318 CONTAGIOUS DISEASES. 



follicles, whereas in human typhoid there is found in the first 

 stage round, or generally oblong, prominent papula3 or patches 

 of swollen lymph follicles, surrounded by swollen mucous mem- 

 brane, after which stage the greater part of the swollen lym- 

 phatic patches dies, and is finally discharged as a slough 

 leaving behind a pit-like excavation bordered by a well-defined 

 fringe of mucous membrane, which is neither thickened nor 

 indurated. 



Next in importance to the intestinal lesions are those dis- 

 covered in the lymphatic glands, which are congested, generally 

 swollen, of a dark red colour, or infiltrated with blood, black, 

 soft, and pulpy ; those in connection with the intestinal canal 

 are not only swollen, but infiltrated with a greyish- white opaque- 

 lookincj matter. 



The condition of the glands is sometimes very slight to the 

 naked eye, there being merely swelling, and an apparent con- 

 gestion ; but even here the microscope reveals bursting of blood- 

 vessels in the cortical tissue, and haemorrhage into the lymphatic 

 follicles and sinuses of that part, amounting in severe cases to 

 total destruction of the adenoid tissue by blood. In severe cases 

 the medullary sinuses, and partly also the medullary lymphatic 

 cylinders, become filled with extravasated blood. In so far as 

 this condition is similar to what is found in anthrax. " This 

 state of the lymphatic system is very characteristic, and, com- 

 bined with the disease of the intestine, is of paramount impor- 

 tance to the diagnosis." — (Klein.) 



Respiratory organs. — In a large number of cases, the tongue, 

 mouth, fauces, and pharynx are ulcerated, and sometimes gan- 

 grenous ; the lymphatic vessels filled with micrococci ; the lungs 

 are generally congested in patches, with distinct mapping out 

 of the lobes and lobules by oedema of the interlobular tissue, 

 succeeded by hepatisation, at first red, subsequently opaque, 

 or white specks or jDatches appear in the red substance, which, 

 as they increase in size, become confluent. This is due to the 

 fact that the bronchial tubes become gradually filled with a 

 white, brittle, cheesy mass, progressing gradually from the finest 

 ramifications on to the larger branches of the lobules and lobes. 

 Finally the whole lobule is transformed into a discoloured, dry, 

 hard, friable mass. The pleura of the corresponding parts is of 

 course inflamed, being in some cases exceedingly thick, and 



