Licence: Public Domain Mark
Credit: Mediterranean, Malta or undulant fever / by M. Louis Hughes. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![bearing on the case in aiding and abetting the poison where it is present. Again, in the subject attacked we may find such predisposing causes as tend towards an increased susceptibility, such as youth, extra- Mediterranean birth and origin, special idiosyncrasy, etc. Many others might be mentioned, but they are all matters bearing on the question of prophylaxis, which will be dealt with later. The great point necessary, if we are to cope with the ravages of this fever successfully, is to remember that the essential factor which occasions its occurrence is the presence of a specific virus (requiring for its existence a certain degree of atmospheric temperature, etc.) within a measurable distance of a susceptible human being. Mode of propagation and dissemination.—That the disease is not propagated by direct contagion from man to man is a fact that is agreed to by all observers (Marston, Bruce, Tomaselli, etc.) Patients suffering from other diseases, occupying beds next to cases of undulant fever, do not develop this fever, nor do the military sick attendants in fever wards suffer from this fever more than those working in other wards, or so much as the soldiers in many of the barracks in Malta, who have not entered the hospital previous to the onset of their attacks. When members of a family are attacked one after another it is due to the presence of a common infective cause, and not to contagion. It is difficult to say, in the present limited state of our knowledge, what is the exact mode by which the virus enters the human body, but by collecting all the pros and cons of circumstantial evidence at our disposal it will be possible to build up a theory which time alone can prove or disprove. On the various theories which attribute its occurrence to chills, climate, exposure to sun, intemperance, etc., we need not ^vaste our time, but refer readers back to the section on predisposing causes in which place these influences have been dealt with. There does not appear to be any evidence in favour of entrance being by inoculation through the broken skin, as has been performed artificially in the case of monkeys. There is no connection, as is the case in tetanus, between attacks of this fever and accidents associated with broken skin. Those who suffer most from mosquito bites during their first summer in Malta are by no means specially subject to this fever, nor do patients or sick attendants bitten by these insects in the fever wards of the hospital develop this fever as a result; mosquitoes are said also to bite but once (Manson). By a process of exclusion we have therefore to look to the sub- stances which enter the body by way of the alimentary canal or air passages {i.e. drink, food, and air, and such accidental substances as they may contain) for the cause of this fever. As regards drink, the soldiers in Malta are supplied with aqueduct water for drinking and cooking purposes, with mineral waters made from aqueduct water, and with milk obtained nominally under adequate su])crvision. They have also access in some cases to an inferior class of](https://iiif.wellcomecollection.org/image/b21936109_0076.jp2/full/800%2C/0/default.jpg)
