A478 The Philippine Journal of Science 1921 
decidedly confusing. Large phagocytic giant cells occur in conjunction 
with collections of odcysts, the latter acting as foreign bodies. In some 
lesions large numbers of eosinophile cells are found scattered through 
the connective tissue. 
The formation of the papilliform projections is to be explained by the 
hyperplasia of the connective tissue, which pushes through the defects in 
the epithelial layer. The question arises as to whether the proliferation 
is primarily of the epithelium or of the connective tissue. As proliferation 
is never confined solely either to epithelium or to connective tissue, it is 
to be presumed that the process involves both tissues at the same time. 
The steps of the process may be summarized as follows: 
Following the invasion of its protoplasm by a parasite, the epithelial 
cell undergoes gradual but inevitable degeneration and finally becomes de- 
stroyed. The death of the cell produces a defect in the epithelial lining 
of the bile-duct. With the destruction of several adjacent cells the injury 
is greater and exudation of fibrin and leucocytes may take place. On 
account of the defect in the ephithelium, the underlying connective tissue is 
stimulated and proliferates. Pushing through the break in the epithelial 
layer, it forms the papilliform projections before described. At the same 
time the epithelium proliferates in an attempt to repair the defect in its 
continuity. As the parasites multiply, many mature forms become free in 
the bile-ducts, where they cause irritation, acting as foreign bodies.’ 
Evidence of this irritation is seen in the thickening and hyperplasia of 
the epithelium of the small ducts and in the hyperplasia of the surrounding 
connective tissue. In some instances the biliary epithelium is desquamated 
and portions of it are passed down the ducts. The epithelial cells often pre- 
sent a peculiar change in their nuclei * * *. The chromatin is condensed 
into several intensely staining masses which lie against the nuclear mem- 
brane. The nuclear material apart from the chromatin is unstained. The 
nucleus as a whole is abnormally large and appears hollow. Councilman 
has described similar changes in the corneal corpuscles of the rabbit’s cornea. 
In that instance this arrangement of the chromatin preceded the direct 
division of the cell and was regarded as a degenerative change. 
It seems to me that the contingency mentioned in Tyzzer’s 
footnote is one that may have to be reckoned with in heavy in- 
testinal infections. Both my case and that of Noc showed that 
many epithelial cells are cast off during the progress of the 
infection. Tyzzer summarizes, in part, as follows: 
The lesion is of the nature of a chronic inflammatory process. The tis- 
sues react to the irritation which the parasites cause by their presence in 
the bile ducts. With the removal of the irritation, repair takes place. Thus 
thé whole is to be regarded as a physiological process, checking the inroads 
™ There is no evidence that the parasites of themselves secrete any toxic 
substance, but their presence in the biliary epithelium renders it more liable 
to bacterial invasion. In some instances the effect of bacteria is to produce 
an abscess cavity, in which but few coccidia are to be found. (This foot- 
note is Tyzzer’s.—F. G. H.) 
