The frequency of schistosomiasis mansoni, of its clinicopathological forms, and of the distribution of Schistosoma mansoni eggs in ectopic locations in each clinicopathological form were studied in 1863 complete consecutive autopsies performed in Belo Horizonte, Brazil, in the period from 1971 to 1990. Three hundred and thirteen cases of S. mansoni infection (16.8%) were found. The intestinal form was the most frequent (67.4%), followed by the hepatosplenic form without pulmonary hypertension (24.9%). The intestinal form showed a smaller number of ectopic sites and a lower percentage of involvement of these sites compared to the more severe forms, particularly the hepatosplenic form with pulmonary hypertension. The distribution of the frequency of schistosomiasis mansoni cases, of the clinicopathological forms of the disease, and of the ectopic sites of S. mansoni eggs over the decades considered showed a marked reduction in all of these parameters, particularly in the more severe forms. These findings can be explained only by earlier diagnosis of the disease and the greater efficacy of the specific chemotherapy used today, preventing progression to the more severe forms of the parasitosis.