21,6 Mendoza-Guazon: Schistosomiasis in the Philippines 545 
Rectum.—The lower part shows the presence of a few hemorrhagic 
areas and one internal hemorrhoid measuring about 0.7 centimeter in 
diameter. 
Intestines.—The wall of the ileum is somewhat thickened, especially the 
serous coat. A large number of Trichuris worms are present in the cecum. 
The appendix shows a definite thickening of the appendicular walls at the 
two enlargements noted in the description of the peritoneum. It is cut 
with considerable resistance and is almost fibrous, but the cut surface is 
rather dry and does not appear to be very fibrous. The mucosa at this 
point seems to be intact but is dark colored. Lumen is patent. In the 
ezecum there are one or two small enlargements of the mucosa. These ap- 
pear to be in the mucous coat proper. No ulcerations. Beginning with the 
lower part of the descending colon (Plate 1, fig. 8), extending through the 
sigmoid and into the rectum, there are numerous small enlargements of 
the mucosa extending into the lumen of the gut. These are very irregular 
in outline and in size, measuring from 8 millimeters to 1 centimeter in 
diameter; most of them seem to be confined to the mucous membrane, look- 
ing more like mucous polyps; some, however, are attached to the muscular 
layer by firm adhesions. Section through the nodules noticed on the ex- 
ternal surface of the lower part of the sigmoid shows a definite tumor 
formation—bands of connective tissue between which cellular tissue is 
_ present. It is attached to the serous coat of the intestine. 
Lymph nodes—The lymph nodes in the mediastinum are all enlarged 
and somewhat cedematous. Retroperitoneal lymph nodes over the lumbar 
vertebre and up as far as the celiac axis are all enlarged; some of them 
are somewhat cedematous, others in the mesocolon of the sigmoid are 
slightly enlarged and very firm. In sectioning through them, the knife 
meets with considerable resistance, almost as though it were calcareous 
material, and in some considerable yellowish necrotic material is present. 
The lymph nodes surrounding the bile ducts and the pyloric end of the 
stomach are enlarged. On section these are very cellular, moist, and 
glistening. The mesenteric lymph nodes are enlarged and show on section 
marked hyperemia. 
HISTOPATHOLOGY 
Lung.—wWith the lower power, the section shows areas of partial atelec- 
tasis and emphysema, and marked congestion of the blood vessels and cap- 
illaries. The bronchioles show desquamation of epithelium and congested 
wall. Irregularly disseminated in the field are various nodules in different 
stages of formation, which at first sight look very much like miliary tuber- 
cles. On close inspection, however, one sees that the giant cells are of 
foreign type and many either are trying to envelop an ovum or contain 
yellow transparent pieces of shells. Another feature is the presence of 
eosinophiles in the fibrous tissue wall (Plate 3, fig. 2). 
Another nodule (Plate 3, fig. 1) shows central necrosis and a zone of 
radiating epithelioid cells with a large foreign-body giant cell at one side, 
toward which many of the epithelioid cells around it are directed. At the 
periphery of this zone of epithelioid cells are many foreign-body giant 
cells, which seem to be formed by their coalescence. The next zone is 
formed by circular fibroblasts and eosinophiles and merges with the outer- 
most zone composed of fibrous tissues, eosinophiles, and small lymphocytes. 
