CHAPTER LV 



UNDULANT FEVER 



Synonyms — • Definition •— History — Climatology — ^Etiology — Pathology — 

 Symptomatology — Diagnosis — Prognosis — Treatment — Prophylaxis — 

 Para-undulant fever — References. 



Synonyms. — Mediterranean fever, Malta fever, Melitensis septicaemia, 

 Melitococcaemia, Bruce's septicaemia, Goat fever, Mountain fever. Slow fever 

 (Texas), Gibraltar fever, Neapolitan fever, Cyprus fever, Munhinyo (Uganda). 

 Latin : Febris Undulans, Febris Sudoralis, Septicaemia Melitensis. French : 

 Melitoccie, Fievre Caprine, Fievre Capriense. Italian : Febbre Mediterranea, 

 Febbre Maltese. German : Malta Fieber. 



Definition. — ^Undulant fever is a chronic, rarely an acute, febrile 

 disorder, with many undulatory relapses, caused by Micrococcus 

 melitensis Bruce, 1893, and probably other closely allied germs, and 

 usually spread by the agency of goat's milk. 



' Remarks. — It seems certain that, like enteric, the term ' undulant 

 fever ' may cover in reality a group of infections due to very 

 closely allied germs. Negre and Raynaud have described a Micro- 

 coccus par ant elitensis, and previously to them Sergent and Zammit a 

 M. pseudomelitensis. These germs have been proved to differ 

 biologically from the common type of M. melitensis by means of 

 agglutination and absorption tests. 



History. — ^Undulant fever has probably existed in the neighbour- 

 hood of the Mediterranean for centuries, and passages are cited 

 from Hippocrates recounting cases of long-drawn-out fevers, with 

 short apyrexial intervals lasting as long as 120 days, which may 

 perhaps refer to the disease. 



In the eighteenth and the early part of the nineteenth centuries 

 references were made to protracted fevers occurring in Malta by 

 various observers — e.g., Howard in 1786, Hennen in 1816-25, 

 Davy in 1842-62 — but it is difficult to be certain what disease is 

 referred to. During the Crimean War there appears to have been 

 a very large temporary increase of the fever incidence in Malta, 

 much of which was undoubtedly enteric, but some of it was not. 

 The change in the type of fever appears to have been so marked 

 that some people thought that a new disease had been imported 

 from the Crimea by the returning troops. 



In 1859 Marston, who personally suffered from the fever, first 

 gave an accurate account of its clinical history and post-mortem 

 appearances under the term ' Mediterranean remittent ' or * gastric 



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