In the month of December, 1874, a Chinese died in the Civil Hospital at Port Louis, Mauritius, whilst he was under the care of Dr William Macgregor, chief medical officer of the Colony of Fiji. The post mortem revealed the presence of a very great number of flukes in the bile-ducts. Dr Macgregor described these parasites with great care, and having favored me with a copy of his manuscript I at once recognised the worms to be identical with the species discovered by McConnell. I also received through Dr Henry Clark, of Glasgow, two Mauritius specimens, which when compared with the Calcutta examples proved to be specifically identical. Dr Macgregor’s paper, communicated to the Glasgow Medico-Chirurgical Society, gives full particulars of the helminthiasis associated with this parasite, whilst both his and Prof. McConnell’s account of the structure of the worm are remarkably complete in details, and well illustrated. It is not a little curious to notice that although these parasites were obtained in countries far removed from China, they were in both instances taken from Chinese; moreover, from the statements of Macgregor, it appears very probable that the parasites in question are a common source of liver disease. Without doubt oriental habits are eminently favorable to fluke infection, for we are now acquainted with four species of flukes whose geographical range is limited to eastern parts.
Bibliography (No. 6).—McConnell, J. F. P., “Remarks on the Anatomy and Pathological relations of a new species of Liver-fluke,” ‘Lancet,’ Aug. 1875; repr. in the ‘Veterinarian,’ Oct., 1875; also in the ‘Lancet,’ March 16th, 1878, p. 406.—Macgregor, W., “A new form of Paralytic Disease, associated with the presence of a new species of Liver Parasite (Distoma Sinense),” ‘Glasgow Med. Journ.’ for Jan., 1877; also in the ‘Lancet’ for May 26th, 1877, p. 775.—Cobbold, T. S., in a note to the ‘Lancet,’ Sept., 1875, and in the Appendix to Macgregor’s paper, p. 15, 1877.—Leuckart, R., l. c., Bd. ii, s. 871, 1876.
Distoma conjunctum, Cobbold.—The little fluke which I first discovered in the gall-ducts of an American fox (Canis fulvus) was fourteen years afterwards obtained from pariah dogs in India by Dr T. R. Lewis (1872); but it remained for Prof. McConnell to show that this entozoon also invades the human subject (1874). A second instance of its occurrence in man was recorded in 1876. We all figured the worm, and in respect of general details our descriptions for the most part agreed (fig. [56]). The worms from the dog and fox gave an average of 1/4″ in length, but the majority of those found by McConnell in man were fully 3/8″ from head to tail.
Writing in the spring of 1876 Dr McConnell says:—“In the ‘Lancet’ for the 21st of August, 1875, I published the description of a new species of liver-fluke found in the bile-ducts of a Chinaman (sic) who died in this hospital. Dr Spencer Cobbold has very kindly interested himself in this discovery, and proposed the name of Distoma Sinense for the new fluke. This discovery (in September, 1874) has stimulated me to pay still greater attention to the morbid conditions of the biliary canals in our post-mortem examinations; but, although more than 500 autopsies have been conducted since that date, I have not met with another instance of distomata in the liver until within the last fortnight. On the 9th of January, 1876, in examining the liver of a native patient who had died in the hospital, I again found a large number of flukes in the bile-ducts, and having carefully examined many specimens, I recognise the species as the D. conjunctum of Cobbold. Dr Cobbold discovered this fluke in 1858; but, as far as I am aware, the human liver has never hitherto been found infested by these parasites, and this will give general interest and importance to the following case.”
“Jamalli Khan, a Mahommedan, aged twenty-four, admitted into the hospital on the 25th of December, 1875. He is a resident of Calcutta, and an ordinary labourer (coolie). He states that he had been suffering from ‘fever’ for the last two months, at first intermittent in character, but for the last seven days more or less continued. He is much emaciated and reduced in strength. Complains of pain on pressure over the liver and spleen; the latter can be felt much enlarged, reaching downwards to nearly the level of the umbilicus; the lower border of the liver, however, can only just be felt below the ribs. Temperature on evening of admission 101° F. Conjunctivæ are anæmic, but not jaundiced. Has also a little bronchitis. The fever continued with slight remissions for ten days (January 4th, 1876), the highest diurnal temperature (in the afternoon) varying from 103° to 104° F.; it then abated, but dysentery set in. He began to pass six or eight stools in the twenty-four hours, attended with much griping, and containing varying quantities of blood-tinged, gelatinous mucus. These became more frequent, in spite of treatment, during the next three days, and on the 8th of January he was manifestly sinking; passed his evacuations into the bedclothes, became cold and collapsed, and died in this state that same evening.
“A post-mortem examination was made on the following morning, thirteen hours after death. All the organs of the body were found more or less anæmic, but exhibited nothing remarkable with the following exceptions. The lungs towards their posterior margins and bases were dark, but still spongy and crepitant. The spleen was found greatly enlarged, heavy; capsule tense and stretched; substance soft, reddish brown, irregularly pigmented; weight 1 lb. 13 oz. The liver was of about normal size; its surfaces smooth, the capsule slightly hazy looking. Hepatic substance firm, but abnormally dark, and the bile-ducts particularly prominent and thickened. Numbers of small distomata escaped from the incisions made into the organ, and could be seen protruding from the dilated biliary canals. The gall-bladder was filled with thick greenish-yellow bile, measuring about an ounce and a half, but containing no parasites, and no ova even could be detected on microscopical examination of this bile and of scrapings from the lining membrane of the gall-bladder. The cystic duct was free from obstruction. The condition of the common choledic duct could not so well be ascertained, as the liver had been removed from the abdominal cavity before anything extraordinary had been detected in its condition, but, so far as it could be examined, it was found patent; the duodenal mucous membrane was well bile-stained, and there was evidence of biliary colouring matter in the fæcal contents of the bowels. On carefully dissecting out, and then laying open, the biliary ducts in a portion of the right lobe of the liver (the rest being preserved entire), numbers of distomata were found within them, lying singly, flattened, and generally with the anterior extremity, or “oral sucker,” directed towards the periphery of the organ, the posterior extremity towards its centre; or in twos, threes, or even little groups of fours, variously coiled upon themselves or upon each other. The lining membrane of the biliary canals was found abnormally vascular, its epithelial contents abundant (catarrh?), and, among these, ova could be detected under the microscope. Sections of the liver, hardened and then examined in glycerine, showed fatty infiltration of the lobular structure, but not to any advanced degree; the bile ducts considerably dilated, their walls thick and hypertrophied, but nothing else abnormal, or in any way remarkable. The weight of the liver was 3 lbs. In the transverse and descending colon numerous indolent-looking, shallow, pigmented ulcers were found, and in the rectum others evidently more recent and highly injected. The submucous tissues throughout were abnormally thickened. The intestinal contents consisted of only about three ounces of thin yellowish (bilious) fæcal fluid, with small bits of opaque mucus. This was carefully washed and examined, but no flukes were discovered. About a dozen distomata escaped from the liver on making the primary incisions, and quite twice this number was found subsequently within the biliary canals. Only a portion of the right lobe has, as I have said, been dissected, so that it may be confidently stated that probably not less than a hundred of these flukes must have infested this liver. All were found dead, but it must be remembered that the autopsy was performed thirteen hours after the death of the patient. It is remarkable that in this case, as in the one before described by me, no distomata were found in the gall-bladder. The presence of these parasites in the bile-ducts seems to have led to catarrhal inflammation of their lining membrane and abnormal thickening and dilatation of their walls, but there is no evidence of their having caused sufficient obstruction to produce cholæmia, as in the case just referred to, and no marked pathological change could be detected in the lobular structure of the liver.”
After referring to the anatomical descriptions of the worm, as recorded by myself (in ‘Entozoa’) and by Lewis (in the memoir quoted below), Professor McConnell further observes that the addition of a few more particulars seems necessary for the determination of the identity of the species. He then gives the following characters:
“Body lanceolate, anterior and posterior extremities pointed, the latter obtusely. Surface covered with minute spines or hairs. Average length 3/8″ (three eighths of an inch); average breadth 1/10″. ‘Ventral’ sucker slightly smaller than ‘oral.’ Reproductive papilla or genital orifice placed a little above and to one side of the former. Alimentary canal double and unbranched. Uterine folds and ovary placed in the median line, and above the male generative organs, the latter consisting of two very distinct globular bodies or testes. Ova of the usual type, i.e. oval in outline, having a double contour, and granular contents; average length, 1/750″; average breadth, 1/1333″. The only point of note is that the average length of these flukes is greater than that of the same species found by the authors above referred to. The D. conjunctum in the American fox, and in the pariah dog, has an average length of 1/4″; only two or three specimens of this size were found in this liver, and these showed evidences of immaturity; a few were found 1/2″ in length; but the great majority exactly 3/8″. The anatomical characters are otherwise precisely identical.”
Professor McConnell concludes his communication by a remark in reference to the common source of infection shared by mankind and dogs in India. The occurrence, however, of this entozoon in an American red fox points to a very wide geographical distribution of the species. It is hardly likely that the fox, though dying in the London Zoological Society’s Menagerie, should have contracted the parasite in England. In the second half of this work I shall reproduce my original drawing (fig. [56]) from the ‘Linnean Transactions;’ but I may refer to my Manual (quoted below) for a reproduction of McConnell’s figure. In my original specimens the integumentary spines had fallen, probably as a result of post-mortem decomposition.
Bibliography (No. 7).—Cobbold, T. S., “Synopsis of the Distomidæ,” (l. c.), 1859; and in “Further Observations on Entozoa, with experiments,” ‘Linn. Trans.,’ vol. xxiii (tab. 33, p. 349), 1860.—Idem, “List of Entozoa, including Pentastomes, from animals dying at the Zool. Soc. Menagerie between the years 1857–60,” ‘Proceed. Zool. Soc.,’ 1861.—Idem, ‘Entozoa,’ p. 20, pl. ii, 1864; and in “Manual of the Internal Parasites of our Domesticated Animals,” p. 81, 1873.—Lewis, T. R., and Cunningham, D. D., in a footnote to their ‘Microscopical and Physiological Researches,’ Appendix C., ‘Eighth Ann. Rep. of the San. Comm. with the Govt. of India,’ p. 168, Calcutta, 1872.—McConnell, J. F. P., “On the Distoma conjunctum,” in the ‘Lancet’ for 1875–76, quoted above; reprinted in the ‘Veterinarian,’ 1876; also (a second case) in the ‘Lancet’ for March 30th, 1878, p. 476.