In 1874, the average strength of the garrison was 4,466 men, exclusive of colonial troops. There were 3,924 admissions into hospital (878.6 admissions/1000 mean strength), with 31 deaths (6.90 deaths/1000 mean strength), including 4 among the invalids on their passage home or at the Invalid Depôt at Netley.
The Departmental Corps had an average strength of 45 with 39 admissions into hospital (866.6 admissions/1000 strength). It had 2 deaths among the invalids (44.41 deaths/1000 strength).
127 invalids returned home from Malta during the year; 93 were discharge at the Royal Victoria Hospital Netley. Constitutional diseases (32) and circulatory diseases (28) were the main causes for invaliding from Malta, followed by debility (15), diseases of the nervous system (12), and diseases of the digestive system (10).
In 1874, the average number constantly non-effective through sickness (mean daily sick), excluding the Royal Malta Fencible Artillery, was 175 men. The ratio per 1000 mean strength constantly sick was 39.73; the average sick time to each soldier was 14.5 days; the average duration of each case was 16.35 days.
Army Sanitary Committee
The population of Malta in 1871 was 123,373. In 1873, the mortality rate in both islands was 22.4 per 1000. During June, July, and August 1874, the death-rate rose to 49.2 per 1000. The mortality rate for the twelve months ending August was 34.9 per 1000.
On 23 July 1874, a medical commission was appointed by the Governor to inquire into, and report upon, the causes of the recent increase in the mortality of Malta. The commission was presided over by Surgeon-General J H Ker Innes. Their report, dated Valletta 10 Oct 1874, attributed the high mortality to growing poverty, a depressed trade, and a population too dense to admit of fitting expansion, and living in reckless violation of the primary laws of health.
It drew attention to defects in the sanitary conditions of the island, the most important of which was the want of pure water. The water supply of Malta was said to be simply its collected rainfall, which, in town districts, was principally stored in cisterns sunk in the solid rock beneath the basement of the houses. In agricultural districts, the inhabitants were dependent upon tanks, in which the surface-water was collected. Under these circumstances, water was at times very scarce and of inferior quality.
As regards sewage disposal, the commission recorded that in towns, cesspits often existed in close contiguity to underground cisterns. Very little sewerage was said to exist, and much of what existed was dangerous to health.
Overcrowding in its worst forms was the natural result of combined poverty and a redundant population. The evils of this overcrowding were intensified by bad local drainage, and the many sources of foulness which had their origin in the prevalent usage which admitted animals to share the same roof with their owners.
To redress the sanitary shortcomings, the Commission suggested the creation of a sanitary authority in charge of the hygiene of Malta, and the appointment of a medical officer of health with responsibility to such authority.
Health of the Garrison
Febrile diseases accounted for 959 admissions into hospital (217.4/1000 mean strength) with 7 deaths (1.58/1000 mean strength). Admissions were for:
57 for nervous system diseases with 2 deaths
88 for circulatory diseases with 8 deaths
206 for respiratory conditions with 5 deaths
884 for digestive diseases with 3 deaths
147 for urinary problems
26 for cutaneous diseases
237 for rheumatism
81 for syphilis
37 for phthisis with 6 deaths
481 for accidents
There were 38 admissions for paroxysmal fevers (8.6/1000), 869 for continued fevers (197/1000) with 6 deaths (1.36/1000) and 7 for eruptive fevers (1.6/1000). Of the 7 admissions of eruptive fever, 1 was due to small-pox and 6 to measles which was prevalent in spring. The cases occurred in the Royal Artillery and 28th Regiment. Many of the admissions for rheumatism followed an attack of fever and were presumably a complication of brucellosis.
Paroxysmal fever were rare in the command. The rise in the number of admissions during the year was due to one of the corps in the garrison having served on the coast of Africa.
Under the return of continued fevers were included enteric fever which was endemic in the garrison. The regimental medical officers refer to the tedious convalescence and liability to relapse in many cases of fever returned as simple continued fever and of the great prevalence of diarrhoea among the children in the garrison.
Simple continued fever and febricula represented the majority of admissions returned in the group of continued fevers.
Work commenced on the building of three forts, Forts Mosta (1878), Bingemma (1874), and Madliena (1878). Fort Pembroke was built in 1878.
New barracks for married families of troops were erected at Floriana. Their occupation enabled the closure of 21 of the objectional Crimean Huts, all of which were in a dilapidated state, and which the PMO considered unsuitable for the accommodation of men, women and children. The Crimean hut had been erected on Notre Dame Ravelin, St James Ravelin and the adjacent Horn and Crown Works. They were occupied either by married families or a company of a regiment.
Candidates for the AMD
Section 9 Clause 22 of Army Circular 1873, had directed that every candidate for appointment to the Army Medical Department had to be registered under the Medical Act in force at the time of his appointment.
The Civil Government pointed out that it was not advisable to make this condition applicable in the case of the vacant post of surgeon in the Royal Malta Fencible Artillery, as the Medical Council had no power to order the registration of colonial degrees or diplomas.
Maltese medical officers would have been precluded from competing for this post, had this condition been adhered to. In the supposition that the Medical Act amendment Bill before Parliament in 1870 had not become law, the Governor felt it his duty to recommend that the condition above quoted may not be observed.