2i6 DISEASES DUE TO BACTERIA 



While the bacilli may be found in any part of the body they 

 prefer the lymphatic tissue. When a clump blocks a cutaneous 

 lymphatic a rose-coloured macular papule appears which explains the 

 characteristic rash. 



Autoinfection may possibly explain some cases of second and third 

 attacks, the bacilli of the gall-bladder or other habitat injecting anew 

 the general system of the patient. 



The gradual onset is the result possibly of the struggle between 

 the antitoxins and the bacterial toxins. The rare sudden onset may be 

 due to lowered resistance of the patient. 



Immunity is partial, sometimes complete for the particular bacilli 

 causing the attack, but not against other varieties. 



P.M. 



Bowels distended with gas. Marked congestion of the mucous 

 membrane about ileo-ca?cal junction. 



Mesenteric glands enlarged and congested. 



Spleen and at times the liver also enlarged and congested. The 

 former is friable and dark red in colour. 



Perforation may be found. 



The heart soft, flabby and friable. 



The voluntary muscles undergo granular degeneration. 



Peyer's patches are affected according to the stage reached. 



First Week : — 



Swelling, the result of leucocytic infiltration. The submucous 

 coat is also involved, and sometimes the muscular coat. 



Second Week : — 



Sloughing, the surfaces are abraded, the sloughs are bile-stained. 



Third Week ; — . 



Separation, the sloughs come away, leaving an ulcerated surface, 

 with undermined edges in the long axis of the bowel having its base 

 of muscularis mucosae, infiltrated mucosa or peritoneum. 



Fourth Week : — 



Scarring, the ulcers granulate up, the scar forming and contracting. 



The solitary glands may pass through the same process. 



The ileum and jejunum are usually affected. 



The bile is usually light coloured, watery, but may be inspissated. 



Kidneys enlarged, both cortex and medulla congested, fatty 

 degeneration, rarely small abscesses. 



There may be an inflammatory condition of part or whole of the 

 respiratory tract. H^emorrhagic infarcts, py^emic abscesses and puru- 

 lent infarcts may be seen. Venous thrombosis is not uncommon. 



The bone marrow is generally congested. 



