550 The Philippine Journal of Science 1922 
cells, fibroblasts, fibrous tissue, and small lymphocytes, but no eosinophiles. 
Isolated ova are seen in the peripheral and intermediary zones of the liver 
lobule without any cellular or fixed tissue reaction around any one of these. 
Focal necrosis is present near the nodules located in the lobule, and in a 
few instances a single ovum is found in the area of necrosis showing signs 
of degeneration and disintegration. 
Intestines—Hyperplasia of the lymphoid follicles and ulcerative ente- 
ritis, typhoid. Groups of ova in the submucosa, muscularis mucose of the 
colon, without any fixed tissue or cellular reaction can be recognized. 
A slight coagulation necrosis only is present in the area occupied by 
the ova. As in the first case, isolated ova are lodged now and then in 
the stroma of the mucosa. Many are found around a lymphoid follicle, but 
in no instance is any found inside. Almost all the ova are well preserved, 
clear, not wrinkled, and in none is a spine detected. The muscular and 
serous coats are free from ova. 
Mesenteric and hemolymph nodes. Single ova and groups of ova are 
deposited in the medulla. 
The other organs are free from ova and eosinophilic infiltration. 
ANATOMIC DIAGNOSIS 
Acute enteritis, acute splenitis, typhoid; fibrosis of the liver; polypoid 
colitis, schistosomiasis; ankylostomiasis; trichocephaliasis. 
Sections show characteristic lesions of typhoid and the pres- 
ence of ova in the liver, colon, mesenteric lymph node, and hzemo- 
lymph node, either singly or in groups without the presence of 
eosinophiles. Presence of calcified ova in the liver and old 
fibrous nodules indicates that the infection with Schistosoma 
japonicum took place before infection with typhoid. What is 
the cause of the disappearance of the eosinophiles in the field? 
The presence of ova without any tissue reaction suggests that 
they are freshly laid. The lesions are not so far advanced as 
in the first two cases. 
FOURTH CASE 
Clinical history.—Bureau of Prisons No. 33742, male, Filipino, 18 years 
old, laborer, single, born in Samar. Admitted to the Philippine General 
Hospital May 31, 1915, complaining of pain in the abdomen, and fever. 
Had malaria at 11 years of age. He was seldom ill and only with occa- 
sional fevers. Had no smallpox nor dysentery. 
A few hours after supper the previous night he felt acute pain in the 
abdomen which became generalized all over the hypogastrium. On account 
of this pain, he was given a purgative. His bowels moved at midnight, but 
the pain became worse. The pain and tenderness became intolerable. 
Next morning he was given an enema, but his condition became worse. 
His temperature became high, and he vomited several times. He was 
then taken to the Philippine General Hospital. 
Patient is well developed and well nourished, feels nauseated and vomits 
greenish yellow fluid with food and mucus. The abdomen is as high as 
the thorax and is tympanitic. Rigidity is more marked in the lower half 
of the abdomen, and the tenderness is more marked in the hypogastrium. 
