Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 3 (2).djvu/7

CESOPHAGOSTOMIASIS IN MAN. 45 valve. The nodules are less frequent and pronounced in the remaining 65 cm. of the infected bowel. These tumours appear to lie on the surface of the external muscular layer of the bowel and just beneath the peritoneum. Thirty-seven easily seen nodules can be counted. The smaller ones are oval and measure up to 9 mm. by 7 mm., and are raised 8 mm, above the surface—others are flatter and more button-shaped—others again are elongated leach-like masses, 14-23 mm. in length and 6 mm. thick. They project 4-9 mm. above the surface. They are opaque and greyish-black in colour, with sometimes a few light ochre-coloured points in the tumour wall. Some are along the mesenteric attachment; others are on the side or upper surface of the intestinal tube. On incising a nodule, a small worm is seen lying in a semi- liquid brownish mass.

Interior.—On opening the bowel about twenty nodules are seen situated in the walls, causing a bulging of the mucous membrane into the lumen of the gut. They are the size of small beans, and on opening one a small worm is found occupying the cyst.

At two places in this piece of bowel the walls are extremely thin and sacculated. At either end of the pouches quite large nodules occur, which, developing m the sub-mucous coat and lying parallel to the mesenteric attachment, have fastened on to both the side walls, and have thus materially narrowed the lumen of the gut, forming a more or less actual stricture, so that it is difficult to introduce the tip of the little finger. Dilatation has occurred, in parts the walls resemble very much a sprue gut. Peyer's patches are slightly enlarged and the mucous membrane of the small intestine shows evidences of inflammation.