232 THE INFECTIOUS DISEASES. 



lfl.r to those iu^ the nodule^ of the intestines, and are usually affected in 

 a degree corresponding to the intensity of the intestinal lesion. 



The podges are at firjjt congested and succijh^nt ; then there is a pn> 

 duction of lymphQid c^lls and large cells as in the intestinal nodules, and 

 thenojfe becomes enlarged. When the enlargement has reached its full 

 extent, congestion diminishes, and the cells begin to degenerate. The 

 degeneration may tak^place slowly, and then the node gradually re- 

 turns to its normal condition ; or mojve rapidly, and then little jx>ci_ of 

 nee r otjc, purulent material are fornied. If the patient recover the snia^l 

 fo.ci are absorbed, leaving a fibrous cifiafcrix ; the larger foci may become- 

 dry, necrotic, and enclosed in a fibrous capsule. Intense exudative in- 

 nimimatiojPmay occur in_ the nodes, wliicir~may be^ densely infilt_rated 

 with serum^, fibrin, and pus. 



The Sple^. In nearly every c^se of tvpjioyl feyer^ the spleen is en; 

 This ejilargenient begins, as a rule, sooji after the commence- 

 of the dj^ase, increases rapidly until the third^ week, remains 

 stationary for a few da^, and then diminishes. The organ is congested, 

 of (iarj^ed^fifllo^, and of firm consistence whQe it is increasing -in size. 

 After^has readied its maximum size, its consistence becomes soft^ a~nT 

 there is a considerable deposit of In-own pjigment. The enlargement ap- 

 pears to l>e duetto congestion and hyperplasia. 



Mallory describes proliferation or endothelial cells, especially in the 

 blood-vessels and pulp spaces, and the formation of venous thrombi. 



In rare cases the softened spleen ruptures, with an extravasation of 

 blood into the peritoneal cavity. There may be infarctions of the spleen, 

 which sometimes soften and may apparently lead to peritonitis. 



The Liver. The Uver may present jtp apparent lesion. It is, how- 

 ever, frequently large, j>al^, and flabby, and in tljis condition the livery 

 cells may ^ the seat of simple a^- 

 imnrinouji degeneration. " ;\ . ','***,*/ 



Less frequently there are present /!', .-', * / , '-. ' , \ ', 



in the j^ver \^ery small, soft, gjray- ,, ;* - ' 'i;X*v;-*x '* * *^' 

 ishjiodules (Fig. 113). These focal * VV^tf^^i^^i' \f^ 

 lesions are sometimes too small to ^ V ''$'<?> :*'*: .r^^i&fV ',*"; 



lesions are sometimes too small to 

 be distinguished by the naked eye. 



p 



n 

 $ 



They may be situated about the 



branches of the portal vein or within 



the lobule. Some of these nodules 



consist of masses of small spheroidal * -'^-ff. v :"/! i'.'.^*.*.* * *>,/. V *: 



cells, which may form a diffuse in- FIG. 113.-FOCAL AREA OF EXDOTHELIAL-CELL 



filtration along the small veins. ^' R FERATION IN THE LIVER I!f TPHOID 



Mallory distinguishes two distinct 



varieties of these focal lesions: one formed in the lymph spaces and 



vessels in the capsule of Glisson by a proliferation of the endothelium 



(Fig. 114) ; the other due to obstruction of liver capillaries, in part by 



the proliferation of endothelium on the spot, in part by emboli of 



eudothelial cell origin, which are derived through the portal circulation 



