HISTOR Y—MTlOLOG Y 



blood-Stream, and also occurring in the milk, by means of which the 

 disease is conveyed to man. 



Eyre has made the suggestion that undulant fever was primarily 

 a disease of the goat, which had its origin in the Persian hills, and 

 has been carried by these animals all over the world. 



Prophylaxis on the lines indicated by the aetiology has resulted 

 in the reduction of the disease in British troops in Malta from 

 643 cases in 1905 to 7 cases in 1907, and i case in 1910. In 1906 

 Lamb and Pai proved that the organism existed in India in men, 

 while Foster did the same for goats. 



In 1912 Bassett-Smith drew attention to the fact that, though 

 the disease has been reduced by prophylactic measures, in some 

 places, it had spread to (or been diagnosed in) Spain, Portugal, and 

 France. In the same year Negre and Raynaud described M. para- 

 mditensis, and their findings have been confirmed by Bassett-Smith, 

 who has fully described a case of para-undulant fever contracted in 

 the South of France. 



Climatology. — ^The endemic areas of the disease are, undoubtedly, 

 firstly, the coasts and islands of the Mediterranean, Italy, France, 

 Greece, Spain, Northern Africa, the Levant, etc.; and, secondly, 

 India, especially the Punjab, where the causative organism has been 

 obtained in human beings and goats. We have met with cases in 

 Ceylon. Recently it has been reported from many other parts of 

 the world — in fact, it may be said to be cosmopolitan, and to extend 

 into the interior of the continents. A case contracted in Northern 

 Nigeria has been reported by Low. 



It is certainly a disease of tropical, subtropical, and temperate 

 climates, and exists, in addition to the localities mentioned, in 

 Russia, East and South Africa, Uganda, where it is called ' mun- 

 hinyo,' the Sudan, Mauretania, China, the Philippine and Fiji 

 Islands, North and South America, and the West Indies. It occurs 

 all through the year, but is more common in the warm weather in 

 Malta. 



etiology. — ^The cause, as has been indicated in the history, is 

 M. melitensis, and some extremely closely allied bacteria, M. para- 

 melitensis Negre and Raynaud, 1912, and M. pseudomelitensis 

 Sergent and Zammit, 1908, which can be differentiated by aggluti- 

 nation and absorption tests. M. melitensis is found in the spleen, 

 liver, kidney, lymphatic and salivary glands, the blood, bile, faeces 

 (rarely), and probably in the alimentary canal (as Eyre's researches 

 on rabbits indicate), the urine, and the milk. It does not occur 

 in the expired air, the sweat, the saliva, or in scrapings from 

 the skin. f 



It can be inoculated, and it may be found in the stomach of 

 mosquitoes which have fed upon patients, but neither they nor any 

 other biting fly, such as a Stomoxys, or a flea, have been proved 

 capable of spreading the disease. It is, however, very resistant, 

 and can live for eighty days in dust, or in water, fresh or salt, for a 

 month, but has never yet been found naturally in air, dust, soil, or 



