UN DU LA NT FEVER 191 



blood, sometimes from the urine, occasionally from the faeces. It can 

 be found in the spleen, kidneys, liver, lymphatic and salivary glands, 

 blood, bile, faeces, urine, milk, ? alimentary tract. It can live in dust 

 for two months and in water for one month. It has been found in 

 mosquitoes, but they are not proven infective agents. Monkeys have 

 been infected and the germ recovered. 



The organism has been found by agglutination in 50 per cent, of 

 Maltese goats examined and has been obtained from the milk of 10 per 

 cent. 



Milk is the chief medium bv which it is carried to man even though 

 but a little in tea is taken. Hence the rich suffer most and hospital 

 patients about the Mediterranean in particular. 



Captain Joshua Nicholson took sixty-live Maltese goats on board in 

 1905. An epidemic of undulant fever followed. Nearly all who drank 

 of the milk suffered. 



Perhaps goats become infected bv drinking human urine when 

 lacking salt : mules, asses, horses, cows, rabbits and foAvls can carry it 

 without being obviously diseased. 



Modes of Injection : — 



(i) By the alimentary canal (common). 



(2) By the respiratory system (rare). 



(3) By the cutaneous (very rare. Flies not proved). 



(4) By sexual intercourse (possible). 



PATHOLOGY. 



A general septicaemia is caused by the germ entering the blood- 

 stream by the alimentary mucosae. 



The spleen is enlarged and congested. 



Perhaps an attack produces immunity. 



The organisms produce liaMiioIysins, the body reacting bv produc- 

 ing agglutinins lasting four to ten years, also a specific serum which 

 can be used for immunization. 



P. M. 



Spleen enlarged, 10 to 44 ounces, congested, sometimes soft and 

 friable. 



Liver enlarged, congested, cloudy swelling or glomerular nephritis.. 

 The whole intestine congested, colon sometimes" ulcerated. 

 Lungs congested especially at the bases. 



SYMPTOMATOLOGY. 



Incubation six to fourteen davs. 



Onset insidious, headache, sleeplessness, anorexia, general mus~ 

 cular pains, perhaps vomiting and constipation for about a week. 



