PA THOLOG Y OF T YPHOID FE VER 305 



Typhoid fever is an acute infectious disease characterised clini- 

 cally by continuous fever, with diarrhoea and other symptoms, and 

 anatomatically by a more or less extensive ulceration of the Peyer's 

 patches in the intestine (ileum), with swelling of the mesenteric 

 glands and enlargement of the spleen. The lesion of importance 

 to us at the moment is the' ulceration of the bowel, partly on 

 account of its origin, partly on account of its result. The subject of 

 the pathogenetic action of the bacilli is obscure, but there can be no 

 doubt that the ulcers in the intestine are directly or indirectly the 

 result of the specific bacillus of typhoid fever. When the bacilli 

 reach the intestine they multiply and, penetrating the mucous and 

 submucous coats, set up the changes, which lead, first to hyperemia, 

 then to infiltration, and finally to ulceration of Peyer's patches. 

 Some of the bacilli pass into the blood, collecting in the spleen and 

 other glands. Whether in the bowels or in the organs of the body, 

 the bacilli produce their toxins, and as a result of their action, inflam- 

 mation and fever follow. The inflammation in the intestine leads, 

 in conjunction with the irritation produced by the ulcers, to 

 increased peristalsis, and therefore diarrhoea. Hence the excreta 

 of a typhoid patient have two characteristics. They are usually 

 abundant and frequent : and they are charged with large numbers 

 of the bacilli of typhoid fever. It is, however, necessary to guard 

 against the idea that typhoid fever is a local disease of the 

 intestine, or even chiefly so. In ordinary cases, it is true, the 

 intestinal lesions form the starting point of the disease, but the 

 bacilli rapidly become generalised and are found in the most 

 varied parts of the body, and not uncommonly in the blood itself. 

 Such a state of things leads to a condition not remote from 

 septicaemia, and this may occur with little or no local lesion in the 

 intestinal tract. The reason why the bacilli of typhoid are not 

 found in greater number in the blood, is probably in part due to 

 the fact that in ordinary cases the blood is not a favourable 

 medium for their growth, and in part to the fact that they are 

 rapidly eliminated or excreted. " Any conception of the disease," 

 writes Dr Horton-Smith, " which regards it merely as affecting the 

 alimentary canal can no longer be maintained. On the contrary, 

 so far from considering it an intestinal disease, pure and simple, we 

 should rather look upon it as a modified form of septicaemia. It 

 is septicaemia in that always, and in all cases, the bacilli pass into 

 the blood and then into the various organs, and in that the 

 symptoms, excepting so far as they are intestinal, are referable to 

 the poisons there produced. It is a modified form, however, in that 



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