3G6 TYPHOID FEVER 



The reaction of the body to the typhoid bacillus is markedly 

 one of the lymphoid tissues. This is further evidenced by the 

 blood cells, for while there is a leucopenia the lymphocytes are 

 relatively increased in numbers. "A successful reaction is 

 accompanied by the appearance of bactericidal bodies in the 

 serum. 



The view of the development of the disease usually taken is 

 that the bacilli, being ingested, multiply in the intestinal tract, 

 cause inflammation and necrosis of the lymphoid tissue, and, 

 gaining an entrance to the general circulation, produce the 

 septicaemic phenomena which we have described. 



Considerable attention has been attracted to another view of the course 

 of infection put forward by Forster and his co-workers in Strasburg. Ac- 

 cording to this, the process is primarily a septicaemia, and the intestinal 

 manifestations are looked on as secondary. The bacilli are supposed to 

 gain entrance to the circulation possibly through the tonsils, sore throat 

 being a not uncommon initial symptom of typhoid fever. In the blood 

 they multiply, and, passing through the liver, gain access to the gall- 

 bladder, set up a catarrhal inflammation there on the products of which 

 they flourish, and thence pass out to infect the intestine. The intestinal . 

 lesions are either due to an elective action of bacteria brought by the 

 blood, or come from infection by the bacilli which pass out from the gall- 

 bladder—the former being apparently the alternative to which Forster 

 leans. The evidence on which this view is based consists, firstly, in the 

 results of animal experiments in which bacilli introduced intravenously 

 have been subsequently found chiefly or solely in the gall-bladder — it 

 may be, persisting there for weeks. Further, it is stated that bacilli can 

 be isolated from the blood during the later parts of the incubation stage 

 of the disease, and before they can be demonstrated in the intestine, 

 where they are said not to appear until sometime during the first week of 

 active disease. And again it is stated that in the bodies of persons dying 

 from typhoid fever, while bacilli are always present in the gall-bladder 

 and in the upper parts of the small intestine, they are frequently absent 

 from the lower part of the latter and from the colon. It cannot be said 

 that this view of the disease has been satisfactorily established. Opinion 

 differs as to the alleged late appearance of the bacilli in the intestine, and 

 the infectivity noticed during the incubation stage must be explained. 

 Further, there is strong reason for believing that multiplication of the 

 bacilli in the intestine can take place. The evidence of this rests on the 

 finding of bacilli, it may be in considerable numbers, in the fseces and 

 even in the blood of healthy individuals who have merely been in contact 

 with typhoid cases or typhoid carriers, and who show no symptoms of 

 the disease. 



Suppurations occurring in connection with Typhoid 

 Fever. — In a certain proportion of such suppurations the 

 typhoid bacillus has been the only organism found. This has 

 been the case in subcutaneous abscesses, in suppurative perios- 

 titis, suppuration in the parotid, abscesses in the kidneys, etc., 

 and probably also in one or two cases of ulcerative endocarditis ; 



