MALTA FEVER 85 



at the same interval. The injections should be made deep into 

 the flank. There may be some local and constitutional disturb- 

 ance, but this is not usually very severe, and appears to be 

 diminished if a large dose of calcium lactate is given at the 

 same time as the injections, or shortly before. 



MALTA FEVER 



This disease occasionally causes mistakes in diagnosis in this 

 country, and its existence should be remembered in dealing with 

 patients who have travelled, especially in the neighbourhood of 

 the Mediterranean, and who suffer from chronic fever of obscure 

 nature. The diagnosis may be made either by means of a blood- 

 culture (see p. 163), or more conveniently by means of an 

 agglutination reaction, a culture of the organism (Micrococcus 

 melitensis) being used. There is no especial difficulty about the 

 technique, but it is advisable always to test the culture used 

 with two or three specimens of normal blood, as various strains 

 of the organism are found to differ greatly in sensitiveness. If 

 the culture to be used is found to clump- with normal blood, it 

 may still be used for the test, but in that case the patient's serum 

 must clump at a dilution two or three times as great as the 

 normal for the results to be of significance. Another point to 

 notice is that it is necessary to test the blood in a series of dilu- 

 tions, as sometimes a specimen will be found which clumps at a 

 high dilution but not at a low one ; the same thing is occasionally 

 seen in typhoid fever. 



The M. melitensis is a minute coccus, apparently motile, not 

 staining by Gram, and, in some cultures at least, of com- 

 paratively slow growth. Its appearances on agar are not 

 distinctive. 



Vaccine treatment has been used, apparently with some 

 success. 



GONORRHCEA 



Nothing is more certain than the fact that gonorrhoea can only 

 be diagnosed by bacteriological methods ; and every practitioner 

 is very strongly urged to practise himself in these methods and to 

 employ them in all cases. Leaving out of account the confidence 



