Epidemiological aspects of typhoid fever in the Maltese Islands

Abstract

The study of the epidemiology of typhoid fever is indirectly a study of the sanitary conditions and the level of public health education prevailing in a country. Proper statistics of the incidence of typhoid and allied fevers are only available for the Maltese islands since the turn of the century when the introduction of modem laboratory methods to aid in the differential diagnosis of typhoid from other fevers resulted in more reliable estimates of the incidence of the disease in the Maltese islands. Nevertheless, earlier official statistics are in all probability an underestimate of the prevalence of the disease as the Health authorities' firm conviction was that many cases of mild typhoid fever were either notified as remittent, Mediterranean or Malta Fever or else not notified at all. It was indirectly this clinical difficulty to distinguish clearly between remittent or Mediterranean Fever and typhoid fever that prompted David Bruce's first studies in the fever for which he would become world famous and Which is now called after him. In 1885 while David Bruce was stationed in Malta as a young army medical officer, an outbreak related to contamination of water supplied occurred among the British troops. Bruce studied meticulously every fever case admitted to hospital in order to establish the criteria by which one fever could be distinguished from the other. Up till that time considerable doubt existed as to whether the two diseases were separate entities or not.