CHAPTEK IV. 

 SPECIFIC FEVEKS. 



TYPHOID FEVER. 



THE bacilli of typhoid fever usually gain access to the body by 

 way of the digestive tract, and find their first nidus in the 

 aggregations of lymphoid tissue which are situated in the lower 

 part of the small intestine. Since the ileum occupies the lower 

 and right divisions of the belly cavity, it is in the right iliac 

 fossa that gurgling and tenderness are most) apt to occur during 

 the course of typhoid fever. The shape of a typhoid ulcer 

 is determined by the distribution of the lymphoid patch in 

 which it arises ; hence, when it is situated, as is commonly the 

 case, in an agminate gland (Peyer's patch) the ulcer is elongated 

 in the direction of the long axis of the gut, and situated at that 

 part of the circumference of the bowel which is most remote 

 from the attachment to it of the mesentery. Ulcers originating 

 in the solitary glands of the bowel may have a rounded outline 

 and occur at any part of the bowel circumference. Ulcers of 

 irregular shape may result from the fusion of smaller ulcers or 

 the partial necrosis of an agminate gland. Although for some 

 reason, possibly the stagnation of intestinal contents above the 

 ileo-caecal valve, ulcers are usually more or less limited to the 

 lower part of the ileum, yet the lymphoid nodules in other parts 

 of the bowel may become involved. Thus ulcers have rarely 

 been discovered in the duodenum, sometimes in the jejunum, 

 more frequently in the appendix vermiformis and the large 

 bowel, the whole extent of which may be involved in exceptional 

 cases. 



The great quantity of lymphoid tissue at the point of entrance 

 of the ileum into the colon accounts for the widespread ulceration 



