Observations on Malta Fever
Authors: D. Bruce
Journal: BMJ (1889)

AN endemic disease of long duration, characterised by fever, continuous, remittent, and intermittent in type, in most cases enlarged spleen, profuse perspiration, sudamina, constipation, relapses almost invariably, accompanied by pains of a rheumatic or neuralgic character, sometimes swelling of joints or orchitis, ending almost always in complete recovery; in fatal cases enlargement and softening of spleen, congestion of the duo- denum and upper part of jejunum, no swelling or ulceration of Peyer's glands, and the constant occurrence in various organs of a species of micrococcus.GLEOGRAPHIC.AL DISTRIBUTION.That this fever occurs at Gibraltar there can be little doubt.Donaldson states that Malta fever and rock fever are identical; and Veale, from his experience at the Victoria Hospital, Netley, is of the same opinion.Mr. White, Her Majesty's Consul, writes that this fever is unknown at Tangier, opposite Gibraltar, and to the eastward of Gibraltar, at Carthagena, it is also said not to occur.Dr. Luigi Zauda, writing from Cagliari, Sardinia, states that this fever is well known in that city, and also in the interior of the island.In Italy it has been described as occurring at Naples, Benevento, and Civita Nova del Samo.Professor Tomaselli describes it as occurring in large numbers, from his experience at Catania, in Sicily.Dr. Perini, from twenty years' practice in Tunis, writes that in 1879 he had the opportunity of observing the first case which occurred there.He goes on to say that, when the French occupation took place, an epidemic of the fever broke out at Goletta, a muddy seaport in the vicinity, and that since then it has become endemic.This fever does not appear to be known at Tripoli.In Constantinople, according to the authority of Dr. Pat- terson, this fever is common, and is known under the vague term, "country fever."Dr. Davids, of the German cruiser Loreley, also states that he had an opportunity of observing fifteen cases of this fever at Constantinople and three at Smyrna.Dr. Antoine Capetanakis writes from Crete that this fever, which tends to become frequent in the town of Candia, is known by various names, such as ' Italian fever," " Neapolitan fever," and " new fever."He states that it first attracted the attention of physicians in Candia about eight years ago.From his description there can be little doubt of its identity. ETIOLOGY.A Specific Disease.-Nothingvery definite is known in regard to the causation of this fever.It is unnecessary to recapitulate the opinions of the various writers, since, if such causes are left out as fatigue, intemperance, etc., there only remains the theory that emanations from decomposing organic matter are the main factor in producing the disease.As in typhoid fever, here also there are two rival schools of theorists: the one claiming for the products of putrefaction pure and simple the power of beginning the morbific process, the other invoking the aid of a specific bacterial organism.There is no mention anywhere of water con- taminated by sewage being the vehicle.Tomaselli thinks it is impossible to conceive the rapid diffusion on a very large scale of this fever, if one denies its miasmatic origin.Rummo, moreover, states that in Naples this fever occurs most frequently in the low- lying parts of the town, and especially in the neighbourhood of the openings of the sewers.Information sufficient to constitute good evidence cannot be gained from the patients themselves.'rhey usually assign some trivial cause, such as the effect of the sun or a chill.Very few blame bad smells.This is probably on