PUBLIC RECORD OFFICE
Reference :-
0885
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH NOT TO
9 PUBLIC RECORD OFFICE, LONDON
148
2. In view of the fact that the Royal Society contributed £200 towards the equipment of the Commission, Lord Elgin is of opinion that it has a not unreason- able claim to the apparatus, &c., and the Lords Commissioners of the Admiralty concur in this view, which appears to be taken by the Society itself.
3. The Government of Malta, however, desire to retain an autoclave and incubator obtained for the enquiry, as those instruments will be of great use to the local officials in continuing the investigations into the causes of Mediterranean fever. The Admiralty, the War Office, and the Royal Society are prepared to agree to this request.
4. In these circumstances, I am to recommend, for the approval of their Lord- ships, that on the conclusion of the enquiry the autoclave and incubator should be retained by the Malta Government, and any other permanent stores handed over to the Royal Society.
5. The following appliances have been provided for the Commission:-
Autoclave
Microscope
Mierotome
Hearson's incubator
£33 12 0
22 0 0
10 5 0
14 17 0
and a quantity of glassware and chemicals as to the cost of which no special account can be given.
I am, &c.,
34934
No. 177.
TREASURY to COLONIAL OFFICE.
(Received September 21, 1906.)
C. P. LUCAS.
[Copy to War Office and Admiralty, September 25, 190€. L.F.F.]
Treasury Chambers, September 20, 1906.
SIB,
In reply to Mr. Lucas's letter of the 14th instant (32415/1906),* relative to the disposal of the apparatus and permanent stores remaining at the close of the Mediterranean Fever Enquiry, I am directed by the Lords Commissioners of His Majesty's Treasury to state, for the information of Secretary the Earl of Elgin, that they sanction the proposal that the autoclave and incubator should be retained by the Malta Government, and any other permanent stores handed over to the Royal Society.
I am, &c.,
35228
MY DEAR READ,
No. 178.
ROBERT CHALMERS.
COLONEL D. BRUCE to Mr. H. J. READ.
(Received September 24, 1906.)
Journal of the Royal Army Medical Corps,
68, Victoria Street, London, S.W., September 23, 1906.
I ENCLOSE a copy of a letter I have just received from McCulloch, which will give you some idea as to what has been going on in regard to the investigation of Malta fever during the last summer.
A. J. Read, Esq.,
• No.176.
Yours, &o.,
D. BRUCE.
149
Enclosure in No. 178.
MY DEAR COLONEL,
Malta, September 14, 1906. As we have now almost finished the programme we drew up for ourselves on coming here, Weir and I are booking passages for England by the P. & O. steamer Caledonia," which leaves on September 26th, and we will get to London about October 4th.
·
The three last months have shown a remarkable lessening in the number of cases. In fact, Valletta is almost empty. There were 14 Mediterranean fever admissions in July, and of these only 12 were fresh cases. sions; and up to date of this letter there have been five cases admitted this month. In August there were eight admis- The figures for last year were as follows:-July 77, August 94, September 87. The monthly ratios have been worked out from the beginning of 1902 up to the present date. I have not lost sight of 1902. On the contrary, I have been bestowing much attention on the back history of the disease in barracks. There are a good many points of difference between the conditions present in 1902 and 1906, besides diminution of the garrison. For instance, 1902 began with a very light prevalence, and prevalence continued light throughout the year. 1906 began very badly; it looked as if we were going to have a heavy roll, and improvement only appeared after the big milk change was brought about. The fever season in 1902 was much hotter than in the present year. 1902 was a year when there was very considerable moving of troops forming the garrison-15 different regiments were in Malta that year; 7 regiments left and 44 regiments arrived during the year; there was also much movement of gunners, as there were 14 different Royal Garrison Artillery companies coming and going, the establishment being eight companies. All this goes to show that there was a very unusual fluctuation in the composition of the gar- rison during 1902. There further appears to be definite cycles of prevalence of continued fevers in Malta. 1902 was at the middle of a cycle; that is to say, at its lowest point, whereas great diminution in prevalence was not due in 1906, under the ordinary run of things. This is, of course, speculative argument, but there is a certain amount of it comparison based on facts, which appear to me to have solid weight,
It is quite impossible to go into these points in a letter, and must wait the report.
I have specially taken up the statistics of Mediterranean fever from 1902 to date, and have gathered together a considerable amount of information bearing on the prevalence of Mediterranean fever in units, its occurrence in the different barracks in Malta, and its relation to simple continued fever and enteric. 1902 was chosen as the starting point for this branch of our enquiry, because the serum reaction did not come into steady use until the close of 1901.
The chief part of our work this year has, of course, been in connection with the investigation of the cases which have come under observation since our arrival. I think we will be able to show the important part that the goat plays in the spread of the disease, and the importance of milk as a causative factor. We have been unable to find any evidence of spread by mosquitoes. Contamination of food by flies is of much greater importance in my opinion. Contact cannot be dis- missed altogether; handling of infected material: excreta, clothing, milk, &c.; and entrance of the germ through an abrasion or cut can occur, though it may not be a very frequent occurrence, e.g., the cases of the three laboratory attendants, Dewberry, Phipps, and Johnson; grooms may get the disease, possibly from horses→→→ we have had two cases pointing in this direction lately; and goatherds from milking infected goats. We have no evidence to support the view that any close relation between the disease and drainage defects exists, or other general sanitary deficiencies, bar the lowering of resistance that living under defective sanitary conditions necessarily brings out. I think, too, that a man may carry the germ of the disease for a long time without any obvious manifestation, until some lowering of the general health, exposure to chill, &c., establishes favouring conditions and gives the organism the upper hand. Mediterranean fever is often most insidious in its onset, more so, perhaps, than enteric fever. In numerous cases, the patient is admitted with febrile symptoms, no reaction is obtained, the case is diagnosed simple con- tinued fever, and is often discharged from hospital to come back a week or a fort- night later, or ever longer, with unmistakable Mediterranean fever. For instance,