TYPHOID FEVER. 



387 



a quarter of an inch thick. 



FIG. 177. 



Swelling of Peyer's patches and solitary 

 glands of the intestine, as seen in 

 typhoid fever (Green). 



Peyer's patches become infiltrated, intensely congested, swollen, 

 and project into the lumen of the intestine. The largest 

 patches may be as much as 

 The solitary follicles vary in 

 size from that of a pin point 

 to that of a pea (Fig. 177). 

 By the end of the first week 

 the number of patches and 

 follicles involved is about as 

 large as it will probably be- 

 come, and the stage of in- 

 flammatory infiltration and 

 hypet-plasia has reached its 

 height. These changes may 

 affect only a few patches and 

 follicles in the neighborhood 

 of the caecum or involve the 

 entire intestinal tract. 



Generally the swollen solitary follicles are not so numerous 

 as the swollen Peyer's patches, though in some cases they are 

 more prominent, the patches being but little affected. Cases 

 of undoubted typhoid have been reported in which all intesti- 

 nal lesions were absent. 



Resolution now slowly takes place through the absorption 

 of the inflammatory products ; or a greater or less number of 



patches, according to the severity 

 of the case, undergo necrosis as the 

 result of interference with the blood- 

 supply by the pressure of the sur- 

 rounding excessive infiltration. The 

 patches become less congested, gray- 

 ish in color, with possibly a yel- 

 lowish or brownish necrotic centre. 

 When the slough separates there is 

 left behind a large ragged ulcer, 

 which generally involves only the 

 mucous membrane, but may extend 

 even through the muscularis and 

 rarely through the serosa, thus producing perforation. 

 Hemorrhage may also occur with the separation of the slough. 



FIG. 178. 



A typhoid ulcer of the 

 intestine (Green). 



