Early twentieth century infectious diseases in the colonial Mediterranean

Abstract

Disease during adulthood can shape the quality of life at both the personal and familial level, interfere with economic productivity, reproductive success and ultimately one’s survival. The objective of this research has been to explore the 20th century health of small-scale populations (Malta, Gozo and Gibraltar) in the context of infectious disease using traditional statistical, anthropological, demographic and epidemiologic methods. This thesis brings us closer to a deeper comprehension of how disease and humans interact. With respect to the differential undulant experience between Malta and Gibraltar, tradition, non compliancy, along with the scale effect contributed to the persistence of undulant fever in Malta throughout the study period. Other factors were: Gibraltar’s effective health-directed policies that dealt with herding and milk consumption, its greater enforcement of policies and higher levels of intra-group compliancy. Gozo’s heightened and unique 1918/19 influenza disease experience compared to its sister island of Malta, was shaped by limited exposure to influenza as a consequence of isolation and rurality, along with a community interconnectedness because of the small-scale society, and limited social distancing measures. There were significantly higher rates of influenza morbidity in reproductively aged women (15 to 44 years) compared to men (z score=5.28; p <.0001) during the 1918/19 influenza pandemic. Children were significant agents of disease by introducing influenza into households and infecting their female caregivers and infant siblings at disproportionately higher rates. The examination of trends in tuberculosis rates in Malta and Gozo reveals that sex differences in tuberculosis was a result of gendered roles similar to that of the influenza experience. In Malta (urban and rural) tuberculosis death rates was significantly influenced by economics, which explains 61% of the variation in TB death rates. In Gozo, there was no significant impact on respiratory tuberculosis (R=0.23; p=0.25), a consequence of the island’s isolation and a self-sufficient economy.