Gargle with a weak antiseptic solution such as permanganate of potash or chinosol. An astringent gargle may be made by dissolving five grains or more of tannin in two ounces of hot water. Sulphate of iron can be used for the same purpose, two grains or more to an ounce of water. If there is much pain, apply poultices to throat. If due to syphilis give one grain of calomel and three grains of iodide of potassium, twice a day, in addition to the local treatment. Kharsivan, or similar treatment, is also indicated (_see_ p. 240). _Undulant (Malta) Fever._ The term Undulant Fever is applied to Malta Fever partly because the latter is not a good name, as the disease occurs in various parts of the world, and partly because the term Undulant affords a good description of the type of the temperature curve. _Cause._—The organism is a small bacterium, which is found in the blood and tissues. Although theoretically the disease can be spread like enteric fever or dysentery, in practice it is found that it is nearly always conveyed by infected goats’ milk. Goats are apt to harbour the organism and excrete it in their milk. It is also found in certain milk products, such as cream and cheeses which are not allowed to ripen. In addition to man and goats, cows, sheep, horses, mules and dogs, are all liable to natural infection. _Symptoms._—Incubation period 5 to 15 days. The disease begins with headache, malaise, anorexia, and sleeplessness. The patient is usually constipated, and there is tenderness in the splenic region, the spleen being enlarged at an early date. The temperature rises gradually for three or four days in a step-like manner, and then falls by a similar descent, reaching the normal on or about the tenth day. At this early stage bleeding from the nose may occur, and profuse night sweats are not uncommon. The tongue is flabby and coated. When the temperature falls the patient feels better for a few days, but is still apt to suffer from night sweats, and continues to lose flesh. A relapse occurs, and is usually accompanied by joint troubles and sometimes neuralgic pains. A series of febrile waves continues to follow each other at short intervals, and the illness is a very wearisome one, running an average course of 60 to 70 days. It may, however, extend for nearly a year, and in some cases terminates fatally. The long course of the illness results in the patient becoming anæmic, and he often suffers from mental depression. There are irregular forms of the fever which are apt to be puzzling, and it is always well to remember that any cases of prolonged pyrexia from tropical or sub-tropical regions may be Malta fever. _Prophylaxis._—Avoid drinking goats’ milk and eating the local products of such milk. If goats’ milk must be drunk it should be boiled. General hygienic measures are also important, and it should not be forgotten that the organism of the disease is found in urine, which should therefore be disinfected.