TYPHOID FEVER. 627 



It occuis far north in Russia and Denmark ; in middle Europe, espe- 

 cially in Germany, France, and the Netherlands ; and even in the 

 south in Italy, Syria, and Turkey it is not rare. In Great Britain, 

 exanthematic typhus is the common form, but abdominal typhus also 

 occurs, especially in the countiy towns, and the parts of England not 

 visited by Irish emigrants (Hirsch^ Griesinger). 



ANATOMICAL APPEAKANCES. It will be most convenient to 

 speak first (as Hamernik does) of the post-mortem appearances when 

 death has occurred early in the disease, before the typhus process 

 proper has set in, and then to give a description of the lesions that 

 are found when death has occurred later, during the repair of the 

 changes induced by the typhus. 



The bodies of persons who have died early in the disease do not 

 appear greatly emaciated ; rigor mortis is very marked ; we find ex- 

 tensive hypostatic congestion in the dependent parts of the body, and 

 occasional bed-sores commencing over the sacrum. The nostrils oftei* 

 appear smoky, and the teeth and gums are covered with a black coat- 

 ing. There are often numerous sudamina on the skin. On opening the 

 body, the muscles appear very dark red, hard, and dry. The blood in 

 the heart and large vessels is thick, dark colored, and contains little, 

 loose, blackish-red coagula, rarely a small amount of discolored fibrin. 

 Chemical and microscopical examinations of typhus blood have so far 

 given negative results as regards the actual anomalies, that is, as to 

 those which depend directly on the infection with typhus poison. The 

 decrease of fibrin occurs in other infectious diseases also ; the increase 

 of blood-corpuscles, on which the dark color chiefly depends, seems to 

 be only relative, and to result from the thickening of the blood, caused 

 by great perspiration, and loss of water by diarrhoea. After the typhus 

 nas continued some time, the blood is consumed, and becomes poor in 

 albumen and blood-corpuscles. The brain and spinal medulla show no 

 constant changes corresponding to the severe functional disturbances 

 of these organs during life. They sometimes contain more, sometimes 

 less blood, and vary in consistence. We find changes in the respira- 

 tory organs in all cases ; the typhous laryngeal ulcer already described 

 (Vol. L) is not unfrequently found, especially in certain epidemics. 

 There are always signs of an extensive catarrh, even in the smallest 

 bronchi, marked by dark redness of the mucous membrane, and scanty, 

 tough secretion. At the dependent parts of the lungs there is more 

 or less hypostatic congestion, sometimes only great hypostatic hyper- 

 aemia and condensation of the pulmonary tissue from swelling of the 

 alveolar walls (splenization) ; sometimes hypostatic cedema ; sometimes 

 the so-called hypostatic pneumonia (Vol. L). Besides the above, more 

 or less extensive portions of lung are not unfrequently collapsed, or in 



