During the battles fought in connexion with the occupation of Tripoli by the Italians, infectious diseases were confined within narrow limits. According to Sforza, the army physician in Tripoli,[321] cholera broke out there in the second half of October 1911, reached its climax in November, and disappeared entirely in the second half of December. The disease was spread chiefly by dates, which had been infected by flies; it first appeared among the native beggars, then spread to the rest of the population, and finally to the Italian soldiers. The pestilence raged only in Tripoli, a fact which Sforza regards as a proof that it was not conveyed thither by the Italians; for had this been the case, cholera would have revealed its presence in Homs, Bengasi, Derna, and Tobruk, in which places thousands of soldiers disembarked, but not a single case of the disease was observed. Typhus fever is endemic in Tripoli; after the Italian occupation twenty cases of that disease were observed among the natives and ten cases among the soldiers. In order to prevent diseases from spreading to Italy, convalescents were not allowed to return home until there was absolutely no danger of their communicating the infection to other persons. The same measures of precaution were used in relation to relapsing fever.