446 Pathogenesis o£ Undiilant Fever 



observed in the spleen in the latter stages of undulant fever. As a sequel of the 

 inflammatory process, a Bantilike disease, accompanied by atrophic liver, 

 cirrhosis with ascites, and sub-icterus, has been noted (Habs," Biirger,"^ ™ 

 Loffler,*" Schottmiiller"). 



The gross lesions in the intestinal tube suggested, aside from the few 

 extravasations in the villi, some involvement of the lymphatic apparatus. 

 Despite the examination of many sections, definite hyperplasia of the reticulo- 

 endothelium of the follicles was not discovered. Just as in the spleen, the 

 germinal centers were lacking. 



Of all the changes, those noted in the kidneys are the most interesting. 

 Localized infiltrations involving the interstitial tissue between the tubules 

 have been described by v. Albertini and Lieberherr,* Cortese,^' de Giorgi,''^ 

 and Gregersen and Lund.^* Equally, necroses of the tubular epithelium lead- 

 ing to nephroses are on record (Bruce;'^ De la Chapelle;^'' Hardy and asso- 

 ciates,* case iD). Clinical data furthermore attest to the occasional involve- 

 ment of the kidneys. Albuminuria with hyaline and occasionally granular 

 casts, even leucocytes and red blood cells, indicate either toxic effects or 

 localization of the specific infection in the urinary tract. The Brucella organ- 

 ism may be isolated from the urine up to 12 months after the onset of a 

 melitensis infection, or the continuous discharge of Br. suis in the bladder 

 of a specifically allergic individual may give rise to a hemorrhagic cystitis 

 without significant cystoscopic and pyelographic findings (personal observa- 

 tions). As a whole, the participation of the kidneys in the course of melitensis 

 undulant fever infection may involve at least 10 per cent of the patients (Dun- 

 can and Whitby^^); on the other hand, a mere dozen of a series of 200 patients 

 with melitensis brucellosis seen by Cantaloube^^ yielded albumin in any signifi- 

 cant amounts, while Simpson^'^ states that only traces of albumin are found in 

 abortus infections. It will be shown below that the absence of chemical or 

 physical damage does not preclude a bacilluria. 



The students of the experimental disease in guinea pigs frequently found 

 the kidneys of the animals injected with Br. bovis diseased. According to 

 Fabyan,^ 29 per cent of these animals showed whitish to gray nodules in the 

 cortex. Radiation toward the medulla was not observed, although the color- 

 less appearance of the renal structures indicated a diffuse process. Microscopi- 

 cally, the focal areas were composed of epithelioid and lymphoid elements, 

 compressing and destroying the convoluted tubules near the glomeruli. In 

 other instances, these "granulomas" were in the vicinity of blood vessels. 

 As far as published records indicate, no attempt has been made to explain the 

 genesis of these lesions, although the examinations of chick embryos infected 

 with Br. suis reveals granulomatous foci consisting of proliferations of endo- 

 thelial cells remarkably similar to those noted in human kidneys. The find- 

 ings made on the sections of the kidneys removed at autopsy from the body 

 of D.S. may shed some light on the evolution of the renal pathology in 

 brucellosis. 



