

TYPHOID FEVER. 029 



it looks as if the diseased intestinal glands were infiltrated with a soft, 

 grayish- white, or pale-reddish encephaloid mass ; and although it has 

 of late been found that in typhus disease the intestinal glands are not 

 infiltrated with amorphous exudation, but that there is an increase of 

 their cellular elements which, even under normal circumstances, are 

 peculiar ; still the expression " medullary infiltration " has almost uni- 

 versally been preserved. Occasionally the degeneration extends be- 

 yond the follicles, and there is a " medullary infiltration " of the con- 

 nective tissue of the mucous membrane in their vicinity, a cellular 

 neoplasm, originating from the connective-tissue corpuscles ( Virchow). 

 In this stage the mesenteric glands are swollen to the size of a bean, 

 or a hazel-nut, are of a grayish-red color, and quite hard. In the third 

 stage, which Rokitansky calls the stage of relaxation, softening, and 

 breaking down, the changes in the affected glands vary greatly in dif- 

 ferent cases. Not unfrequently the process becomes retrogressive, 

 without the occurrence of destruction of the wall of the follicle or of 

 the mucous membrane covering it ; the swelling of the glands subsides, 

 while their contents are reabsorbed after the cellular elements have 

 been destroyed by fatty metamorphosis. These cases appear chiefly 

 to correspond to the so-called abortive typhus. In other cases, the 

 covering of the follicles is changed to a dry, friable slough, colored yel- 

 low by the faeces ; this slough sometimes extends over the whole of 

 the gland, so that its form and size correspond to those of the plaque ; 

 sometimes it is limited to part of the covering, and the slough has an 

 irregular, angular, or roundish form. In still other cases, the individual 

 glands composing Peyer's patches rupture, and empty their contents 

 outwardly, without the covering sloughing. As a result of this, the 

 surface of the plaque looks as if full of holes, or has a net-like appear- 

 ance (plaques d surface reticulee). The mesenteric glands are most 

 swollen in this stage ; some of them attain the size of a pigeon's or 

 even of a hen's egg. Their covering is usually bluish or brownish red, 

 while their substance has a grayish-red, medullary appearance. In the 

 fourth stage, or that of ulceration, the sloughs formed on the plaques 

 or solitary glands are either thrown off in mass, or, after precedent dis- 

 integration, and a loss of substance, a typhous ulcer remains. Roki- 

 tansky gives the following as the most important characters of the 

 typhus ulcer : According as it has resulted from a solitary follicle or 

 from a Peyer's patch, it is round or oval, and, if there has only been a 

 partial slough on the Peyer*s patch, it is irregular ; it varies in size 

 from that of a hemp-seed or a pea to that of a dollar ; its seat is in the 

 lower part of the small intestine, and the ulcers proceeding from Peyer'a 

 patches are of course opposite to the insertion of the mesentery. The 

 long diameter of the elliptical ulcer corresponds to the long axis of the 



