448 Pathogenesis o£ Undulant Fever 



"secretion." Knowledge concerning the physiology of these groups of cells 

 is largely speculative. The localization, however, is probably not a mere co- 

 incidence, since it is well-known that Sporozoa of the character of coccidia 

 not infrequently are present in the same cellular elements as the Brucella 

 organism. Apparently, the nutritional conditions in the epithelia are suitable 

 for a diversity of parasites, which somehow enter the cytoplasm through 

 motility of their own or through other physical forces as yet poorly understood. 

 As a sequel to intracytoplasmic proliferation, the majority of epithelial cells 

 undergo necrosis. The bacterial masses are discharged into the collective 

 tubules where they form casts, and in turn cause death of the tubular lining. 

 A reactive inflammation extends along the uriniferous tubules deep into the 

 medulla and even into the calyces. The cells forming the infiltrative reaction 

 are mostly mononuclear histiocytes and lymphocytes; some with broad cyto- 

 plasmic margins have ingested nuclear detritus and some bacilli. This type of 

 medullary localization is merely a part of the metastic elimination yiephritis. 

 The possibility exists that renal abscesses or inflammatory infiltrations may 

 be the sequel of hematogenic embolic processes, which are so commonly seen 

 in coccic infections, and described for lesions observed in guinea pigs in- 

 fected with Br. abortus or Br. suis. A careful scrutiny of many sections from 

 ten separate portions of the kidneys of D.S. failed to demonstrate connections 

 with emboli. The entire process is confined to the uriniferous tubules, and 

 ultimately to the intracytoplasmic growth and necrosis of the epithelial cells. 

 What the outcome of these lesions may be is well illustrated by v. Albertini 

 and Lieberherr,* who foimd in the fifth month of a Bang's infection massive 

 interstitial granulation tissue composed of large phagocytic granuloma cells. 

 Unfortunately, no information relative to the bacteriology of the urine of 

 this particular case has been published; it is noted that the diazo reaction 

 was strongly positive. It would have been of interest to know whether the 

 focal lesions in the kidneys were closed or whether they discharged Brucella 

 occasionally or intermittently. According to Huddleson," Brucella abortus 

 has been cultured very few times from the urine of infected human beings. 

 On the other hand, Horrocks^"* succeeded in culturing Br. melitensis 39 times 

 from the urine of 13 different patients. He reports that the organism has not 

 been isolated from the urine earlier than the fifteenth day or later than the 

 eighty-second day of disease. The actual number passed varied between 4 to 

 596 organisms per cubic centimeter. Occasionally, a trace of albumin was 

 noticed, but no physical or chemical changes common to all the urines and in- 

 dicative of the passage of Br. melitensis has been observed. As a rule, the dis- 

 charge of the bacilli was intermittent and occasional, while in very few cases it 

 was continuous over a period of two weeks. The observations were made on 

 cases of the undulant, intermittent, and irregidar types of melitensis fever. 

 Renewed interest in the bacteriological examination of the urine in brucellosis 

 infections due to Br. abortus and Br. suis might indicate that the discharge of 

 the specific bacteria is not so rare as published statements would imply. 



