REiAPSlNG FEVER. 657 



eration is not confined to, or even chiefly locaieu in muscles, which, 

 during life, were the seat of severe pain, but, when found at all, usu 

 ally extends to all the muscles of the body. 



In recent cases the blood is dark cherry-red, and contains but few 

 fibrinous clots. In protracted cases the blood is watery and without a 

 trace of coagulation. 



When death occurs at the height of the disease, the brain and 

 meninges are vascular and dry, the ventricles empty. If death does 

 not result till the later stages of the disease, the meninges are slightly 

 injected, the brain itself bloodless and pale, the subarachnoid spaces 

 and lateral ventricles containing quantities of serous fluid. 



Some observers (Kremiansky) found hsemorrhagic pachymeningi- 

 tis very often, partly in its commencing stage, partly as an extensive 

 haematoma of the dura mater. 



The bronchial mucous membrane presents no constant changes ; 

 the lungs are more or less congested, especially at the dependent 

 parts; in protracted cases they sometimes contain haemorrhagic in- 

 farctions or extensive pneumonic infiltrations. 



The heart is flabby, pale, and friable. On microscopical examina- 

 tion, Ktittner found it infiltrated with an albuminous or fibrous mass. 

 If the disease has lasted long, the walls of the heart are occasionally 

 much thinned. 



As a rule, the gastric and intestinal mucous membrane is reddened 

 by injection and ecchymosis. The intestinal glands are sometimes 

 enlarged, but never sloughing. The ductus choledochus is occasion- 

 ally closed, by swelling of its mucous membrane, and obstructing 

 masses of mucus. In such cases the contents of the intestine are but 

 little colored, while the gall-bladder is distended. 



The liver is considerably enlarged, apparently from the increased 

 amount of blood in it. According to Ifiittner, it sometimes has a mar- 

 bled appearance, distinct, yellowish- white, wax-like spots appearing in 

 the normal parenchyma ; when far advanced, these resemble nodules 

 of medullary cancer. At such points the individual acini are not rec- 

 ognizable. The liver-cells have lost their polygonal form ; the nuclei 

 are perceived with difficulty, and filled with homogeneous contents. 

 In cases beginning with icterus, and proving fatal in the first attack 

 (bilious typhoid), the same author found the liver smaller, the paren- 

 chyma jaundiced, much relaxed, and broken down. There were the 

 same microscopical appearances as in acute yellow atrophy of the 

 liver. 



The spleen also is enlarged ; it may attain five or six times its 

 normal size and weigh four pounds or more ; its parenchyma is only 

 exceptionally as soft and fluid as in the first stages of the other forms 



