J Royal Naval Medical Service 2010, 96.3 185-187

History Surgeon Captain Sheldon F Dudley and the person to person spread of brucellosis by inhalation

H V Wyatt

Abstract at the culture tubes.’(3). When I worked in a Analysis of brucellosis epidemics in ships of hospital laboratory in 1954, staff opened the the Mediterranean fleet in the nineteenth petri- dishes to sniff cultures grown on the century are most easily explained by aerosol agar, as some bacteria can be recognised by transmission in grossly overcrowded, hot and their distinctive odours. The dangers of this humid confined spaces. practice are now recognised. In 1931 Captain Dudley RN proposed that brucellosis could be Introduction transmitted by droplet infection. Brucellosis may well be the disease most easily acquired in the laboratory. Almost all workers Brucellosis in the Mediterranean Fleet with the bacteria have been infected and almost Surgeon Captain Sheldon F. Dudley RN, all veterinarians who have had contact with Professor of Pathology at the RN Medical susceptible animals have high titres of College at Greenwich, gave the 1931 Milroy antibodies against the bacteria. The members of lectures which were printed in the Lancet . The the Mediterranean Fever Commission (MFC) in third lecture was on brucellosis (Undulant fever) Malta all had episodes of ill-health, but whether in the 19th century, but this paper has probably this was from the bacterial cultures or from been overlooked and forgotten. He traced the goats’ milk is not clear. Captain Hughes was in outbreaks of brucellosis in ships of the Malta from 1890 until he was invalided to Britain Mediterranean fleet in the later half of the 19th with brucellosis in 1896. In the preface to his century when they had been at sea for many classic book on the disease, he recorded that his weeks. In 1882 two ship epidemics accounted wife and two sisters had also contracted the for 42 % of the fleet cases. One of these ships disease(1). He recommended goats’ milk for was HMS Superb which had 136 cases, 77 of army hospital patients with brucellosis. Captain whom were invalided home and one died, Dudley RN commented that in the navy in the ‘typical undulant fever figures’. The Medical 19th C ‘fresh milk was essentially a wardroom Officer gave the spatial distribution of the cases: luxury; the men did not get milk on board, and ‘The ratings in the Superb slept on three probably rarely drank goats’ milk ashore..… decks. The flying deck was a kind of huge shelf officers were more frequently infected with brucella than men.’(2). This was probably the Deck Ventilation No. ratings % fever case for army officers too. Flying worst, lowest cubic 140 29 In the 1950s Francois Jacob joined the space per man other members of the Institute on the annual Lower 196 17 pilgrimage to Pasteur’s crypt. Among the Battery better and relatively 250 10 ‘Pastorians … was the one to whom all France spacious sent microbes that were hard to characterize, and who made his diagnosis by smell, sniffing Table: Fever on HMS Superb .

185 Surgeon Captain Sheldon F Dudley and the spread of brucellosis by inhalation 186

cutting part of the lower deck horizontally in two.’ from the space above. All the ports as well as the small round scuttles were kept closed Strange Epidemics at night.’ Further details followed . His graph of illnesses in the Mediterranean Dudley concluded ‘that it would seem that Fleet showed that peaks of fevers frequently in this environment Br melitensis had acquired coincided with those of rheumatism. For the power of spreading by droplet infection… individual ships, there were also ‘strange … this unusual form of pneumonic undulant epidemics’ where there were coincident peaks fever became temporarily able to spread by of rheumatism and pulmonary disease. He droplet infection in the relatively spacious noted that ‘The naval commentator of the 1856 wards of the Malta Naval hospital [at Bighi]’. report writes that “the prevalence of fever in the [HMS] Hannibal for a period of two years Aerosol From a Monkey can only be ascribed to the successive Aerosol infection had been suggested by an transmission of the disease by infection from incident in Malta during the researches into one set of men to another” . Dudley noted transmission of the disease by the MFC. that cases before 1897 (when diagnosis of Captain Kennedy RAMC noted that ‘One of the Mediterranean Fever was first used) were monkeys had become very knowing and learnt often described as ‘phthisis or inflammation of to shut his nostrils when the dust was being the lungs’. Phthisis was used to describe the blown in by means of a rubber bag. One day progressive wasting disease, especially of the attendant [RAMC] instead of using the pulmonary tuberculosis: since the use of rubber squirt put his mouth to the tube antibiotics it is no longer used. intending to blow it in himself. Unfortunately HMS St. Jean D’Acre and Cressy both for him, the monkey blew first ! A fortnight to suffered ‘the same peculiar disease’. In the 3 weeks later he was sent to hospital with an former ship, 416 out of 880 men suffered attack of fever. Whether the infection was from the pulmonary illness while the latter had really contracted by him in this way cannot be 285 cases with 102 ‘were definitely diagnosed absolutely decided, but he himself blames the “phthisis” and 117 “cachexia pulmonis”; 112 dust’(4). of these were invalided home but only six died’. ‘The cases from both ships quickly Later Career recovered on their return to England – a Sheldon Dudley (1884 – 1956) became characteristic of the pulmonary complications Surgeon Vice Admiral, Medical Director-General of Malta fever seen in more recent times’. of the Royal Naval 1941 - 1945. He was made HMS London recorded 54 pulmonary KCB and OBE and was elected Fellow of the cases, 12 of which were “phthisis” : this Royal Society in 1941(5). He was given many epidemic was attributed to bad ventilation honours both here and abroad and won many between decks. Dudley then reprinted the prizes for his researches. ‘Dudley’s work at description of the lower deck in her sister ship Greenwich can with justice be claimed to have the St Jean D’Acre : made possible the success of the national ‘All the ship’s company amounting to campaign for diphtheria immunization’. In his about 930 men…slept on this deck. The retirement he wrote two books, The four hammock hooks were placed ordinarily at pillars of wisdom and Our national ill-health only 14 inches apart – less than the average service . breadth of the mens’ shoulders; consequently while in harbour when no Discussion watch was required at night and all hands had Dudley wrote three special reports for the turned in, they formed a compact mass close Medical Research Council including The beneath the beams, the only air available for spread of droplet infection in semi-isolated respiration being above them, that beneath communities in 1926. His analysis of the the hammocks being almost entirely shut out droplet infection of brucellosis was therefore 187 J Royal Naval Medical Service 2010, Vol 96.3

part of a general study. From the naval health Droplet infection between humans seems very reports of the 19th century he concluded that unlikely in ordinary circumstances, but prior to 1856 there had been little or perhaps conditions in detention camps and prisons in no brucellosis in the Mediterranean Fleet. The many countries make it a real risk even in first recognition of the disease was in the these times. ships carrying invalided soldiers from the Crimea to Malta. He explained that the ship References epidemics were caused by droplet infection, 1. Hughes ML. Mediterranean, Malta or Undulant quoting broncho-pneumonia and signs in the Fever. MacMillan 1897, p 232. lungs as a common complication of ordinary 2. Dudley SF. Some lessons of the distribution of brucellosis, which simulates phthisis with infectious disease in the Royal Navy. Lecture III. remarkable accuracy. He quoted that ‘ Br. The history of undulant fever in the Royal Navy. melitensis had been recovered from the Lancet 1931; 1: 683-691. sputum of patients resembling clinical phthisis 3. Jacob F. The statue within . An autobiography. which was seen in an epidemic of undulant Unwin Hyman Ltd, London. 1988 (see p 245-246). fever at Naples’. 4. Wyatt HV. Dr. James Crawford Kennedy RAMC Dudley was a notable Professor of and the sexual transmission of brucellosis. Pathology and a perceptive naval surgeon: his JRAMC in press. analysis of those far off epidemics was far 5. Obituaries of Sheldon Dudley, BMJ 1956; 1; 1113 sighted, but unheeded. These and other and 1177. arguments make his explanation of droplet 6. Olle-Goig JE, Canela-Soler J. An outbreak of infection accurate and convincing. Recent Brucella Melitensis infection by airborne epidemics confirm that inhalation brucellosis transmission among laboratory workers. Am J happens. For instance, airborne transmission Pub Health 1987; 77: 335-338. of bacteria caused an outbreak of brucellosis among laboratory workers in Spain in 19826(6).

H V Wyatt, PhD FSB Visiting Lecturer in Philosophy, School of Philosophy,, (formerly Honorary Research Fellow in Public Health Medicine), University of Leeds. Leeds LS2 9JT

Address for correspondance: 1 Hollyshaw Terrace, Leeds, LS15 7BG, Tel: 0113 264 6679