498 



Typhoid Fever 



diminutive breaches of continuity, is not known. We 

 usually find it well established in the intestinal and mesen- 

 teric lymphatics at the time we are able to recognize the 

 disease, though in rare cases it appears able to reach the 

 blood through other than the customary channels and 

 occasion an entirely different pathologic picture. 



There is always well-marked blood-infection during the 

 first couple of weeks of the disease, and upon this depends 

 the occurrence of the rose-colored spots. 



The bacilli enter the solitary glands and Peyer's patches, 

 and multiply slowly during the incubation period of the 



Fig. 151. Intestinal perforation in typhoid fever. Observe the 

 threads of tissue obstructing the opening. (Museum of the Penn- 

 sylvania Hospital.) (Keen, "Surgical Complications and Sequels of 

 Typhoid Fever.") 



disease one to three weeks. The immediate result of their 

 activity in the lymphatic structures is an increase in the 

 number of cells, and ultimately necrosis and sloughing of 

 the Peyer's patches and solitary glands (Fig. 151). From 

 the intestinal lymphatics the bacilli pass, in all probability, 

 to the mesenteric glands, which become enlarged, softened, 

 and sometimes rupture. They also invade the spleen, liver, 



