DIFFERENTIAL DIAGNOSIS 389 



which have a yellowish, mottled appearance. The small intestine is 

 firmly attached to one of these. The disease has, however, not invaded 

 the wall of the latter. The border of these spots is intensely hypertemic. 

 When the caecum is slit open its width is three to four times that of the 

 undisturbed tube, and the thickness of the wall varies from one-eighth 

 to one-half of an inch, being not less than one-eighth of an inch over 

 three-fourths of the entire length. When the brownish feces were 

 washed away the increased local thickenings were found covered with 

 firm exudates, usually attached in but one spot. 



"Sections were examined of that portion of the caecal walls which 

 was very much thickened, and to which the contiguous small intestine 

 was inseparably attached by the new growth. 



"The mucosa of the caecal portion had sloughed away, while that of 

 the embedded small intestine was intact. The neoplastic tissue between 

 caecum and intestine was fully i cm. (two-fifths inch) thick. Inas- 

 much as the infiltration probably followed the narrow mesentery 

 between caecum and intestine the original boundary lines of the caecal 

 wall are no longer recognizable. The muscular coat of the caecum may 

 be traced for oflly a short distance into the neoplasm, when it appears. 

 Microparasites were not seen distinctly in the diseased tissvie. 



"The liver is very much enlarged, and dotted everywhere with 

 roundish spots of varying appearance. The majority are from 5 to 12 

 mm. in diameter, round or slightly oval. The center of each is usually 

 occupied by a group of yellowish dots and the circle is bounded by a 

 narrow yellowish ring. The space of the circle is mottled brownish. 

 Among these spots there are also circles of a completely yellowish color. 

 On the convex surface of the left lobe there is a very firm, ring-like, 

 j-ellowish mass, cutting like firm cheese. 



"In crushed preparations of fresh liver tissue from within the brown- 

 ish circles many giant cells are seen. They consist of a meshwork of 

 protoplasm of a rather coarsely granular character inclosing spheres 

 which appear homogeneous. The giant cells are up to 30 /( in diameter. 



"Sections of liver tissue hardened in alcohol and in Foa's solution 

 were also examined. The foci of disease contain necrotic areas in 

 which are numerous giant cells each inclosing a number of micro-para- 

 sites. In some portions there is much cell infiltration in the interlobu- 

 lar tissue around the portal vessels. Among the cells the protozoa are 

 recognizable." 



^ 302. Differential diagnosis. This disease is to be 

 differentiated from certain local affections of the cecum not 

 especially uncommon in turkeys. Ziirn (^Deutsche Zeit. f. 

 Thiermed, Bd. X(i883), p. 189) has described a cecal disease 

 in water fowls and turkeys and von Ratz has described a 



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