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~Ournal of Tfie J R Army Med Corps: first published as 10.1136/jramc-07-04-01 on 1 October 1906. Downloaded from VOLUME VII. OCTOBER. 1906~ No~ 4 ~ournal of tfie ~riginal ~ommunicationg. REPORTS OF THE COMMISSION APPOINTED BY THE Protected by copyright. ADMIRALTY, THE WAR OFFICE, AND THE CIVIL GOVERNMENT OF MALTA, FOR THE INVESTIGA­ . TION OF MEDITERRANEAN FEVER, UNDER THE SUPERVISION OF AN ADVISORY COMMITTEE OF' THE ROYAL SOCIETY. (Reprinted by permission of the Royal Society and Colonial Office.) (Continued from p. 254.) REPORT ON THE PREVALENCE OF MEDITERRANEAN FEVER, AMONGST BRITISH TROOPS IN MALTA, 1905. http://militaryhealth.bmj.com/ By LIEUTENANT-COLONEL A. M. DA VIES. Royal Army Medical Corps; Member of the Mediterranean Fever Commission. It is worth while considering a converse instance; D and F Companies went from St.' EImo to Gozo on September 1st, 1904, and returned to St. EImo on May 8th, 1905. From these two com­ panies two cases of Mel1iterrauean fever were admitted on Septem­ ber 8th, 1904, one on September 18th and one on October 3rd; the first three and perhaps the fourth case may be presumed to have become infected before leaving St. EImo; a fifth case was admitted on September 28, 2021 by guest. on October 8th (thirty-eight days a.fter leaving St. EImo), and not a single other case occurred during their eight months' stay· at Gozo, nor (with one exceptioll) during their stay at St. EImo between May 8th and July 8th; four cases were admitted at 23 J R Army Med Corps: first published as 10.1136/jramc-07-04-01 on 1 October 1906. Downloaded from , 308 Repm·ts of the Oommission on Meditermnean Fever Imtarfa during the latter half of July. The one case admitted after return to St. Elmo that appears to have cOlltracted the infection in Gozo (Private Lawrence, F Company) was admitted on May 21st, thirteen days after arrival. Whatever the conditions were that led to the prevalence amongst the occupants of Lower St. Elmo, they appear to have been absent from Gozo even more completely than from Imtarfa. The immunity enjoyed by these two companies while at Gozo continued for two months after their return to St. Elmo, yet in G and H Companies twenty-one cases occurred in the same two months, May 8th to July 8th, 1905. The 2nd Essex having marched up to Imtarfa on July 8th, their quarters in Lower St. Elmo were taken over by the 1st Lltncashire Fusiliers, who marched in on July 11th. This regiment had landed in Malta from England on February 27th, 1905, and on arrival were quartered in Polverista Barracks; they marched to Pembroke Camp on March 20th, thence to Mellieha Camp on April 30th, and returned to Polverista on May 8th, remaining there until their Protected by copyright. ,move to Lower St. Elmo. Six companies then occupied these ,barracks, and two (B and D) went into Manoe! Hutments. The first admission to hospital for Mediterranean fever occurred <>n April 5th, that is thirty-seven days after landing in Malta; the second admission was on April 17th; until their move to St. Elmo there were eighteen other admissions, that is, twenty in fifteen weeks; during the same period the Essex Regiment had fiftyadmis­ sions; the prevalence in the Lancashires was, therefore, much less than in the Essex. During the next four weeks eight cases were . admitted from Lower St. Elmo, having presumably contracted infection in Polverista. From August 9th to the end of September, http://militaryhealth.bmj.com/ nineteen cases occurred in the six companies in St. Rlmo, and three cases in the two companies occupying Manoel, presumably due to infection contracted in those places. In this regiment, unlike the Essex, the incidence on different companies has varied but slightly. During the whole period from their 'landing until the end of September (seven months) the distribution of cases has been as follows:- A. B. c. D. ' Fl. F. G. H. Total. 5 4 9 8 8 5 4 8 51 on September 28, 2021 by guest. There is here no marked preponderance, as in the case of B, G, and H Companies of the Essex. Before the move to St. Elmo ~the distribution had been thus :- A. B. c. D. E. F. G. H. Total. 2 1 2 '7 2 ~ 1 1 20 J R Army Med Corps: first published as 10.1136/jramc-07-04-01 on 1 October 1906. Downloaded from A. M. Davies 30D Within the next four weeks the cases occurred thus :- A. B. C. D. E. F. G. H. Total. 1 1 2 0 2 0 1 1 8 From August 8th until September 30th the cases occurred thus :- A. B. C. D. E. F. G. H. Total. 2 2 5 1 4 1 2 6 23 In the first set of twenty cases D Company certainly furnishes a disproportionate number, but no commop origin is apparent, and the cases were spread over three months. It may be noted that two cases in A Company were admitted from the same room (No. 3 Polverista), and two cases in F Company also from one ro.om (N o. 14 Polverista). These rooms accommodate fourteen men ill each. The battalion was quartered in a number of small barracks, including not only Polverista itself, but also all the others making up Cottonera Lines, and was therefore widely scattered. On coming to Lower St. Elmo six companies were concentrated in one build­ Protected by copyright. ing under like conditions. It is to be noted that seven cases occurred in C Company, which occupied :Nos. 5 to 8 rooms in the middle storey, the same that had just been vacated by G Company of the Essex Regiment; this company had furnished nineteen cases of Mediterranean fever, thirteen of which appear to have contracted infection while occupying these four rooms, seven of these having been admitted within the preceding three weeks. Of the seven cases in the Lancashires one was a colour-sergeant who occupied the same room as a colour-sergeant of the Essex, admitted with Mediterranean fever eight weeks before; of the other six, three cases came from No. 7 room, a room from which two cases at least http://militaryhealth.bmj.com/ had been admitted in the Essex Regiment within the preceding six weeks. Is it a mere coincidence that six men should be admitted from the same four rooms as had furnished seven cases in another regiment during the few weeks immediately preceding? The other company that showed a relatively large number of admissions after arrivillg at St. Elmo was H Company; seven cases occurred between July 11th and the end of September; they were admitted from the four rooms, Nos. 10 to 13, in the upper storey; two of these came from the same room, No. 12, on September 22nd on September 28, 2021 by guest. and 25th respectively. These rooms had been occupied between . May 8th and July 8th by F Company of the Essex Hegiment, which had arrived from Gozo on May 8th, and did not show any especial prevalellce during its stay at St. Elmo; shortly after arri ving at Imtarfa, however, three cases occurred, on July 13th, J R Army Med Corps: first published as 10.1136/jramc-07-04-01 on 1 October 1906. Downloaded from 310 Reports of the Oommis.~ion on Mediterranean Fever 24th and 28th, which, had presumably contracted infection when staying in the rooms now mentioned. With regard to the other group of cases, in C Company, the position may be stated thus: We have a body of men that have been living in Malta for rather over four months, and in that period have furnished two cases of Mediterranean fever, apparently arising at two different places (Pembroke Camp and Corradino Prison), and with a month's interval between the two, the last admission having been six weeks since. This body of men now move into fresh quarters, consisting of four rooms, just vacated by another gronp of persons, who have furnished eleven cases of fever during the year up to the date of leaving, seven having been admitted during the preceding three weeks. Out of the new company four are seized with the fever within six weeks. There is, I submit, a presump­ tion that the infective agent is connected with the place. If this be considered a reasonable presumption, a further point to be noted is that the first admission amongst the fresh body of men occurred Protected by copyright. twenty days, and the second twenty-two days, after their arrival at the presumably infected barrack rooms, indicatillg an incubation period of about twenty-one days. An examination of the incidence of Mediterranean fever in these two bodies of men, the Essex and the Lancashires, so far indicates that the disease may prevail in a strictly localised fashion. Both these battalions have occupied old barracks with many sanitary defects; the next case to be considered is that of a battalion living in good modern barracks in a healthy situation. http://militaryhealth.bmj.com/ § 3. The 1st Royal Dublin Fusiliers have occupied St. George's Barracks, Pembroke, since March, 1904; they arrived in Malta from South Africa, in November, 1902; in February, 1903, five companies left for Crete and Cyprus, the remaining three being stationed at Imtarfa. At the beginning of March, 1904, the whole battalion came into St. George's. During 1904 only four cases of Mediterranean fever occurred, one of which was contracted in Cyprus. Therefore, the battalion and the barracks were almost on September 28, 2021 by guest.
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