Medicine: Feeling Rotten?

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Any patient with chronic symptoms that are hard to diagnose should be suspected of having chronic undulant fever. That is, if he has ever drunk unpasteurized milk, as who has not? This is the conclusion which two Indiana small-town doctors, Neal Davis of Lowell (pop. 1,450) and Dan L. Urschel of Mentone (pop. 730), reached independently after seeing many such cases. Nobody paid much attention to this mild form of undulant fever until Drs. Urschel and Davis began calling attention to it in the Indiana State Medical Association Journal.

No Cure. In contrast to the well-known acute form, chronic patients usually have little if any fever and may report any combination of 34 different symptoms. The most common symptom is tiredness.

"The patient," says Dr. Davis, "gets up tired and feels as if the morning will never end. By noon he gains strength and by evening he feels pretty good. Weakness usually occurs in the hips and knees. Frequently patients say their knees buckle out from under them and they actually fall. Spells of sleepiness may accompany the weakness, and at times it is necessary to rule out epilepsy because of the similarity with this disease."

Dr. Urschel says that 48 out of 124 chronically ill patients had undulant fever (he uses skin tests as well as symptoms in diagnosis). The average chronic undulant fever patient had been sick three years, eight months. Both Drs. Urschel and Davis treat patients with undulant fever vaccine in small, gradually increasing injections, spread over several months; and both refuse to consider any patient cured, because relapses are fairly common.

Whether acute or chronic, the disease rarely kills anybody. But it often makes a patient wish he were dead. Between 11 and 20% of U.S. dairy cattle are infected with the undulant fever organism in one of its three forms. Most dangerous to man is Brucella suis. Experts used to guess that 10% of U.S. citizens were infected with Brucella and that 1% of those infected were ill with undulant fever at any one time. But the work of the Indiana doctors may eventually prove that there are many more than that.