Changes in the liver and spleen are of common occurrence in typhoid fever. Of the two the spleen is most frequently affected. This might be expected on account of the Character of the spleen as a lymphatic organ. The changes con sist of congestion with proliferation of the cell ular elements of the spleen and consequent in crease in the size of the organ. Of the conditions which may be present in the liver. the most com mon is a simple acute degeneration, such as oc curs in other infections diseases.
Lesions not distinctly a part of, but more properly the result the typhoid lesions also occur. Thus, in addition to the inflammation of the intestinal lymph nodes already described. there may be extensive involvement of the in estinal mucous membrane. This may lead to gangrene of considerable areas or to the forma tion of false membranes. Extension of the in n:limn:Ilion through the muscular coat may cause infection of the serous coat and, setting up a localized peritonitis, result in the formation of adhesions. of lymph glands in other parts of i.be body may be secondary to the ty phoid lesions in the intestinal glands.
Cases of typhoid infection resembling septi caemia, presenting no characteristic lesions and recognizable only by the finding of the bacillus ty phosus, have been reported.
Typhoid fever is widely distributed through out the world, but is especially prevalent in the temperate zones. From its prevalence during the autumn it has been called autumnal fever. Young adults are usually attacked, the affection being comparatively rare among children and old per sons. , llot and dry weather are favorable for its development.
The incubation period of enteric fever lasts from 8 to 14 days, or, exceptionally, longer. The onset is gradual, feelings of lassitude and malaise being followed by nausea, loss of appetite, head ache, pains in the back and extremities, nose bleed, and perhaps a distinct chill. For a few days the patient may go about his work, but at the end of that time is compelled to go to bed. This may he reckoned the definite onset of the disease. The fever is very characteristic. During the first week the temperature rises steadily by a degree or a degree and a half a day until 103° to 105° F. is reached; during the second week the fever remains high: during the third week, in eases of moderate severity, it gradually declines, and in the fourth week convalescence begins. The
pulse is rapid, full and soft, and the respirations increased in number. About the 7th to the 10th day the patient presents the typical appearance of enteric fever. lie is dull, listless, and apa thetic% the eves are bright, the pupils dilated, the face pale, with flushed cheeks and dark lips. The tongue is dry and roil, with a band of white fur on each side. At the end of the first week a rose-pink rash appears on the abdomen. It con sists of from ten to thirty raised circular spots, which fade on pressure. These spots last only No or three days, but successive crops appear. The abdomen is distended and tender, and several offensive yellow stools may he passed daily. Death may occur at the end of the second week, from hemorrhage or perforation of the bowel. The third week is marked by great weakness, muscular tremors, delirium, and failing heart, although the fever is slowly dropping, and death may take place from exhaustion. Hemorrhage of the bowel is heralded by a rapid collapse. Convalescence in the average case sets in during the fourth week. The fever abates and appetite and strength gradually return. In a certain num ber of cases relapses occur; these are, as a rule, shorter and milder than the original attack, but are similar in character. One attack of enteric fever confers immunity from others. The mortal ity ranges from 10 to 30 per cent.
There are several clinical varieties of typhoid fever. .1/i/(/ and aborting forms are characterized by a shorter course and speedy recovery (S to 10 (lays), although the onset may be sudden and severe and the symptoms similar in kind to the graver attacks. In the latent or ambulatory type the onset is mild and the patient does not take to his bed until the disease is well advanced. Hem orrhage or perforation of the bowel may be the first marked symptom of this type; in other in stances delirium sets in and the patient goes through a very severe attack. This form is very fatal. Hemorrhagic typhoid is a rare form char acterized by cutaneous or mucous hemorrhages. Fxeeptionally, typhoid runs its course without elevation of temperature (the afebrilr type).