K. F. Meyer 44g 



Fortuitous circumstances permitted an exhaustive bacteriological exami- 

 nation of the organs of D.S. at the time of autopsy. The quantitative estima- 

 tions reveal more definitely than any other evidence the septicemic-metastatic 

 character of the infection. Every organ, in fact every tissue fragment, yielded 

 Br. suis, sometimes in such numbers that accurate counting was impossible. 

 The absence oi Brucella in the heart blood must be ascribed to the overgrowth 

 by the pneumococcus in the rich culture afforded by the clot in the right 

 ventricle. Attention must be directed to the estimation of 3,600 organisms 

 per gram of spleen or approximately 1,512,000 bacteria for the entire organ 

 which, in all probability, is due to the presence here of the main reticulo- 

 endothelial system and its "filteration" of the Brucella from the blood stream. 

 Such a limited storehouse of bacteria could not have served as the seedbed for 

 the blood stream. In all probability the distributions of the organisms is 

 uneven and the number of bacteria calculated for the entire organ is probably 

 too low. However, it should be remembered that in typhoid fever the con- 

 tinuous bacteremia is, as a rule, maintained by the focal lesions in the bone 

 marrow. The same is suspected for a Brucella infection. Unfortunately, the 

 possibility had not been considered and therefore no cultures were prepared 

 from the marrow of D.S. It certainly should not be missed in future autopsies. 



The literature on undulant fever due to Br. abortus or suis contain 44 re- 

 ports on supposedly fatal infections attributable to the specific organisms. In i^ 

 of the reports no microscopic-anatomical data are presented. The histories of 15 

 cases together wath 8 observations of their o^vn have been analyzed by v. Alber- 

 tini and Lieberherr.^ In addition, data on 7 cases of Bang's infection (one by 

 De la Chapelle^° was caused by Br. 7nelite7isis) are detailed in the American 

 literature (Rabson°). A condensed analysis definitely indicates that Brucella 

 infections due to the bovis or suis types are very rarely fatal. Of the total num- 

 ber of 44 only 7 were uncomplicated deaths directly attributable to the specific 

 organisms. In the remaining 37, death was due to some complication such as 

 embolism, uremia, tuberculosis, hemorrhages, rupture of the spleen, hepatic 

 cirrhosis, pneumonia, recurrent endocarditis, etc. Invariably in typical Bru- 

 cella suis or abortus deaths, a definite sepsis was demonstrable. To attribute a 

 death to a Brucella infection because the patient's serum gave immunological 

 reactions suggestive of undulant fever, without an autopsy followed by micro- 

 scopic study of the tissues and detailed bacteriological examination of the 

 organs, is not justifiable in the light of available experience. No effort should 

 be spared to secure autopsies on supposedly fatal cases of brucellosis. 



Knowledge relative to the pathogenesis of the Brucella infections in the 

 aberrant host— man— is entirely inadequate. The pathways of infection are 

 supposedly proved. One suspects the intestinal and the percutaneous routes. 

 The clinical course manifests itself in the form of an intermittent or undulant 

 fever. By analogy with malaria, spirochetosis, and endocarditis, the bouts of 

 fever presuppose repeated invasions of the bacteria into the blood stream. 

 These seedings come, according to Wohlwill." from an\ one of the reticulo- 



