21,6 Mendoza-Guazon: Schistosomiasis in the Philippines 551 
Laboratory examination—May 31, 1915. White count, 15,100; polynu- 
clears, 88 per cent; small lymphocytes, 8 per 'cent; and transitionals, 4 per 
cent. 
June 2.—High fever, delirious, pain persistent, relieved by ice cap. 
Tenderness marked in the right iliac region. 
June 10.—Restless and weaker. White count is 38,200. 
Clinical diagnosis.—Peritonitis, acute; appendiceal abscess. 
Morbid anatomy.—Autopsy 4676.—An undersized male adult Filipino 
with sunken abdomen and rigid musculature. The peritoneal cavity con- 
tains about 3 liters of greenish creamy material; the coils of the intestines 
are adherent to each other, and the serosa presents a necrotic appearance. 
The omentum is thick, blue, cordlike, and attached to the right iliac region. 
On looking for the source of this suppurative process, the appendix is 
found elongated and retrocecal, and 1.5 centimeters below its tip is an 
oval opening which has perforated all the walls of the appendix. The 
mesenteric lymph nodes are all enlarged and deep red. The peribronchial 
glands and bronchial glands are all enlarged and deep purple. 
The spleen is enlarged, the capsule is pale bluish, and numerous fibrous 
tags are found attached to the wrinkled capsule. 
The liver is covered with pus, especially the anterior surface and the 
dome. It cuts easily, and the cut surface is swollen, pinkish yellow, and 
pale. The lobulations are not distinct. The liver weighs 1,503 grams. 
Stomach contains about 1 liter of dark green fluid. The mucosa and 
wall of the intestine are edematous, but there is no ulcer anywhere. The 
ileocecal valve is especially cedematous, and the opening is very small. 
On opening the appendix the wall of the proximal part is found to be 
4 to 6 millimeters in thickness, and firm and hard; the mucosa is white and 
thick, but the distal part is gangrenous and, as noted before, an opening 
is found near the tip which is about 7 to 8 millimeters in diameter, having 
its longest axis parallel to that of the appendix. 
HISTOPATHOLOGY 
Liver—Foreign giant cells containing shells enveloped by old fibrous 
tissue and small lymphocytes. Single ova and groups of ova in the portal 
and interlobular septa. Isolated ova in the periportal zone of the lobule. 
Capsule covered with fibrino-purulent exudate. 
Intestines.—Groups of from 6 to 34 ova are found in the thickened sub- 
mucosa, mostly below the muscularis mucose. In the muscularis they are 
enveloped with fibrous tissue, lymphocytes, and few eosinophiles. Serosa 
shows congestion, and fibroblast and many plasma cells, the capillaries are 
congested with red and polynuclear cells. The exudate is composed of 
fibrin and dead cells. 
Appendix.—Groups of ova are found in all the cbt. nad of acute 
fibrino-purulent inflammation are also present. 
The other organs are free from ova and eosinophilic infiltration. 
ANATOMIC DIAGNOSIS 
Acute fibrino-purulent peritonitis; perforation of the appendix; schis- 
- tosomiasis; fibrosis of the spleen with enlargement; chronic interstitial 
nephritis; dilatation of the heart. 
The abdominal pain complained of by this individual suggests 
that it was probably caused by the deposition of ova in the wall 
