MALTA FEVER. 499 



in the Caribbean Sea, Porto Rico, in Hongkong, 

 Manila, and in India. Historically, it has been 

 traced to the beginning of the nineteenth century, 

 but it was first described as an independent disease 

 by Marsten in 1859. It is said to be extending. 

 The disease usually runs a long course, which is 

 somewhat typhoidal in character, and there may be 

 one or more relapses. The spleen is enlarged, but 

 the intestines are not involved. 



"It is distinguished from typhoid by its long du- 

 ration, sometimes extending over many months; 

 by a course of fever exhibiting marked undula- 

 tions; by the occurrence of copious perspirations; 

 by the frequent appearance of rheumatic articular 

 disorders as well as by neuralgia and inflammation 

 of the scrotum and epididymis" (Scheube). It 

 occurs especially in the summer months. The 

 incubation period is about fifteen days. 



Basset-Smith found the serum in practically all 

 stages of the disease and in convalescence to have 

 little or no bactericidal power for the coccus. Nor- 

 mal serum appeared to be more bactericidal than 

 that of the patients, although such an action was 

 often missed in normal serum. Wright says that 

 normal human serum is devoid of bactericidal 

 power for the organism. Basset-Smith also con- 

 cluded that the phagocytic power of the patient's 

 leucocytes is less than in the case of normal leuco- 

 cytes. According to Wright, the organism "is em- 

 inently sensible to the opsonic action of the nor- 

 mal serum," under the influence of which it is 

 taken up in large numbers by the leucocytes. 



Agglutination by the serums of patients takes 

 place in dilutions varying from 1-300 to 1-2000 



