May 14, 1908] 



NA TURE 



39 



THE EXTINCTION OF MALTA FEVER} 



'T'HE subject of this evening's discourse is the extinction 

 -*■ of Malta fever, and I propose to bring before you in 

 this paper the various steps in the investigation of this 

 disease which led up to the discovery of its mode of 

 spread, and so to its prevention and extinction. 



Historical. 



This fever has been studied in various ways for the last 

 quarter of a century, but it was not until 1904 that the 

 Government, alarmed by the great wastage in man caused 

 by it, took the matter up seriously, and asked the Royal 

 Society to undertake a thorough investigation of the 

 disease. This the Royal Society agreed to do, and early 

 in the summer of the same year sent out to Malta a small 

 Commission for this purpose ; and it is principally the 

 result of the work of the Commission which I have the 

 honour of bringing before you this evening. 



It seems a pity that this research was not undertaken 

 twenty years earlier, as during this time some 14,000 or 

 15,000 sailors and soldiers have suffered from the disease. 

 It is to be hoped that the result of this work will bring 

 home to the Government the great good to be gained by 

 introducing scientific methods of research into the study of 

 disease in the Army. This, strange as it may seem, has 

 not vet come home to Government departments. If an 

 application was made to the Treasury to-morrow for, say, 

 100!. for such scientific purposes, the answer would be 

 that it was not the function of the Royal Army Medical 

 Corps to engage in scientific research, but that their duty 

 was to attend to the sick soldiers. This waiting until a 

 man is sick is fatal. It ought to be our chief duty to 

 anticipate and prevent sickness. 



Before I leave the subject of the Commission, I may 

 remark that its work went on for three years before the 

 successful result was attained. 



But now to return to Malta fever. 



Description of JI.^lt.a Fever. 



At the outset it will be necessary to give a short de- 

 scription of this fever, in order that you may know what 

 \^•e are dealing with. 



Malta fever is no trivial complaint, but is a severe and 

 dangerous disease, which lasts a long time, and is accom- 

 panied by a good deal of pain. To give you an idea of 

 the long duration of this fever, I may tell you that our 

 soldiers remain under treatment in hospital with it on an 

 average for 120 days, and it is by no means uncommon for 

 a patient to suffer almost continuallv from it for two or 

 even more years. 



During the whole course of his illness the patient is apt 

 to suffer from severe rheumatic pains in the joints, and 

 neuralgia in various nerves, and this, combined with the 

 long-continued fever, brings about a condition of extreme 

 emaciation and weakness, from which recovery is slow. 



In order to show you to what a degree of emaciation 

 ;[ few weeks of this fever may bring a man, I will take 

 the liberty of throwing on the screen a photograph of a 

 lioldier who has been suffering from it for a few weeks. 

 (Here a picture of a man extremely thin and evidently very 

 ill was thrown on the screen. "l 



On admission to hospital this man was a robust and 

 muscular soldier, and now see what a few weeks have 

 brought him to. 



Incidence of Mai.t.v Fever in the Garrison. 



Next I would direct your attention to the number of 

 I a'ies of this fever which occur among our sailors and 

 soldiers in Malta, in order to impress upon you the import- 

 ance of this disease to the State, .'\mong our soldiers, who 

 number about 7000, there have been on an average 312 

 admissions to hospital every year from Malta fever alone, 

 and among the sailors about the same number. This 

 means that 624 soldiers and sailors have been treated in 



1 Discourse delivered at the Royal Institution on Friday, January 24, by 

 Colonel David Bruce, C.B., F.R.S. 



NO. 201 1, VOL. 78] 



hospital 120 days each, which makes about 75,000 days of 

 illness per annum. 



To illustrate this I throw on the screen a diagram 

 (Fig. I). 



Now I have said enough to show you that we are deal- 

 ing with a severe and important form of disease. 



Study of Malta Fever from the Epidemiological 

 Point of View. 



Before we begin the experimental investigation of this 

 fever, it is well that we should know as much as possible 

 about it from a general point of view. For example, in 

 what parts of the world is it found ; under what con- 

 ditions of climate ; whether any connection can be made 

 out between it and the temperature or rainfall ; whether 

 age or sex render a person more liable ; whether occupa- 

 tion or social position has any bearing on it ; whether a 

 difference in sanitary conditions has any effect, as, for 

 example, do people living in small villages without any 

 proper system of water supply suffer more than those living 

 in towns supplied with pure water and a modern drainage 

 system? 



NoKT it is clearly impossible for me to go into all these 

 points with the time at my disposal, but I would like to 



Fig. I. — Charts of inci Jence in 1899-1905, and 1905. 



bring before you a few facts which bear on the problem 

 we have before us. 



Geographical Distribution. — For example, it is interest- 

 ing to know that Malta fever is not confined to Malta, 

 but occurs in most parts of the world. 



Climatic Conditions. — Then again in regard to the 

 effect of climate. Malta is extremely hot and dusty in 

 the summer, and correspondingly cold and wet in winter. 

 But, although the number of cases of Malta fever do show 

 an increase in summer, yet it is a disease which is pre- 

 valent all the year round, one-third as many cases occur- 

 ring in the coldest and rainiest months as in the hottest 

 and dustiest. 



Another fact of importance is that if we study the 

 occurrence of Malta fever in individual years we are 

 struck by its irregularity, a number of cases appearing in 

 December or February or other of the cold and rainy 

 months. 



Social Position. — Another curious fact in regard to this 

 disease is that the better the social position of a person 

 the more risk is there of catching this fever. Officers and 

 their wives and children, living in large, airy, and clean 

 houses, suffer more frequently than the men in their more 

 crowded barrack-rooms. In fact, the chance of a naval 

 or military officer taking this fever was more than three 

 times as great as in the case of the men. 



