65 
coalescing of so many tumours produces at these centres a great 
thickening of the wall, as is well seen in Plate II, fig. 2, and Plate III, 
fig. 1. 
The cysts composing these strands are of varying dimensions, 
measuring 8 mm. by 3 mm. to 40 mm. by 4 to 7 mm. It is difficult to 
determine the exact length of some of the tumours without opening 
them. Some of the largest tumours, on being incised, are found to 
consist of a row of five to seven equal-sized cysts. Others again, with 
irregular outlines, and all the appearances of a series of cysts lying 
end-on-end, prove to be composed of one or two long cysts. 
The cysts are soft and very compressible, differing from the harder 
cysts encountered in the ileum. Many of the spongy cysts have their 
walls dotted with yellowish areas. A few of these areas are actual 
sloughs, and quite moderate pressure suffices to rupture the necrosed 
wall. There are no calcareous patches. The bulging of the mucosa 
caused by these cysts is pronounced and varies from 3 to 5 mm. up 
to 9 mm. along the plica sigmoideae. Plate III, fig. 1 depicts a 
medium sized distended cyst, and through the thinned and tightly 
stretched mucosal covering the outlines of a large worm can be easily 
seen. This cyst was continuous with a large cyst in the external 
muscular coat, which bulged inwards as well as outwards. 
On making a cross-section through the caecum, a striking picture 
is obtained. The wall in the vicinity of the longitudinal bands is 
thickened by dense fibrous tissue and honeycombed by a number of 
cysts of different sizes. Many of these cysts have been cut through, 
and parts of worms are lying in the cyst cavities (Plate V, fig. 2). 
The cysts appear to be situated in the subperitoneal and submucosal 
fascia; some lie between the internal and external muscular coats of 
the bowel. Some cross-sections show that all three forms of cysts 
have developed through being superimposed on each other. In such 
a case, the submucosal and intramuscular cysts appear to be of older 
and the subperitoneal cysts of more recent growth. The cysts with 
much cicatrical tissue around them are usually empty and may be 
partially calcified. 
The thickness of the wall varies. At the anterior band it is 6 mm. 
to 9 mm., and in betwen the clusters of cysts the bowel wall is thinned 
and very transparent (Plate II, fig. 2). 
P 
