MORBID ANATOMY 



fatty degeneration described in the liver, as well as because of 

 the other pathological features. 



As a result of this activity on the part of the parasites and of the 

 reaction on the part of the body, local pathological changes take 

 place in different organs, and these are in general agreement with 

 the symptoms exhibited by the particular case. 



At present there is no evidence of any secondary infection being 

 responsible for any of the essential pathological features of the 

 disease. 



Maribid Anatomy. — In an autopsy upon the body of a person 

 dying from the acute phase of the infection, a certain amount of 

 serous effusion is remarked upon opening the abdomen. The liver 

 is seen to be enlarged, and to be in a state of fatty degeneration. 

 The spleen is also enlarged, hyperaemic, and very soft, as are the 

 mesenteric glands. On opening the chest s-erous effusion is seen 

 in both pleural cavities, as well as in the pericardial sac. The 

 pericardium shows signs of haemorrhagic pericarditis, while the 

 enlarged heart is in a condition of intense myocarditis. The 

 lymphatic glands of the mediastinum are also swollen and hyper- 

 aemic. In the neck the thyroid gland is seen to be enlarged, as are 

 the lymphatic glands. The dura mater is congested, and there is 

 leptomeningitis and encephalomeningitis, and firm adhesions be- 

 tween the leptomeninges and the cerebral cortex. The liquor 

 cerebro-spinalis is increased in amount. There is a generalized 

 myxoedematous condition under the skin. 



Histopathology. — ^As already stated, the most likely place to find 

 the parasites is in the muscular system. In the heart they occupy 

 the central undifferentiated protoplasmatic portion of the muscle 

 cell, and growing therein, destroy the sarcoplasm, and convert 

 the body of the cell into a parasitic cyst without affecting the pro- 

 cesses. When this cyst ruptures, the now flagellate parasites 

 escape into the intermuscular tissue, and give rise to patches of 

 interstitial myocarditis. No changes are to be seen in the larger 

 bloodvessels of the heart, nor can parasites be found associated 

 with patches of pericarditis or endocarditis which may be present. 

 In the skeletal muscles the parasites are mostly found in those of 

 the extremities and the back. Here, again, the parasites grow 

 in the centre of the muscle fibre (Fig. 114, p. 428). 



In the central nervous system a similar process appears to take 

 place. The parasites invade a neuroglia cell, which becomes con- 

 verted into a parasitic cyst, on the rupture of which a patch of 

 inflammatory reaction is produced. Parasites have never been 

 seen to invade the nerve cells or the leucocytes of the central 

 nervous system [vide Figs. 642 and 643). 



A similar invasion of the medulla or cortex of the suprarenal 

 capsule and inflammatory reaction can also be seen in the kidneys, 

 the hypophysis, and the thyroid gland. In animals the parasites 

 have been seen in the testicular tubules, but they have not been 

 noted in the human ovary. 



