EEVIEW TROPICAL MEDICINE, ETC. 119 



8. Infection by contaminated dust was found rarely, if ever, to occur. Malta Fever 



9. It was definitely proved that the organism in the vast majority of cases, reaches the human body by way — conlinued 

 of the alimentary canal. 



10. Infection by the agency of mosquitoes and other biting-flies is of the rarest occurrence. 



11. The infection, as is now well known, takes place by the ingestion of contaminated goat's milk. Ten per 

 cent, of the Maltese goats were found to secrete the micrococci in their milk and 50 per cent, of these animals 

 gave the specific agglutination test when their bloods were examined. 



Malta fever disappeared from Gibraltar because the Maltese goat has disappeared from that station. 



12. Another mode of infection is probably by the absorption of the urine of infected patients. 



13. Preventive measures, on the lines indicated by this important discovery, have already resulted in very 

 marked benefit, and there is every hope that the disease will be stamped out from the garrison in Malta. 



Basset-Smith,^ in a somewhat similar and more recent review, mentions in addition: — 

 (a) The constant presence of the organism in the peripheral blood of cases suffering from the disease. 

 (6) The presence of the infective organism in the urine of apparently healthy men. 



(c) The infection of other domestic animals (mules and dogs), although goats are those chiefly implicated. 



(d) The occurrence of localised epidemics. 



(e) Complete cessation of cases where infected milk was removed from the dietary or when it was properly 

 sterilised. 



(/) The question of "protective inoculation." — This still remains sub jtuHce. 



((/) The question of treatment. The use of anti-sera and vaccines has proved disappointing. As regards drugs, 

 quinine in large doses is harmful. Salicylate of quinine may do good in combating the insomnia and persistent 

 neuritis of the later stages. Arsenic and iron are indicated for the cachexial and strychnine for cardiac irritation. 



(}i) Pathologically there is evidence that the condition is a general septicsemia, as witness various local lesions 

 such as ulceration of the small intestine. 



Leishman- considers that it is very desirable that investigation should be directed 

 towards ascertaining the line of communication from diseased to healthy goats. He 

 suggests that the disease might be attacked by immunising those animals by means of 

 injections of attenuated cultures of the micrococcus, and cites the good results achieved by 

 this method in cholera (Haffkine) and in plague (Strong). 



Davies' doubts if milk is the only source of infection, and has seen cases which suggest 

 that the mosquito may be a vector. He found that the disease was four times as common 

 in children who consumed unboiled milk as in those drinking boiled milk. 



Williams^* cites a case of a woman, suffering from Malta fever, who gave birth to an 

 infected child. The colostrum contained M. meUtensis. On the fifth day after birth, the 

 child's blood was found to give the agglutination reaction in a dilution of 1 in 500. 



Brayne= gives a good account of 26 cases met with in India. They departed from the 

 classic type met with in the Mediterranean in many particulars. The following are the 

 chief points noted, and one records them because it is very probable that cases in the 

 Sudan will be found to conform to this Indian type, the climatic conditions and general 

 surroundings in both countries being more or less similar. Brayne's cases all gave the 

 agglutination test : — 



1. The fever is irregular, lasting any time from one week to two months. 



2. There was a tendency in the severer cases for the fever to be of a high-continued or remittent type for 

 two weeks or so, and, if the patient lives, to then assume an intermittent character. 



3. There was a great tendency towards the rapid development of anaemia. 



4. The pulse was noted to bear no relation to temperature, thus a weak dicrotic pulse of 108 was often seen 

 with a practically normal temperature, and within half-an-hour the rate might have fallen to 60. 



5. The very profuse sweating was most characteristic, and as a result the patients had a characteristic smell. 



6. There was complete absence of joint symptoms. 



7. The spleen was somewhat characteristic, in the majority of cases, being just palpable, very hard and, if 

 tender, very slightly so. 



' Basset-Smith, P. W. (January -Ith, 1908), "Recent Work on the Cause, Prevention and Treatment of 

 Mediterranean Fever." Lancet, p. 21. 



"- Leishman, W. B. (January 4th, 1908), "Recent Work on the Cause, Prevention and Treatment of 

 Mediterranean Fever." Lancet, p. 21. 



3 Davies, A. M. (January 4th, 1908), "Recent Work on the Cause, Prevention and Treatment of 

 Mediterranean Fever." Lancet, p. 21. 



■• Williams, E. M. (July, 1904), "Mediterranean Fever: Infection in Utero." Journal of the Royal Army 

 Medical Corps, Vol. IX., No. 1. 



^ Braync, F. W. (December, 1907), "Notes on 26 Cases of Malta Fever in the Native of India." r7idian 

 Medical Gazette, p. 441. 



• Article not consulted in the original. 



