An acquaintance with the many anomalies of this process is of such importance, that we would not trust a person ignorant of them to judge of a post-mortem examination in a case of acute fever. Their diagnosis is the result of researches which we have for many years devoted to the subject. We add a list of the anomalies, and subjoin the most essential explanations at once:

1. Anomalies In Reference To The Amount Of The Process

Anomalies In Reference To The Amount Of The Process occurring on the intestinal mucous membrane.

a. Arrest of its development. a. Arrest in the congestive stage - diffused typhous process in the intestinal mucous membrane.

ft. Imperfect development of the patches - low plasticity of the morbid product. This variety is allied to the diffused form.

y. Retrogression (retrogradwerden) of the morbid growths by absorption; - to this head belong Chomel's plaques a surface reticulee.

d. Slow metamorphosis of the morbid growth, tardy separation of the slough, and purification of the ulcer.

£. Scanty formation of the morbid growth.

b. Excessive development of the local process.

a. Tumultuous1 (tumultuarisch) metamorphosis of the morbid growth, violent congestion of the intestine, unusual turgescence of the morbid growths. The congestion not unfrequently gives rise to peritonitis, which proceeds from one of the patches; or an extravasation of blood occurs between the intestinal coats, and in their tissue; intestinal apoplexy, or a fungoid degeneration of the morbid growths takes place, and death ensues from excessive vegetation, by paralysis, or from exhaustion by hemorrhage (haemorrhagia intestinalis).

ft. Numerous formations of morbid growths - extension of the same to the solitary follicles.

y. Extension of the process beyond the ileum to the jejunum and stomach, or to the colon.

1 [The German word "tumultuarisch" implies, violent symptoms taking place with suddenness and rapidity; Rokitansky has himself used the term in a new sense; the translator, to avoid frequent circumlocution, has therefore ventured to employ the word " tumultuous"' as most adapted to convey the author's exact meaning. - Ed].

2. Anomalies In Quality

a. Impeded cicatrization of the ulcer - it assumes the torpid form.

b. Degeneration into a perforating typhous ulcer.

These two forms constitute genuine typhous intestinal phthisis. We have seen that the local condition for the cure of the typhous ulcer consists in a complete termination of the local morbid process in the intestinal mucous membrane, and a perfect purification of the ulcer of all morbid growth, and that, as a general condition, an extirpation of the typhous and of every secondary dyscrasia is required; it is therefore evident that the degenerations of the typhous ulcer which we are now considering may be complicated with a variety of anomalies; of these some have already been considered.

Perforation of the intestine by the typhous ulcer constitutes a very remarkable phenomenon. How is this effected? The typhous process invariably meets with an isolating tissue in the lower stratum of the submucous cellular layer and of the muscular coat; the destructive process which occurs beyond the mucous membrane, is therefore not the result of a previous typhous affection (infiltration), but of an essentially distinct process. It is this that affords a marked distinction between the perforating typhous and the perforating tubercular ulcer. The process by which perforation of the intestinal parietes at the base of the ulcer is effected, is softening or mortification of the tissue; the slough that results only affects the deepest parts of the ulcer to a small extent, and we rarely find the orifice larger than a pin-hole, or a millet or hemp-seed.

The varying period at which in the course of typhus the ulcer degenerates in this manner, is remarkable, as also the rapidity with which occasionally the perforation is effected. We have observed it occur rapidly in ulcers that had scarcely formed, whilst the remaining morbid growths were engaged in the metamorphosis, or even in the crude stage; and again we have seen it occur slowly or quickly at every subsequent stage; long after the termination of the local process, and even after the genuine typhous had subsided into the atonic ulcer.

The consequence of the intestinal perforation, and of the resulting effusion of the intestinal contents into the peritoneal cavity is peritonitis; it generally gives rise to tolerably copious, but uncoagulable and liquid exudation; it frequently takes place even before actual perforation has ensued, and is developed as soon as the process of perforation approaches the peritoneum.

The exudation commonly induces an adhesion between the perforated coil and another coil, or between its mesentery and the pelvic parietes; which may certainly be looked upon as an effort of the vis medicatrix naturce, but which our investigations have proved, never to effect a radical cure of the typhous perforation of the intestine.

Our experience with regard to the perforating process, does not, except in rare cases, allow us to concur in the view adopted by several French observers of distinction, that it is to be considered as a rupture of the ulcerated part; nor can we sanction the doctrine of Judas, that the intestine, when on the point of being perforated, moves into the pelvic cavity, in order to find suitable spots for adhesion, inasmuch as the typhous intestine sinks into the lowest region of the abdominal cavity long before the ulcerative degeneration takes place.