TYPHOID FEVER. 631 



etill covered with a blackish coating. Over the sacrum, trochanters, 

 and elbows, we usually find bed-sores ; there may be destruction of 

 the skin only, or of the other soft parts also, extending to the bones. 

 In many bodies there is slight oedema of the lower extremities, and, if 

 one or other femoral vein be obstructed by a thrombus, there is very 

 marked oedema of the corresponding limb. Lastly, on the skin we 

 often find petechise, miliary vesicles, ecthyma pustules, and, in some 

 cases, abscesses in the subcutaneous and intermuscular connective 

 tissue, and suppuration of the parotid glands. On opening the body, 

 the muscles no longer appear red and dry, but are pale and infiltrated. 

 The blood in the heart and great vessels has lost its , dark color, is 

 fluid, and not unfrequently contains fibrinous clots, particularly when 

 there has been inflammation of any organs. The brain is usually pale, 

 moist, and the blood-points appearing on its cut surface are lighter, 

 and contrast less with the white brain-substance than they did earlier 

 in the disease. In the lungs, besides extensive hypostasis, we often 

 find lobar or lobular pneumonia, and occasionally there are inflamma- 

 tory exudations in the pleural sac ; any laryngeal ulcers extend deeply 

 and reach or destroy the perichondrium. In rare cases we find peri- 

 chondritis laryngea without ulceration of the mucous membrane (Vol. 

 I.). The heart is very relaxed and flabby, the endocardium and tunica 

 intima of the vessels are greatly infiltrated. The swelling of the spleen 

 has subsided, its capsule is often wrinkled, its tissue relaxed and pale ; 

 occasionally it contains haemorrhagic infarctions. The distention of the 

 vessels and capillary hyperaemia of the stomach have disappeared at the 

 same time as the swelling of the spleen. The ulcers of the intestine are 

 on the road to recovery, or are already cicatrized, especially in those cases 

 where death was due to other causes. Rokitansky describes the healing 

 and cicatrization of typhus ulcers as follows : The loose border of mu- 

 jous membrane, forming the edge of the ulcer, becomes attached to the 

 floor of the ulcer gradually from the periphery toward the centre, at the 

 same time it becomes more pale and less thick ; the delicate connective- 

 tissue layer, which covers the muscular coat in the floor of the ulcer, be- 

 comes whitish, thickened, and is finally transformed into a serous plate, 

 into which the adherent border passes imperceptibly, thinning as it ap- 

 proaches the centre. The mucous membrane gradually extends over 

 this plate toward the centre of the ulcer, but, at the same time, be- 

 comes thinner, from the tension to which it is subjected. When the 

 edges of the mucous membrane come together and adhere, the healing 

 is complete. From the thinning of the mucous membrane, the cicatrix 

 forms a slight depression ; it is often somewhat pigmented, it is 

 smoother than the parts around, and studded with a few tufts. Cica- 

 trization of typhus ulcers never causes stricture of the intestines. As 

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