CHAPTER XXIV. 



TYPHOID FEVER. 



TYPHOID FEVER is a specific febrile disease peculiar to man, with 

 characteristic pathological lesions in the intestine, mesenteric 

 glands, and spleen. The Peyer's glands pass through three stages. 

 They become swollen from infiltration of round cells in lymph 

 follicles, due, it is supposed, to the presence of the typhoid fever 

 bacillus. The enlargement of the lymph follicles is followed by 

 coagulation necrosis until the entire patch becomes necrosed, and 

 sloughs away, leaving an ulcer. The disintegration of the patch 

 may extend in depth, and result in perforation and peritonitis, or 

 the ulcer may heal, and a pigmented scar take the place of the 

 Peyer's patch. The lymphatic glands are found more or less 

 enlarged, and may be easily felt in the groin, axilla, and neck. In 

 some cases there is a tendency to haemorrhage, followed by infarctions 

 in the spleen and lungs, which may develop into pysemic abscesses 

 In the mesenteric glands similar changes take place, but without 

 ulceration. Pneumonia may occur as a pulmonary complication. 

 The bacteria of pneumonia and Streptococcus pyogenes may be 

 found in association with the bacillus of typhoid fever. It is 

 now generally accepted that the disease is conveyed by water and 

 food which have become contaminated with the virus contained 

 in typhoid evacuations. This has been practically proved by the 

 number of cases which have been shown to have been intimately 

 connected with contamination of drinking water from wells and 

 other sources, by sewers, cesspools and faulty drains, the sewage 

 presumably having been infected with typhoid excreta ; but whether 

 sewage independently of typhoid contamination can originate 

 typhoid is still an open question. Accepting the former theory 

 as a working hypothesis, we must assume that a typhoid fever 

 bacillus exists in the intestinal evacuations, and that it must be able 

 to retain its vitality under very varying conditions until it gains 



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