EXTENSIVE FOCAL NECROSIS OF THE LIVER 
IN EARLY TYPHOID FEVER 
By E. E. GLYNN, M.A., M.B. (Cantab.) 
(Pathologist to the Liverpool Royal Infirmary) 
R. B., male, aged 28, a labourer, was laid up for four months in 1893, with 
rheumatic fever. After recovery, his health was good till the beginning of September, 
1901, when he was attacked with 'shortness of breath and palpitation.' He ceased 
work on November 9, and was admitted two days later to the Liverpool Royal 
Infirmary under the care of Dr. Barr, with the physical signs of moderate mitral 
stenosis and regurgitation, and symptoms of failing compensation ; pulse seventy-six 
and irregular. There was neither orthopnoea nor oedema of the feet. The tongue 
was slightly coated, bowels regular, there was no abdominal distension or tenderness ; 
the liver and spleen were distinctly enlarged. There was no headache, no cutaneous 
eruption. The urine was normal, but diminished in quantity. 
On the night of admission, November 11, the evening temperature was ioo°F. 
During the next forty-eight hours, it varied between 99° and 97*2°. But on November 
14, the morning temperature rose to 101 0 , the evening to 103*8°. During the next 
three days pyrexia continued with morning remissions (vide chart). The pulse 
averaged seventy-four, the respirations twenty-four ; the bowels became confined. On 
November i 8, he was delirious, the temperature rose to 104*8°. Next day it reached 
105*9°, the pulse was one hundred and thirty-two ; coma supervened, and he died on 
the ninth day after admission, six days after the onset of the pyrexia. 
The main features of the autopsy were as follows : — 
The heart was enlarged (weight 1 8 ounces), the cavities were dilated 
especially on the left side. There was moderate sclerosis of the 
mitral orifice. 
The lungs were congested at the bases. 
The liver (weight 52 ounces) was very pale, soft, and dotted irregularly 
with bright red spots varying in size from a pin head to a pin point. 
The Peyer's patches and solitary follicles of the last three feet of ileum 
were greatly swollen ; but without evidence of ulceration. 
There was enlargement and congestion of the mesenteric glands. 
The spleen was enlarged (weight 1 1 ounces) and rather tough. 
The kidneys were pale and the brain normal. 
