proportion of the boatmen and raftsmen and farmers have been found infected. Europeans also have acquired the disease in the latter district, mostly sportsmen addicted to snipe-shooting in the rice fields.
Morbid anatomy.—Catto's patient during life presented enlargement of the liver and spleen. At the autopsy the appearance of the peritoneum suggested repeated attacks of peritonitis. The appendices epiploicæ were thickened, and in some places matted together. The recto-vesical pouch was almost obliterated. The mesenteric and prevertebral glands were enlarged, the largest group forming a cluster near
Fig. 143.—Operculum and shell of Katayama nosophora. (After Robson.)
a, Operculum, x 12, diagrammatic to show scheme of coiling; b, oral aspect of shell, x 4; c, lateral aspect of shell, showing labial swelling, x 4.
the duodenum. The liver was considerably hypertrophied, its surface nodular, its consistence greatly increased. The coats of the gall-bladder were thickened, and a layer of fat almost completely encased this organ, which was distended with clear mucoid material containing several minute black gall-stones. The spleen was enlarged and pigmented. The colon was much thickened throughout. Its mucous membrane was swollen, hyperæmic, and friable; it presented numerous small circular superficial erosions and patches of necrosis. The outer coats were very tough, almost cartilaginous. The walls of the rectum were three-quarters of an inch thick and adhered to the bladder. It nearly filled the true pelvis. The sigmoid flexure also was uniformly thickened.
