K. F. Meyer . 443 



Discussion 



Pure Brucella abortus infections with a duration of less than three weeks 

 have not as yet been reported. Therefore, it is indeed a rare experience to be 

 able to study an overwhelming Brucella sepsis during its rapid clinical course 

 as well as post mortem. Unfortunately, the Brucella disease was complicated 

 by a lobar and lobular pneumonia in part induced by pneumococci, staphylo- 

 cocci, and streptococci. In consequence, the lesions in the lungs were partly 

 obscured by the supervening microbian invasion, which was in all probability 

 of the type of an aspiration pneumonia with relatively little involvement of 

 the bronchial tree. On the other hand, there is definite proof that the abscesses 

 in the right lobes were at least in part of hematogenous origin, and repre- 

 sented metastatic-embolic localization of the Brucella which circulated in very 

 large numbers in the blood stream early in the course of the infection. Both 

 the bacterioscopic and cultural examinations proved the predominance of the 

 Brucella organisms in the purulent monocytic exudate. Old (Sharp^) and new 

 (v. Albertini and Lieberherr,* and Rabson") analyses of the pathology of 

 undulant fever mention pulmonary localizations as a complication of the 

 disease. Hardy, Jordan, Borts and Hardy" (case 40) describe a pulmonary 

 abscess in a patient who was infected with both suis and bovis varieties, but 

 they were unable to determine whether it was caused by one or both of the 

 primary infectious agents or to some secondary invasion. In all probability, 

 the same difficulties would have arisen had the patient, D.S., survived for a 

 slightly longer period of time. The presence of clusters of a great variety of 

 bacteria within many of the air sacs filled with an inflammatory exudate 

 amply attest to such a possibility. 



The extensive icterus, the increased weight, and the mottled appearance of 

 the liver suggested extensive lesions in form of widespread necroses, which 

 were readily recognized both in the periphery of the lobule and occasionally 

 in the center of the columns of the hepatic cells. Necrobiotic processes around 

 the central vein, as described by Lillie (see Hardy and associates,* fatal case 

 iD and 2D, p. 77-79), Wohlwill,'' and others were relatively rare. Focalized 

 necroses or typical "granulomas," as observed by a number of pathologists 

 (for detailed references see Rabson^) in livers derived from human or guinea 

 pig Brucella infections, were strikingly absent. To be sure, the extent of the 

 liver damage hardly accounts for the icterus. This complication seems to be 

 rare. The analysis of 125 cases (1929) and subsequently 300 cases by Hardy 

 and his associates,"'^ also Hardy's summary in Huddleson," and the review 

 by Sharp^ make no mention of jaundice as a symptom of ab or tus- wndnX^nt. 

 fever. It is stated that a subicteric tinge is common and that in all severe cases 

 there is urobilinogenuria. Ebskov and Harp0th'° in describing a case of 

 febris undulans with jaundice interpreted the complication as a hemolytic 

 icterus induced by the infection. Schittenhelm"^ observed icterus in one case 

 of a series of sixty. Urobilinogen is present in the urine of one-half of the cases 

 observed; but, since localized pain in the region of the gall bladder arouses 



