Discussion
Historically, the pattern of milk consumption in Malta was the drinking
of fresh unpasteurized goat milk of local origin. The goat was
considered to be a household feature of Maltese culture and daily life
(Tripp & Sawchuk, 2015). Much like the rest of the Mediterranean, Malta
lacked refrigeration; the high concentration of the population and short
distances between villages and towns, and the poverty of grazing land,
made the goat an ideal candidate for distributing milk on customers’
doorsteps (Azzopardi, 2012). The belief system was based on conviction
that boiling milk: (1) ruined the quality and flavour of milk; (2) was
considered superfluous by the people because it was known that the
Maltese goat did not suffer naturally from tuberculosis which the
precautions of boiling had been advocated abroad; but now great emphasis
was laid on this simple yet effective measure; (3) having the goat
milked at the door meant that contamination or adulteration of the milk
is not possible, (4) distrust with scientific findings with ‘the general
public has yet to be convinced that an apparently normal beverage drawn
straight from the familiar goat can be productive of a deadly fever’.
Finally, (5) the request by authorities to boil their milk was simply
unobtainable given that the poor could simply did not have the means to
boil milk (Tripp & Sawchuk, 2015).
As the Gozo notification records show both sexes were likely to contract
undulant fever during their reproductive period. The fact that adults
were more likely to fall ill with the disease is not surprising,
considering that children and in particular infants were not encouraged
to drink milk (Ganado, 1937). Consequently, milk consumption of fresh
goat milk could have a potential impact on fetal loss through
stillbirths.
The main finding of this study on the Malta as a whole is that there was
a significant increased risk of male stillbirths associated with
undulant fever after controlling for seasonality associated with
birthing and undulant fever. Generally, the literature on sex-based
differences in human stillbirths indicates that male stillbirths are
more common than female stillbirths (Stinson, 1985).
Our study shows that the male fetus is significantly more vulnerable
under an insult from brucellosis than a female fetus. Given the nature
of this study we are unable to address this issue other than in broad
terms. A review by Clifton (2010) may offer a plausible explanation as
his review of the literature has found that mothers under adverse
environmental conditions or events initiate different coping strategies
according to the sex of the fetus. Female fetal growth was reduced while
in contrast, the male fetus continues to grow normally which can
ultimately result in preterm delivery and stillbirth.