UNDULANT FEVER 195 



child appears to have a congenital immunity as early infection is rare, 

 according to the experience of some. Still it would be advisable to 

 interdict the woman, whose mammary secretion was infected, from 

 suckling her infant. 



It is worth knowing too, that horses, mules, cows, and sheep may 

 all become naturally infected, that milk products may harbour the 

 germ, and that the latter is fairly resistant outside the body. 



The malignant types cause death from hyperpyrexia or the typhoid 

 state during- the second or third weeks. 



The intermittent types last from six weeks to six months without 

 serious symptoms. 



The ambulatory types are dangerous as carriers of disease. 



COMPLICATIONS. 



Intestinal ulcers, haemorrhage, persistent vomiting, diarrhoea, 

 hyperpyrexia, pneumonia, pleural effusion, cardiac failure, orchitis, 

 parotitis, arthritis, neuralgia. 



DIAGNOSTIC FEATURES. 



The prolonged undulant fever. 



The profuse sweatings. 



The arthritic symptoms. 



The agglutination test. 



Exclude typhoid by a Widal reaction (see p. 611). 



Exclude malaria by blood parasites. 



Exclude kala-azar by spleen puncture. 



TREATMENT. 



Entirely symptomatic. General principles hold good. 



The utmost nursing care is needed. Be careful to change the 

 clothes after sweating. The heart and lungs must be carefully 

 watched. 



Vaccine and yeast therapy can be tried. 



Give 100-500 millions of autogenous germs as a vaccine. 



Give yeast, dr. ii, twice dailv. 



Avoid goat's milk in endemic areas or sterilize it before using, 



Leave the district as soon as possible. 



PROPHYLAXIS. 



This is all important. In Gibraltar this fever disappeared after the 

 goats were removed. In Malta the case incidence amongst the British 

 troops was reduced from 643 in 1905, to 7 in 1907 and i in 1910. 



(i) General measures. Notification, isolation, disinfection, steril- 

 ization of water and milk, good hygiene. 



