The heart-muscle is more or less de generated. In severe cases the heart is flaccid and easily torn, and the muscle presents a reddish-brown color. Endo earditis and pericarditis are rare com plications. Endarteritis with thrombo sis is sometimes met with. Thrombi and emboli may contain bacilli. Phlebitis with thrombosis, especially in the lower extremities, is a frequent lesion.
Inflammation of the lining membrane of the larynx is sometimes met with, as well as of the deeper lesions involving the cartilage. These terminate sometimes in stenosis, ulceration of the cartilage, with formation of pus, which may penetrate into the mediastinum. Emphysema sometimes results. The danger of ul ceration of the cartilage is shown by the mortality: 71 out of 75 cases (Keen).
Lobar and broncho-pneumonia have been already referred to. Pleurisy and empyema are very occasionally found after fever.
Zenker has described two forms of muscular degeneration: the granular and the waxy. The former is similar to the advanced stages of fatty degenera tion, and in the latter the contractile substance is changed into a waxy, homo geneous mass. This form of degenera tion occurs in other fevers as well as in typhoid. Inflammation of the me ninges is not a frequent complication. Typhoid bacilli have been found in the -suppurative form. I had under observa tion some years ago a case of typhoid fever with symptoms of meningitis and with well-marked neuritis. The patient recovered.
Hoffmann has described an atrophy of the brain in the later stages with smaller size of the convolutions and greater width of the lateral ventricle. Degen eration of the ganglion-cells as well as of the nerve-fibres has been described. This is present in many cases when there are no symptoms of neuritis.
Galezowski has classified the patho logical condition of the eye in typhoid fever into: Necrosis of the cornea; thrombosis of the ophthalmic and or bital veins; emboli of the central artery of the retina; optic neuritis with atrophy of the disk (de Schweinitz).
General Pathology.—The question has been much discussed as to whether the intestinal lesions of typhoid fever are the result of a local infection or are a local manifestation of a general disease.
The theory of general infection is sup ported, to some extent, by Sanarelli's experiments. He found that whether•
the bacilli were introduced under the skin or into the peritoneal cavity, the principal lesions were found in the ab dominal organs, and an acute mucous inflammation of the intestine existed, as well as swelling of Peyer's patches. Mar tin points out the fact that these lesions are the result of the toxins, and not of the bacilli, and are produced also by other toxins, as those of the colon bacil lus, Gartner's bacillus, as well as by the vegetable toxins: abris and ricin. Ulceration has rarely followed such in travenous or subcutaneous injections.
The fact, previously mentioned, that llemlinger has produced in animals the intestinal lesions by feeding them with a pure culture of typhoid bacilli and that the result has not previously been reached by subcutaneous injections would con firm Martin's view.
Prognosis. — Death in typhoid fever may result from asthenia, or from inter current diseases and accidents, the re sults of typhoid lesions. The severity depends upon the virulence of the poi son, as well as upon its amount and on the nature of the soil. This has been demonstrated by experiments on animals.
The rate of mortality in typhoid-fever cases is from 7 to 15 per cent. Cayley gives that of the Continental hospitals at from 7 to 15 per cent. Delafield col lected 1305 cases of typhoid fever in five years in the New York Hospitals, with a mortality in 1879 of 21 per cent. and in 1880 of 30 per cent. (Wilson.) Murchison's statistics of 1S,612 cases collected from British and Continental hospitals gives 18.62 per cent. of deaths. They also prove that the mortality is lower between ten and fifteen years of age.
The previous condition of the patient bears some relation to the prognosis. A system weakened from overwork or un healthy surroundings, or one with a family history of tuberculosis, will not withstand the disease as well as one who has been previously strong and healthy.
When the temperature rises suddenly at first and remains high for a number of clays, the prognosis is usually grave. The writer has had under observation cases of rapidly-rising temperature when the temperature, after four or five days, partially subsided, the disease afterward running a comparatively mild course.