V. R. RAJAGOPALAN AND N. S. SANKARANARAYANAN 35
the substance, with a tendency to project above
the surface (Plate IV, fig. 2). The liver was some-
what tougher than normal.
The right kidney was enlarged. The mediasti-
nal, portal and mesenteric glands were enlarged
but presented no evidence of caseation.
It is important to note that the nodules were
evenly distributed throughout the substance of
organs affected, whereas Baumann [1927] records
that in his case the lesions were confined to the
surface of the organs.
HISTOPATHOLOGY
The most prominent and characteristic lesion
was the formation of granulomata in the liver and
the lungs. The histological structure and develop-
ment of these pseudotubercles were best appre-
ciated in the sections of the liver.
The youngest nodules, visible only under the
microscope, were represented by focal collections,
in the interstitial tissue, of mononuclear cells,
mainly lymphatic and partly monocytic in type
(Plate V, fig. 1). With the growth in size of these
cellular collections, necrotic changes set in quite
early, resulting in the loss of cell outline and marked
by extensive karyorrhexis of the inflammatory
cells. Old macroscopic nodules were composed
almost entirely of a mass of nuclear debris lying
in a practically structureless bed surrounded
by a narrow zone composed of morphologically
intact polyblasts and, towards the periphery, by a
few fibroblasts, with evidence (in the form of com-
paratively scanty collagen tissue) of ill-defined
encapsulation (Plate V, fig. 2). Towards the
centre of the oldest and largest nodules were seen
several areas which, in contrast with the surround-
ing nuclear detritus, were completely amorphous,
took up the eosin stain and in all probability
were evidence of caseation. It was also in the
largest nodules that fibrous tissue formation
was more evident.
Giant cells were absent, while neutrophil and
eosinophil cells were never present in significant
numbers. There was no evidence of club-forma-
tion as seen in 'actinophytotic' granulomata.
As a rule, the nodules were comparatively
avascular, but in a few large ones fair sized healthy
looking blood vessels had persisted.
It was
towards the periphery of the nodules, however, that
several apparently newly-formed blood and bile
vessels were present. The surrounding paren-
chymatous tissue showed ample evidence of com-
pression. The adjacent columns of liver cells were
much distorted, and the individual liver cells
atrophied. The sinusoidal spaces were greatly
widened and showed a more or less generalized
infiltration of inflammatory mononuclear cells.
There was also some cellular infiltration in Glisson's
capsule, but cirrhosis was not a prominent feature.
Some bile ducts showed catarrhal changes and
were denuded of epithelial lining. There were a
few haemorrhages, but no evidence of pig-
mentation.
The pulmonary lesions presented essentially the
same features as those seen in the liver and were
primarily of the nature of an interstitial pneumonia.
Besides several well-defined granulomatous nodules
of various sizes, the lungs showed a general con-
gestion of blood vessels, a low grade bronchial
catarrh, accompanied by a more or less generalized
cellular infiltration in the peribronchial and peri-
vascular interstitial tissue and a catarrhal pneumo-
nic change, and consolidation of the alveoli
surrounding the nodules. The alveolar exudate
was highly cellular, and as one would expect in
pathological processes of this type, was composed
mainly of catarrhal epithelial cells and mononu-
clear polyblasts. As in the liver, the ploymor-
phonuclear cells were scanty, and fibrin forma-
tion was not marked. The predominance of
lymphocytes in the contents of the larger blood
vessels, along with other available evidence,
clearly indicated that these cells were primarily
concerned in this pathological process.
No gram-positive or acid-fast organisms were
found but sections of the liver or lung stained with
methylene blue or Leishman's stain revealed
numerous clusters of round and ovoid micro-
organisms. There was no histological evidence of
worm infestation nor were any worms or their
developmental stages seen in the sections examined.
BACTERIOLOGICAL EXAMINATION
Pure cultures of the organism were obtained
from the spleen, liver, lungs and some of the
enlarged lymphatic glands.
The organism was Gram-negative, non-sporing
and seen in films as short rods. It was non-
motile when grown at 37°C., but actively motile
when grown at room temperature (18°C). On
agar plates it formed bluish-grey, relatively
opaque flat colonies, with entire edge and shining
moist surface. In broth there was uniform turbi-
dity, with a tendency for the growth to form thin,
loose flakes at the surface which fell to the bottom
on disturbing the tube. There was a powdery
deposit, which increased in 48 hours, our the cost
of the turbidity of the supernatant fluid. The
organism formed acid but no gas from dextrose,
maltose, mannitol and salicin.
Lactose and
sucrose were not attacked. It did not liquify
gelatin, formed no indol, did not reduce nitrates,
produced hydrogen sulphide, and rendered litmu