MORBID ANAToMV 



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cortex and medulla are seen to be congested, with often fatty 

 degeneration, and more rarely small abscesses or infarcts. The 

 pelvis is congested, but the ureter and bladder are usually normal, 

 though signs of cystitis may be found at times. 



With regard to the thorax, if there is much meteorism, the dia- 

 phragm may be noted to be pushed up considerably higher than 

 usual. The trachea and bronchi may show signs of inflammation, 

 and in the lung pneumonia, haemorrhagic infarcts, pyaemic abscesses, 

 and purulent infarcts may be seen. The heart is usually flabby and 

 without any sign of rigor mortis, and is often pale, soft, and friable, 

 from fatty degeneration. Rarely will vegetative or ulcerative endo- 

 carditis or aortitis be found. 



In the neck the thyroid gland may in cases of great rarity be 

 seen to be enlarged, and even to have abscesses. There may be 

 congestion and alceration of the larynx and tonsils, but they are not 

 common in our experience. The tongue will be seen to be covered 

 with sordes, and may, perhaps, show fissures. 



The brain is often congested, as are the meninges, but meningitis 

 and other naked-eye signs are rarely met with. Venous and, much 

 more rarely, arterial thrombosis may be seen, whfle Zenker's 

 vitreous degeneration may be found, especially in the adductors 

 of the thigh, the rectus muscles of the abdomen, the pectoralis, 

 and the diaphragm, and very rarely one of these degenerated 

 muscles may be found ruptured and surrounded by haemorrhages. 

 The bone-marrow may also be congested and show signs of focal 

 necrosis. 



Finally, there may be the signs of the complications or sequelae— 

 as, for exarnple, the arthritis of the joints, the abscesses in various 

 parts of the body, etc. 



The pathological history of these post-mortem appearances may 

 now be briefly related, beginning with the history of the lesions of 

 the Peyer's patches. 



At first a Peyer's patch or lymphoid follicle is hyperaemic, but 

 this is followed by a proliferation of the lymphoid and epithelioid 

 cells of the follicles, together with a swelling of the endothelial cells 

 of the capillary vessels, and these together produce a more or less 

 definite blocking of the capillary vessels, which causes an anaemia, 

 and produces the whitish colour of the hyperplastic Peyer's patches, 

 to which attention has already been drawn. The typical bacilli 

 can be found lying in the centre of the follicle, and also in the lym- 

 phatic vessels, not merely of the follicle, but also of the submucosa. 

 Such is the condition of the follicle about the eighth to the tenth 

 day, and now one of two things may happen: either the excess of 

 lymphoid cells undergo fatty degeneration and absorption, with 

 the result that the blood-flow returns, and the follicle becomes 

 normal; or the blockage of the bloodvessels is increased by fibrinous 

 thrombosis, with the result that the superficial portion of the 

 swollen follicle dies and forms a slough, which, separating from the 

 edges towards the centre, becomes an ulcer some time during the 



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