DIFFERENTIAL DIAGNOSIS 



363 



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tuff^?^ 



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necrotic tissue contained in the larger nodule.s, but they are 

 almost invariabl}' found in the smaller ones. In a few sections 

 the tapeworm has been traced through the mucosa to the 

 nodule in the muscular tissue in which its head appeared. In 

 the earlier stage of the nodular development, there is a cell in- 

 filtration about the head of the worm. This process continues 

 until the infiltrated tissue reaches a considerable size. 



A larger form is commonly found 

 in the intestinal contents. Although ^ 



macroscopically they appear to be dif- 

 erent. Dr. Stiles has found that they 

 are presumabh' of the same species. 



§ 291. Differential diagnosis. 

 Tuberculosis is the only known dis- 

 ease for which this affection is liable to 

 be mistaken and it is of much impor- 

 tance that the two diseases should not 

 be confounded. The diagnosis has 

 not in my experience been difficult, as 

 in every case the attached tapeworms 

 were readily detected upon a close ex- 

 amination of the intestinal contents, fjg, -2. (/) Cross 

 or of the mucous membrane of the seiiwn of a nodular con- 

 infected portion of the mtestine. /"""",;' nt-crolic cheesy tis- 

 ,, ., ,, sue. [>) Cross section show- 

 However, the worms are quite small . , . . 



^ ing hee;in)iiiig of neerohe 



and could easily be overlooked ui a ,„;;^^ ,,7,^,,/ /,;,,„/^ ^j ^ /,,^,. 



hurried or cursor3r examination. In worm. (3) Secliou slwiving 

 case of doubt, if the affected intestine worm between villi and 

 is opened, and the mucous surface hooks within the viusele. 

 washed carefully in a gentle stream of water, the small worms 

 will be observed hanging to the mucous membrane. This 

 discovery, in the absence of lesions in the liver or other 

 organs, would warrant the diagnosis of the tapeworm disease. 

 Although much is written concerning tuberculosis in fowls, 

 the investigations of poultry diseases in America thus far show 

 that it is not common among fowls in this country. 



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