1376 THE ENTEROIDEA GROUP OF TROPICAL FEVERS 



site of disease is, as already stated, in the ileum near the ileo-ca?cal 

 valve; while the contents of the bowel will be noted to be of a 

 yellowish colour, unless there has been a haemorrhage, when blood 

 will be seen, or unless medicines have been administered which 

 alter the colour of the motions. The Peyer's patches in the lower 

 few feet of the ileum will be enlarged, prominent, and whitish in 

 colour, and covered, perhaps, with yellowish sloughs, or perhaps 

 containing ulcers, which may be in the form of one large central or 

 several small ulcers. 



On inspection, a typical ulcer will be noted to have its long axis 

 in the same direction as the long axis of the bowel, to be of ovai 

 form, with thin and undermined edges, and a base formed from the 

 muscularis mucosae, the infiltrated submucosa, or from the muscular 

 or even the peritoneal coats of the bowel; while in cases of perfora- 

 tion a rent may be noticed through this last coat, permitting com- 

 munication between the lumen of the bowel and the cavity of the 

 peritoneum. In cases of extensive haemorrhage injection of water 

 into the carefully dissected out mesenteric artery may demonstrate 

 more or less correctly the source of the bleeding. The solitary glands 

 will also be seen to be enlarged and congested with sloughs or 

 roundish ulcers, while the mucosa around these and the Peyer's 

 patches will be seen to be intensely congested and red in colour. 

 This congestion may be traced for a considerable distanc^^along the 

 ileum and into the jejunum, but it is rare to find the duodenum or 

 the gastric mucosa in a state of acute congestion. 



Tracing the bowel downwards into the ascending colon, it will be 

 noticed that the mucosa of the caecum and ascending colon is often 

 congested, and at times the solitary glands will be seen to be swollen ; 

 but as a rule they are not ulcerated. 



These typical appearances may be varied by finding only one or 

 two Peyer's patches enlarged, and perhaps only one or two small 

 ulcers, and very rarely there may be no signs beyond a catarrhal 

 inflammation of the mucosa of the bowel. On the other hand, the 

 ulceration in the region of the ileo-caecal junction may be so exten- 

 sive that there are only ridges and islands of intensely congested 

 mucosa left, while at other times pieces of the bowel may be black 

 and almost or quite gangrenous. 



• The mesenteric glands will be seen to be swollen and congested, 

 and on section they will show marked congestion and perhaps pus. 



The spleen is enlarged and swollen, dark red in colour, friable, 

 with a tense capsule, while the liver may also be enlarged and con- 

 gested, and may even on rare occasions show multiple abscesses 

 brought about by a septic pylephlebitis. The gall-bladder and 

 bile-ducts may be congested, or more rarely may contain pus, while 

 the bile is usually light-coloured and watery, but may be inspissated. 

 The pancreas is usually normal, but we have seen it congested and 

 even haemorrhagic. The suprarenal capsules are generally normal 

 in uncomphcated cases. The kidneys are usually enlarged and 

 congested, with a capsule which strips off readily. On section, both 



