59 
diaphragm; capsule dull, not thickened; organ pale, friable, cloudy 
swelling, commencing to decompose. 
Kidneys slightly enlarged, very soft, especially the right ; cloudy 
swelling. Decomposition advanced. 
As the adhesions were very firm, the small intestine, caecum, 
ascending and transverse colon, were taken out en masse and placed 
in Kaiserling’s fluid for later examination. 
The following description of the affected bowel was made some 
months after it had been in Kaiserling’s fluid : — 
SMALL INTESTINE 
Exterior. 
The surface of the small intestine, extending from the ileo-caecal 
valve, for a length of about one metre, is studded with small raised, 
dark-coloured tumours; the majority of these involve the lower part 
of the ileum for a distance of 35 cm. from the ileo-caecal valve. The 
nodules are less numerous and pronounced in the remaining 65 cm. 
of the infected bowel. 
Thirty-seven well-marked tumours can be counted. The greater 
number of them appear to be lying between the external muscular 
layer and the peritoneal covering of the bowel. The surfaces of the 
nodules are usually smooth, but some few are roughened and covered 
with plastic adhesions. The majority of these growths are small and 
oval in shape, and vary from the size of a small pin s head to 7 mm. 
by 9 mm. and elevated as much as 6 mm. to 8 mm. above the surface 
of the bowel (Plate IV, fig. 2). Some are flatter and more button¬ 
shaped (Plate V, fig. 5). Others again are elongated, leech-like masses. 
These latter (eight in number) measure from 14 mm. to 23 mm. in 
length and 6 mm. to 11 mm. in width; they project 4 mm. to 
9 mm. above the surface; their base is somewhat constricted so that 
the contents of the cyst cause a bulging of the tumour walls (Plate 
IV, fig. 1). 
The nodules are opaque and greyish-black in colour, with some¬ 
times a few light ochre-coloured points in or underneath the cyst 
wall. 
The situation of the nodules varies. Some lie along the mesenteric 
attachment; others are on the sides or upper surface of the gut. I he 
larger tumours appear to lie on the upper wall and parallel to the 
