4 QUATERCENTENARY STUDIES IN PATHOLOGY 



number of small, flat, whitish nodules of firm, fibrous consistence, varying 

 in diameter from three to five millimetres. These discs were not unlike 

 the flat fibromata so often seen on the capsule of the spleen ; they were 

 especially seen at the margins of the organ, where they formed a discon- 

 tinuous fringe resembling a row of small pearls. From analogy with 

 bilharzial lesions, I concluded from the naked eye examination that 

 these nodules were fibrous in nature, and would contain ova of bilharzia, 

 but the microscope revealed quite another and unexpected condition, 

 viz.^ the masses were tuberculous, and were composed almost entirely of 

 closely packed giant-cell systems, particularly at their free margin ; the 

 deeper portions {i.e. nearer the lung) were more fibrous in nature. 



The lung itself was firm, particularly at the apex ; a few small solid, 

 pale yellow masses (tubercle) were apparent at wide intervals, and the 

 intervening parenchyma showed under the microscope a multitude of 

 tiny tubercles with numerous beautiful giant-cell systems, although to 

 the naked eye this tissue appeared to be normal. The bronchial glands 

 were but little enlarged, were jet black, and were not caseous. One of 

 them was carefully examined microscopically, and showed neither 

 tubercles nor deposits of ova. 



There was no ascites. Numerous bilharzia worms {Schistosomum 

 hcematobium) were present in the portal vein. 



The Liver (see Fig. i) was a typical specimen of advanced 

 bilharzial cirrhosis, and in every particular tallied with the description 

 given of this condition by the writer in the Journal of Pathology and 

 Bacteriology^ Vol. 9, p. 237. 



It was slightly smaller than the average, weighing 1225 grammes, the 

 surface presented numerous small flat fibrous growths on the capsule ; 

 the cut section showed an enormous periportal cirrhosis, " as if a number 

 of white clay pipe-stems had been thrust at various angles through it," 

 these white cirrhotic masses contrasting sharply with the drab colour of 

 the general parenchyma. Microscopically, the ova of the worm were 

 distributed in the same manner as was mentioned in my original 

 description of this disease. 



The Spleen and Kidneys showed nothing of note. 



The Urinary Bladder showed the slight roughness and peculiar 

 sandy discolouration of the mucous membrane which is so characteristic 

 of incipient bilharziosis of this viscus, and a scraping of these discoloured 



(42) 



