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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![Duncan in 1888 writes ; “ I cannot help thinking that some form of faecal poisoning is at the bottom of it. It is less common in Gibraltar than in Malta, for Gibraltar is better drained and on harder rock. Now, in both Malta and Gibraltar, but especially in Malta, there is danger of faecal contamination of air and water, and Malta must be saturated with faecal detritus. To me it seems that the constant breathing of a faecally- polluted atmosphere—that is to say, in which the faecal element exists widely ditfused, and is so little concentrated as not to be perceptible by the senses—would result in such an affection.” Bruce, in 1889, says: “There is no mention anywhere of water contaminated by sewage being the vehicle.” Surgeon Moffet, at Gibraltar {A.M.D. Bep. 1889), says: “The disease is intimately related to enteric fever as regards etiology at least, which is apparent from the following facts :—Both diseases exist side by side, occurring as localised epidemics together or alternately with each other. Cases of both are furnished by the same barracks, often from the same rooms, the number of cases of one kind of fever bearing a marked ])roportion to those of the other, and while certain barracks in one year furnish a large number of cases of both diseases, the following year those remain tolerably healthy, whilst others, which during the previous year had been healthy, now become the foci of violent epidemics.” In 1886 the south wing of the Town Range Barracks, occupied by a company of the Royal Engineers, furnished forty-one cases of fever, twenty-one of which were returned as simple continued, the remainder, more severe in type, as enteric fever. All cases presented many symptoms in common, and it is probable that the number returned as enteric fever was over-estimated. Those who had an opportunity of watching the epidemic in all its details had no difficulty in assigning all the cases to a common origin. The following account of the sanitary defects in connection with this epidemic is taken from the report of the medical officer in charge of the station hospital:—“ AVhen the back yard, which was covered with asphalt, was opened up, a nine-inch earthenware sewer pipe leaked at every joint, saturating the soil with sewage, which also passed into a catch-pit, and thence into the tank containing rain water, which was used by the men. The drain from the men’s ablution room also leaked, and allowed the escape of its contents into the drink- ing-water tank. The sewer gas which escaped found an exit up the rain-water pipe which opened just below the window of a room, from which the fatal case of enteric fever (? so returned) was admitted into hospital.” The water of this tank was found to be polluted in an ex- treme degree, and condemned as quite unfit for use. The only fatal case was that of a man well known to be of intemperate habits, and who, according to his own account, never drank water, but he slept in a small room upstairs, the window of which opened immediately above the rain- water pipe, which had not been disconnected from the catch-pit of the tank, and which therefore acted as an escape pipe for the sewer gas generated in the catch-pit below. “ This man’s disease, at first](https://iiif.wellcomecollection.org/image/b21936109_0081.jp2/full/800%2C/0/default.jpg)
