Mediterranean or Malta fever was for long confused with typhoid and other fevers. Our soldiers and sailors at Malta, Gibraltar, and Cyprus, as well as many frequenters of the African and Asiatic shore, were subject to this disease, and often incapacitated by it. In 1887 Colonel David Bruce discovered in the blood of patients the minute Micrococcus melitensis, which is its cause, and established the fact that it is a definite independent disease. The hospital at Malta has received as many as 624 patients in a year suffering from Malta fever from among the 8,000 soldiers on the island and the 12,000 sailors on the Mediterranean Station. And as they stay in hospital on an average for four months, this means 74,880 days of illness. This means a considerable loss to the State, as well as a large amount of personal suffering terminated, in some cases after two years’ sickness, by death.

The War Office, Admiralty, and Colonial Office applied in 1904 to the Royal Society of London to undertake a further investigation of this disease. The society sent out a small commission, which has been at work for three years, and has published seven volumes of reports. The problem before the commission was to discover the mode of infection by the Malta-fever germ (the Micrococcus melitensis), and thus, if possible, to arrive at a means of arresting the infection. Various hypotheses, guesses as to probable and possible methods of dissemination, were entertained and examined. As the germ occurs in the blood, it was naturally considered possible that gnats or other insects were the carrying agent. But negative results followed all experiments in this direction. Then it was found that the “germ” passes out of the body in large quantities by the renal secretion, and it was thought that it might be conveyed in a dried form with dust in the air. This also proved to be an incorrect supposition.

Next a very important discovery was made. The germ was found in the blood and the excretions of 10 per cent. of the goats which are kept in Malta as the sole source of milk, and are driven through the streets to supply customers, whilst 50 per cent. of the goats were found to have been infected at some time. Then the germ was found in the milk itself, and it only remained to prove by experiment that it was from the goats’ milk that human beings acquire the infection. A monkey fed with the milk of an infected goat acquired the fever.

The next step was to stop the consumption of goats’ milk by the soldiers and sailors in the hospital and barrack. Actually we were carefully feeding our invalid soldiers and sailors in the great hospital at Valetta with a highly poisonous infected fluid—the milk of the Maltese goat! The preventive measure—the stoppage of goats’ milk—only came into operation in July, 1906. In the first six months of that year there were thirty-one cases of Malta fever in every thousand of the garrison (numbering about 8,000 men). In the preceding six months there had been forty-seven cases per thousand. Now when the goats’ milk was stopped after July, 1906, what was the result? From July to December, 1906, there were only ten cases per thousand of the garrison. In actual numbers there were in July, August, and September in 1905 as many as 258 cases, whilst in the same months in 1906, after removal of goats’ milk from the dietary of the troops, there were only twenty-six cases, and these were probably due to the independent purchase of goats’ milk by soldiers outside the barracks. In the naval hospital until 1906 almost every patient who remained in the hospital a few weeks took the disease. Since the exclusion of goats’ milk not a single case has occurred.

The Director-General of the Medical Department of the Navy reports that there has been no case of Malta fever during the year among the sailors, and only seven cases among the soldiers up to the end of September, 1907.

Gibraltar had a fever of its own, identical with Malta fever. It has now been shown that it was probably introduced by the importation of goats from Malta for the supply of milk. This is likely, because the importation of Maltese goats ceased in 1883, and the fever began to disappear from Gibraltar in 1885, and finally vanished altogether in 1905.

In South Africa Malta-fever is common amongst the white population. It is probable, according to Colonel Birt, that it was introduced by means of infected goats imported from the Mediterranean. The soldiers, however, in South Africa are free from this disease, excepting those who have already contracted it in the Mediterranean, since in South Africa goats’ milk does not enter into the dietary of the soldier. It is the civilian population which suffers.