652 Malta or Mediterranean Fever 



The report of " British Government Commission for the 

 Investigation of Mediterranean Fever," published by the 

 Royal vSociety, April, 1907, has greatly elucidated our knowl- 

 edge of the pathogeny of the disease by showing that the 

 Micrococcus melitensis leaves the body of the patient in the 

 urine and in the milk. It has not been found in the saliva, 

 sweat, breath, or feces. The discovery of the organism in 

 the milk suggested that it might be through milk that the 

 disease organisms were disseminated, and an investigation of 

 the goats at Malta, where the disease is most prevalent, and 

 their milk most generally used, showed that a large per- 

 centage of the animals were infected with the specific cocci. 

 The commission has, therefore, concluded that it is by 

 goats' milk that the disease is commonly disseminated, 

 though they point out that fly-transmission is also possible. 

 In the Colonial Office Report on Malta in 1907 it was shown 

 that over 40 per cent, of the goats of Malta gave the serum 

 reaction, showing that they had had the disease, while 10 per 

 cent, of them were actually secreting the cocci in their milk. 

 The authorities permit no milk to be used in the garrison 

 unless it is boiled, and notice that by this simple measure 

 the incidence of the disease, which was 9.6 in 1905, had 

 fallen to 2 in the corresponding month of 1906. In Report 

 VII. of the Mediterranean Fever Commission (1906-07) we 

 read: 



"The epidermologists are led to believe that quite 70 per cent, of 

 the cases are due to the ingestion of goat's milk." In their opinion 

 ordinary contact with the sick, conveyance of infection by biting insects, 

 house flies, dust, drain emanations, food (other than milk), and water, 

 play a very subordinate part, if any, in setting up Mediterranean fever 

 in man. The excellent results following the preventive measures di- 

 rected against goat's milk in barracks and hospitals also point to goat's 

 milk as being the chief factor. Among 'the soldiers this resulted in a 

 diminution of about 90 per cent. 



"For example, in the second half of 1905 there were 363 cases of 

 Mediterranean fever, whereas in the corresponding part of 1906 there 

 were only 35 cases. Among the sailors there was also as marked a fall 

 in the number of cases. The Naval Hospital had a bad reputation, as 

 about one-third of the cases of fever occurring in the fleet at Malta 

 could be traced to residence in this hospital, either as patients suffering 

 from other diseases or among the nursing staff. The goats supplying 

 the hospital were found to be infected, and since their milk was absolutely 

 forbidden, not a single case of Malta fever has occurred in or been traced 

 to residence in this hospital." 



