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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![channels and rooms showed not only a larger percentage of chemical constituents of sewage, much organic matter, and a very large number of putrid and non-pathogenic organisms when compared with similar but unpolluted stone. Again, though unpolluted stone was highly alkaline, the stone of these walls was neutral or faintly alkaline, form- ing therefore a suitable nidus theoretically for the micrococcus of this fever. Between September and December 1891 a thorough overhauling of the drains took place, these channels being cleared and converted into surface-water drains, gratings being placed at intervals almost on a level with, adjacent to or even opposite the windows of the barrack- rooms. Owing to their situation and construction there was a varying yet constant current of air from the sea, travelling up these channels and passing out of the gratings into the fort, the porous walls at the same time being wet or dry according to the state of the atmosphere and the amount of rain. There was ample opportunity for miasmata to pass from the rock channels into the barrack-rooms, and it is a sig- nificant fact that these 45 cases slept in beds grouped in close and definite relation to the rock-channels and sewage-soaked walls, and in direct proportion to the amount of varying dampness present. The first case was admitted four days after the cessation of the heavy rain. There was no other apparent cause for the outbreak, and obvious sanitary measures have resulted in a cessation of this fever prevalence. 8. In a large modern and well-built hospital, built on one of the best sites in Malta, a number of cases of this fever (20-40) have for many years past been constantly treated in wards on the top floor, without the disease spreading to others in the same wards. The hospital had always been considered a very healthy one until recently, when a few cases of this fever began to occur among venereal patients on the middle floor, and the patients and sick attendants occupying the ground floor suffered severely and even fatally from this fever. In the kitchen behind the hospital two cooks died of its effects, and patients suffering from slight ailments such as sprains, etc., and who occupied tents immediately behind the building, also developed the fever. Many of the sufferers had been in hospital over a month, while others had resided in the building for many months previously. The water-sup]^ly was good and common to a large district, the milk-supply was above suspicion. On investigation it was found that the hospital drain-pipe, which ran along the back of the hospital, between the main building and the ground occupied by the kitchen and tents, had been blocked for some time, beyond the main building, and that the faecal sewage, from the'fever and other wards, had forced the joints of the pipe, and leaked in all directions under the hospital foundations and through the ground on which the kitchen and tents were situated. At the same time, in three officers’ quarters in the same grounds, but well detached and for many years considered to be among the healthiest in Malta, six cases of this fever occurred in one year. In this case the main and house drains were found blocked, and the backflow of sewage](https://iiif.wellcomecollection.org/image/b21936109_0086.jp2/full/800%2C/0/default.jpg)
