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.