448 MALTA FEVER. 



to allow all the organisms to be killed. On these points, 

 however, further information is still necessary. Any anti- 

 microbic power which the serum may possess after the crisis 

 has not yet been demonstrated. It is further to be noted 

 that relapsing fever is unique amongst bacterial diseases 

 affecting the human subject, in respect of the enormous 

 numbers of organisms which can be observed in the circu- 

 lating blood during life. 



MALTA FEVER. 



Synonyms Mediterranean Fever: Rock Fever 

 of Gibraltar : Neapolitan Fever, etc. 



THIS disease is of common occurrence along the shores of 

 the Mediterranean and in its islands. Although from its 

 symptomatology and pathological anatomy it had been 

 recognised as a distinct affection, and was known under 

 various names, its precise etiology was unknown till the 

 publication of the researches of Surgeon-Major Bruce in 

 1887. From the spleen of patients dead of the disease he 

 cultivated a characteristic organism, now known as the 

 micrococcus melitensis, and by means of inoculation experi- 

 ments established its causal relationship to the disease. 

 His results have been confirmed by other observers, and 

 additional confirmatory evidence has been supplied by 

 means of serum diagnosis, as will be described below. 

 Bacteriological methods have therefore been the means of 

 differentiating the disease, and also of affording a more 

 exact basis for diagnosis. By means of the agglutinating 

 test Wright and Smith have shown that it occurs also in 

 some parts of India, and there can be little doubt that its 

 distribution will be found to be much wider than was 

 formerly supposed. 



The duration of the disease is usually long often two 

 or three months, though shorter and much longer periods 

 are met with. Its course is very variable, the fever being 

 of the continued type with irregular remissions. In addi- 



