Treatment 493 



tased upon a study of the agglutinative phenomena. Their conclu- 

 sions are: 



1. Prognosis is unfavorable if the agglutinating reaction is persistently low. 



2. Also, if the agglutinating reaction rapidly fall from a high figure to almost 



zero. 



3. A persistently high and rising agglutinating reaction sustained into con- 



valescence is favorable. 



4. A long illness may be anticipated if the agglutination figure, at first high, 



decreases considerably. 



The agglutination reaction appears early, is available by the 

 end of the first week, and often persists for years after convalescence. 



The organisms may sometimes be cultivated from the blood taken 

 from a vein, but are more certainly to be secured by splenic puncture. 



Pathogenesis. — The micro-organism is not pathogenic for mice, 

 guinea-pigs, or rabbits, but is fatal to monkeys, goats, dogs, horses, 

 asses, and mules, when agar-agar cultures are injected beneath the 

 ■skin. 



Bruce not only succeeded in securing the micro-organism from the 

 cadavers of Malta fever, but has also obtained it during life by splenic 

 puncture. 



Accidental inoculation with Micrococcus melitensis, as by the 

 prick of a hypodermic needle, is almost invariably followed by an 

 attack of the disease. Six cases of this kind in human beings have 

 ■occurred in connection with bacteriologic work on Malta fever at 

 Netley and two additional at the Royal Naval Hospital at Haslar 

 and in the Philippines.* 



Treatment. — The treatment of Mediterranean fever by means of 

 hacterio-vaccines has been attempted with what seems to be glit- 

 tering results by Bassett-Smith. f 



Sanitation. — The report of " British Government Commission for 

 the Investigation of Mediterranean Fever," published by the Royal 

 Society, April, 1907, has greatly elucidated our knowledge of the 

 pathogeny of the disease by showing that the Micrococcus melitensis 

 leaves the body of the patient in the urine and in the milk. It has 

 not been found in the saliva, sweat, breath, or feces. The discovery 

 of the organism in the milk suggested that it might be through milk 

 that the specific organisms were disseminated; and an investigation 

 of the goats at Malta, where the disease is most prevalent, and their 

 milk most generally used, showed that a large percentage of the 

 animals were infected with the specific cocci. The commission has, 

 therefore, concluded that it is by goats' mUk that the disease is, com- 

 monly disseminated, though they point out that fly-transmission is 

 also possible. In the Colonial Office Report on Malta in 1907 it was 

 shown that over 40 per cent, of the goats of Malta gave the serum 

 reaction, showing that they had had the disease, while 10 per cent. 



*See Wright and Windsor, "Jour, of Hygiene," 1902, 11, p. 413. 

 t "Journal of Hygiene," 1907, vu, p. 115. 



