SEPTEMBER, 1948]
JOHN
B.
POLDING
155
Now it is queer, to say the least of it, that case reports in India subsided so soon after 1907,
the very year succeeding that in which the infection rate in the British garrison at Malta was so
greatly and dramatically reduced. But nearly all the cases of genuine Malta fever reported in India,
occurred in cantonments and in the words of Scott [1939]. The disease was shown to be widespread
in north-west India and especially in places where British troops were stationed. (The italics are
the present writer's.) Can it be accepted then, that infection in Indian cantonments was brought
by trooping movements from Malta, that dissemination from the human vector was purely localized,
and, to round off the premise, that when fresh sources of infection from Malta failed, the local endemics,
in the absence of a sufficient animal reservoir and possibly in the face of stricter boiling of milk,
partially, or wholly died out ?
During the present investigation constant attempts have been made to stimulate medical interest
in Brucellosis ; but it has been rightly contended that, during the wartime emergency, little effort
could be spared for a disease of such apparent minor importance as Brucellosis. This branch of the
work has, therefore, been considerably handicapped by the unavoidable circumstances of war.
Nevertheless, it is of deep epidemiological interest why a disease, so prevalent in man living
on the goat populated Mediterranean littoral, should be apparently so rare in man in India ; where,
in certain parts at least, sheep and goats are bred abundantly. At one time the simple explanation
of the almost universal Indian custom of the boiling of milk was stressed as the explanation but, in
France, Taylor, et al [1938] has clearly shown that amongst goat and sheep-breeders, at least, and
possibly also amongst all who come in close contact with these animals such as stall-holders, house-
wives, and butchers probably 40-60 per cent of infection is transmitted to man, by contact. For a
considerable section of the Indian public, therefore, the boiled-milk explanation fails and, if it can
be assumed that Brucellosis in man would be diagnosed and reported were it a sufficiently prevalent-
disease in this country, an assumption which is probably valid then it appears that, the reason for
its rareness in man, must be its rareness in animals ; or, more remotely, that the conditions for contact-
transmission prevailing in France are absent in India.
As for animals, occasional verified Br. melitensis strains seem to have been isolated in the Punjab
and it is possible, therefore, that the disease has indeed reaohed this country probably via Persia or
by sea from Malta. Nevertheless, it has been shown earlier in this paper that Brucellosis is rare in
Indian sheep and goats, that indeed the only places where a regular, if low, incidence of reactors
can be traced in these animals are in south India, where they are cohabiting with abortus infected
indigenous cows. In the north-west, on the other hand, reactors are almost entirely absent.
The inference is, that, as in man, so in sheep and goats Brucellosis is uncommon in India. The
whole position, therefore, appears to be one of disease transmission and the probable reason why
Br. melitensis infection is rare, in man and animals alike, is because the main reservoir of near-Asia
is shut off from India by vast expanses of sparsely populated sun-scorched desert and arid vegeta-
tionless hills. At the same time, even the trace infection that has so far reached the north of India
is barely able to survive in the destructive climate of the Thar desert and valley of the Indus.
Nevertheless, looking back on the section on transmission it seems sufficiently clear that, if
enough infection can traverse the Thar desert southwards then Br. melitensis infection might become
an important endemic in south and central India.
A second means by which melitensis infection might reach south India is through the personnel
of the fourth Indian division, which might have contracted sufficient undulant fever during its cam-
paign in the Mediterranean to disseminate the disease after demobilization. In this respect, it must
be recalled that man may eliminate Brucella organisms in the urine for months, or even years, after
primary infection.
Br. melitensis is not, however, the sole Brucella variant pathogenic to man, and it seems possible
that a variable number of Indians must become infected with Br. abortus by contact with
infected animals. Serum-positive patients, suffering from [fever, are encountered from time
F