CHAPTER XVII 



MALTA FEVER 



History. It has long been known that a fever prevalent on the 

 shores and islands of the Mediterranean differs from those of other 

 regions. It is not malarial, nor typhoid, nor typhus. It is a low, long- 

 continued fever with a low mortality and characterized by a chronic 

 course accompanied by slow but progressive emaciation. It has been 

 given many names, such as Malta, Mediterranean, Cyprus, Gibraltar 

 and Neapolitan fever. It has prevailed extensively on the island of 

 Malta and has afforded a field of research for English physicians sta- 

 tioned there. There have been some differences of opinion as to 

 whether or not it is included among the diseases described by Hippo- 

 crates. Since the means for its positive identification have been placed 

 in the hands of the profession, its distribution has been found to be 

 much wider than was formerly supposed. Besides the Mediterranean 

 shores, it has been found in India, China, the West Indies, South 

 America, the Philippines, and in Texas. Cases are reported in most of 

 the great ports of the world among those who have visited infected 

 regions. The specific cause was discovered by Bruce in 1887 in the 

 spleen of a man who died of the disease at Malta. 



The Organism. This is known as Micrococcus melitensis and is 

 one of the smallest of the bacteria, having a diameter of about 0.4 of a 

 micron. It may be seen as isolated bodies, in twos, and in chains. On 

 certain media it is more ovoid than spherical and in this form it 

 is regarded as a bacillus. It is non-motile, save the molecular oscilla- 

 tions seen in all small suspended bodies, and takes the ordinary basic 

 aniline stains readily and deeply. On artificial culture media it 

 grows slowly with the temperature of the animal body as its optimum. 

 Under 6 and above 45 C. it does not multiply. It does not liquefy 

 gelatin and develops very slowly in this medium, requiring about five 

 days at 22 to show recognizable colonies. On agar plates the colonies 

 are not always visible to the unaided eye and when seen through a 



