OBSERVATIONS ON THE PATHOGENESIS OF 



UNDULANT FEVER 



CONTINUOUS perusal of the many papers which have appeared during the 

 past fifteen years on human brucellosis, induced by the abortus and siiis 

 types of Brucella, makes it appear that this disease still remains an inade- 

 quately understood and consequently an intriguing subject. Despite the vast 

 amount of research and the collection of case histories, relatively little is 

 known concerning the genesis and pathology of the infection. In fact, what 

 has been reported is frequently contradictory and little agreement has as yet 

 been reached. In order to elucidate certain phases of the morbid processes, the 

 pathological and bacteriological findings made on a laboratory-animal care- 

 taker, who succumbed to a fulminating Br. suis septicemia within eleven days 

 after he was observed to be ill, are herewith reported. 



The history of the patient presents the following essential data: White male, D.S., age 24, 

 laboratory technician with a strongly positive phagocytic index test of 6.88 for Br. abortus and 

 a positive allergic skin test indicative of a passed latent Brucella infection, complained on 

 November 24 of discomfort in the abdomen, nausea, vomiting after a week of malaise, marked 

 spells of perspiration, and occipital headache. The examination disclosed a purplish hue of 

 the skin over his back, face and anterior thorax, a temperature of 101° F., tachycardia (128), 

 vesicular breathing, a soft large spleen; he was decidedly restless and irritable, occasionally 

 irrational. R.B.C. 4,640,000; W.B.C. 13,200; 91 per cent P.M.N, and 4 per cent monocytes; 

 urine: albumen-1-H-, small hyaline and granular casts. A quantitative blood culture yielded 

 1,750 colonies of Br. suis per cc. On November 27, a slight icteric tinge of the sclera was noted 

 and the urine ^vas positive for urobilinogen. He developed a progressive jaundice (icterus 

 index 130. van den Bergh direct and indirect); the serum gave a positive agglutination test 

 with Br. abortus 1 :4o. On December 2, extensive consolidation at the base of the right lung was 

 recorded; he became comatose and expired on December 4, despite repeated transfusion and 

 glucose administrattion by clysis and supportive treatment. 



Autopsy: The autopsy was performed 7 hours after death by W. T. Partch, M.D., and the 

 author. Only the significant findings as dictated are recorded. 



The body of a ^veil-nourished male about 30 years of age shows marked icteric tinge to 

 the skin and post-mortem lividity. On incision in the abdominal cavity and in the right 

 pleural cavity approximately 50 cc. of slightly blood-tinged fluid are found. No exudate is 

 seen in the left cavity while the pericardial cavity contains 50 cc. of clear straw-colored fluid. 



The weight of the heart is 370 gm. The valves and the myocardium are essentially normal. 



Left Lung: A slight amount of fibrinous exudate is present over the visceral pleura of the 

 left lower lobe. In cut section the entire lobe is seen to be markedly reddened and edematous 

 (hemorrhagic edema). No consolidation is present; mediastinal lymph nodes are reddened, 

 soft, and markedly enlarged. 



Riglit Lung: On palpation of the upper lobe and the posterior aspect of the right lower 

 lobe many areas of consolidation are felt; the middle lobe crepitates normally throughout. 

 The upper lobe on section is red in appearance, and practically consolidated. There is central 

 consolidation in the base. From numerous nodules along the posterior asfject of the lower 

 lobe droplets of pus exude from the cut surface. There is a very recent fibrinous exudate over 

 the visceral pleura of the right lung. 



The Spleen ^veighs 420 gm.; it is moderately firm on palpation and dark bluish in color. 



1:439] 



