6i 
surrounded by a mass of fibrous adhesions, omentum, appendices 
epiploicae, etc. In separating the ileum, a cyst, the size of a large 
pea, was ruptured, and an immature adult ocsophagostome escaped. 
In the mass of adhesions, two other small cysts were found, but these 
were free from any connection with either caecum, colon or ileum. 
Interior. 
On opening the small intestine, some twenty nodules are seen 
situated in the walls, the majority of them causing a distinct bulging 
of the mucous membrane. 
The greater number of the tumours are small and oval in shape, 
measuring 4 mm. by 6 mm., up to 5 mm. by 9 mm. Some few have 
an elongated form, 15 mm. by 6 mm. (Plate IV, fig. 2). Though 
causing this bulging of the mucous membrane, none of the tumours 
is so markedly elevated as those nodules situated on the external 
surface of the intestine. The average bulging of the mucosa, 
produced by the cysts, is from 1 mm. to 6 mm. 
A few of the nodules on the external surface are seen to cause 
a bulging of the mucous membrane into the lumen of the bowel. They 
are all more or less flat tumours with broad bases (Plate V, fig. 5). 
(The opened cyst with a worm partially drawn out is one with these 
characters, Plate IV, fig. 2.) The long leech-like tumours (Plate IV, 
fig. 1) produce no bulgings into the lumen of the canal; they are 
nearly all situated over the areas of Peyer’s patches, which are 
enlarged and slightly inflamed. 
The tumours in the submucosa lie transversely or diagonally, a 
few longitudinally to the axis of the bowel, and the majority of them 
are situated along the attachment of the mesentery. These adhere 
firmly to the wall, and are generally harder than those on the external 
surface. 
The walls of the bowel are unusually thin in places. At 23 cm. 
and 47 cm. from the ileo-caecal valve are two pouched areas (p. 60); 
the lumen of the bowel is considerably enlarged, and beyond the 
sacculations, are constrictions of the canal. Examination shows that 
the constrictions cause an actual narrowing of the lumen of the gut, 
forming partial strictures, so that it is difficult to introduce the tip 
of the little finger. Dilatation of the tube in the proximity of the 
constrictions has resulted in the formation of the two pouches. The 
