Pathogenesis 



641 



With the most approved methods yet devised, Peabody 

 and Pratt* were unable to recover the micro-organism from 

 the intestinal contents in more than 21 per cent, of febrile 

 cases, and only in small numbers as a rule. The greatest 

 number was obtained when there was much blood in the 

 stool. 



There is always well-marked blood-infection during the 

 first couple of weeks of the disease, and upon this depends 

 the occurrence of the rose-colored spots. 



The bacilli enter the solitary glands and Peyer's patches, 

 and multiply slowly during the incubation period of the 



Fig. 223. Intestinal perforation in typhoid fever. Observe the 

 threads of tissue obstructing the opening. (Museum of the Penn- 

 sylvania Hospital.) (Keen, "Surgical Complications and Sequels of 

 Typhoid Fever.") 



disease one to three weeks. The immediate result of their 

 activity in the lymphatic structures is an increase in the 

 number of cells, and ultimately necrosis and sloughing of 

 the Peyer's patches and solitary glands (Fig. 223). From 

 the intestinal lymphatics the bacilli pass, in all probability, 



* "Journal of the American Medical Association," Sept. 7, 1907, 

 xux, p. 846. 

 41 



