FOCAL NECROSIS OF THE LIVER IN TYPHOID FEVER 445 
pigs with toxalbumins of diphtheria. Flexner's experiments with ricin have 
already been mentioned. 
Focal necroses do not occur in every fatal case of typhoid. According to Osler 
they apparently produce no symptoms. Their presence is probably an indication of 
the virulence of the infective process, and one would expect to find the lesions most 
frequently in those who died from toxaemia and not from perforation and 
haemorrhage, which are often accidents. Longridge recently reported a case of 
marked focal necrosis in a patient dying in the second week of typhoici, and the case 
described here died earlier still. Again on examination of the liver of two patients 
who died in the fourth week of typhoid, from haemorrhage and perforation respec- 
tively, I was able to find only slight focal necrosis in the one and none in the 
other ; in both the periportal connective tissue was infiltrated with lymphocytes. 
Longridge suggests that if the typho-toxins were exceptionally virulent, the 
necrotic areas would coalesce and produce a condition hardly distinguishable from 
acute yellow atrophy, and also points out that in three out of two thousand Munich 
autopsies of typhoid, acute yellow atrophy of the liver was found. 
The ultimate fate of the areas of focal necrosis is doubtful. Wagner noted that 
they had completely disappeared in two and a half months after recovery from typhoid. 
Reed, on the other hand, believed that he found evidence of previous focal necrosis 
in the presence of peculiar ovoid areas of dense connective tissue in the liver of a 
woman who died twenty-five years after an attack of typhoid. 
This is a point of some interest in connexion with the views of many French 
pathologists as to the relation of cirrhoses of the liver to changes in them, due to 
acute infective processes. 
