BRUCELLOSIS AND ITS TREATMENT

OBSERVATIONS — PRELIMINARY REPORT.

EDWIN C. MICK, M.D.

East Orange, N. J.

Introduction. Hippocrates referred to an intermittent fever that could very possibly have been undulant fever. If that is so, the disease we know today as brucellosis was already known as long ago as 400 B.C. It is certainly known to have existed along the shores of the Mediterranean for five or six hundred years. It was not until the 18th Century that the medical world made a special study of it. The name “Malta Fever” was applied to it about this time.

Murston was the first author to describe it accurately and differentiate it clinically and pathologically from typhus and typhoid This was in 1859. Wright and Douglas, in 1897, published the result of experiments proving that the disease could be diagnosed by the sero-agglutination method.

In 1904, the British Admiralty and War Office sent an investigating committee to Malta to study the disease. After three years, this body compiled an exhaustive report. Our present knowledge of undulant fever is based on that report.

The causative factor, according to Dr. Bruce, one of the commission, was the Micrococcus melitensis, in later years known as the brucellosis bacillus. It is found in the liver, kidneys, spleen, lymphatics and salivary glands, in the blood, bile, urine and milk.

It is very widely distributed throughout the entire world and is truly described, in contemporary literature, as a cosmopolitan disease. It has been erroneously diagnosed as rheumatic fever, typhoid, typhus, malaria or kala-azar. The diagnosis will be clarified by the result of agglutination tests and hemocultures.

The symptoms will be fairly well described in the case reports to follow. They vary from one case to another, but have a fairly typical general picture.

CASE REPORTS

Case 1. Mrs. D., 35 years old, weight 130 pounds.
Symptoms:

  1. Extreme fatigue, beginning 1940.
  2. Daily headaches.
  3. Abdominal pains with intestinal upsets.
  4. Troublesome dysmenorrhea.
  5. Pains in hips and arms, knees and other joints.
  6. Recurrent fever of 99°-102° F. every six to eight weeks, lasting from three to five days. During this time the above symptoms were intensified.

Appendix, removed 1946; it was normal. X-rays of hips and other joints in 1946 were all negative. Definite diagnosis of undulant fever was made in 1946.

Brucellosis abortus vaccine was given bi-weekly with considerable alleviation of symptoms. The fever still returned at same intervals, with the same symptoms, somewhat diminished.

March 1953. Started taking 3000 mg. daily of ascorbic acid. Shortly afterwards the patient moved from this neighborhood.

June 1954. She wrote as follows:

  1. General health greatly improved.
  2. No fever since July 1953.
  3. Feel better than at any time in past eleven years.
  4. All former symptoms have disappeared, except occasional headaches.

November 3, 1954 she wrote again:

  1. Fatigue all gone.
  2. Abdominal pains gone.
  3. Have occasional pains in joints, but they are not a problem. All other symptoms have disappeared.

Case 2. Mr. 5., 52 years old, height 6 feet 2 inches, weight 129 pounds.

Symptoms (beginning July 1947):

  1. Severe pains and stiffness in joints.
  2. Daily fever, increasing up to 8 P.M., when it fairly consistently reached 102° F.
  3. Sleepless nights, bed sweats, loss of appetite, feeling of discouragement and defeat.
  4. Extreme fatigue, loss of weight.

Since 1947 he had spent nineteen months in a hospital and had been unable to work for three years.

September 1953. Started 3000 mg. daily ascorbic acid: no other treatment.

May 3, 1954.

  1. Weight 204 pounds.
  2. Except for a slight skin eruption, he is symptom-free, enjoying life, working full time.

Case 3. Mr. D. F., 28 years old, weight 140 pounds, height 5 feet 10 inches.

Symptoms (beginning about January 1951):

  1. Extreme fatigue.
  2. Attacks of fever, lasting two to four days, with 100°—102° F. These attacks recurred every two or three months.
  3. Pains in muscles of neck and left arm; burning sensation on top of head. These symptoms were constantly present, but intensified during attacks.
  4. Above symptoms were pretty much a routine occurrence for two years. He was forced to go to bed during attacks. Unable to hold a position. Great mental depression and discouragement.

November 1953. Started on 3000 mg. ascorbic acid daily. No other treatment.

June 8, 1954. All pains gone. No fever for four months. Fatigue still present but diminishing.

November 3, 1954. Symptom-free. Working full time. New outlook on life.

February 21, 1955. No further symptoms.

Case 4. Mr. E. 5., 56 years old, weight 125 pounds.

Symptoms (diagnosed as undulant fever, September 1948):

  1. Extreme fatigue; unable to work for two years.
  2. Pain in elbows, hips, hands and arms.
  3. Hands and arms numb and cold.
  4. Very hungry. Ate four to five meals a day, but lost two to three pounds a week.
  5. Tremors in arms and legs.

September 16, 1954. Started to take 4000 mg. daily ascorbic acid.

October 14, 1954, one month later, there was definite improvement.

February 23, 1955.

Case 5. Miss H. D., 38 years of age, height 5 feet 6 inches, weight 130 pounds. History of undulant fever since childhood. Definite diagnosis of brucellosis was made on several occasions.

Symptoms:

  1. Extreme fatigue. Unable to engage in any strenuous sports.
  2. Fever 99°-100.5° F. daily for years.
  3. Abdominal pains, spastic colon, chronic constipation.
  4. Profuse perspiration.
  5. Fear complex, restlessness, defeatism.

This patient has been taking 3000-4000 mg. of ascorbic acid daily for the past six months. There has been no apparent result. She has refused intravenous injections of sodium ascorbate. It may be that she is not getting sufficient absorption of ascorbic acid to be of any therapeutic benefit on account of the intestinal disturbance. This is her worst symptom.

Case 6. Mrs. R. H., 42 years of age, weight 120 pounds. Undulant fever from childhood.

Symptoms:

  1. Extreme fatigue.
  2. Pain almost constant in abdomen and back.
  3. Fear complex.
  4. Burning sensation in head.
  5. Dysmenorrhea for many years. Hysterectomy, 1951
  6. Frequent attacks of nausea

Mrs. H. has been taking 4000 mg. ascorbic acid daily since October 29, 1954. She has not had any evident result, and has consented to take sodium ascorbate intravenously.

From my experience in this treatment, sodium ascorbate 1000 mg. in 2 cc. ampules should be given intravenously two or three times a week from the beginning in all cases.

Case 7. Mr. W. M., 38 years of age. He states that in all probability he has had undulant fever since early childhood.

Early symptoms:

  1. During spells of sickness as a child, he remembers often feeling hot and cold, and being confined to bed two to four weeks. He lived in a remote area of Pennsylvania, and drank raw milk.
  2. He had spells of fatigue, and was unable to hold a position later in life.

Symptoms (November 11, 1954):

  1. Very depressed skeptical of proposed treatment.
  2. Took injections, brucellosis abortus vaccine, every two to three weeks. Feels “very low” just before injection. Compelled to go to bed two days after injection to recover from the reaction. Then felt better for a couple of weeks.
  3. Many pains daily, especially in leg muscles. Violent headaches.
  4. “Eyeballs feel sore.” Difficulty in reading.

November 11, 1954. Started taking ascorbic acid 6000 mg. daily; later reduced to 4000 mg. daily.

February 23, 1955.

Case 8. Mr. P. B., high school teacher, age 56 years.

Symptoms (January 14, 1955):

  1. Extreme fatigue.
  2. Fever 100°-104° F. Comes in cycles of three to five weeks.
  3. Pains in eyeballs; infection in lids.
  4. Pain in arms, legs, joints. Pains flit from place to place.
  5. At one period in his illness he ran a daily fever as high as 104° F. for seven months.
  6. Severe night sweats, sleeplessness, mental depression.
  7. Severe pain on moving from one position to another.

January 14, 1955. Started taking 4000 mg. ascorbic acid daily. February 20, 1955. Reports that he is very definitely improved. Almost free from pain; fatigue disappearing; appetite improved.

February 26, 1955. Having attack of fever; feeling quite miserable. Will resort to the intravenous method after two months if improvement is not more marked.

Case 9. Mr. F. S., age 48 years, weight 148 pounds, height 5 feet 8 inches.

Symptoms (January 18, 1955):

  1. Hot, burning sensation, with pressure on top of head.
  2. Sleeplessness, vision blurred.
  3. Pain below knees, especially in shin bones.
  4. Itching all over body.
  5. Fever. Has spells every two to four weeks; then fever of 99°— 101 ° F. is present for three to four days. All symptoms are intensified during these spells.
  6. Pain in elbows.
  7. Constantly fatigued since 1950.
  8. Nausea, slight, but good appetite. Eats well but does not gain weight.

January 18, 1955. Started to take 4000 mg. ascorbic acid daily.

February 28, 1955.

Case 10. Mrs. E. S., age 43 years, weight 120 pounds.

Symptoms (onset October 1950):

Present symptoms (January 18, 1955):

  1. Fatigue.
  2. Pain almost daily in muscles of arms, wrists and elbows.
  3. Headaches quite persistent and almost daily.
  4. Sense of failure and defeat. Takes one to two hours rest every afternoon.
  5. Frequent nausea, but appetite good.

Present condition (February 28, 1955):

Case 11. Miss F. S., 19 years of age, weight 145 pounds. When seventeen years of age had an attack of undulant fever. Positive test for brucellosis in 1952.

Present symptoms (December 30, 1954):

  1. Extreme fatigue; subnormal temperature.
  2. Ankles swollen.
  3. Severe headaches.
  4. Dizzy on changing position.
  5. Has given up college for remainder of year.

Between ages of seventeen and nineteen, the patient was in fairly good health. With the exception of a considerable measure of physical inertia, there were no other symptoms relevant to undulant fever, In all probability she had undulant fever between the ages of 15 and 17 when she had the above symptoms, with one exception. When 15 to 17 years old, she ran a consistent fever of 99° F. No fever during present attack.

Present condition (February 28, 1955):

Case 12. Mr. B. S., 17 years old, weight 130 pounds, height 5 feet 9 inches, high school student.

Present symptoms (onset 1950):

  1. Pains in tibiae.
  2. Fatigue unable to participate in any strenuous sports.
  3. Father reported the boy frequently appeared mentally dull. It was an effort to make him understand simple solutions, but he made good marks in school. This was probably due to a lack of concentration.
  4. He liked to remain in bed all day.

January 18, 1955. Started to take 4000 mg. ascorbic acid daily.

February 28, 1955. Mother said he was definitely improved less fatigue; pains gone; symptom-free. It will require another month or two to make a proper appraisal.

DISCUSSION

The therapeutic use of ascorbic acid was suggested to the writer by reading reports, one by Dr. W J. McCormick,1 who reported spectacular results. He stated that “he has found ascorbic acid by mouth and sodium ascorbate intravenously better than any or all of the antibiotics for infectious diseases, bacterial or viral.”

Patients suffering from brucellosis have remissions during which time they are almost free from symptoms. This is especially true of the less severe cases. In considering new cases, this must be taken into consideration. Accurate appraisal can be made only after close observations carried out over a year or longer.

If this treatment proves to be effective for undulant fever, its possibilities are great. In New Jersey alone, some authorities say that there are probably 30,000 new cases yearly. Some authorities believe that as much as 10 per cent of the entire rural population of the United States is infected. Statements similar to the above will be found in a booklet by Dr. Alice C. Evans,2 entitled “Crippler in Disguise,” the story of undulant fever in America, published by the National Society for Crippled Children and Adults. This would make the number of cases of undulant fever in the entire United States around 8,000,000. The United States probably pasteurizes as high a percentage of its milk as any country in the world. Therefore, the number of cases throughout the world, where the raw milk of cows and goats is used, must be staggering.

The author believes that this preliminary study justifies the interest of those who have better opportunities to study this Problem on a suitable scale.

SUMMARY

  1. Twelve cases of undulant fever treated with large doses of ascorbic acid are described briefly.
  2. It would appear that this treatment has much to offer.

REFERENCES

1. McCormick, W. J.: Ascorbic Acid as a Chemotherapeutic Agent. ARCH. PEDIAT., 69: 151-155, April 1952.

2. Evans, Alice C.: Crippler in Disguise. Pub. by National Society for Crippled Children and Adults.

From Archives of Pediatratics, Volume 72, Number 4, April, 1955, pp. 119-125.

[Note: The original article was densely formatted with many contiguous sentence fragments in paragraph format. In the interest of clarity, numbered and bulleted lists have been used instead, with rules added between patient records. Content and enumeration (where employed) are unchanged .  -AscorbateWeb ed.]

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