MALTA FEVER – BRUCELLOSIS

MALTA FEVER

(Brucellosis)

Adieu thou damned’st quarantine

That gave me the fever and the spleen

Return to scribbling or a book,

Or take my physic while I’m able

(Two spoonfuls hourly by the label),

Prefer my nightcap to my beaver,

And bless the gods I’ve got a fever.

These verses are taken from Lord Byron’s ‘Farewell to Malta’, a poem he wrote in 1811, while undergoing quarantine at the Lazzaretto on Manoel Island. Do the symptoms mentioned by Byron hint that he was suffering from the ‘Maltese fever’? And if it was indeed Brucellosis, did Byron actually contract the disease at the Lazzaretto as he claimed? Or had he contracted the microbe in Constantinople where from he had just travelled? *   

—–

Up until 1920, a total of some 20,000 goats were reared at any one time on the Maltese islands. The main product procured from them was milk, but also consumed was the typical Maltese cheeselets (ġbejniet) produced from the same milk. Each day, goatherds used to lead a small number of goats into towns and villages to milk them on demand to the womenfolk, who would eagerly be waiting on their doorstep with their small bowls or jugs in hand. It is estimated that some 2,000 goats entered daily through Valletta’s Porta Reale, to distribute fresh milk to households, directly from the goats’ udder. Certain tea rooms in Valletta even had a goat tied outside so that milk would be served fresh to customers. (Herbert Ganado, 1977).

Why Malta Fever?

It is estimated that during the 19^th and early decades of the 20^th century, up to fifty percent of the goats reared in the Maltese Islands, carried the malignant and sometimes deadly microbe, the Micrococcus melitensis. One out of ten goats were transmitting this microbe to humans via milk and the cheeselets that were profusely consumed. (H. V. Wyatt, 2005). However, the disease was not merely restricted to the Maltese islands. Prior to the official scientific nomenclature given to the disease, the symptoms, then not yet related to any one particular illness, were referred to by a variety of appellations, namely, Gibraltar fever, Maltese fever, Mediterranean fever, Bang’s Disease, Rock Fever, and Undulant Fever thus showing the the disease was widely spread all over the Mediterranean and beyond. Undulant Fever was perhaps the closest to the Maltese understanding as it was related to one of the numerous symptoms, deni rqiq, or deni biered, both terms referring to the frequent fluctuation of low and high fever that the patient suffered from. Other symptoms of Brucellosis include profuse sweating, pain caused by rheumatism in the joints and muscles, and the swelling of various internal organs, such as the liver and the spleen (Maltese: milsa). If untreated by proper medication, Brucellosis can be lethal, sometimes causing death within a matter of weeks, while some patients endure gradual debilitation for decades before they succumb to it.   

Throughout the second half of the 19^th century and prior to the discovery of the microbe that was causing the disease, many were of the opinion that the unhealthy symptoms were caused by either one of the following: a malignant virus in the air, unclean potable water, air emitted from ventilators of sewage, street dust, or else lack of personal hygiene. Dr John Hennen who was in Malta between 1821 and 1823 to investigate the health status of the British troops stationed locally as well as that of the Maltese population at large, records that thousands of Maltese and British soldiers were afflicted by what he calls in a generic term, ‘the fever’. He actually classifies six varieties of ‘fevers’, but nowhere does he relate the symptoms to one particular causal source. Hennen was very suspicious of the air emitted from swampy areas, such as the coastal marshes of Marsa and St Paul’s Bay. He reports that many suffering from ‘fevers’ were those living in Naxxar and Mosta as well as in Qormi as these lived or worked close by to marshy land. (John Hennen, 1830).

Dr David Bruce discovers the microbe Micrococcus melitensis 

In 1884, the British military establishment decided to send a medical commission to Malta to investigate the causes of this mysterious illness which was affecting their troops stationed there. The selected team was made up of several medical and military personnel headed by Dr. (Captain) David Bruce (1855-1931), a Scottish pathologist and microbiologist.

During his stay in Malta, Dr. David Bruce together with his wife Elisabeth, was allocated a modest residence – two rooms within a wing of the Sacra Infermeria, the former hospital of the Knights of St John, located close to the tip of the Valletta peninsula. The same apartment served Dr Bruce as his laboratory. Dr Bruce tirelessly examined human organs under a microscope at his bedside until finally in 1887, he was able to identify the microbe inside the spleen of a dead British soldier. This microbe he named Micrococcus melitensis. Yet, in spite of this discovery, for many years, nothing changed as the source of the microbe had not been traced and so the microbe kept maiming and killing scores of patients.

The discovery of the source by Themistocle Zammit

In 1904, a new medical commission was set up to further investigate the disease and to try to find out its source and way of transmission into the human body. The Maltese doctor Themistocle Zammit, a prominent Maltese scholar, was chosen as a member of this commission. After graduating in medicine from the University of Malta, Zammit specialised in bacteriology in London and Paris. He was provided with a small room within the government’s Department of Health, in Strada dei Mercanti, in Valletta, to make use of as his laboratory. The building had formerly served as law courts (known as the Castellania) that included prison cells for those indicted for crime and awaiting trial (Paul Cassar, Heritage Encyclopedia).

The small laboratory that Zammit set up was situated on the topmost floor and close to the roof of the same building. Thus, Zammit could carry out his tests on animals that were kept in cages on the terrace outside. There were a variety of animals on which experiments were held, namely monkeys, guinea pigs, farm animals such as sheep and cows, and domestic animals such as dogs. The carcasses of the diseased animals were burnt on that same terrace. Apart from these specimen, Zammit also put mosquitoes and other insects under his microscope as suspected transmitters of the disease.

The tested animals were fed the Micrococcus melitensis that Dr. Bruce had previously discovered, to see if they were prone to infection and thus hosted the microbe. Zammit bought six goats to test on. During the repeated tests, Zammit found that five out of six goats were infected (H.V. Wyatt, 2005). It was now important to find out how this microbe entered into the human body, whether by the consumption of goats’ meat, physical contact with goats, or else via dairy products produced by the same animal. After innumerable tests, on June 25 of 1905, Zammit could officially report the discovery of the culprit microbe in the blood, urine and the transmission of the microbe via milk of goats. Further investigations would eventually prove that Micrococcus melitensis could also infect cows, dogs, pigs and other farm animals and humans in various other ways.

The question still remained, how did the goats contract the microbe in the first place. A major risk of transmission was accounted for. The Maltese goats can provide up to 5.5 litres of milk daily, and thus carry a heavy udder that dangles heavily sometimes almost reaching the ground. Thus, when grazing in farms which were often very dirty, or else while goats were led through the streets, their udder would sometimes touch the ground, causing abrasions and thus get infected by urine or other dirt. In farms, goats could easily come in contact with the vaginal discharge of other infected goats. The disease could also be transmitted between goats when mating. One other way the transmission occurred, when the farmer milked numerous goats in one session and so his wet fingers would transmit the infected milk from one goat to the next. In goats, the microbe could create serious health problems, such as causing pregnant goats to abort or else give birth to weaklings. (W.H. Wyatt, 2009).

Preventive actions against infections  

Following Zammit’s discovery, British soldiers were no longer being supplied with goats’ milk and thus, in a short while the military was no longer being exposed to such infections. ** The Maltese were warned not to consume fresh milk. Such information was relayed to the largely illiterate population, mainly from the pulpits of churches where the Maltese congregated daily (Ganado, 1974). The warnings to the Maltese had only minor success. While some desisted from purchasing fresh milk from herdsmen and opted to consume tinned milk most others, especially those in the rural areas simply ignored the warnings. Along the years, various awareness campaigns were launched to slow down and eradicate the transmission of the microbe to humans from infected milk, but for the most part, the infections from Brucellosis remained high. As from 1932, the authorities pushed actively for pasteurisation and herdsmen were now required to take their goats to milking stations in Ħamrun, San Ġwann and Tarxien (J. Arena, 2021). It was only in 1938, that a law to have all milk be pasteurised came into force. In so doing, the small herds of goats vanished altogether from the streets of the Maltese towns and villages. 

Dr. Themistocle Zammit’s laboratory

The laboratory inside the Ministry of Health, were Zammit carried out his experiments still exists to serve as a memento to the discovery and to honour the erudite scholar. The laboratory room contains a small writing desk with a black glass top, on which an old Bunsen burner, a microscope and an ink pot stand. Next to it are a mortar and pestle, test tubes and a hand driven centrifuge for two glasses. In the middle of the room a shelf holds glass containers full of chemicals. Old labels have hand written names: “Chloroform”, “Sulphuric acid”, or simply “Water”. Once, there were also files filled with calculations of tests resulting from Zammit’s experiments. Labels were written in pencil and underlined with red with the words, ‘Tube C shows abundant growth of M’.

Zammit’s discovery of contaminated milk as the vector for transmission into humans of the Brucellosis microbe, as well as his pioneering work in archaeology and Maltese literature earned him local fame. Yet, it is rather odd that Zammit, unlike Dr. David Bruce did not acquire international fame in the history of medical science.

* The incubation period for the microbe takes between one and several weeks, and the human body may not suffer from any adverse effects till later (National Library of Medicine, November 1999).

** It is worth noting that the famous Louis Pasteur following his pioneering work and discoveries in vaccination and microbial fermentations, in 1864, advocated the sanitisation of consumables such as milk by boiling – not specifically to prevent Brucellosis, as this microbe had yet to be discovered.  

Martin Morana

11.05.2023

http://www.kliemustorja.com

Bibliography 

Arena Jessica, ‘When the British Empire waged war on the Maltese goat’, The Sunday Times of Malta, November 14, 2021.

Bonnici Joseph, Michael Cassar, A Chronicle of Twentieth Century Malta. Book Distributors Limited. 2004.

Cassar Paul, ‘The Discovery of the Microbe of Undulant Fever in the Goat’, Heritage Encyclopedia, Vol I. Midsea Books.

Ganado Herbert, Rajt Malta Tinbidel – L-ewwel Ktieb (1900 – 1933). Interprint Malta Ltd. 1977.

Hennen John, Sketches of the Topography of the Mediterranean. Thomas and George Underwood. 1830.

Wyatt H.V., ‘How Themistocles Zammit found Malta Fever (brucellosis) to be transmitted by the milk of goats’, Journal of the Royal Society of Medicine, Volume 98, October, 2005.

Wyatt H.V., ‘Brucellosis and Maltese goats in the Mediterranean’, Journal of Maltese History, Vol. 1. no. 2, 2009.

‘Detection of Brucellae in Blood Cultures’, National Library of Medicine

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC85661/

https://en.wikipedia.org/wiki/Brucellosis

https://en.wikipedia.org/wiki/Themistocles_Zammit

*     *     *