21,6  Mendoza-Guazon: Schistosomiasis in the Philippines 549 
nuclears, 31 per cent transitionals, 11 per cent small lymphocytes, 7 per 
cent large lymphocytes, 1 per cent eosinophiles, and 1 per cent mast cells. 
Smears from the blood are negative for all types of malaria. Widal reac- 
tion is negative. 
Clinical diagnosis.—Malaria, cerebral type, and meningitis. 
Morbid anatomy.—Autopsy 4087. Body of a poorly nourished, adult, 
Filipino male. The abdominal cavity itself is dry and sticky. The appen- 
dix is retrocecal, extends almost to the liver, and is bound by fibrous adhe- 
sions. The colon is considerably enlarged; it fills the entire pelvis, and the 
loops are adherent to each other and to the surrounding tissue and bladder 
by means of a sticky sero-fibrinous material. The appendices epiploice 
upon the colon are considerably enlarged and in some places matted 
together. Abdominal viscera lie in normal relationship to each other. 
The right pleural sac contains some adhesions posteriorly. 
Intestines.—The entire wall of the colon is considerably thickened and 
somewhat firm in consistency. The mucosa of the colon appears to be 
thickened and in the rectum has a bluish red tinge, is somewhat elevated 
in slight nodular masses which are of a somewhat polypoid appearance, 
while throughout the remaining portion of the colon the mucosa is thrown 
into very prominent ruge and has a pale color with areas of pinkness, is 
moist, and shows no further growth or change. The appendix is thickened, 
rather firm in consistency, and considerably elongated. The mucosa of 
the ileum is altered over the lower 1.5 to 2 meters. Covering this area 
there are about fifteen Peyer’s patches which are elevated from 3 to 5 
millimeters above the surrounding mucosa, and much of the solitary lym- 
phoid tissue over this part of the intestine is elevated likewise. 
The lymph nodes throughout the mesentery are much enlarged; the 
largest measures about 4 centimeters in diameter. All of these glands 
are dark bluish externally, and on section show a pale pinkish surface 
which bulges, and on some of the cut surfaces there are smooth, deep red 
areas 2 to 3 millimeters in diameter from which blood-tinged fluid oozes. 
Liver.—The common bile duct is patent. The liver itself weighs 1,677 
grams; it is firm in consistency, the capsule is bluish gray, and the sur- 
face is somewhat roughened by pale, opaque, anastomosing bands Of tissue, 
giving the surface a somewhat nodular appearance; there are also some 
depressed puckering scar areas, and beneath the capsule minute yellowish 
areas 1 to 2 millimeters in diameter are visible, which are diffused irreg- 
ularly over the entire surface. Section into the liver shows it to be cut 
with some resistance; the cut surface is marked in many places with pale 
dense strands of tissue, and dark red areas which vary in size from a few 
millimeters to 1.5 centimeters, and diffused over the entire cut surface 
there are yellowish areas 1 to 2 millimeters in diameter. The lobules are 
faintly visible; some have a yellowish brown tint, others have a reddish 
color. There are also pale strands of tissue extending into the liver from 
the capsule. 
Urinary bladder contains some amber-colored urine. The mucosa is 
pale and smooth. 
HISTOPATHOLOGY 
Liver shows focal areas of necrosis, typhoid; congestion; cloudy and 
fatty degeneration; portal cirrhosis, schistosomiasis. Nodules with well- 
formed clear or calcified ova, resembling those of autopsy 2191, are found 
in the interlobular septa and in the lobule containing foreign-body giant 
