120 REVIEW — TROPICAL MEDICINE, ETC. 



Malta Fever Rogers' deals with Malta Fever in India but practically, owing to lack of material, 



— continued gives an account of the disease as seen in Europe. He has, however, a note on the degree 

 of dilution desirable for the agglutination test in India. He prefers to put up the blood 

 in dilutions of 1 in 40, 1 in 80 and 1 in 160, and to look only on 1 in 80 as a certainly 

 diagnostic reaction, and 1 in 40 as a suspicious one necessitating re-testing at a later date 

 in higher dilutions. The reaction appears within a few days of the commencement of the 

 fever, and appears to persist fairly constantly throughout its course, and for some time 

 after convalescence is established. 



Kennedy- has a paper on the bacteriology and etiology of the disease. He gives the 

 chief naked eye appearances of a two to five days' culture of M. meliteusis as — its 

 transparency and amber colour by transmitted light, its white globular appearance by 

 reflected light, and a beautiful phosphorescent green shadow which is cast through the 

 medium by direct light, and is best seen by looking sideways through the medium. The 

 micrococcus is killed in ten minutes by dry heat at 90° C. to 95° C; by moist heat at 57-5° C. ; 

 by 1-2000 hydiarg. perchlor. and by 1-100 phenol ; in one hour by sunlight, 130° F. 

 (54-4° C.) ; in four to five hours by 1-2 per cent. Clayton gas or 0-7 per cent, liquid SO^. An 

 important practical point mentioned is that it may be recovered from the three weeks' old 

 urine of a patient, or from the clothes on which the urine has dried. 



On artificial media it retains its vitality for a very long time, having been recovered 

 from an agar culture 820 days old. In recovering it from a litmus milk culture during a 

 period of nine months (284 days), Kennedy noted that about the fifth month it lost its 

 character of emulsifying and remained clumped like a staphylococcus, but about the eighth 

 month it recovered its normal characteristics. He also states that in doing the agglutination 

 test it was not at all infrequent to find that 1-100 gave a complete reaction immediately, 

 1-50 took longer, and 1-10 and 1-20 gave no reaction or only a trace (paradoxical 

 agglutination reaction). 



Zammit^ found that the agglutination test could be applied to the milk of infected goats 

 as well as to the blood. The technique is as follows : — A strong emulsion of the M. melitensis 

 is prepared in normal saline solution in a watch-glass. To this a small quantity of 

 formaldehyde solution is added (one small loopful of a 1 per cent, solution), the whole 

 being drawn into a pipette. The formaldehyde prevents the milk turning sour. One drop 

 of the emulsion is placed on a glass slide and a loopful of milk is mixed thoroughly into it. 

 This mixture is then drawn up into a fine capillary pipette, left in an upright position for 

 12 hours, and the reaction noted at the end of that time. The reaction is often seen after a 

 few minutes. The cream collects at the surface and does not interfere with the reaction. 



Critten* draws attention to the difficulty in diagnosis from early pulmonary tubercle, 

 for while tubercular disease does not induce the formation of substances capable of 

 agglutinating M. melitensis in 1-10 and 1-20 dilutions, still, owing to co-existent or 

 past infection with M. melitensis, the serum of a patient suffering from tubercle of the 

 lung may clump the micrococcus and the possibility of tubercle should always be excluded 

 by careful clinical and bacteriological examinations. 



The organism has been obtained from small quantities of blood, hence vein puncture 

 may not be necessary, for, if the blood be collected in the usual way, with proper precautions 

 in a large, curved, collecting tube into which a little five per cent, citrate of soda has 

 previously been introduced, and the blood be then expelled into a broth flask and incubated 

 at 37° C, growth may result. 



Birt' has some useful notes on the agglutination test. He says : — 



It is essential to make use of a recently-isolated culture or one grown on a medium which does not induce 

 auto-agglutinability or sensibility to the agglutinins of normal blood. I have found that emulsions of growths 

 on glucose nutrose agar of +25 reaction (Eyre's scale), though isolated more than a year, are still satisfactoi-y. 

 When emulsions of old laboratory cultures on ordinary agar are made with physiological salt solution, no clumping 

 may be apparent, yet a minute trace of human serum from any source may agglutinate the micrococci completely. 

 Hence it is incumbent on the bacteriologist to control his emulsion by testing it with normal human blood. 

 A reliable culture is usually unaffected by, and is never completely dlumped by, a tenfold dilution of blood serum 



' Rogers, L., " Fevers in the Tropics." 1908. 



- Kennedy, J. C. (December, 1907), " Remarks on the Bacteriology and Etiology of Malta Fever." Journal of 

 Ute Royal Institute of Public Health, p. 728, Vol. 15, No. 12. 



» Zammit, T. (February, 1908). Comm. Rep., Part IV. p. 98. 



* Critten, A. (June 1st, 1907), "Some Observations on Blood Serum Reaction in Tubercle and Mediterranean 

 Fever in Malta." Journal of Tropical Medicine and Hygiene, p. 187, Vol. X. 



' Birt, C. (November 9th, 1907), " Mediterranean Fever in South Africa." British Medical Journal, p. 1336. 



