21,6 Mendoza-Guazon: Schistosomiasis in the Philippines 561 
posited, and the repeated inflammation, which as we have already 
described is of the productive type, gives rise to fibrosis in the 
substance of the different organs and in their capsules, in the 
form of nodules, scars, and fibrous adhesions. The liver was 
the only internal organ that contained the ova in all of the 
cases and, with the exception of two cases of typhoid and peri- 
tonitis, all had eosinophilic infiltration. As an extension from 
the inflammation of the liver, pleural adhesions in the right 
cavity were present in all, except in the case of peritonitis and 
in the last case of typhoid. Fibrous adhesions around the ap- 
pendix were present in five cases. Polypoid growths and 
thickening of the wall of the colon were present in the first 
three cases and in the last case, and in all of these ova were 
seen in the sections. The mesocolic and retroperitoneal lymph 
nodes were enlarged in the first three cases. Not only were 
the mesenteric lymph nodes enlarged, but they also contained 
ova in almost all of the cases. 
Eosinophilic infiltration was found in every organ contain- 
ing ova. Eosinophilic infiltration was seen without the ova, 
in the heart in one instance, and in the spleen in another. 
In no instance did the urinary bladder, kidneys, pancreas, 
prostate, testes, adrenals, or stomach contain either ova or 
eosinophilic infiltration. 
As we have seen, the later symptoms and morbid anatomy 
depend not only on the presence of the emboli of ova, but also 
on the extent of the fixed tissue reaction, which in some cases 
may become so uncontrollable as to give rise to tumor for- 
mations. Such a condition has been noted by Mouchet and 
Frouvicle(30) in a case of fibromata of the wall of the appendix, 
where lateral-spined ova of Schistosoma mansoni were found 
embedded in the wall. Similar ova were discovered in a case 
of alveolar carcinoma of the liver with metastases in the lungs. 
These authors believe that bilharziasis causes mechanical irri- 
tation and this, as is well known, can give rise to cancer. 
Pirie(32) says that the common occurrence of carcinoma of 
the liver among South African natives can be traced to cirrhosis 
of the liver caused by schistosomiasis. 
If the infection is not of long duration and the immediate 
cause of death is some intercurrent disease, whose lesions 
have been superimposed on the mild infection of schistosomiasis, 
the findings at the autopsy table are not characteristic and the 
presence of the ova is revealed only by the microscope. 
