300 
THE MEDITERRANEAN NATURALIST 
occurrence. The fevers I allude to are (a) Enteric 
Fever (Typhoid,). ('■<> Mediterranean Fever (Rock 
or Malta Fever) and (c) Ague (intermittent, mala- 
rial or marsh fever). 
Mediterranean Fever, so common in Malta af- 
fords an interesting clinical link between the 
other two, for in its severe forms it often closely 
simulates in its clinical characters, the appearances 
of Enteric Fever; while 1 in its more chronic 
remittent and intermittent forms it has often 
been confounded with ague. To the various coun- 
tries situated on the coasts of the Mediterranean, 
the prevalence of these fevers is of great moment, 
but. to England it is of especial importance, for 
even if we omit the enormous yearly loss of life 
and money in the East and West Indies and in 
Africa, England has at present in the Mediter- 
ranean besides visitors and Mercantile interests, 
a force of some 24,000 soldiers and sailors, who are 
more or less permanently exposed to the effects of 
these fevers. 
A Enteric Fever'-— A bacillus first described in 
1880 by Ebertk and verified later by Kock, Gafi'ky 
and many others has been found to be present in 
the tissues of patients suffering from this disease, 
in such situations as the nature of the symptoms 
would point out. It is present in no other diseases 
and has now been accepted as the proxi mate cause 
of Enteric Fever, either itself causing the symp- 
toms or doing so by means of products it may form. 
The Disease is believed not to exist among animals. 
These bacilli are rods 2 to 3 micrometres long and 
about three times less in breadth, with rounded ends, 
beingfound present in the human tismes, singly, in 
pairs and as small isolated deposits. In 1884 Gaffky 
succeeded in obtaining pure cultivations of this 
bacillus from man, growing them artificially outside 
the human body; and recently Peiffer has succeded 
in isolating a similar bacillus from the stools of 
patients suffering from enteric fever. Their arti- 
ficial cultivations on gelatine or agar appeared first 
as small citron coloured plates on the surface and 
in stab cultivations as a whitish thread along the 
needle-tract with a greyisli-white fiat layer on the 
surface. The surface plates on agar at the tempe- 
rature of the blood become visible to the naked 
eye in about 20 hours and grow very rapidly as a 
hat grey i ll film, with an irregular, indented and 
even branched margin until finally they cover the 
whole surface of the nutrient mater'. .1. but without 
liquefying it. At the ordinary temperatur-. dices 
of potato inoculated with small qnantitiesof bacil- 
lus typhosus appear almost ampletely unaltered 
after two or three days; at most the surface in the 
neighbourhood of the tract c ; the inoculation has 
acquired a somewhat moist and more shiny ap- 
pearance. If we examine this more minutely we 
we find the surface nearly covered with a skin 
formed of masses of these bacilli, and this peculiar 
mode of growth on potatoes is characteristic' of 
this variety of bacillus. 
The bacillus will grow, with or without oxygen 
in fairly alkaline media and in meat infusions, 
milk, vegetable infusions, tap-water Jbc. In a dried 
state they can live for over 3 months and in fiuids 
for a much, longer period. They have been found 
present so far in all fatal cases experimented on 
in Malta. 
From the above facts and strong cii cumstat. rial 
evidence principally of a sanitary nature, it is Re- 
lieved that that this living infective agent, passing 
from the body by way of the faeces, infects linen, 
soil, or bj - of defective drains food water 
air, and so may again enter the body by way of the 
intestine and set up- in another man a similar u rra 
of fever. 
Thus a defective drain pipe may infect a water 
supply and so infect milk, either when used for 
washing cans or when added fraudulently and has 
also similarly infected other food such as R . -creams, 
aerated-waters Ac. The same drain may if defec- 
tive infect the soil under a house, and bacilli may 
be drawn up from the soil imo the house by cur- 
rents of air, or straight from the drain as sewer- 
gas. Enteric fevar is also common here in Malta 
when the first heavy rains are washing .he accu- 
mulated filth of the summer from the surface of 
the soil and streets into the wells and tanks and 
also from the roof where drain ventilators have 
constantly been discharging sewer gas. Improved 
drainage and water supply have done much to 
banish this disease from certain part" of Malta and 
it hoped that in time this good work will be ex- 
tended to t Lie whole of this thickly populated 
island. 
( to be c wf in tied) 
