196 
Spain— Gibraltar ; Islands of the Mediterranean — Balearic Islands, 
Corsica, Sardinia, Sicily, Malta, Gozo, Cyprus, Crete; Italy — Rome, 
Naples, Caserta, Benevento, Campobosso, Aricca, Terano, Fermo, 
Padua, Cittanova, etc.; Greece — Athens, Cephalonia; Turkey — Con- 
stantinople, Smyrna; Palestine — Jerusalem; Africa — -Tunis, Algiers, 
Alexandria, Suakin, Massowah, Zanzibar, Kimberley (?), Aden; 
India — Calcutta, Mian-Mir, Xowshera, Secunderabad, Simla, Delhi, 
Lucknow, Agra, Allahabad, Choabattia, Subatha, Assam, Swat Val- 
ley; China — Hongkong; Philippine Islands; Fiji Islands; North 
America — Mississippi Valley ( ?) ; West Indies ( ?) — Cuba ( ?), Porto 
Rico (?) ; South America — Venezuela, Brazil, Montevideo. 
Malta fever is a general infection not unlike other specific bacte- 
remias, such as typhoid fever. The Micrococcus melitensis is found 
especially in the spleen and also in the blood. The inoculation of 
pure cultures of this organism into monkeys produces a prolonged 
febrile disease similar to Malta fever. There have been several in- 
stances of the inoculation of pure cultures into man, both intention- 
ally and accidentally, which were followed by the characteristic 
symptoms of the fever after an incubation period of from five to 
fifteen days. Little doubt, therefore, remains that the organism is 
the true cause of the disease. 
From the standpoint of prophylaxis it is of the first importance 
to determine the channel of infection by which the micrococcus enters 
the body. In the cases before mentioned in which the disease was 
produced by inoculating pure cultures of the Micrococcus melitensis 
into man, in one instance the culture was accidentally introduced into 
the conjunctival sac; in the others, by subcutaneous inoculation. One 
case which arose in England is supposed to have been conveyed from 
son to father by using a clinical thermometer in the mouth imme- 
diately after its use by the patient. From experimental evidence, 
therefore, it would appear that the infection of Malta fever may be 
taken in through wounds, the mucous membranes, or by food and 
drink introduced into the mouth. There is no evidence that the 
disease is directly contagious from the sick to the well. 
Malta fever occurs especially in the officers and men of the British 
army and navy stationed at Malta and Gibraltar. All authorities 
recognize the influence of unfavorable hygienic conditions as an etio- 
logical factor of the greatest importance in prophylaxis. Sex has 
no predisposing influence and every age is prone to attacks, but it 
occurs mostly between the ages of 6 and 30 years. 
In Malta the greatest incidence of the disease is in the hot, dry 
month of July. Chilling of the surface, bodily and mental depres- 
sion, etc., are quoted as incidental causes. 
The morbid process is that of a general infection and is seen espe- 
cially in the condition of the spleen, which is enlarged, soft, even 
