Excerpt from The American Journal of the Medical Sciences, Vol. 106
In the smallest a few parasites are seen, one or two adult forms, while there may be five or six that have not developed a capsule; the majority, however, are free in the lumen of the duct, a few are wedged in between the cells. In some ducts the process has gone further, and small folds are just beginning to form, and in these ducts the lumen is much larger and the parasites more numerous. The relation of the parasites is, however, very plain, and by using a binocular microscope with a high power it can be ascertained beyond a doubt; the parasites that are wedged in between the columnar cells by their growth and presence cause desquamation and disintegration of contiguous cells, but in no case are they contained in the columnar cells. This would be a physical impossibility, as the smallest forms of the parasites are much larger than the columnar cells. It is, of course, possible for the parasite, in an early stage of its growth, to get inside a cell and expand it as it grows. I cannot, however, find any parasite small enough to do this, neither do any of the columnar cells show evidence of any displacement of their nuclei, which must take place if another body was growing inside them.
On examining some of the large cells that have no capsule, a few will be found which have had a portion cut off in making the section. These cells show a margin of granules, while the centre is free from them. This shows that the granules are on the outer margin of the cells, and the binocular microscope confirms this view. We have, then, a large oval cell having a granular covering. On examining a number of these, it is at once apparent that this granular covering varies very much in different cells. In some it is very fine and difficult to make out, having scarcely any appreciable thickness, in others the granules are much larger and the coating is thicker. Further examination shows that this granular covering increases in thickness and in the size of its elements until definite patches are seen covering the cell. In some this change has gone on until the cell is almost covered; this is the development of the capsule, and the appearances described might easily be considered as the expansion of one cell by the growth of another inside it. All these stages in the development of the capsule can be seen going on in the spaces of the dilated bile ducts. It seems to me that this explains the view held by some that the parasite inhabits the cells of the bile ducts.
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