MORBID ANATOMY 



259 



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appearance. In cases of ordinary severity the wall of tlie 

 caecum which is not more than 0.2 to 0.5 mm. thick normally 

 becomes 2 to 3 mm. thick. 



With the progress of the 

 disease the mucous membrane may 

 be shed and a coagulable fluid 

 poured out into the caecum. In 

 some cases it appears in isolated 

 masses, which adhere to certain 

 spots of the mucous membrane. In 

 others, this exudate fills the entire 

 tube with a yellowish-white mass, 

 built up iu concentric layers con- 

 sisting of a mixture of blood cor- 

 puscles, fibrin and small round cells 

 in variable proportion. 



In the further progress of the 

 local disease it is not iinprobable 

 that bacteria are also concerned. 

 The exudate contains immense 

 numbers of them and the denuded 

 mucosa furnishes a favorable place 

 of entry. It is otherwise difficult 

 to explain the continued increase in 

 thickness of the walls of the caecum 

 after the mucous membrane has 

 been shed. This continued increase 

 in thickness is due to an extensive 

 infiltration of small round cells and 

 the presence of some giant cells. 

 Parasites in this advanced stage are 

 scarce and usually recognizable 

 ■only as vacuole-like bodies within 

 the giant cells. 



The thickening of the wall is associated in some cases 

 with an extension of the inflammation to the contiguous wall 

 of the intestine which becomes firml5' attached to the caecum. 



Fig. 65 Diseased caecum 

 showing thickness of wall 

 and ulcerated mucosa. 



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