These glandular sacs become enlarged by morbid growth, softening ensues, and at length they exfoliate or slough away leaving ulcera-tions in the spaces they occupied. Perforation of the intestines is an accident which sometimes occurs, the contents of the intestinal canal escaping into the peritoneal cavity; peritonitis follows as a result, terminating almost always in death. Another occasional event is haemorrhage from the ulcers. This is sometimes profuse, and may be the cause of a fatal termination; but in the majority of the cases in which this accident occurs recovery takes place. The mesenteric glands which are in immediate relation to the Peyerian and solitary glands become considerably enlarged. If recovery from this fever takes place, the enlargement of these glands gradually disappears, and' the intestinal ulcerations become cicatrized. The spleen is also constantly more or less enlarged and softened in typhoid fever. These morbid changes constitute what are called the anatomical characteristics of this disease; they are wanting in typhus fever.

Typhoid fever is undoubtedly communicable; yet it is rarely communicated to those who are brought into contact with cases of it, namely, physicians, nurses, and fellow patients in hospital wards; and it occurs when it is quite impossible to attribute it to a contagium. Hence, this is a disease which, although produced in a certain proportion of cases irrespective of either a virus or an infectious miasm, may yet generato either one or both of these forms of contagious material. Facts go to show strongly that the contagium is contained in the intestinal evacuations, and that the disease may be diffused by means of drinking water into which excrement in ever so small quantities has found access. Outbreaks of this fever have been repeatedly traced to defective waste pipes and obstructed drains or sewers. This fever is not restricted in its prevalence to any particular sections, but it is indigenous in every quarter of the globe. All ages are not alike liable to it. It is rare in infancy, but not very unfre-quent in childhood, and occurs very rarely after the age of 50 years. It is more apt to prevail in the autumnal months than at other seasons.

It was observed by Louis that in Paris persons who had resided there but a short time were more likely to be affected than native or older residents, and this has been observed in other cities.-In most cases typhoid fever is developed gradually. The average period from the first evidence of illness to the time of taking to the bed is about five days. The early symptoms are chilly sensations, pain in the head, loins, and limbs, lassitude, and looseness of the bowels. Bleeding from the nose is of frequent occurrence. During the course of the fever stupor, as in cases of typhus, is more or less marked. Low muttering delirium is common, and in severe cases subsultus tendinum. The symptoms which are especially distinctive, as contrasted with typhus fever, are those referable to the intestinal affection, namely, diarrhoea, flatulent distention of the abdomen, tenderness in the iliac regions, and a sound of gurgling when pressure is made in these regions. These are known as the abdominal symptoms of typhoid fever. In the majority of cases there is a characteristic eruption, usually confined to the trunk, but sometimes extending to the limbs. The eruption, however, is rarely abundant, differing in this respect from that of typhus.

It also differs in character, that of typhoid fever being papular (pimples, not spots); the color is rose red (hence called the rose papules); the redness disappears momentarily on pressure with the finger; the papules are not persistent, but come and go throughout the disease, and all appearance of the eruption disappears after death. The eruption appears later than in typhus, not being discoverable until about the seventh day from the time the patient takes to the bed. The duration of the fever is longer than that of typhus, the average, dating from the time of taking to the bed, being about 16 days in the cases which end in recovery; it is somewhat less in fatal cases. In some cases the duration is greatly protracted, and may extend to 60 days. Relapses sometimes occur, the patient during convalescence or shortly after recovery being again seized and passing through a second course of the fever. These second attacks rarely prove fatal. Convalescence is preceded by a decline in the temperature of the body (called defervescence); and frequently before a persistent reduction there are notable variations, as shown by the thermometer, between the morning and evening temperature.

The average mortality is about the same as that from typhus, 1 to 5 or 6; the rate varies much, however, at different times and places. Generally death is attributable to accidents, such as perforation of the intestine and haemorrhage; to complications, as for example pneumonia; or to the existence of antecedent disease.-The general principles of treatment are the same in cases of typhus and typhoid fever. It is doubtful if the cause of these diseases be ever arrested, but they appear sometimes to end prematurely; abort, as it were, spontaneously. It may be said, at all events, that there are no known measures which can be relied upon for cutting short their course. The great object, therefore, is to aid in bringing them to a termination in recovery. The mineral acids have been found to diminish the rate of mortality. The use of cold water, by means of the bath, the wet pack, and sponging the surface, not only affords relief by the abstraction of heat, but clinical observation lias shown that it conduces to recovery. Supporting the powers of "life by a proper alimentation, and resorting to alcoholic stimulants when these powers begin to fail, constitute essential measures of treatment.

Milk is preeminently the appropriate article of diet, and alcoholic stimulants are sometimes tolerated in very large quantities without any of the excitant or intoxicating effects which they would produce in health. There is reason to believe that lives are sometimes saved by the very free use of alcoholic stimulants, but it is important always to be governed in their use by the indications afforded by the symptoms. Favorable hygienic conditions are important, such as free ventilation, a proper temperature, and cleanliness. The benefit of an abundance of pure air is illustrated by the success with which these fevers have been treated in tents. In addition to the general principles of treatment, particular symptoms and events claim, of course, appropriate therapeutic measures.-As already stated in the account of periodical fevers, the special cause of these (malaria) may act in conjunction with the special cause of typhoid fever, giving rise to a combination of the symptoms of both kinds of fever, the disease being then known as typho-malarial fever.