Anatomical Changes. 271 



in its entire length. At tlie same time tlie flexures of the intes- 

 tines may stick together, and this condition may also be seen in 

 the convolutions of the small intestines, or there may even be 

 adhesions. In acute cases there are lentil to dollar-sized, flat, 

 round, yellow, greenish-yellow, brown or blackish-gray, dry 

 scabs on the mucous membrane of the colon and caecum, espe- 

 cially around the Bauhin's fold (ileo-caecal valve), and some- 

 times also in the adjoining small intestines, under which the sub- 

 mucosa or the muscularis is infiltrated or thickened. Between 

 these the follicles are swollen to hemp-seed size hard nodules, 

 from which a caseous mass may be squeezed. In some cases 

 the affection may be confined exclusively to an ulceration of 

 the follicles, in which deep ulcerations, with raised, thickened 

 margins, cover the mucous membrane of the intestines. These 

 ulcerations increase in numbers posteriorly, and are of the size 

 of lentils, round and covered with dry tissue debris (Fig. 50). 



In more chronic cases the inner surface of the intestines 

 usually contains thick, hard scabs, in small numbers, sometimes 

 flat, at other times hemispherical, colored similarly to the above- 

 described lesions, so-called buttons or boutons, which protrude 

 over the neighboring mucous membrane (Fig. 51). The cut sur- 

 face of these buttons appears sometimes in layers, they adhere 

 firmly to the submucosa or the muscularis, and are surrounded 

 by a thickened ring of the mucous membrane. Around these 

 nodules the intestinal wall is frequently thickened and stiff. 



In some cases the mucous membrane may be necrotic over 

 large sections of the large intestines ; in less advanced cases the 

 necrotic epithelium forms a mushy deposit on the surface of 

 the mucous membrane, while later it may change in its entire 

 thickness to a dirty yellow, or greenish-yellow, dry, mushy detri- 

 tus. At the same time the outer layers of the walls of the large 

 intestines are greatly thickened, so much so that the affected sec- 

 tion represents a stiff tube with a constricted lumen. 



The mucous membrane of the stomach, especially in acute 

 cases, shows a pronounced hemorrhagic inflammation, and is 

 frequently covered with croupous pseudo-membranes. 



In the acute cases the h^npll glands are swollen, hyperemic, 

 and even hemorrhagic. In the later stage they contain small, 

 grayish points, disseminated in reddish tissue; in still more 

 severe cases they change to hard growths up to the size of a 

 hen's egg, which on the cut surface prove to consist of a gray- 

 ish-red, dry, homogenous necrotic tissue, or of a dry or soft 

 caseous mass. These changes are most frequently and most 

 prominently present in the mesenteric glands, less frequently in 

 the other lymph glands of the abdominal cavity, are sometimes 

 also to be found" in the glands of the thoracic cavity, and in 

 rare cases even in the body lymph glands.^ 



In some cases tumor-like lesions which resemble those of 

 the lymph glands may be found in other internal organs, which 



