PROGNOSIS—TREA TMENT 



1445 



Saisawa and later Missiroli and others have applied to Malta fever the 

 Bordet-Gengou complement-deviation reaction, but the technique is rather 

 complicated for routine work. 



The presence of a high opsonic index for M. melitensis may help the diag- 

 nosis. A precipitin test has been worked out by Vigano. 



The diseases from which Malta fever must be distinguished are 

 typhoid, recognized by a positive Widal reaction; malaria, recog- 

 nized by the presence of the blood parasites; and kala-azar, by its 

 parasite in the spleen juice. 



Prognosis. — • The prognosis in the usual form and the mild type is 

 good quoad vitam, the dangers being syncope and complications. 

 The sudden malignant type is rare, but very fatal. The mortality 

 is placed as low as 2 per cent, by Bruce, but others have reckoned 

 it as high as 13 per cent, for the army in Malta, and 9 per cent, for 

 the civilian population. 



Treatment. — ^The treatment is symptomatic, as no drug is known 

 which will kill the parasite, and vaccine and serum treatments 

 have not been very successful. The principal symptoms which 

 require treatment are fever, pain, gastric and intestinal disturbances, 

 congestion of the mouth and throat, nervous symptoms, and haemor- 

 rhages. Attention must be paid to the skin, lungs, and heart. 



The patient also requires the utmost care as regards nursing, 

 and in the acute stages the bed-pan should be used. Chills must 

 be avoided by the use of warm clothing, and the room should be 

 rendered gnat -proof to keep off flies. Care must be taken that the 

 bladder is emptied regularly. 



The fever is best treated by tepid sponging when moderate, and 

 cold sponging and ice-packs when severe. As regards pains, 

 headache is treated by bromides, with or without morphia, or small 

 doses of phenazone or phenacetin with caffeine may be used; pains 

 in the joints by hot fomentations with belladonna or opium ; general 

 pains by a hypodermic injection of morphia. Scott's dressing may 

 be applied to a swollen and painful joint, and pain in the soles of the 

 feet may be treated by cold-water applications. Vomiting is to 

 be treated as described under Malaria. Constipation is met by a 

 dose of calomel and a saline, and the bowels kept open by compound 

 liquorice powder or enemata. Diarrhoea is controlled by some 

 ordinary astringent mixture, or bismuth, or tannalbin powders in 

 some form, while Dover's powder is very useful, as it also relieves 

 pain. 



If the colon is affected, the treatment may be on the same lines 

 as for a mild attack of dysentery, boracic enemata being used. 

 Small doses of calomel — \ grain — three or four times a day as 

 an intestinal disinfectant, are useful. The dyspepsia may require 

 treatment on the ordinary lines. A mouth-wash of glycothymoline 

 or glycerine, borax, and myrrh, or listerine, should be used, and the 

 throat cleaned by an alkaline spray, and then astringed by a gargle. 

 The nervous symptoms are soothed by cool sponging, or by the 

 bromide and morphia mentioned above. Insomnia is a common and 



