CHAPTER XXI
UNDULANT FEVER
FEBRIS UNDULANS, MALTA FEVER, MEDITERRANEAN FEVER
Definition.— Undulant fever— a disease of low mortality, indefinite duration, and irregular course —is the result of infection by a specific germ, the Micrococcus melitensis. In its more typical form it is made up of a series of febrile attacks, each individual attack, after lasting one or more weeks, gradually subsiding into a period of absolute or relative apyrexia, also of uncertain duration. Common and characteristic complications are rheumatic-like affection of joints, profuse diaphoresis, anaemia, liability to orchitis and neuralgia.
Geographical distribution.— Undulant fever was somewhat unfortunately named Malta fever, for we now know that the disease which was so designated is not, as was formerly supposed, confined to Malta, or even to the Mediterranean. It is very common there, particularly in Malta and the eastern and southern littoral of the Mediterranean; but recent investigations show that it occurs in Italy, France, Spain, the Red Sea littoral, India, China, South Africa, Somaliland, West Africa, the West Indies, the Brazils, the United States, and even in England. I have seen two cases which originated in England; they gave the serum reaction.*[1] It is highly prob-
- ↑ * Experience has taught me to place little reliance on the serum-reaction test as ordinarily applied. Although with fresh blood and reliable cultures the reaction may be trustworthy, with stale blood and questionable cultures this test is most untrustworthy. Time after time, in London, I have got contradictory laboratory reports on blood from the same patients, presumed to have Malta fever. If the cultures in the London laboratories be so manifestly unreliable, it is probable that many of those in use in India and America are equally so, and that inferences as regards the geographical distribution of this disease, founded on the behaviour of these cultures with blood serum, are most un-
