330 TYPHOID FEVER 



Of all the solid organs it usually contains the bacilli in greatest 

 numbers. They can be seen in sections, occurring in clumps 

 between the cells, there being no evidence of local reaction 

 round them (Fig. 110). Similar clumps may occur in the liver 

 in any situation, and without any local reaction. In this organ, 

 however, there are often small foci of leucocytic infiltration, in 

 which, so far as our experience goes, bacilli cannot be demon- 

 strated. The bacillus is found, often in large numbers, in the 

 gall-bladder, where it may persist for years. Clumps of bacilli 

 may also occur in the kidney. 



In addition to these local changes in the solid organs there are also 

 widespread cellular degenerations in the solid organs which suggest the 

 circulation of soluble poisons in the blood. 



In the lungs there may be bronchitis, patches of congestion and of 

 acute broncho-pneumonia. In these, typhoid bacilli may sometimes be 

 observed, but evidence of a toxic action depressing the powers of resist- 

 ance of the lung tissue is found in the fact that the pneumococcus 

 frequently occurs in such complications of typhoid fever. 



The nervous system shows little change, though meningitis associated 

 either with the typhoid bacillus, with the b. coli, or with the streptococcus 

 pyogenes has been observed. 



The typhoid bacilli probably travel by the blood stream, and they can 

 be isolated from the blood much more readily than was formerly supposed. 

 Considerable quantities of blood (say, 4 c.c.) must of course be taken 

 (v. p. 68). They have been found in the roseolar spots which occur in 

 typhoid fever, but it cannot be yet stated that such spots are always due 

 to the presence of the bacilli. The fact that the typhoid bacilli are usually 

 confined to certain organs and tissues shows that they probably have a 

 selective action on certain tissues. 



To sum up the pathology of typhoid fever, we have in it a 

 disease the centre of which lies in the lymphoid tissue in and 

 connected with the intestine. In this situation we must have 

 an irritant, against which the inflammatory reaction is set up, 

 and which in the intestine is sufficiently powerful to cause 

 necrosis. The affections of the other organs of the body suggest 

 the circulation in the blood of poisonous substances capable of 

 depressing cellular vitality, and producing histological changes. 

 The occurrence of bacilli in the blood and organs links typhoid 

 fever with septicsemic processes. 



Suppurations occurring in connection with Typhoid Fever. 

 With regard to the relation of the typhoid bacillus to such 

 conditions, statements as to its isolation from pus, etc., can be 

 accepted only when all the points available for the diagnosis of 

 the organism have been attended to. On this understanding 

 the following summary may be given : In a small proportion 

 of the cases examined the typhoid bacillus has been the only 



