1446 



UNDULANT FEVER 



distressing symptom, and trional and other hypnotics, and occa- 

 sionally opium preparations, may have to be administered. Haemor- 

 rhages must be controlled by rest, applications of ice, careful 

 regulation of food, and administration of adrenalin and calcium 

 chloride. The skin must be carefully watched, and prickly heat, 

 boils, or threatening bedsores promptly treated, and special care 

 must be taken that after sweating, which often occurs at night, the 

 clothes are changed. The lungs should be watched for signs of 

 congestion and pneumonia or pleurisy, which must receive the usual 

 treatment. The heart must be carefully studied, and digitalis, 

 strychnine, iron, or some other cardiac tonic administered as 

 required. 



Low diet is necessary during the attack; but if milk is used, care 

 must be taken that it is not goat's milk, or derived from an infected 

 source, otherwise, while treating the patient, a process of reinfection 

 may also be carried out. During the intermission the patient 

 should be given light nutritious food, care being taken to see that 

 it is really digested. 



Stimulants, in the form of champagne or brandy, are often 

 necessary in severe cases, because of the cardiac and general 

 depression. 



De Brum claims to have had good results in the treatment of Malta fever 

 by giving massive doses of quinine (i drachm daily). Gabbi uses thymol 

 enemata 



Scordo recommends intravenous injections of perchloride of mercury, while 

 Bassett-Smith and others suggest preparations of yeasts (2 drachms twice 

 daily), with the object of increasing the polymorphonuclear leucocytes, and 

 so of facilitating the destruction of the infecting organisms and also of reducing 

 the tendency to neuritis, which is a common feature of certain types of the 

 disease, and especially of those seen in Egypt. Summa and others have used 

 intravenous injections of protargol, and Marshall has obtained satisfactory 

 results in animals with salvarsan. 



Treatment by Serums and Vaccines.- — ^Serums have been prepared and used 

 by various authors, but the results have been disappointing. Vaccines at 

 times give better results, especially in protracted cases with low fever, and 

 Bassett-Smith has recommended that autogenous vaccines in doses of 100- 

 500 millions should be given According to some workers, these vaccines give 

 better results when administered intravenously in doses of 25-80 millions. 

 Various types of sensitized vaccines have been used and have given, at times, 

 fairly satisfactory results. 



Prophylaxis. — ^The prophylaxis appears to be simple and to consist 

 in the avoidance of goat's milk. The Gibraltar authorities have 

 completely stamped out Malta fever by prohibiting the importation 

 of goats from Malta, which, together with the diminution of the 

 disease in Malta, clearly demonstrates the great practical value of 

 the work performed by the late Commission. The average number 

 of cases in the British troops stationed at Malta before 1906 used 

 to be 240 per annum; since 1906 condensed milk only is supplied, 

 and the number of cases has steadily decreased, until in 1910 one 

 case only was recorded. It should be kept in mind, however, that 

 the source of infection is not limited only to the ingestion of con- 

 taminated milk, and importance should be given also to direct 



