1. Tumultuous Metamorphosis

Tumultuous Metamorphosis of the typhous product in the mesenteric glands.

This sometimes consists in very violent congestion of the gland, which not unfrequently gives rise to inflammatory injection of the mesenteric laminae above the gland; or great tumefaction takes place, and the gland is converted into a medullary, ichorous pulp; or, lastly, a fungous growth forms, which perforates one of the mesenteric laminae, commonly the anterior one. General peritonitis is a frequent consequence of these occurrences; in the last instance we have, as in the case of intestinal hemorrhages, extravasations into the peritoneal sac. This anomaly generally occurs in a gland that is seated near the termination of the ileum, and is accompanied by a tumultuous metamorphosis in the intestinal mucous membrane.

2. Atrophy Of The Mesenteric Glands

The involution of the mesenteric glands after the termination of the typhous process is sometimes carried to excess, and an atrophy of these glands results. They then appear shrivelled, flaccid, coriaceous, perfectly bloodless, pale or gray, or even of a dark blue color. Occasionally the atrophy is less perceptible, as the gland appears of its normal, or even beyond its normal size; this, however, is only the consequence of passive congestion or stasis, from dilatation of the vessels, which are full of blood, and give it a bluish-red color, the glandular tissue itself being diminished.

The typhous ulcer of the intestine at the same time assumes a torpid condition, or it may have advanced, in some measure, to cicatrization.

We shall show at a future period how this condition forms an important anatomical basis for the constitutional debility consequent upon typhus.

3. Secondary Typhous Processes

An acquaintance with these processes is the more important, as they throw much light upon the nature of typhus, as they have hitherto been but little known, and as their connection with the primary disease is commonly overlooked. They almost invariably present anomalies in reference to the seat of the typhous process; several of them are remarkable for the frequency of their occurrence. They are to be distinguished either as genuine or as degenerated typhous processes.

Genuine secondary typhous processes generally depend upon marked anomalies in the degree of the primary process. The most exquisite form in which they present themselves is seen in the mucous membranes, which we must consider as the true nidus of the typhus.

A. Secondary Processes In Mucous Membranes

a. Recurrent eruption of the mucous membrane of the small intestine. - We may find typhous patches of recent formation in the crude stage, intervening among typhous formations which are undergoing the metamorphosis or at the side of the typhous ulcer. These must be carefully distinguished from the patches which are less advanced in their development. This eruption is occasionally seen in a very undeveloped state, in the form of miliary swelling of the solitary follicles.

|B. Secondary typhous process in the mucous membrane of the colon and stomach; - secondary colo-typhus, secondary gastric typhus. - The latter is a rare occurrence; it stops short at the congestive stage when it does take place, and very rarely presents the nodulated form of the typhous deposit.

Y. Secondary Laryngeal Typhus

This is a secondary typhous process of considerable importance, both on account of its frequency and on account of its unfavorable prognosis. Its seat is the posterior surface of the larynx and the edges of the epiglottis; it not unfrequently gives rise to typhous laryngeal phthisis, accompanied by necrosis of the cartilages.

o. Secondary pharyngeal typhus occurs much more rarely than the former, and never except in company with it.

E. Secondary Bronchial And Pneumonic Typhus

This must be carefully distinguished from the hypostatic pneumonia frequently developed in the course of typhus, as well as from capillary phlebitis of the lungs.

£. Secondary typhous process in the vesical mucous membrane.

n. Secondary typhous process in the mucous membrane of the female sexual organs.

B. Secondary Typhous Processes In Serous Membranes

Among these we reckon the typhous inflammations of the pleura, of the meninges, of the capsule of the aqueous humor, and of the internal coat of the vessels (Phlebitis typhosa).

C. Secondary Typhous Processes In Parenchymatous Organs

These are the typhous inflammations of the liver, the spleen, the parotid, and the ganglionic substance of the brain and spinal cord.

The degenerated secondary typhous process occurs in various forms; in almost all of them a suspicion arises of the existence of a disease analogous to typhus, and this fact offers the more interest, as we have arrived at similar results in our special investigations of the morbid anatomy of ileo-typhus. Autenrieth describes them as neuroparalytic inflammations, Schonlein as neurophlogoses, Eisenmann as pyra, Buzorini under the head of typhus. They are based upon a corresponding degeneration of the typhous process in the blood, and may be classed as follows:

A. Degeneration Into Croupy Inflammation

This includes the entire exudative processes of the mucous membrane, of the respiratory organs, the oesophagus, the stomach, the intestinal canal, the female sexual organs; as well as all the secondary exudative processes occurring on serous membranes; and the exudations that ensue on the cellular and muscular base of the typhous ulcer, as a degeneration of the local affection of the intestinal mucous membrane.

3. Degeneration Into Acute Softening

To this class belong first of all the remarkable and frequent cases of black ramollissement of the fundus ventriculi and the oesophagus in which the spleen sometimes participates, and which originates in the vascular system; and in a second degree the softening of the pulmonary parenchyma, and of the mucous membrane of the bladder. When occurring as a degeneration of the local process, it is found at the base of the typhous ulcer, and may superinduce perforation of the intestine. (Vid. p. 69).

Y. Degeneration Into Gangrenous Inflammation And Primary Gangrene

This includes the well-known phenomena occurring in the course of typhus in the shape of noma, gangroena pulmonum, sloughing of the nates (decubitus), of parts to which vesicants have been applied, and of the female sexual organs. It may occur as a degeneration of the local process, and by sloughing at the base of the typhous ulcer induce perforation of the intestine.

D. Degeneration Into A Process In Which Pus, Or Rather A Fluid Analogous To Pus Is Formed

This involves suppuration of the patches and of the typhous ulcer, in the mesenteric glands; as well as suppuration in the lungs, the spleen, the liver, the parotid, in the subcutaneous cellular tissue, between the muscles, etc.

Besides these anomalies, there are other sequelae of typhus, which are based upon a permanent depression of the entire vegetative system, such as tabes universalis; or upon a diminution of nervous power, as obtuse-ness of the senses or paralysis; or again upon continued irritation, as hydrocephalus; or lastly, upon a secondary constitutional disease, as presented in oedema, anasarca, permanent suppurative processes, and Bright's renal disease.

The depression of the vegetative system remaining after typhus demands special investigation. It is presented either as a very slow progress of convalescence, or in the advanced degree as genuine tabes; both forms are distinguished by their peculiar type. The following are the anatomical points which characterize them: a. Genuine intestinal phthisis, or where a cure of the intestinal ulcers has begun, or is almost terminated, a loss of villi and follicles;

/B. A shrivelled condition or marasmus of a considerable number of mesenteric glands; and y. The flaccid atrophic condition of the abdominal ganglia, and more especially of the solar and superior mesenteric plexus, which, as well as the former, we have already adverted to.