upper testis perfectly, but also the many times transversely folded, simple, uterine rosette which is certainly not branched. There are also traces of an organ which I take to be the cirrhus-pouch; but I have never seen the penis protruded externally.
For the purposes of diagnosis I subjoin the following characters. The Distoma crassum is a large, flat helminth varying from an inch and a half to two and a half inches in length, and having an average breadth of five eighths of an inch; it is especially also characterised by its uniform and considerable thickness, combined with the presence of a double alimentary canal which is not branched; the body is pointed in front, and obtusely rounded posteriorly; the integument being smooth and unarmed; the reproductive orifices placed immediately above the ventral sucker; the testes form two large rounded organs, situated below the uterine rosette, and disposed in the middle line, one in front of the other; the uterine folds occupy the front part of the body; near the lateral margins there are two large vitelligene glands, one on either side of the intestinal tube; the excretory organ probably consists of a central trunk with diverging branches, opening below.
Bibliography (No. 5).—Budd, original notice in his ‘Diseases of the Liver,’ 2nd edition, quoted by Lankester in Appendix B to Küchenmeister’s ‘Manual of Parasites,’ p. 437, 1857.—Cobbold, T. S., “Synopsis of the Distomidæ,” in ‘Journ. of the Proceed. of the Linnean Soc.,’ vol. v, Zool. Div., 1860 (original description p. 5).—Idem, ‘Entozoa,’ p. 193, 1864.—Idem, “Remarks on the Human Fluke Fauna, with especial reference to recent additions from India and the East,” the ‘Veterinarian,’ April, 1876.—Idem, “On the supposed Rarity, Nomenclature, Structure, Affinities, and Source of the large Human Fluke (D. crassum),” ‘Linn. Soc. Journ.,’ vol. xii, Zool. Div., 1876, p. 285 et seq.—Idem, “Observations on the large Human Fluke, with notes of two cases in which a missionary and his wife were the victims,” the ‘Veterinarian,’ Feb., 1876.—Idem, “The new Human Fluke,” in a letter published in the ‘Lancet,’ Sept., 1875.—Leidy, in ‘Proceed. Acad. Nat. Sciences of Philadelphia;’ see also Dr McConnell’s paper quoted below (Bibl. No. 6).—Leuckart, l. c., Bd. I, s. 560.—Weinland, l. c. (Bibl. No. 2), Appendix, p. 87.
Fig. 3.—The Chinese fluke (Distoma Sinense). a, Oral sucker; b, œsophageal bulb; c, intestine; c′, cæcal end; d, ventral sucker; e, genital pore; f, uterine folds; g, ovary; h, vitellarium; i, vitelligene duct; k, upper seminal reservoir; l, testes; m, lower seminal pouch; o, vas deferens; p, pulsatile vesicle; p′, water vessel. After McConnell.
Distoma Sinense, Cobbold.—The discovery of this species is due to Prof. J. F. P. McConnell, who “on the 9th of Sept., 1874, found a large number of flukes in the liver of a Chinese, obstructing the bile ducts.” The species measures 7/10″ in length, by 1/7″ in breadth, the eggs being 1/833″ by 1/1666″. Dr McConnell showed in his original memoir that the worm cannot well be confounded with Fasciola hepatica, with Distoma lanceolatum, or with D. conjunctum. In this conclusion he was supported by Dr T. R. Lewis, who examined the specimens with him. In a letter communicated to the ‘Lancet,’ quoted above, I proposed the nomenclature here given; but Prof. Leuckart, unaware of this step, afterwards suggested the terms Distomum spatulatum. Later on I received numerous specimens from Calcutta, the examination of which enabled me to confirm the accuracy of the original description. As regards the male organs in the subjoined figure, it will be seen, by comparing the lettering and references, that I have interpreted the facts of structure somewhat differently from Prof. McConnell.