42 CLINICAL APPLIED ANATOMY. 



the arytenoid cartilages and at the posterior extremities of the 

 true vocal cords. The ulceration at the base of the arytenoid 

 cartilages from its position may invade the perichondrium of the 

 cricoid and lead to the exfoliation of this cartilage. 



Peritonitis in typhoid fever is an invasion by contiguity. It 

 usually arises in consequence of the perforation of the bowel, but 

 may possibly arise from bowel without actual perforation in some 

 cases. Infarction and abscess of the spleen, suppuration in 

 mesenteric glands, ulceration and perforation of the gall-bladder, 

 and abscesses in other parts such as the ovary, rectus abdominis, 

 the sheath of which is deficient posteriorly in its lower part, and 

 the urinary bladder may all be the cause of peritoneal infection. 



From the relation of the ulcerated bowel to the portal tribu- 

 taries it is easy to see how portal pyaemia and liver abscesses may 

 arise as complications. The cholecystitis of typhoid fever is 

 probably due to blood infection, but it is conceivable that an 

 ascending infection along the bile duct might occur. 



Otitis media as a result of typhoid fever is more common in 

 children than in adults. The reasons for this are given below 

 when dealing with scarlet fever. Extension of infection from the 

 mouth along the parotid ducts gives rise to parotitis. Ulcerations 

 of the palate and pharynx are also secondary infections from the 

 mouth. 



Certain muscles are apt to rupture in the course of the 

 fever. Muscular degeneration is the basis for this, but no doubt 

 mechanical factors come into play. The muscles which are most 

 likely to give way are the rectus abdominis, the adductors of 

 the thigh, the psoas or the pectorals. 



Bed-sores, being due to continued pressure on debilitated 

 tissues, are likely to occur where bony prominences have a 

 scanty tissue covering ; hence they may occur over the sacrum, 

 the trochanters, the points of the heels, front and outer side of 

 the knees, elbows, shoulders, malleoli, scapulas, and the anterior 

 superior spines of the ilia. 



The bacilli may be eliminated in large numbers through the 

 kidney, and thus involve the renal pelves, the ureters, and the 



