168 PATHOLOGY OF TYPHUS IN MAN 



Focal necroses of a few to several liver cells were found in 

 four livers and central necrosis in five. The latter condition, 

 in three instances, was associated with important complica- 

 tions, phlegmon and impetigo in one case, confluent bilateral 

 bronchopneumonia in two cases. 



(f) The gastro-intestinal tract: Sections were made from the 

 stomach, duodenum, jejunum, ileum, and colon as a matter 

 of routine. In no case, exclusive of the case with superior 

 mesenteric artery thrombosis, were lesions of large blood ves- 

 sels found. The ulcers found in the stomach in two cases have 

 no distinctive histology. In two other cases shallow ulcers of 

 the stomach appear to have taken origin in areas of hemorrhage 

 limited to the mucosa. In one of the above cases with ulcers 

 a vein with a mural thrombus in the submucosa was found. 

 Vascular lesions were conspicuously absent in all parts of the 

 alimentary tract. Thrombi in blood vessels of the submucosa 

 of the stomach were found in three cases; in the small intestine 

 in another three cases and in the colon in one case. These 

 findings agree with the rarity of gross lesions at autopsy. 



(g) The pancreas: No lesions of the pancreas referable to 

 typhus were found in the thirty-three examined. There were 

 two pancreases that showed invasion of the interlobular con- 

 nective tissue with polymorphonuclear leucocytes; a not un- 

 common finding in our experience with acute infections of 

 various sorts. Two showed slight chronic pancreatitis. Lesions 

 of the blood vessels of the pancreas are absent. 



(h) The kidneys: Characteristic focal lesions in the kidneys 

 and small hemorrhages have been described as of almost con- 

 stant occurrence by Aschoff, Ceelen, Jaffe, and others. These 

 lesions in our experience do not exhibit the proliferative reac- 

 tion seen in the " nodules" of the skin and central nervous 

 system. They do resemble the lesions in the myocardium in 

 that only small blood vessels are affected and that the cellular 

 response is infiltrative rather than proliferative. The lesions 

 consist of small collections of cells incorporating one or several 

 tubules which show varying stages of degeneration up to com- 

 plete disintegration and necrosis. In many instances it is 



