204 
In the examination of 103 cases of Malta fever for the specific 
organism the minimum quantity of blood from which a positive 
result was obtained was cubic centimeters. This fact has an 
important bearing on the question of the possibility of the trans- 
mission of infection by biting insects such as mosquitoes. This is a 
larger amount of blood than any biting insect to be found in Malta 
can contain.® 
The water supply of Malta is drawn from two sources, the one for 
general use being derived from three springs which are pumped to a 
central reservoir and thence distributed, the second being rain water, 
most of the houses being provided with cisterns for the collection of 
rain water which is largely used for drinking purposes. 
The milk supply of Malta is derived almost entirely from goats, 
though there is a small number of cows on the island and condensed 
milk is used to some extent. The number of milk goats in Malta is 
probably at least 20,000. 
As showing the prevalence of the disease in Malta the following 
figures are of interest: From 1894 to 1903 there was an average of 
32 cases per 10,000 inhabitants per year in the civil population ; for 
the same period in the military population the yearly average was 
25.6 per 10,000 ; from 1901 to 1903, for which years only figures are 
obtainable, the yearly average was 28.55 per 10,000 among the naval 
population. 
In regard to infection other than through goat's milk, Major Hor- 
rocks * * 6 concludes that so far as the experiments go it appears that 
infection can not be conveyed from infected to healthy monkeys by 
skin contact alone, all other sources of infection being excluded. In- 
fection can not be conveyed from infected to healthy monkeys by 
ecto-parasites alone. When healthy monkeys living in intimate con- 
tact with diseased monkeys, under mosquito-proof conditions, become 
infected, the infection is due* to the absorption of the M. melitensis 
excreted in the urine of the diseased monkeys. 
There is no evidence that Mediterranean fever can be contracted 
by contact with cutaneous surfaces uncontaminated by urine.® 
Infection can be acquired by the absorption of urine secreted by 
cases of Mediterranean fever, and this is probably one way in which 
workers in hospitals become infected. 
There is evidence to show that monkeys can be infected by dry dust 
artificially contaminated with cultures of M. melitensis isolated from 
® Reports of the commission * * * for the investigation of Mediterranean 
fever * * *. Part 3, 1905, p. 14. 
6 Reports of the commission * * * for the investigation of Mediterranean 
fever * * *. Part 4, 1906, p. 36. 
c Reports of the commission * * * for the investigation of Mediterranean 
fever * * Part 4, 1906, p. 81. 
