The Army Medical Department
And the Malta Garrison
1865

The average strength of the garrison was 5,523 men, exclusive of the colonial troops. There were 5,402 admissions into hospital (978/1000 mean strength), with 146 deaths (26.44/1000 mean strength), of which 132 occurred in hospital, 10 out of hospital and 4 among the invalids on their passage home and at the Invalid Depôt at Netley.

The average number constantly sick, excluding the Royal Malta Fencible Artillery, was 261 men. The ratio per 1000 mean strength constantly sick was 47.26; the average sick time to each soldier was 17.25 days; the average duration of each case was 17.63 days.

During the year, miasmatic diseases from infections accounted for 2,750 admissions into hospital (497.9/1000 mean strength) with 103 deaths (18.65/1000 mean strength). Admissions were for:

• 53 admissions for parasitic conditions
• 44 for tubercular diseases with 4 deaths
• 260 for respiratory conditions with 7 deaths
• 367 for digestive diseases with 7 deaths
• 122 for nervous system diseases with 1 death
• 50 for circulatory diseases with 5 deaths
• 14 for urinary problems with 1 death
• 243 for venereal diseases
• 603 for accidents with 9 deaths

8 soldiers were admitted to hospital after receiving corporal punishment. There was 1 suicide.

There were 5 admissions for paroxysmal fevers (0.9/1000 mean strength), 1,162 for continued fevers (210.4/1000 strength) with 13 deaths (2.35/1000 strength), 654 for dysentery and diarrhoea (118.4/1000 strength) with 3 deaths (0.54/1000 strength), 117 for spasmodic cholera (21.2/1000 strength) with 86 deaths (15.57/1000 strength), 362 for ophthalmia (65.5/1000 strength), and 262 for rheumatism (43.8/1000 strength). There were 16 admissions (2.9/1000 strength) for eruptive fevers, with 7 cases of measles in the 2nd/7th Regiment prior to its departure from the command.

Miasma from decomposing organic matter was blamed for fever. It was believed that as the porous ground became contaminated with sewage from leaking drains, the gases produced seeped into barrack rooms and infected the troops. Thus, it was assumed that removing the troops from their unhealthy habitations to tents on airy and exposed locations would bring an epidemic to an end.

Certain valleys in Malta, such as St Paul's and the Great Marsa, were, for a long time, productive of remittent and intermittent fevers, which were thought to have arisen from the dank and marshy conditions of the lower parts near the sea. Once properly drained, these fevers were said to have entirely disappeared.

In May 1865, cholera broke out among pilgrims in Mecca and spread to Alexandria. Quarantine was established at Malta on 14 June. On 22 June, a child of an Artillery man occupying the married quarters at the Plague Hospital, adjacent to the Lazaretto, died within 8 hours of contracting cholera. Other women and children in the same quarters were affected and on 1 July they were moved to Saint Salvatore Counter Guard. The epidemic reached its height on 9 August after which it decreased until it ceased in mid November.

When cholera first appeared in Malta the strength of the troops, exclusive of the 2nd/22nd, which had left the island in July and of the Royal Malta Fencible Artillery, was 5,336 men. Among these were 117 cases of cholera (21.93/1000 strength) with 86 deaths (16.11/1000 strength). The 100th Regiment at Lower St Elmo Barracks had the highest proportion of cases and deaths followed by the 2nd/4th at Floriana Barracks, the 29th at Fort Ricasoli and the 84th at Verdala Barracks. With the exception of the Royal Engineers which had none, the 2nd/8th in Fort Manoel had the smallest proportion of cases and deaths. The Royal Malta Fencible Artillery had 9 cases with 4 deaths.

On 31 Aug 1865, Governor Sir Henry Knight Storks reported that among the troops, the epidemic was almost extinct, as they were in a better sanitary position than the civilian population. The more I see of this disease wrote Storks, the more I am convinced that it is highly infectious, and all goes to show that the present cholera is of the most virulent type. The medical officers who had studied the disease in the Crimea, in India and in other parts of the world would concur in my opinion, that they never experienced a type of cholera so obstinate in its resistance to treatment, nor so deadly in character.

Women have suffered in a larger proportion than men, and children have been also attacked with great severity. The places best situated in a sanitary point of view with good air, good houses and a thriving population have in many instances suffered very severely, whilst the crowded quarters of the towns, the public institutions, prisons, and the abodes of the poor have enjoyed a perfect immunity from attack. All goes to show that neither science nor experience have yet discovered the causes nor the treatment of this mysterious but fatal scourge.

The last soldier became infected on 12 Nov 1865. Among the 225 officers in the garrison there was only 1 case of cholera which proved fatal. There were 501 women and 794 children in the garrison with 46 cases (91.82/1000 strength) and 33 deaths (65.87/1000 strength) among the women and 23 cases (28.97/1000 strength) and 17 deaths (21.41/1000 strength) among the children. 120 NCOs and men were infected with 87 deaths.

On 29 June, cholera appeared in the civilian population; it spread to Gozo on 24 July. By August, from 30 to 70 people were falling ill every day, with half dying of their infection. The epidemic lasted until 24 Oct in Gozo and till 9 Nov in Malta. In the civil population in Malta, there were 2,362 cases with 1,479 deaths, and in Gozo 545 with 252 deaths. Between 7 July and 17 Nov the total deaths among the soldiers and their families were 126 cases with 90 deaths.

In Jan 1865, a special fever appeared in Zejtun and Zurrieq where the people complained of debility, headaches, loin pains, and cough. The symptoms were followed by fever, which was accompanied by a cutaneous eruption of a miliary character on the trunk and arms. The illness lasted about a fortnight, with sweating heralding a recovery. The doctors, called it eruptive rheumatic fever, a type of Simple Continued Fevers.

In Jan, 23 fell ill with fever at Zejtun. In Feb, there were 32, in Mar 47, and in Apr another 47. The mortality rate was 11.4% of those treated. The annual mortality rate from fevers in Malta was around 9 per 1000 of the population. In the first six month of 1865, it soared to 17 per 1000. On 22 Apr 1865, the Government set up a Special Board of Enquiry to investigate the fever at Zejtun. The medical members were Drs Engerer, A. Ghio, S. L. Pisani, Inspector of Hospitals Hume Thomas David and Staff Surgeon Matthew Thomas Patrick. The Board concluded that the fever was typhus fever. It attributed the prolongation and propagation of the disease to ill patients remaining in their narrow dwellings, surrounded by their frequently numerous families.

On 30 June 1865, the Government published Ordinance No VII, To make certain provision relative to the Public Health, promulgated by proclamation number IV. This stipulated that persons affected by infections or contagious diseases, if dwelling in unhealthy or overcrowded places, might, independent of their consent, be removed to the hospital, for their own benefit, and to prevent as much as possible the spreading of disease. A compulsion order was to be supported by two medical officers, stating that the disease was of a nature easily propagated, and that the continuation of the patient in his dwelling place, might, owing to the unhealthy condition of that place, and the number of persons by which it is inhabited, seriously contribute to the propagation of the disease.