Detailed report of the Medical Commission sent by the Maltese Civil Government on April the 5th. 1893, to Benghasi, in order to investigate and report upon the causes and nature of an epidemic disease, said to be raging in that place.

  • Malta. Medical Commission.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Detailed report of the Medical Commission sent by the Maltese Civil Government on April the 5th. 1893, to Benghasi, in order to investigate and report upon the causes and nature of an epidemic disease, said to be raging in that place. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Epidemiology. Its prevalence was in exact proportion to the amount of overcrowding- present and also to the amount and continuance of the rainfall and cold, these latter factors producing indirectly a state of over-crowding by confining the people to closed up rooms and tents. The disease spread from house to house, in regular succession of streets and c[uarters as a rule affecting a number of the inmates of each house though this was not so markedly the case in the more hygienic Christian Community. Its cessation was synchronous with the cessation of over-crowding the enforcement of primitive hygienic measures and the advent of dry warm weather. Among the Jews it ceased at the Paschal Feast, at which time they are compelled to wash themselves, their clothes and utensils and to whitewash their houses. The disease attacked young and old, strong and weak, relapses were not noted and typical second attacks in the same individuals were uncommon. The troops suffered less than the townsfolk owing to their being mostly in Barracks and tents outside the town, but here even 13 °]^ caught the fever. The troops have a separate water supply to the town. Post Mortem examinations are not allowed on account of religious prejudices. Symptomatology. The duration of the disease (not including the first day or two of onset) was from 15-17 days reaching in exceptionally severe and complicated cases to nearly a month but not more. Recovery usually took place about the 14th or i8th day, the worst symptoms occurring between the 5th and 12th day, onset fairly rapid but not sudden, said to have extended as a rule over 4 days, marked by pains in the limbs and back and by head-ache which last symptom was usually a severe and early one. Heaviness, listlessness with confusion of ideas, and tendency to cerebral symptoms with restlessness and delirium between the 5th and loth days and even stupor and coma. In severe cases tremors, subsultus tendinum and exceptionally aphasia, and even apparently paralysis of the lower e.xtremities, lasting into the convalescent stage. Urine much diminished in quantity and at times retention occurred. Rapid emaciation, with marked and early change in facial expression. Great muscular prostration and a tendency to dorsal decubitus. Pulse frec{uent with great tendency to weakness. Cardiac and cerebral complications common, but no tendency to pulmonary complications. Tongue furred becoming dry and brown at the back and centre during the second week and often tremulous. Constipation was the rule, combined with great thirst. The temperature soon rose to 102° F. and remained above this until the 14th day, even reaching 104° 105° F. about the 7th day. Eruption about the 5th to 7th day lasting some 4 or 5 days, present in the 9 cases seen by ourselves, and in almost every case seen by Dr. Mizzi. It was present on the abdomen and lower part of the chest and less commonly on the legs and arms also, consisting of small dusky red morbilliform spots, in large numbers spread evenly over the surface, not raised and quite distinct from the rose rash of typhoid or enteric fever. In some cases, bluish black spots, petechiae and even echymoses of the back and loins were present. Occasionally parotitis, even ending in suppuration, occurred as a complication and pimples, furuncles, and orchitis, during convalescence, but there was no tendency to the formation of inguinial or axillary buboes or carbuncles. Resolution occurred occasionally by crisis after a prolonged sleep about the 14th day, but more often by steady lysis. Convalescence when once fairly set in was progressive and constant. Death was from cardiac or cerebral complications, blood-poisoning, or exhaustion, and occurred in very bad cases about the 7th day, in others from the 10th to the 21st day.