A REMARKABLE CASE OF BILHARZIOSIS 9 



The Intestine. — The prominent and distinctive lesion of the 

 present case is found in connection with the bowel, particularly as 

 regards the external or serous portion thereof. 



Beginning five feet above the coecum, there were on the serous 

 surface of the ileum a number of small polypoid outgrowths, varying 

 in size — about a centimetre in length — consisting of a hard club-shaped 

 extremity, often flattened or discoid, and connected with the bowel by a 

 pedicle of loose connective tissue. These pedicles were flattened from 

 side to side, often forming little sheets of membrane whose linear axis 

 ran with the long axis of the gut. The distal portions of the pedicles 

 contained the small firm masses above-mentioned, masses from the size 

 of a split pea to a horse bean, of various shapes, discs, oryzoid, globes, 

 round and oval masses, like a captive balloon or airship. Many of these 

 fibrous bodies lacked the pedicle, and were connected to the gut by broad 

 bases. As we pass down the bowel towards the coecum, the pedicles 

 become fewer and disappear, the fibrous masses become larger, increasing 

 in size to that of a hazel-nut, a walnut, a pigeon's egg (see Figs. 2 and 2A). 

 Nearing the coecum the masses are several inches — four to six — in length, 

 project an inch from the bowel surface, and occupy half or more of the 

 circumference of the gut, looking like large sausages split longitudinally 

 and applied to the wall of the viscus. The masses rise abruptly from 

 the bowel, are situated on the side opposite the mesenteric attachment, 

 and are continued almost uninterruptedly down to the coecum. They 

 are covered by a smooth lining of peritoneum continuous with the serous 

 coat of the bowel — show in places secondary polypoid growths, like 

 those higher up the ileum, and are composed of dense white fibrous 

 tissue, which contains numberless ova in certain parts. 



The coecum shows a similar condition of its serous coat — a mass 

 almost as large as a pigeon's egg. The colon is extensively affected, 

 showing huge masses of fibrous tissue, an inch in thickness (see Fig. 3 j 

 extending along the whole length of the free surface of the bowel, and 

 occupying from a half to three-quarters of the circumference of the 

 intestinal tube. The secondary polypoid masses, growing from the colon 

 tumours, were numerous and much larger than the corresponding iliac 

 tumours, although the most extensive sessile growths were on the lower 

 ileum. In short, as regards the external portions of the bowels, there 

 was in the ileo-colon region a series of fibrous growths, increasing in 



(47) 



