162 PATHOLOGY 



the germs are not usually found in the circulation. They 

 consist of fatty degeneration of the heart muscle and 

 acute interstitial myositis. The kidneys are also affected, 

 the lesions varying from simple degeneration to intense 

 nephritis. The liver and spleen show degenerative 

 changes, with foci of necrosis. Degeneration of the 

 peripheral nerves and neuritis also occurs. 



Morbid Physiology. While deglutition and interfer- 

 ence with respiration may occur from the presence of 

 the membrane and inflammatory reaction, the lesion is 

 purely a local one, and the systemic disturbances (chill, 

 fever, prostration, and visceral lesions) are caused by the 

 toxin, which is very soluble and highly toxic. Intro- 

 duction of the toxin into animals reproduces practi- 

 cally all the general manifestations of the disease. Va- 

 rious degrees of susceptibility to the toxin and also to 

 the growth of the germ exist, so that frequently an ex- 

 aggerated local lesion is accompanied by slight consti- 

 tutional disturbances and vice versa. An attack con- 

 fers temporary immunity. 



CEREBROSPINAL FEVER 



Definition. An acute infectious disease caused by 

 the meningococcus and characterized by inflammation 

 of the cerebrospinal meninges and a clinical course of 

 great irregularity. 



Etiology. Epidemics of this disease are localized, 

 and occur with greater frequency in the country than 



