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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![water used only for flushing and washing purposes, and in a very few instances to well water \ but not only are they warned not to drink such water by notices on the taps or wells, but there are taps of good water at most of such places to prevent their using inferior water through laziness. Besides these they drink good English beer, tea, etc. and in many cases various wines and inferior drinks in the local grog shops. Though the distribution of enteric fever in Malta follows the distribution of water-supplies found accidentally polluted, this is not the case with undulant fever. Valetta Barracks have been almost entirely free from enteric fever, other than imported cases, during the ])ast five years, and the same may be said for barracks situated in Floriana; but these barracks have been far from free from undulant fever. The immunity from enteric fever is due to the excellence of the drinking water, which comes through iron pipes from large covered settling tanks in the country, supplied from underground springs in the hills. These barracks have no wells, but have separate inferior aque- duct water-supply for washing and flushing purposes. Were this latter the cause of the fever, in spite of the absence of enteric fever, we should expect the inhabitants of private houses in the same area supplied only with the good water to be immune from undulant fever; but this is very far from being the case. Again, when a very large portion of another water-supply became polluted and enteric fever became general over that water-supply area, undulant fever remained localised, among the soldiers, to the same blocks of buildings and in the same quantity as before and after the pollution occurred. Again, epidemics of undulant fever occurring in any particular barracks have not been attended by an increased prevalence of the disease in other barracks on the same water-supply area. The fact that well water in many of the Maltese houses, where cases of “ remittent fever ” occur, has been found polluted, has led some of the Maltese to the belief that polluted well water is the cause of the disease. There is a fallacy, however, in this theory, in that most cases of enteric fever which occur among Maltese are returned as “remittent fever,” and an enormous part of the English garrison, and even of the Maltese, who suffer severely from this fever have no access to well water of any kind. Even, therefore, if such water causes certain cases, they are but a very small portion of those met with in Malta, and it is far from being the common cause. In Gibraltar, where the main supply is collected rain water from tanks, this fever is less prevalent than in Malta. Though it has been noticed in Malta that soldiers who are teetotalers {i.e. water drinkers) are especially liable to attacks of enteric fever, this is not the case with undulant fever. Also, the writer has found undulant fever occurring amongst families who drank nothing but the best aqueduct water which had been previously well boiled. Again, at one period when all drinking water was ordered to be boiled on account of the prevalence of enteric fever at the time, though the effect of this proceeding on the prevalence of enteric fever was most](https://iiif.wellcomecollection.org/image/b21936109_0077.jp2/full/800%2C/0/default.jpg)
