Treatment 469 



Lamb also arrive at certain conclusions regarding the prognosis 

 based upon a study of the agglutinative phenomena. Their conclu- 

 sions are: 



1. Prognosis is unfavorable if the agglutinating reaction is persistently low. 



2. Also if the agglutinating reaction rapidly fall from a high figure to almost 



zero. 



3. A persistently high and rising agglutinating reaction sustained into con- 



valescence is favorable. 



4. A long illness may be anticipated if the agglutination figure, at first high, 



decreases considerably. 



The agglutination reaction appears early, is available by the 

 end of the first week, and often persists for years after convalescence. 



The organisms may sometimes be cultivated from the blood taken 

 from a vein, but are more certainly to be secured by splenic puncture. 



Pathogenesis. The micro-organism is not pathogenic for mice, 

 guinea-pigs, or rabbits, but is fatal to monkeys, goats, dogs, horses, 

 asses, and mules, when agar-agar cultures are injected beneath the 

 skin. 



The micro-organism usually seems to be absent from the circulat- 

 ing blood, though Hughes has cultivated it from the heart's blood 

 of a dead monkey. 



Bruce not only succeeded in securing the micro-organism from the 

 cadavers of Malta fever, but has also obtained it during life by splenic 

 .puncture. 



Accidental inoculation with Micrococcus melitensis, as by the 

 prick of a hypodermic needle, is almost invariably followed by an 

 attack of the disease. Six cases of this kind in human beings have 

 occurred in connection with bacteriologic work on Malta fever at 

 Netley and two additional at the Royal Naval Hospital at Haslar 

 and in the Philippines.* 



Treatment. The treatment of Mediterranean fever by means of 

 bacterio-vaccines has been attempted with what seems to be glit- 

 tering results by Bassett-Smith.f 



The report of "British Government Commission for the Investi- 

 gation of Mediterranean Fever," published by the Royal Society, 

 April, 1907, has greatly elucidated our knowledge of the pathogeny 

 of the disease by showing that the Micrococcus melitensis leaves the 

 body of the patient in the urine and in the milk. It has not been 

 found in the saliva, sweat, breath, or feces. The discovery of the 

 organism in the milk suggested that it might be through milk that the 

 specific organisms were disseminated, and an investigation of the 

 goats at Malta, where the disease is most prevalent, and their milk 

 most generally used, showed that a large percentage of the animals 

 were infected with the specific cocci. The commission has, therefore, 

 concluded that it is by goats' milk that the disease is commonly 

 disseminated, though they point out that fly-transmission is also 



* See Wright and Windsor, "Jour, of Hygiene," 1902, n, p. 413. 

 t "Journal of Hygiene," 1907, vn, p. 115. 



