630 



ACUTE INFECTIOUS DISEASES. 



intestine ; the margin of the ulcer is formed by a bluish-red, later slate- 

 gray border of mucous membrane, about a line broad, which is movable 

 over the surface of the ulcer. The floor of the ulcer is a delicate layer 

 of submucous connective tissue, which covers the muscular coat. As 

 soon as the slough is detached, the swelling of the mesenteric glands 

 begins to subside, but they long remain larger and more vascular than 

 normal. There are many deviations from this customary course of the 

 disease on the mucous membrane ; we shall briefly mention the more 

 important of them : Occasionally, in the second and third stage, the 

 hypereemia of the mucous membrane over the swollen glands, and in 

 then* vicinity, becomes excessive. The mucous membrane is dark red, 

 covered with ecchymoses; the patches resemble spongy, vascular, 

 polypous proliferations, and the contents of the intestines are often 

 mixed with a quantity of blood. A very serious event in the third, 01 

 sloughing stage, is the perforation of the intestine, which results from 

 gangrene, not only of the mucous covering, but also of the correspond- 

 ing part of the serous and muscular coats. The perforation is followed 

 by severe peritonitis. Milder peritonitis also occurs without perfora- 

 tion. The deviations of the intestinal affection in typhus, as regards 

 extent, are very marked ; sometimes only a few Peyer>s and solitary 

 glands are affected ; sometimes the ileum is almost covered with them. 

 In the latter case we usually find the process further advanced in the 

 vicinity of the valve than in the upper part of the intestine, and oc- 

 casionally the difference of the stages in the different points is so 

 marked as to lead us to suspect a succession of attacks. Not unfre- 

 quently the colon participates in the disease (colotyphus), then the 

 solitary glands of the colon undergo the same changes as those of the 

 small intestines. Far more rarely the process extends to the jejunum, 

 and even to the pyloric portion of the stomach (gastrotyphus), the 

 solitary glands, and certain portions of the mucous membrane, which 

 usually correspond to the folds, undergoing the changes characteristic 

 of typhus. 



Where death occurs during the recovery of the ulcer and the other 

 results of the disease, after the proper typhus process has run its course, 

 the post-mortem appearances differ from those above described, and we 

 must not limit ourselves to describing the processes which precede the 

 healing of the ulcer, but must give a short glance at the state of the 

 other organs, particularly as they show certain anatomical changes 

 which never or very rarely occur during the first weeks of the disease. 

 Ihe bodies of patients who have died during the third or fourth week 

 of the disease, or later, are more or less emaciated ; the skin is pale, 

 rigor mortis moderate, and, if there be decided anaemia, there is but 

 little hypostatic congestion. In many cases the teeth and gums are 



