234 THE INFECTIOUS DISEASES. 



these. There inq-y be croupous inflammation of the intestinal mucous 

 membrami of either the larjj^ or small intestine. A sligjit peritonitis 

 sometimes accompanies the intestinal lesion. Severe peritonitis is 

 usually jiue to perforation, less frequently to ulcers which reach the serous 

 coal, but do not perforate. When there is infiltration of the serous coat 

 with the new cell growth, described above, peritonitis may be asso- 

 ciated with a production of little gray nodules of the same character 

 throughout the peritoneum. LufarctiojlS of, the spleen^ inflammation^ of 

 the ovarj^s, and perforation of the gall-bladil^r are sometimes the incit- 

 ing^ factoj in peritouit^. 



Haemorrhage from the intestines, may be slight and due to the inflam- 

 matory swelling and congest^ of the mucous membrane ; orjt may be^ 

 duetto the ulceration of the follicles and openingof the bipods-vessels, 

 and is then often profugg. 



There may be hvperplasig, of the tonsil^ and of the lymphojd tissue at 

 the base of the tongue. Gangrenous ulcers of the sid^> and floor^of the 

 mouth may be present. Catarrha^ and croupous inflammation of the 

 pharyiixjnay be associated with superficial or deep ulceration. Inflam- 

 matlo^i of the pgrofj^leading to suppuration is not infrequent. The ^ub- 

 maxiHarii al.nnJ1 L may be similarly affected. Enlargement and induration 

 of the salivary gjatuh and of the pancreas in typhoid feve^ have been de- 

 scribed and are believed to be due to hyperplasia of the gland cells with 

 accumulation of their secret^!. ^This may be followed by degeneration. 



The Circulatory Organs. The heart in many cases is the seat of albu^ 

 minous, fat^, or hyalin degeneration, or of pigmentation. Mvocarditis : 

 endocardjjj^. and pericarditis are of occasTonal occurrence. Thrombi 

 may form upon the valves or in the heart cavities, and detadied fr_ag- 

 meuts of these may be lodged as emboli in vaious parts of the body^ 

 The arterif^jnav be the seat of acute inflammation.^ Jf this involve the 

 intima^ an occluding thrombus may be formed which may lead to gan- 

 ^grene^of the part supplied By the vgSSfiJ- Tnrombosig of the veins Js, 

 common, and especially frequent in the femoral vein late in the disease. 



The Respiratory Organs. The Larynx is frequently the seat of catarrliaT 

 inflammation, with or without superficial erosions : Less frequently there 

 is croupou^ inflammation, followed in some cases by destructiv^ ulcer- 

 atiojj ; fTpdein^. of the gloTtis occasionaTly occurs. 



The Lung&. Catarrhal inflammation of the large bronchi is very com- 

 n. Bon 



mon. Bfon^ljo-pneinnoiiia occurs in two f onos. There may be a sever 

 jnflammation^pf mos^ of the Jhronchi of both lungs, with cellulaj infiltra^ 

 tirn^ of the walls of the bronchi and zones jof peribronchitic pneumoni^; 

 or there is an intebsy general bronchitis, with loonies of the lung corre- 

 spopdi^P- to obstructed bronchi^ either collapsed or inflamed, or both. 



From the long-continued recumbent position of the patients, the pos- 

 terior portions of the lungs become congested, dense, and Tinaerated. 

 Sometimes, i^T addition to This, irregular porTions of l^e Jungs become 

 hepati/ed^ Less frefpuently there is acute lobar pneumonia^ Infarctions 

 are np^uncommon, and gangrene occasionally occurs, either associated 



