740 
J. F. WINCHESTER. 
protoplasm being vacuolated and often invaded with leucocytes. 
The focal and diffuse lesions were not found associated in 
anv of the cases examined. 
j 
Spleen .—The spleen presented no constant lesion. In seven 
of the nine examined histologically there was a large amount of 
brown pigment, in the form of spherules from one-half to one u. 
in diameter, enclosed within cells in the pulp. Two spleens 
showed in the centre of the lymph follicles a circumscribed 
area, composed of epithelioid cells, many of which contained in 
their protoplasm nuclear fragments. The appearance simulated 
closely that seen in diphtheria. 
Kidney .—The kidneys exhibited the most constant lesions 
of any of the organs examined. In every case there was acute 
parenchymatous degeneration, shown b} a more or less exten¬ 
sive degeneration of the convoluted and the collecting tubules. 
Casts were occasionally found. In six of the ten cases in which 
the kidney was examined microscopically, there was evidence 
of a chronic interstitial process, consisting in small areas in 
round cell infiltration, containing atrophied tubules (one case), 
or in the formation of interstitial tissue around the glomeruli, 
with occasional bands of connective tissue surrounding atro¬ 
phied tubules and glomeruli. There was, in several cases, a 
diffuse increase in the interstitial tissue of the pyramids. In 
one kidney almost every glomerule was surrounded by more or 
less connective tissue. 
Psoas Muscle .—As a matter of routine the psoas muscle was 
examined histologically in every case. In seven out of ten 
there was a more or less extensive degeneration of the muscle 
fibres. The change was selective, attacking some fibres and 
leaving wide areas of normal structure intact. The affected 
fibres were unevenly swollen, and contained hyaline areas which 
were irregularly eroded and often invaded by leucocytes. In a 
single muscle fibre degenerated portions were seen alternating 
with apparently normal muscle structure. A dissolution of 
parts of some fibres had taken place, and the sarcolemma could 
be traced from one hyaline mass to another, the intervening 
