REVIEW — TROPICAL MEDICINE, ETC. 121 



derived from healthy people or from those suffering from any disease except Malta fever. Nor are traces of a Malta Fever 



reaction observed in a twenty-fold dilution. Therefore agglutination of the Micrococcus ineKtcnsis by a serum conlinucd 



diluted twent.v times, is diagnostic of Mediterranean fever, past or present. Of all serum tests, it is most reliable, 

 since we are not embarrassed by " coagglutinins " which may complicate the diagnosis of typhoid and para-tyjihoid 

 fevers. Thus, during the course of a typhoid infection, the body may elaborate coagglutinins for the para-typhoid 

 bacillus and vice- versa. In my experience, emulsions killed by heating to 5.5° C. for one hour, with 0-5 per cent, 

 phenol added afterwards, are more generally useful than suspensions of the living micrococci. With the former I 

 have not observed the occurrence of " agglutinoids," which I have occasionally encountered when the latter have 

 been employed. That is to say, while the lowest dilution of the serum failed to clump the living micrococci, the 

 higher dilutions agglutinated them, notwithstanding that the serum was in less amount. 



Eyre' reviews the whole question of Melitensis Septicaemia in the Mih-oy Lectures for 

 this year. He describes acute, subacute and ambulatory types and enters carefully into a 

 consideration of its effects on the different systems, giving an analysis of clinical symptoms 

 met with in 1000 cases. The morbid anatomy is detailed, special mention being made of 

 the numerous globuliferous cells found in sections of the spleen, liver and kidney. They are 

 derived from the endothelium lining blood sinuses, and contain in their interior from one to 

 15 or 20 red blood discs. The increase of lymphoid tissue in the spleen is noted and the 

 bone marrow is stated to be of a typical lympho-erythroblastic type (presence of giant cells, 

 mononuclears, lymphocytes with dimunition of myelocytes and polymorphs) as opposed to 

 the leucoblastic marrow associated with pneumococcic infections. 



The technique for the agglutination reaction both macroscopic and microscopic is 

 described. As regards the latter. Eyre himself requires a positive reaction in a dilution of 

 1 in 30 to 1 in 50, preferably the latter, within half an hour. He cites certain precautions 

 which must be observed in carrying out the test : — 



1. The serum should be clear and free from blood discs. 2. The culture of Micrococcus iiielilcnsis employed 

 should be one recently isolated from the human body (or recently passed through a laboratory animal) and grown 

 on agar of + 8 or + 10 reaction and incubated at 37° C. for not longer than two or three days — a 24 hours' old 

 culture giving the most reliable results. 



He notes that — 



Old cultures, or cultures many generations removed from the animal body, are prone to agglutinate automatically 

 in the presence of normal serum, or normal saline solution, or even when simply suspended in distilled water. 



The so-called " pro-agglutinoid " zones are more common in Micrococcus melilcnsis than, for example, in 

 enteric, i.e. a serum will yield a good reaction when tested against Micrococcus laelilensis in, for example, 

 dilutions of 1 in 30, 1 in 40, 1 in 60, 1 in 80, but will fail completely to clump the cocci in dilutions of 1 in 50, 

 or will react in dilutions from 1 in 50 upwards to 1 in 500, and fail to react in lower dilutions such as 1 in 10 

 and 1 in 20. It is therefore essential to prepare and observe a series of dilutions in performing the test for 

 diagnostic purposes. 



He gives the technique for the recovery of the organism from the spleen, the blood, the 

 urine and the faeces. As regards the blood examination, be thinks the blood should be 

 collected from a vein of the arm late in the day, when the patient's temperature tends to be 

 high and at or near the height of a pyrexial attack. 



Withdraw 5 c.c. into a sterile syringe already containing a few drops of 10 per cent, sodium citrate solution. 

 Transfer the citrated blood to a test-tube or small flask containing 45 c.c. of nutrient broth, and incubate at 37' C. 

 Prom the third to the tenth day of incubation an agar slope-tube must be inseminated from the broth culture, 

 and itself incubated for from three to seven days before a negative result can be recorded. 



The work of the Commission is reviewed and evidence advanced to prove that the 

 micrococcus can be transmitted by sexual congress. Eyre considers that the mosquito may 

 certainly act as a carrier, and suggests an unusual mode of possible infection through a skin 

 abrasion from the infected excrement of mosquitoes, a method similar to that described by 

 Lamb in the case of the flea and plague {vide " Plague," page 162). There are very interesting 

 notes regarding the goat and its history, and with reference to the mechanism of goat 

 infection from the milking methods in vogue. Lack of space forbids a more minute review 

 of this section, but one may note that the progeny of infected milch goats is itself uninfected 

 at birth. This is a point in connection with the preventive measures advocated. A 

 modification of the " Bang process " for the reproduction of tuberculous herds is 

 recommended for Maltese goats, and Eyre believes if this were carried out under scientific 

 supervision the whole of the infective animals seized could probably be replaced in three or 

 four years by healthy goats. The flesh of infected goats is harmless when cooked. Enough 

 has been said to show that these lectures contain much of interest and value and will well 

 repay careful perusal. 



Eecent Italian work, dealing with the vitality of the -1/. melileunis in various beverages, 

 the histo-pathology of the disease, etc., will be found mentioned in the Journal of Tropical 

 Medicine and Hygiene for July 15th, 1908. 



' Eyre, J. W. H. (June 13th, 20th and •27th, 1908), " Melitensis Septicaemia." Lancet, Vol. I. 



