312 TYPHOID FEVER. 



clumps occur in the liver in any situation, and without any 

 local reaction. Here, however, there are often small foci 

 of leucocytic infiltration, in which, so far as our experience 

 goes, bacilli cannot be demonstrated. Clumps of bacilli 

 may also occur in the kidney. 



In addition to these local changes in the solid organs there are also 

 widespread cellular degenerations. These usually take the form of 

 cloudy swelling of the specialised cells of the liver and kidney, or of 

 the muscular fibres of the heart. A granular disintegration of such 

 cells may occur. As they may exist altogether apart from local 

 presence of the bacilli, these changes suggest the circulation in the 

 blood of soluble poisons. 



In the lungs there may be patches of congestion and of acute 

 broncho-pneumonia. In these, typhoid bacilli may sometimes be 

 observed, but evidence of a toxic action depressing the powers of resist- 

 ance of the lung tissue is found in the fact that the pneumococcus is 

 frequently found in such complications of typhoid fever. 



The nervous system shows little change, though meningitis associated 

 either with the typhoid bacillus, with the B. coli, or with the strepto- 

 coccus pyogenes has been found. 



The typhoid bacilli probably travel by the blood stream, but they 

 have not been frequently isolated from the blood. Whether they have 

 ever been found in the roseolar spots which occur in typhoid fever is 

 a subject of dispute. The fact that the typhoid bacilli are usually 

 confined to certain organs and tissues, shows that they must have a 

 selective action on certain tissues. 



To sum up the pathology of typhoid fever we have in it 

 a disease, the centre of which lies in the lymphatic tissue 

 in and connected with the intestine. In this situation we 

 must have an irritant, against which the inflammatory re- 

 action is set up, and which in the intestine is sufficiently 

 powerful to cause necrosis. The affections of the other 

 organs of the body suggest the circulation in the blood of 

 poisonous substances capable of depressing cellular vitality, 

 and producing histological changes. 



Suppurations occurring in connection with Typhoid 

 Fever. The relation of the typhoid bacillus to such condi- 

 tions has been the subject of much discussion, and it must 

 be observed at the outset that statements as to its isola- 

 tion from pus, etc., can be accepted only when all the 





