GROSS PATHOLOGY 157 



from the capsules when incised. There were no important 

 complicating infections in these cases, and the parenchymatous 

 changes were probably secondary to the lesions of typhus. 

 The ureters showed no lesions. The bladder in a few cases 

 only showed marked injection or minute hemorrhages into 

 the mucosa or sub-mucosa. No lesion of importance was found 

 in any case. 



(ri) Genitalia: The skin of the external genitalia shares in 

 the lesions attending the eruption of typhus. No gross lesions 

 were seen in the internal genitalia of either sex in any case; 

 this is in marked contrast to the lesions of the male genitalia 

 in Rocky Mountain spotted fever. 



(o) The skeletal muscles: In no case in our series were gross 

 lesions of the muscles found. The dry appearance of the 

 muscles described by Aschoff (1915) is not substantiated by 

 our experience. Waxy degeneration (Zenker's degeneration) 

 was not seen by us in gross as described by Ceelen (1919). 

 Minute necroses of muscle found microscopically are due to 

 blood vessel lesions. 



(p) The serous membranes: The pericardium, pleura, and 

 peritoneum showed no changes attributable to typhus. We 

 did not find the greasy condition of the peritoneum described 

 by Aschoff (1915). In a few instances we found a marked 

 dusky injection of the tendon sheaths in the ankles. 



(q) Ductless glands: No gross lesions of the thyroid gland 

 and pituitary body were found. The adrenal gland showed 

 occasionally non-distinctive lesions such as are found in other 

 infectious diseases congestion and minute hemorrhages. 



(r) The central nervous system: The gross changes observed 

 by us were not striking; except in a few instances, where very 

 marked injection of the blood vessels of the meninges and 

 substance of the brain was noted. There were three cases 

 where the degree of injection gave a pinkish coloration to the 

 cortex of the cerebrum, and to the basal ganglia. In addition 

 to these, three brains were slightly edematous. In four other 

 brains the degree of vascular injection was pronounced. The 

 degree of injection and edema of the brain has not corre- 



