6 7 
examination showed several foci. If the bowel wall at the side of a 
submucous cyst be incised, little difficulty is experienced in shelling out 
the cyst intact, which then appears as a thin membranous sac 
containing a worm. It is impossible to shell out old submucous cysts 
with much fibrous tissue, or subperitoneal cysts, without rupture of the 
wall. 
MICROSCOPICAL EXAMINATION 
Nodules from various parts of the small and large intestine were imbedded in 
celloidin or paraffin and, where possible, serial sections were made. Many of the 
nodules in the wall of the caecum and colon required decalcification before 
imbedding. The serial paraffin sections were affixed to the slide with glucose- 
dextrose solution and, after drying, were passed through toluol and alcohol and 
flooded with thin celloidin. The film was allowed to harden and the slide was then 
placed in water to dissolve the glucose; the sections protected by the thin celloidin 
covering floated off and could be manipulated with ease. Van Gieson and \\ eigert’s 
elastic tissue stains were found of service. 
Ileum 
Oval submucosal cyst. Cut transversely. 
The cyst has developed in the subinucosa; though distended the cyst does not 
appear to press on either the muscularis mucosae or the internal muscular coat. The 
walls of the cyst are of thickened connective tissue. The cystic contents appear to 
consist almost entirely of degenerated erythrocytes; a few large mononuclears are 
present. In some of the sections portions of a worm are seen cut across. The cyst 
wall is infiltrated with numerous mononucleated cells and some small round 
lymphoid cells. . 
Examination with a higher power, shows that the cystic contents contain a few 
perfectly preserved red blood cells, and a few large mononucleated polygonal-shaped 
cells which contain a few pigment granules. Small clumps of granular pigment are 
scattered about. The cross-section of the worm shows that there are many degene¬ 
rated as well as some normal red cells in the intestine. The cyst wall is infiltrate 
by large mononuclears and granulation cells, the infiltration being more dense m 
the inner part of the walls. The side abutting on the internal muscular coat is 
especially infiltrated, the infiltration extending halfway through the internal 
muscular coat. The tissue of the submucosa exhibits a slight infiltration of 
mononuclear leucocytes, but the muscularis mucosae and mucosa are entirely free. 
The vessels in the cyst area are engorged with blood; many of them contain 
numerous mononuclear leucocytes. Traversing the internal and external muscular 
coats are large cells containing pigment granules; none of these cells is noticed in 
the mucosa. No eosinophiles are to be found. 
Oval submucous cyst with necrotic -patch on wall projecting prominently into 
intestinal canal. 
The cyst has developed in the submucosa and has involved the inner fibres of the 
internal muscular coat. The distension is extreme and has caused a very prominent 
bulging of the mucous membrane. The fibres of the muscularis mucosae are no^ 
atrophied but appear to be thinned. The necrotic patch in the mucous mem rane 
proves to be only a superficial ulceration which does not extend to the deeper ayers 
nor involve the muscularis mucosae. There is very little infiltration of t e in ® r ” 
muscular coat or of the tissues in the immediate vicinity of the cyst. e con ei 5 
