Notes on Mediterranean or Malta Fever / by David Bruce, [M. Louis Hughes and Sinclair Westcott].

David Bruce

Date:: [date of publication not identified]

Credit: Notes on Mediterranean or Malta Fever / by David Bruce, [M. Louis Hughes and Sinclair Westcott]. Source: Wellcome Collection.

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$Mkdical JoURNAf. incubator._ In these the characteristic growth appeared, after *57 hours, '■'be following chart illustrates the course of the disease. July. 1387 d 9 10 II 12 13 14 IS OAY 1 2 3 4 5 6 7 3 III' no 109 3 ■P. M ioa“ 2 3 0 P. 4 ID 7 2 p.r 1 • 106° 12 45 P. M. 10 6 -to Vw A i04 a r A * r t5i *t— 103 11 7 1 V Y SA 101 t 101 100° 99 a. 99 Pulse: 96 110 120 160 18L Resp 30 28 48 48 48 Stools 0 0 1 0 0 2 Cask iv.—.T. taged 22 years : duration of illness twenty-four days. The six tubes inoculated from the spleen showed the usual growth after the usual time. (See chart.) Case y.—G. W., aged 23; duration of illness fifty-three days. Inoculations were made from the liver, kidney, atid spleen, but all re¬ mained perfectly sterile except one, in which the usual growth appeared after several days. I can only account for this scarcity of the micro¬ organisms by supposing that most of them had died out owing to the long duration of the case. The following chart illustrates tlie course of the disease. AUGUS'i 1887 i 2 3 4- 5 6 7 8 8 10 II 12 13 1 + is 16 17 18 19 20 21 22 23 24 25 26 27 OAY i 2 3 4 S 6 7 8 8 10 n 12 13 14 15 16 17 18 18 20 21 22 23 24 25 26 27 —i.Q6 105 \ 104 Va r | 103 % 1 A A J \o{ \J ■4 7 V Y A r\ 4 \ 4 * k1 f a 131 w T AG V Y Y A 100° * / a 99 n CD C£j. 97 Pulse 104 96 100 tot 104 /OS. 102 104 102 IDO 102 too 38 96 100 39 104 IOC IOC too 96 96 Pesp 30 36 36 46 44 44 36 34 29 2 3 30 28 24 24 23 28 28 2 a 23 23 26 26 Sroou 2 0 0 0 3 0 2 5 3 1 i 1 0 O 2 0 0 1 4 0 0 2 0 1 0 0 8 SEPTEM BER. 1837 23 29 30 31 1 2 3 4 5 6 7 8 9 10 (1 12 13 14 15 16 17 13 19 20 21 22 OAY 28 29 30 31 32 33 34 35j36 37 38 33 40 41 42 43 44 45 46 47 48 49 50 51 52 53 m 1. 105 104 Y- A a 103 t ft * 7 vs A * T V* 7 Y A r J 7 Y Y I02 L A 7 u Hr- Y t T / s 0 . 101 / 7 T \ * I 100° T !r 0 99 23 97’ Pulse as 92 30 90 100 100 96 84 96 wo wo 96 100 96 wo 94 wo wo too io4 no nz 116 i/a 136 Pesp 24 24 22 22 24 24 22 20 24 76 30 27 28 28 28 26 31 34 34 38 36 32 41 40 43 Stool s 3 / I 0 0 3 0 0 1 3 4 5 4 3 2 4 3 2 ! 4 2 6 4 Case vi.—T. G., aged 23; duration of illness eight ,days. This case resembled one of typhoid very closely. The stools throughout were fluid and yellow, the abdomen tympanitic, and the tongue dry and brown. The post-mortem examination showed the organs congested. The spleen weighed 19 ounces ; no enlargement or ulceration of Peyer’s glands or other glands of the small intestine; large intestine normal. Six agar- agar tubes were inoculated from the spleen, and showed the character¬ istic growth of Malta fever on the fourth day. (See chart.) Case vii.—L. G., aged 22; died after a few days’ illness. The spleen was 22 ounces in weight. Five agar-agar tubes were inoculated and placed in the incubator. The characteristic growth appeared in all the tubes on the morning of the fourth day. Case viii.—C. D., aged 28; died on the eighth day of illness. Body that of a strong muscular man ; mesenteric glands not enlarged ; large and small intestines showed no appearance of glandular enlargement or ulceration. The spleen weighed 19 ounces, and was soft and pulpy. Six agar-agar tubes were inoculated from this organ and placed in the incu- ch °*t) ^ei ^our days the characteristic growth appeared in all. (Sec Case ix.—M. K., aged 21. Duration of illness thirty-four days. Post mortem appearances : Body much emaciated. Heart normal. Right lung adherent to the chest wall throughout; the adhesions evidently of long standing; substance of lung intensely congested, but no approach to consolidation. Left lung normal in appearance, except for some con¬ gestion at the base. Liver enlarged and congested. No trace of ulcera-/ tion throughout the whole length of the alimentary tract. Mesenteric glands normal. Spleen enormously enlarged and congested; weight 23 ounces. Although this seemed to be a typical case of Malta fever, none of the inoculations made into agar-agar tubes gave any result. Afterwards it was discovered that the nutrient medium used was ex¬ cessively alkaline in reaction, which accounted for the negative results. To these nine eases may be added nine examined by Sur¬ geon-Captain Hughes and two by Surgeon Gipps, R.N., in all of which the same micro-organism, shortly to be described, was demonstrated. From the foregoing twenty fatal cases of this disease it will be seen that in nineteen one and the same micro-organism was. found. I further made the attempt while in Malta, during the autumn of 1891, to grow this micro-organism from tlie tissues of the living subject by splenic puncture. Eight attempts in all were made, and of these two were successful, but the six failures were due to the use of an excessively alkaline nutrient medium in which the micro-organism would not grow. From the foregoing considerations I think the constant occurrence in the disease of a particular micro-organism can be held as proved. In regard to its non-occurrence in other diseases, I may mention that while in Malta I made inoculation experiments from several fatal cases of typhoid fever, and in each case cultivated a bacillus corresponding in size and manner of growth to the one described by Ebertli and Gaffky. In these test tubes a copious growth appeared on the agar-agar at the end of twenty-four hours-, being in marked contrast to the extremely slow growth of the micrococcus of Malta fever. In the same way dysentery, tuberculosis, pneumonia, and in fact every fatal case that occurred was made into a control experiment, but in no instance was there at any time culti¬ vated a microbe bearing the most distant resemblance to that found in the disease under consideration. Morphology and Cultural Characters of the Micro¬ coccus of Malta Fever. The Micrococcus Melitensis is round or slightly oval in form, and measures in dried preparations about 0.33y.. in diameter. It is therefore a very minute organism, and requires a magnifying power of 1,000 or 1,500 diameters. Viewed in a drop of water, unstained, the-microbes are seen as bright points in active molecular movement, the great majority of them single, a few in pairs, but never in chains.1 Like most micrococci, they possess no power of spontaneous movement. They can be readily stained in a watery solution of gentian violet, but Gram’s method is not applicable, as they become decolorised in the process. Treating specimens with alcohol at once removes all colour from the micro¬ organisms, even after fixing them with osmie acid, corrosive sublimate, or tannic acid. In nutrient peptonised broth, kept at 37° C., no change can be seen for the first few days, but after some time the fluid becomes decidedly cloudy, without any formation of pellicle on the surface. The best medium for the cultivation of this species is ordinary 1.5 per cent, peptonised agar-agar beef jelly. In stab cultures no change takes place for several days. Then the growth appears as minute pearly white spots scattered round the point of puncture, and minute round white colonies are also seen along the course of the needle track. After some weeks the colonies on the surface grow larger, and join to form a rosette-shaped colony, while the needle track becomes strongly marked, solid-looking and yellowish-brown in colour, with serrated edges. After the lapse of some months the growth remains restricted in area, and its colour deepens to buff. AVhen growing on the sloping surface of agar-agar and examined by transmitted light, the appearance of the colonies is somewhat different. At the end of nine or ten days, if kept at 37° C., some of the colonies are as large as No. 4 shot. They are round in shape, with an even contour, raised above the surface of the agar, smooth and shining. On holding up the tube and examining such colonies by Surgeon-Captain Hughes writes me that ho has succeeded in growing this microbe into short chains in hanging drop cultures.$

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Notes on Mediterranean or Malta Fever / by David Bruce, [M. Louis Hughes and Sinclair Westcott].

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