558 The Philippine Journal of Science 1922 
The greater omentum is bound to the anterior surface of the liver above 
the gall bladder at one point. The cecum is firmly attached to the retro- 
peritoneal tissues, and the fatty tissue about it is firm from fibrosis. There 
is a similar fibrosis of pericolonic fat at many points, especially midway 
of the transverse and descending portions, where there are thickening, 
contraction, and scarring of the intestinal wall. Perirectal fibrosis firmly 
binds the rectum to the pelvis. In the omentum overlying the fundus of 
the stomach is an irregular, firm, light brown patch measuring 2 by 3 
centimeters, involving fatty tissue, which was found later to be a mass 
of Schistosoma ova. The duodenum, jejunum, and colon are dark from 
bloody content, but the ileum is pale. 
The cesophagus is very pale. No ulceration, inflammation, or dilated 
veins are noted. The stomach is of normal size. It contains a fresh 
blood clot forming a cast of the fundus about 10 centimeters in diameter. 
The entire mucosa is covered with blood. There is some post-mortem 
softening of the mucosa. No distinct ulceration is noted, but there are 
many minute erosions, in each of which is a thread of tarry blood. About 
2 centimeters below the cardiac orifice are four slightly elevated areas 
of mucosa (0.5 centimeter) in the center of which appear to be small 
fresh ulcers. There is a coating of mucus over the mucosa. The duode- 
num and jejunum are filled with softened fresh blood clot. The blood 
adheres to the mucosa; when it is removed no gross ulceration is evident, 
but minute threads of bloody material are in the mucosa as if there had 
been bleeding from many small points. The remainder of the small in- 
testine is bloodless, but the entire colon is filled with black sticky tarlike 
material, evidently from a previous hemorrhage. The mucous membrane 
of the small intestine is otherwise normal in appearance. About 4 centi- 
meters above the ileocwcal valve there is a patch (1 centimeter) in the 
serosa which is brown and dry like the area in the omentum. An Asca- 
ris lies in the ileum. 
Large intestine—Two large Trichuris are attached to the mucosa. 
When the tarry content is washed away the mucosa is found to be irreg- 
ularly thickened (1 or 2 millimeters) and slightly rough. The thicken- 
ings are in irregular patches and in them the mucosa is finely perforated 
in places, giving them a worm-eaten appearance. There are a few gran- 
ular elevations of mucosa, and one or two small cystlike projections (3 
to 4 millimeters) which appear to contain blood-stained material. Two 
of these elevations take a linear course, as if following a submucous blood 
vessel. The surface of these mucous thickenings has a faint brownish 
discoloration, and in some of them the induration involves the entire bowel 
wall. The appendix is normal in size, the mucosa pale and smooth ex- 
cept at the tip which contains a firm brown nodule. 
There are a few isolated areas of thickening in the ascending colon; 
about midway of the transverse portion the bowel wall is indurated and 
constricted for a length of 8 centimeters. In this area there is an adhe- 
sion of mucous surface which divides the lumen by the formation of a 
small lateral channel. Here the mucosa is thickened, finely granular and 
delicately perforated, and the entire bowel wall is indurated. A firm 
nodule (2.5 by 1.5 centimeters) projects from the serous surface. A few 
scattered patches of thickening intervene between this portion and the 
mid-descending colon where there is another similar zone of induration and 
constriction. Below this are a few small areas of thickening until the 
rectum is reached, which appears normal. 
