374 MALTA FEVER 



for intraspinous injection. In some cases the blood used was 

 taken from the patient himself, and they obtained encouraging 

 results after the use of both methods. The method is perfectly 

 rational, and we might expect on a priori grounds that fresh serum, 

 containing its full amount of complement and thermolabile opsonin, 

 would be of more benefit than stale immune serum. With the 

 idea of causing an increased outflow of preventive substances 

 from the patient's blood by producing a mild aseptic inflammatory 

 process, Briscoe has injected dilute carbolic acid solutions and 

 other fluids into the cerebro-spinal canal, but without success. 



The treatment by vaccines has not attracted much attention, 

 but in the subacute and chronic cases it is well worthy of a trial. 

 I have used it in four cases, with three recoveries and one death. 

 These figures are not sufficiently great to argue about, but what 

 was most obvious was the very decided clinical improvement 

 which followed almost every dose. This occurred too frequently 

 to be mere coincidences, and as these patients were all young 

 children the question of their being due to a mental effect need 

 not be considered. The dose has been 250 millions, increasing to 

 500 millions, and 1,000 millions, and no bad effects have been 

 noticed. They have been usually regulated by opsonic control, 

 and the improvement in the general condition as the index rises 

 appears to me to be more definite in this disease than in most 

 others. It need hardly be pointed out that no form of specific 

 treatment will cure the obliteration of the foramina in the roof of 

 the fourth ventricle and consequent hydrocephalus, which is so 

 frequently present in these chronic cases. 



In some cases the index shows a very marked rise (to 10 or 

 more) as a result of a single injection of a homologous vaccine, 

 whilst in others the reaction is much less, and the level does not 

 rise much above unity. It is probable that these two types of 

 reaction correspond to infections with the cerebro-spinal and basic 

 meningitis types of organism, but the cases show no obvious 

 clinical difference. 



Malta Fever. 



The toxin of Malta fever appears to be an endotoxin. Killed 

 cultures are decidedly toxic for animals, and their prophylactic 

 use in moderate doses has been followed in some cases by the 

 development of chronic aseptic abscesses (Eyre, Bousfield). 

 The type of immunity is not known ; no bactericidal substance is 



