TYPHUS. 4:U 



infiltrated portions of the bowel. As tlio ileiun is always most 

 intensely affected for about twelve inches above the ileo-coeeal 

 valve, it is here that we may expect to find the most perfect 

 examples of the morbid changes in the lymphatic glands. In 

 their histological characters these faithfully reproduce the 

 primary disorder. A moderate degree of catarrhal swelling is 

 followed by a medullary intumescence of colossal proportions^ 

 nearly approaching those of scrofulous enlargement. It becomes 

 impossible to distinguish the boundary- line between cortical and 

 medullary substance with the naked eye. The microscope shows 

 that the follicles and their prolongations into the medulla (the 

 lymphatic nodules and trabecular) are the chief seat of morbid 

 change, while the lymph- sinuses, and especially the connective 

 tissue, are infiltrated with ^^ typhous" elements to only a mode- 

 rate extent. Here — i.e. in the lymphatic nodules, of which from 

 fifteen to twenty may, as w^e know, be counted in a longitudinal 

 section through a gland of average size — we meet, first, with 

 that mordinate dilatation of the capillary network which seems 

 to me to be the most characteristic feature of the medullary con- 

 dition. Side by side with this dilatation, we may often note an 

 obvious ^^ plugging"' of many capillaiy loops, and even of some 

 of the larger vessels, with a dark, granular matter, concerning 

 whose nature I am still in doubt. Further, the condition of the 

 adenoid reticulum is very singular. All its trabeculse are from 

 three to fom- times thicker than usual ; the nodal points are 

 especially swollen, the nuclei themselves A'esicular ; the old 

 anastomotic network of corpuscles has obviously returned to hfe, 

 the shrmiken cells have grown plump hj the absorption of pabu- 

 lum, the nuclei are ready to resume their function as cytoblasts. 

 The continuity of the network is already interrupted at many 

 points ; the resulting gaps being occupied by globular aggrega- 

 tions of cells. The proliferation is mainly fissiparous, though 

 the endogenous mode is also not unfrequent. The edges of the 

 lymphatic trabeculie — the brink of the stream of lymph — are 

 often so thickly studded with mother-cells, that these even out- 

 number the ordinar}^ l^anph-corpuscles. Here too, the process 

 ultimately tends to the development of the maximum number of 

 ^'typhous'" cells. The acme once reached, every space in the 

 interior of the gland which is not pre-occupied by the vessels — 

 among others the lymph-path itself — is gorged with these 



