332 TYPHOID FEVER. 



Pathological Changes in Typhoid Fever. As these 

 are sufficiently described in ordinary pathological text- 

 books, we can confine our attention solely to their bacterio- 

 logical aspects. It is generally recognised that the inflam- 

 mation and ulceration in the Peyers patches and solitary 

 glands of the intestine are the central features of the disease. 

 In the early stage these have a swollen and slightly pinkish 

 appearance, and microscopically it is seen that there has 

 been produced an acute inflammatory condition, attended 

 with extensive leucocytic emigration ; sometimes small 

 haemorrhages may be observed. It is at this period that 

 the typhoid bacilli are most numerous in the patches, 

 groups being easily found between the cells. There 

 follows a necrosis of the cells which may involve the 

 whole tissue of the patch, and a slough forms which on 

 being cast off leaves an ulcer. This necrosis is evidently in 

 chief part the result of the action of the toxic products of 

 the bacilli, which now gradually disappear from their former 

 positions, though they may still be found in the deeper 

 tissues and at the spreading margin of the necrosed 

 area. They also occur in the lymphatic spaces of the 

 muscular coat. It is important to note that the ulcers in 

 a fatal case of typhoid may vary much in numbers. The 

 whole lower third of the small intestine may be ulcerated, 

 or only two or three ulcers may be present even in a case 

 where death has occurred by the severity of the fever. 

 Further, small ulcers may also occur in the lymphoid follicles 

 of the large intestine. 



The condition of the mesenteric glands in typhoid is 

 important. Those corresponding to the affected part of 

 the intestine are usually enlarged, sometimes to a very 

 great extent, the whole mesentery being filled with glandular 

 masses. In such glands there may be acute inflammation 

 attended with haemorrhages, and even necrosis in patches 

 may occur, but this is never the outstanding feature as in 

 the case of the Peyer's patches. Sometimes on section 

 the glands are of a pale -yellowish colour, the contents 

 being diffluent and consisting largely of leucocytes. Typhoid 



