TYPHOID FEVER. 187 



conviction, but such statements will hasten the day 

 when the germ theories will he relegated to the past 

 as they surely will he. Are there any morbid changes 

 that are always present in typhoid? Yes; tender- 

 ness along the digestive tract, and ulceratioii of 

 what are called Peyer's patches; yet, as already stated, 

 tenderness may and usually does occur without typhoid, 

 and ulceration of Peyer's patches can only he proven "by 

 a post mortem examination. 



Scattered throughout the small howel are numerous 

 small glands. They are placed in the mucous mem- 

 brane; have no excretory ducts, and their use is said 

 to be unknown. Yet they undoubtedly aid in diges- 

 tion, as they are largest or most developed during the 

 digestive period. In places these glands are clustered 

 together, forming little groups. These groups are 

 called Peyer's patches, because first described by Dr. 

 Peyer. There are from twenty to thirty N of these 

 groups, varying from one-half inch in width to three, 

 four or more inches in length. 



The mucous membrane covering them is highly vas- 

 cular; i. e., abundantly supplied with blood vessels. 

 The normal blood supply being greater than in the sur- 

 rounding mucous membrane, the inflammation is more 

 intense, therefore a good field for degenerative changes, 

 ulceration, etc., and that is the reason ulceration oc- 

 curs at these particular points. 



Ulceration of Peyer's patches is understood by phy- 

 sicians everywhere to mean typhoid fever. Without 

 such ulceration it is not typhoid fever. Post mortem 



