638 Typhoid Fever 



centrically situated nuclei, abundant, sharply defined, acidophilic 

 protoplasm, and are characterized by marked phagocytic properties. 

 These phagocytic cells are produced most abundantly along the hne 

 of absorption from the intestinal tract, both in the lymphatic ap- 

 paratus and in the blood-vessels. They are also produced by dis- 

 tribution of the toxin through the general circulation, in greatest 

 numbers where the circulation is slowest. Finally, they are pro- 

 duced all over the body in the lymphatic spaces and vessels by ab- 

 sorption of the toxin eliminated from the blood-vessels. The 

 swelling of the intestinal lymphoid tissue of the mesenteric lymph 

 nodes and of the spleen is due almost entirely to the formation 

 of phagocytic cells. The necrosis of the intestinal lymphoid tissue 

 is accidental in nature and is caused through occlusion of the veins 

 and capillaries by fibrinous thrombi, which owe their origin to degen- 

 eration of phagocytic cells beneath the lining endothelium of the 

 vessels. Two varieties of focal lesions occur in the Hver: one 

 consists of the formation of phagocytic cells in the lymph-spaces and 

 vessels around the portal vessels under the action of the toxin ab- 

 sorbed by the lymphatics; the other is due to obstruction of hver 

 capillaries by phagocytic cells derived in small part from the Uning 

 endothehum of the hver capillaries, but chiefly by embohsm through 

 the portal circulation of cells originating from the endothelium of 

 the blood-vessels of the intestine and spleen. The hver-cells lying 

 between the occluded capillaries undergo necrosis and disappear. 

 Later the foci of cells degenerate and fibrin forms between them. 

 Invasion by polymorphonuclear leukocytes is rare." 



" . . . Histologically the typhoid process is proliferative and 

 stands in close relationship to tuberculosis, but the lesions are diffuse 

 and bear no intimate relation to the typhoid bacillus, while the 

 tubercular process is focal and stands in the closest relation to the 

 tubercle bacillus." 



The growth of the bacilli in the kidneys causes albuminuria, and 

 the bacilli can be found in the urine in about 25 per cent, of the cases. 

 Smith* found them in the urine in 3 out of 7 cases which he investi- 

 gated; Richardson,! in 9 out of 38 cases. They did not occur before 

 the third week, and remained in one case twenty-two days after 

 cessation of the fever. Sometimes they were present in immense 

 numbers, the urine being actually clouded by their presence. Petru- 

 schkyj found that albuminuria sometimes occurs without the 

 presence of the bacilli; that their presence in the urine is infrequent; 

 that the bacilli never appear in the urine in the early part of the 

 disease, and hence are of little importance for diagnostic purposes. 

 Gwyn§ has found as many as 50,000,000 typhoid bacilli per cubic 



* "Brit. Med. Jour.," Feb. 13, 1897. 



t "Journal of Experimental Medicine," May, 1898. 



t "Centralbl. f. Bakt. u. Parasitenk.," May 13, 1898, No. 13, p. 577. 



§ "Phila. Med. Jour.," March 3, 1900. 



