326 
THE MEDITERRANEAN NAT LRA LIST 
At this time they somewhat resemble split pearls 
lying on the agar surface. Under a low power with 
transmitted light the colonies appear of an orange 
colour, quite round, and with a definite but granular 
margin. If kept on moist agar they increase in size, 
but remain circular in shape, and gradually coalesce. 
In the course of three months they turn to a bright 
buff or even orange colour, and increase in thick- 
ness by heaping up at the centre of the colony, but 
never attain a great diameter. No liquefaction 
occurs. Though they cease to grow at the end of 
two months the colonies retain their vitality at a 
suitable temperature for over three months. They 
cease to grow at 18'5° C. and die if kept long at a 
moist temperature below 15‘5° C., but live a long 
time in a dry state. They will not grow as pri- 
mary growths on agar having an alkalinity in 
excess of the blood, but if cultivated in successive 
media of increasing alkalinity they may be educa- 
ted to grow in very alkaline media. In this case, 
however, they are longer in appearing, and grow 
more slowly and in a very diffuse manner over the 
surface of the agar, showing at the same time many 
abortive attempts at colonisation. 
These diffuse growths, however if transferred to 
agar having a suitable alkalinity, again revert to their 
original characteristicform of growth. They grow also 
in gelatine and bouillon. In the former it grows very 
slowly at. 22° C. without liquefying. In the latter 
it gives rise to a general and increasing opaqueness, 
commencing on the fifth or sixth day and after- 
wards forming a white precipitate consisting of 
these cocci, but without forming a surface pellicle. 
Microscopically in the hanging drop they appear 
asveryminute0'008-0'3mm. (Bruce), ovoid or nearly 
round in shape, in rapid molecular motion, and at 
tunes to be seen in chains composed of two or more. 
They stain readily with gentian or methyl-violet 
and fuchsine, but lose their stain rapidly if treated 
with alcohol. Mounted in balsam the}' appear as 
minute cocci, here and there arranged in short 
chains. They can be observed in fresh splenic 
substance after death and in the blood during life 
of men suffering from this fever. 
From accessible data collected from the statistics, 
records and literature of this fever during the past 
70 years, from investigations during a recent 
localised epidemic, and from the distribution of 
the cases of this fever, I am led to the belief that 
its existence in Malta and Gibraltar is connected 
with the presence of human excrement. 
From the above facts also, and particularly from 
the fact that on shore the admission rate varies in 
frequency in inverse ratio totherai fall, it A highly 
j probable that the poison is aerial in nature and 
arises from faecal and organic matter in the porous 
| soil, when these are undei'going a pr >ce.-5 of dry- 
| ing, somewhat after the manner in which the 
miasm of Malaria (ague) in said to be given off' 
from suitable sources. In this instance it would 
enter the human frame by way of the air passages. 
It is less severe and less frequent iu Gibraltar 
where the rock is less porous and less absorbent. 
Cold weather would also appear t.> have some 
effect in retarding and preventing 'its occurrence. 
I have no evidence in favour o: infected food or 
drink having any causal connection with this 
fever. Its occurrence as an enidemie will I believe 
| 
be found preventible. 
Although this fever is, I am informed, increasing 
in its frequency among the civil population of 
Malta, it has steadily decreased in frequency 
among the troops during the last thirty-three 
years, o wing no doubt to sanitary improvements 
in barracks. A chart of the admission-rate per 
thousand of strength since 1860, for il.e -Malt:, 
garrison, presents a series of cycles, alternately 
rising and falling every three or four years 
In 1888, 1889 and 1890 it had reached its lowest 
point and in 1891 it began to rise and has ri.-en 
still higher in 189a’, to reach I piesume its maxi- 
mum this year. 
What is now needed so much, is some definite 
place for this disease amongst fevers and more 
searching and accurate investigations into its 
cause, since here in Malta we have so many possi- 
bilities of foecal infection and so much ‘over. The 
balance of evidence gained by past experience and 
investigations at present being carried out would 
point to the following seats of foecal contamina- 
tion as being likely sources of infection, and I 
bring them forward at this early stage with a hope 
that others may be led to give us the benefit of 
their experience in these matters:— 
(a) The old Knight’s drains, cut in the porous 
rock, filled for so many years with often stagnant 
sewage and now in many instances used as surface 
and storm water drains. These are more or less 
