A Text-book of the practice of medicine / by James M. Anders.

  • Anders, James M. (James Meschter), 1854-1936.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: A Text-book of the practice of medicine / by James M. Anders. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    28/1354 (page 20)
    changes, and correspond Avith the lesions noted in the intestines {vide supra). The mesenteric glands exhibit great variations in size, rang- ing, as they do, from that of a pea to a hen's egg. Their color-appear- ance is a grayish-red. Resolution occurs quite commonly, but, if it does not take place, then necrosis of the central portion (due, most probably, to the same causes that produce necrosis of the intestinal lymph-follicles) occurs, and suppuration has been observed in some cases. Still other glands become hyperemic and swollen (retroperi- toneal, bronchial); but these usually tend toward resolution. The Spleen.—AVith rare exceptions the spleen becomes enlarged in typhoid fever. At first hyperemic, the tissue then grows soft and gran- ular, and at times is almost diffluent on section. Infarction is not a rare occurrence and may lead to suppuration. Keen has searched the litera- ture and found only 9 cases of abscess. In rare instances, either spon- taneously or as the result of injury, a rupture of the organ may occur, and the records of 2000 post-mortems at the Munich Pathologic Insti- tute furnish o cases. (2) Secondary Lesions due chiefly to the Continued Fever and to Sec- ondary Infections.—The lesions in other organs are of subsidiary import- ance, and are, for the most part, secondary in nature, though we can- not, in the present state of our knowledge, draw a sharp line of dis- tinction between these lesions and those that are primary. While the pathologic changes above described are chiefly due to the direct action of the specific bacillus of typhoid, yet a few of them are ascribed to secondary infection, and, at all events, they do not belong peculiarly to this disease—e. g. suppurative processes, etc. Further, in connection with the clinical history of the affection I shall point out that in a small percentage of cases the initial specific lesions may be localized, either in the throat or in the lungs or kidneys. It is to be emphasized, therefore, that whilst the essential pathologic processes of the disease have been described above, a classification of the lesions into primary and secondary, based upon the involvement of particular organs, can only be approximately correct. The liver early becomes hyperemic, and later is softer and paler than is natural. Handford has described necrotic areas, and Wagner minute lymphomata. Infarction and abscess occur in rare instances. The gall-bladder may show^ catarrhal inflammation, and rarely a croupous, diphtheritic, or ulcerative inflammation leading to perforation. West- cott has tabulated 30 cases of typhoid infection of the gall-bladder that resulted in perforation. The bile is thin and pale. The microscope reveals parenchymatous and granular degeneration. The cells contain an abundance of fat, whilst their nuclei have lost, in great part, their outline. The kidneys, like the liver, exhibit parenchymatous degeneration. They are somewhat pale-looking, are cloudy on section, and slightly swollen, and under the microscope granular and fatty degeneration of the epithelial cells of the convoluted tubules is observed. More rarely the lesions are those of acute hemorrhagic nephritis. Small areas of round-cell infiltration may develop late in the course of typhoid, and these may present an appearance similar to lymphomata or may undergo softening and suppuration, giving rise to miliary abscesses. The mu-