PA THOLOGY- SYMPTOMA TOLOGY 



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the cutaneous system, which is very rare; (4) by sexual intercourse, 

 which is possible. 



A variety of M. melitensis, called M. paramelitensis, is described 

 by Negre and Raynaud as the cause of a variety of fever termed 

 ' para-undulant fever ' (see p. 1447). 



Pathology. — ^The micrococcus enters the blood-stream via the 

 mucosae of the alimentary canal, and causes a genuine septicaemia, 

 with enlargement and congestion of the spleen as the most marked 

 feature; so that the disease somewhat resembles typhoid fever in 

 many of its characters, without, however, producing such typical 

 intestinal lesions as that disease. According to some authors 

 (Ross, etc.), the germ can be conveyed by mosquitoes, but this has 

 not been proved. For clinical and experimental reasons Bruce 

 believes that one attack produces an immunity, but Manson and 

 Bassett-Smith doubt this. The organism produces haemolysins, 

 while the reaction on the part of the body is shown by the formation 

 of agglutinins, which may last from four to ten years, and a specific 

 serum, which may be useful for immunization. There is also an 

 immune body in the blood suitable for complement deviation, and 

 this corresponds generally with the quantity of the agglutinins. 



Morbid Anatomy. — ^The morbid anatomy shows an enlarged and 

 congested spleen, some congestion of the liver, kidney, and mesen- 

 teric glands, duodenum, jejunum, large intestine, and lungs. The 

 spleen is usually much enlarged, weighing from 10 to 44 ounces. 

 It is dark red in colour, and may be soft and friable, and is very 

 congested, with enlarged Malpighian bodies. The liver is con- 

 gested and enlarged, and shows cloudy swelling, with a round- 

 celled infiltration between the lobules. The kidney is congested, 

 and may show a glomerular nephritis. The alimentary canal may 

 not merely be congested, but the colon may also be ulcerated, 

 particularly in cases of haemorrhage. The lungs are congested, 

 especially at the bases, and may show patches of consolidation. 



Symptomatology — Incubation. — Monkeys fed with infected milk 

 require an incubation of fifteen days, while in human beings the 

 period, according to Johnstone, is fourteen days. The prodromata 

 are usually malaise, chilliness, headache, muscular pains, and 

 dyspepsia. 



Onset. — The onset comes on gradually, and the patient con- 

 tinues his work though feeling ill, while the temperature rises 

 in a ladder, being higher each evening, and remitting somewhat 

 in the morning. About the fourth or fifth day of the illness 

 a doctor is consulted for the headache, and pains in the body 

 and limbs, which may have been thought to be rheumatic. The 

 patient looks ill, and his temperature is found to be about 103° F., 

 his pulse 80 to 90, and his tongue coated dorsally with a white fur, 

 while the edges are red, and may be indented by the teeth. There 

 is usually a slight sore throat and a tender epigastrium, with some 

 bronchial catarrh or congestion of the lungs, and enlargement and 

 tenderness of the spleen, which develop in the course of a v/eek or so. 



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