552 The Philippine Journal of Science 1922 
of the ileocecal valve. The administration of the purgative 
undoubtedly aided the intestinal contractions and the expulsion 
of the ova into the intestinal lumen and peritoneal cavity. Both 
processes weakened the intestinal wall, allowing in this way the 
intestinal bacteria to gain a foothold not only in the intestinal 
wall but also in the peritoneal cavity, either directly or through 
the lymphatics. This case and the one reported by Dr. P. Gua- 
zon place this infection as one of the etiological factors of appen- 
dicitis. 
FIFTH CASE 
B. M., male Filipino, 57 years old, residing in San Nicolas, Manila, died 
suddenly in the Luneta Police Station on February 5, 1918, due to severe 
hemorrhage from the lungs. 
Morbid anatomy.—Autopsy 5948. A fairly developed, but greatly ema- 
ciated, Filipino adult. The appendix is long, pointed toward the pelvic 
region, and there are some fibrous adhesions at the base. Fibrous adhe- 
sions bind the anterior surface of the liver to the diaphragm. The right 
lung is firmly adherent to the thoracic wall. The left lung is voluminous, 
grayish, and shows old scars in the middle of the upper lobe. Another 
sear is found below and anterior to it. There are also old scars in the 
lower lobe. Fibrous thickenings of the visceral pleura are found in the 
apex of the superior lobe of the right lung and also in the middle of the 
lower lobe. Firm nodules which seem to contain minute sandlike material 
are present in the anterior surface of the superior lobe. Section of the 
superior lobe of the left lung reveals a large cavity, just below the scar, 
containing caseated material. Around this cavity and in the septa of the 
lungs there are large, solid, fibrous bodies. Lower lobe shows a mottled 
appearance of swollen red lung tissue and fibrous tubercles, especially in 
the septa and around the bronchi. Right lung is firmly adherent to the 
thoracic wall, and is completely fibrous and covered by a thick pleura. A 
cavity, about 7 centimeters in diameter, is found in the apex of the superior 
lobe. This cavity has many fibrous cords running through it, and the wall 
is rugged and fibrous. 
The spleen is small and pale purple. 
The liver is small, soft, flabby, and pale, and the anterior surface is 
covered by fibrous tissue. The liver cuts easily, and the cut section is 
pale brownish, soft, and swollen. Liver weighs 1,520 grams. 
Intestines contain yellowish, acid, fecal material; otherwise, they are 
apparently normal. 
HISTOPATHOLOGY 
Liver—In the peripheral zone of the lobule were seen isolated single 
ova, sometimes without any cellular reaction and sometimes with a giant 
cell around the ovum; in the portal areas or beneath the capsule of the 
liver were groups of ova, varying in number from two to fourteen, inclosed 
in a thin capsule of fibrous tissue that contained round cells and eosino- 
philes. Section of nodules contained fibroblasts, eosinophiles, and round- 
cell infiltration without any trace of ova. Fatty infiltration in the periph- 
eral zone of the lobules, and congestion and dilatation of the portal veins 
are seen. 
