Copyright © The Malta Historical Society, 2005.
Source: Melita Historica : Journal of the Malta Historical Society. 1(1952)1(19-32)
[p.19] Maltese Medical Journals 1838-1952
P. CASSAR, M.D., B.Sc., D.P.M.
(Lecture delivered to the Malta Branch of the British Medical Association on the 20th December, 1951.)
Origin of medical journalism
Medical journalism originated in France in the seventeenth century when the first medical journal — “Nouvelles Descouvertes sur toutes les Parties de Medicine” — was published in 1679 by Nicolas De Bligny (1652-1722), who later became surgeon to Louis XIV.  Its publication was followed by the issue of the first Dutch medical journal in 1680, and, later on, by the first British medical periodical — the “Medicina Curiosa” — in 1684. German, Spanish, Italian, Russian and American medical journals were published initially in 1717, 1734, 1792, 1763 and 1707 respectively, so that by the beginning of the nineteenth century the medical journal as we know it to-day — a medium for the publication of original papers and for the diffusion of reviews and abstracts of current medical literature — had become firmly established.
The pioneer Maltese medical periodical made its appearance later in the day, when Dr. C.G. Schinas published his L’Ape Melitense — Giornale di Medicina in the last quarter of 1838. His declared aim was to compile a journal that would appeal not only to the newly fledged doctor but also to the mature and experienced physician. All the articles, extracts and reviews were either written or translated by Schinas himself, so that the Giornale di Medicina cannot be said to be representative of the knowledge, views and experiences of the Maltese medical profession of the time. However, in spite of this personal bias, its contents furnish valuable material to the medical historian on the status of medicine and surgery of the first quarter of the nineteenth century, both in Malta and abroad. The Ape is wholly written in Italian but considering the number and length of the abstracts and reviews of foreign medical publications, which form the bulk of its four numbers, it appears that Schinas was equally familiar with the English, French and German languages. He must have had a good grasp of contemporary medical literature for the principal medical journals of Europe, such as Guy’s Hospital [p.20] Reports, Berliner medicinische central Zejtung, and Bulletin Medical Belge supplied him with “copy” for extracts and reviews.
Dr. C.G. Schinas was a Greek. He studied medicine at Pisa University and came to Malta in 1823 when revolution broke out in his native country. In 1833 he was chosen Professor of Medicine at our University, a post which he held until his death in May 1856. 
The journal contains seven original articles, the subject matter ranging from cholera, Werlhoff’s purpura, smallpox vaccination and the pharmacology of Segala Cornuta to the use of calomel in intestinal disorders, animal magnetism, phrenology and the description of an improved urinary catheter by Dr. Giuseppe Stilon. Like Schinas, Dr. G.M. Stilon was of foreign birth. He studied medicine at Naples and after obtaining his degree he practised in Calabria. At that time Southern Italy was overrun by French troops and Dr. Stilon was pressed into the French service by the French commander who was short of medical officers. At the battle of Maida fought on the 4th July 1806, the French were defeated and Dr. Stilon was taken prisoner by the British and in due course reached England, where he subsequently regained his freedom. Sir William Burnett, who was at the head of the medical department of the navy at the time, was impressed by the professional skill of Dr. Stilon, whom he persuaded to enter into the naval medical service. Dr. Stilon married the widow of a naval officer and after serving at sea for some time he was appointed surgeon to the Malta dockyard and Bighi Hospital. When he retired from the service he entered into practice in Valletta where he resided until his death in 1848. 
The most important article in the Ape is the epidemiological and clinical study of the cholera epidemic that struck Malta in June 1837. We learn how it started at the Ospizio of Floriana and how it spread quickly to the towns and countryside of Malta and Gozo so that in the words of Schinas “there remained no village, no inhabited place, no harbour and no bay that was not visited by the disease, which did not even spare the ships that happened to be sailing in the vicinity of the Island.” At the beginning panic spread among the population. Some abandoned the towns while others shut themselves up in their homes in the hope of finding salvation in isolation from their fellow men. The cause of the disease was then still unknown and its manner of spread had not yet been definitely established. The cholera vibrio was only discovered in 1884. 
It is not surprising, therefore, that the profession was divided into two opposing camps, one section favouring the contagious theory, the other the miasmatic theory of origin. “The electrical movements” of the atmosphere were thought to influence the number and severity of the attacks of cholera, while the wearing of a woollen belt round the abdomen and the avoidance of excessive sexual relations were enumerated among the precautions to be taken against the disease. 
[p.21] This epidemic became the subject of a prolonged controversy, involving both medical and ethical issues. The fear that had seized the population at the outbreak of the epidemic had spread also to a few members of the profession who were subsequently accused of having failed to succour their patients stricken with the disease. Among these few was the compiler of the Ape who was sincere enough to admit that at first he was afraid a little too much, though later he fully atoned for his initial alarm. The reflections of the Ape on the psychological conflict of the physician called upon to fight a relentless enemy when his heart is in the throes of fear for his own personal safety and when he is fully aware of his helplessness against an all-pervading foe that might strike him down at any moment, are penetrating and not without pathos. “Doctors” says the Ape, “have certainly not been privileged by nature with the exemption from fear... When the occasion for fear is real even the bravest man will feel afraid and nobody will deny that cholera is such an occasion... If the physician believes in contagion he fears contact with others; and if he does not believe in contagion, he is afraid of the air and of noxious foods... I cannot deny that I was afraid a little too much at the beginning... but I must confess that the physician is in duty bound, in similar circumstances, to tender his aid and to show himself courageous; because, although he believes himself to be weak, he is held to be omnipotent by the people; and when the people miss his help they get discouraged, and when they see him frightened they despair.”
The cholera epidemic had hardly ended after carrying off 4,243 victims, when another scourge in the form of a smallpox epidemic made its appearance in Gozo. It was still raging in October 1838, when the Ape published the “Reflections on vaccination and revaccination.” During a previous epidemic in 1830, 15% of non-vaccinated persons who were attacked died of the disease, while the death rate among the vaccinated was only 5%. In the 1838 epidemic the death rate up to October of that year was 36% among the non-vaccinated and 10% among the vaccinated. Schinas was an enthusiastic admirer of Jenner and in his paper he cited the above figures as a proof of the efficacy of vaccination against those who maintained that vaccination was a useless procedure. He insisted that the inoculations should be carried out by experienced persons and that the doctor should himself ascertain that the vaccination had been really successful. He knew that the immunity conferred by vaccination was of a temporary nature and he recommended re-vaccination in non epidemic times after a period of 5 to 7 years as he had observed that smallpox epidemics usually occur after such an interval. “Research” says Schinas “may throw further light on several aspects of vaccination but essentially it will not change my recommendations.” It is amazing how completely he had foreseen the future and how modern the Ape’s views remain after more than a century of medical progress. Here is what, in fact, a leader in the British Medical journal of the 15th September 1951 has to say on the subject: “The Society of Medical Officers of Health have performed a useful service in publishing an authoritative statement on the policy, technique and materials of smallpox vaccination, a subject on which there is, surprisingly, still much confusion. After reaffirming the Society’s complete confidence in vaccination as a means of protection of the individual and the community against smallpox if carried out properly and at appropriate intervals, the statement continues with recommendations that primary vaccination in the first six months of infancy should be encouraged to the [p.22] widest extent; and that in non epidemic periods parents of children who have received primary vaccination in infancy should be urged to have their children revaccinated during school life... In 1896 a Royal Commission considered that, in general, immunity lasted for ten years after successful vaccination, and thirty years later (i. e. in 1927) Leake recommended revaccinations every five to ten years.” 
The passage of time, on the other hand, did not uphold the Ape’s optimism with regard to the usefulness of phrenology, which according to the journal, was one of the most important studies of the day — an opinion shared by many continental physicians. Phrenological theories were first put forward by Gall in 1810. In brief, Gall had claimed to be able to tell the moral and mental qualities of a person by an examination of the bumps and hollows on his skull. Gall’s theories had excited great interest at the time and it is reported that at a meeting of the Royal Medical Society of Edinburgh in 1823, the reading of a paper on phrenology gave rise to a discussion that lasted until four o’clock the next morning.  In the first number of his journal Schinas had published an extract of an article by Broussais, which had appeared in a French phrenological journal, and in his comments he declared that while he entertained no doubts as to the existence of the so called central organs, he was not altogether convinced about their reputed numbers and their exact situation. He also believed that it was very difficult to estimate their development simply from an external examination of the skull.
The Ape’s attitude towards animal magnetism — that other pseudo-science of the early nineteenth century — was that of the neutral observer who neither accepts nor despises, but who prefers to wait for further developments before expressing judgement. This cautiousness was fully justified by subsequent events for like phrenology, animal magnetism or mesmerism was debunked and relegated to the limbo of pseudo-scientific theories.
The Ape was not a credulous and irresponsible propagator of sensational theories. It is typical of its outlook that while encouraging new ideas and methods of clinical investigations — such as the use of microscopy in the examination of urine — it did not refrain from criticising the exaggerated optimism of those who saw in the influence of chemistry and physics on medicine an easy solution of physiological and therapeutical problems.
The life of this journal was a very short one — only four monthly numbers having been issued between September and December 1835, the whole volume amounting to 288 pages of 8vo size. I have not discovered why the Ape stopped publication. We know, however, that Schinas had to face publishing difficulties from the very beginning. Scarcity of paper was not the main problem as it is today, but it was the inability of the publishers to cope with the ever increasing volume of publications and the scarcity of operatives that handicapped Schinas. To understand his difficulties it is important to bear in mind that there were very few printing presses at the time in Malta. In fact up to a few years previous to the appearance of the Ape the press was subject to a Government censorship and as the Government had refused to grant licences to exercise the trade of a printer there was [p.23] only one press in the Island — the one belonging to the Government itself.  Under these conditions it is not surprising that Schinas did not solve the printing problem, and that the November and December numbers — the last two numbers of his journal — were only published in the following year.
It was not long, however, before Schinas with the assistance of a few doctors on the staff of the Civil, Sauna and Santo Spirito hospitals, launched another periodical under the title of Il Filocamo. Unlike the Ape, the new journal was not dedicated exclusively to the art of medicine. In fact it had as its sub-title Giornale Medico Scientifico e di Educazione, but as articles on general science and education occupied only a very small part of its columns, it deserves to he classified as a medical journal. Its first number carries the date of the 1st January 1841. The journal was published monthly but subsequently it was issued every fortnight. It is of quarto size and consists of two volumes which together make up 256 pages.
The Filocamo’s main preoccupation centred round the frequent outbreaks of smallpox and the constant threat of an invasion of the Island by plague which at the time had appeared in Italy. We cannot but sympathise with the editor when we realise that the mode of transmission of plague was still a matter of controversy and speculation in 1841, and when an editorial informs us that prophylaxis against smallpox could have been secured for the people if the Government had been willing to spend the paltry sum of £150 annually.
The treatment of tetanus forms the subjects of various contributions to the journal. A certain Dr. A. Speranza claimed to have cured two cases of tetanus by means of mercury rubbed into the skin on the internal aspects of the patients’ thighs. Schinas on the other hand, in a paper read in October 1839 before the Medical Section of the Congress of Italian Scientists at Pisa, had to confess that out of twelve cases of tetanus treated by him with mercury rubbed into the skin over the spine, only one recovered. We are not surprised at his disappointing results when we learn that this treatment was based on the assumption that tetanus was the outcome of the exposure of the body to cold air after exercise.
A very unusual case of a woman who went into convulsions after drinking large amounts of coffee is reported in an annotation on the “Action of Coffee.” We are not told how big the dose of coffee was, but we are assured that the convulsions could not have been due to anything except coffee, since they occurred only after the ingestion of this beverage and since they could be reproduced experimentally by simply giving a sufficient amount of coffee to the patient.
Very interesting. too, are the Filocamo’s observations on the psychological derangements of the human organism. It accepted the contemporary view that there was no such thing as a purely mental illness and that insanity was always the result of a lesion in the brain. This traditional view of the aetiology of mental disorder, however, did not cause the journal to ignore the important part played by the psychological element in the causation of mental illness. It admitted that psychic factors could produce insanity but that they did so indirectly after they had occasioned a lesion in the brain. Neuropathological research has so far furnished no evidence in support of such a theory but recent trends in current medicine have [p.24] shown how much the Filocamo was abreast of the times when it insisted on the need of a psychological approach to illness — an argument dealt with in an introductory annotation to an article on psychotherapy reproduced from a French journal. The following extract from Schinas’ introductory paper expresses a truth that the medical profession has been slow to learn to appreciate and to practice. “It is necessary” says Schinas “to evaluate the part played by the psychic factor in the genesis of disease in order to be able to eradicate the illness, for psychological causes not only produce disease but they also perpetuate it... It must also be borne in mind that though they do not cause illness directly, they can complicate a physical derangement and make it worse... Finally it is important to remember that just as psychological causes may modify the patient’s condition, so can physical factors influence his mental state.” Here in a nutshell is the formulation of the concept of the psychosomatic unity of the human organism — a concept that modern medicine rediscovered not so long ago and is now applying in its approach to illness.
The Filocamo had such a wide circle of readers, not only locally but also abroad, that it aspired to become the medical journal of the near East. With this aim in view it opened its columns to the medical profession of the Eastern Mediterranean. This was in June 1842. An article on the mineral waters of Greece was contributed by Dr. Bouros, Professor of Pathology at the University of Athens, but the next number of the Filocamo which should have been issued on the 31st July 1842 did not make its appearance. It was published five months later on the 24th December 1842, and as far as we can judge from the copies preserved at the Royal Malta Library, this was the last number of the second medical journal to be published in Malta.
The third attempt at the foundation of a medical periodical was made by Dr. Gavino Gulia after an interval of almost thirty years when on the 25th July 1871 he published the first number of Il Barth — Gazzetta di Medicina e Scienze Naturali. The periodical is named after Dr. Joseph Barth, the Maltese physician who had the high honour of occupying the first Chair of Ophthalmology in Europe established by the Empress Maria Theresa at the University of Vienna.
The journal was issued every forty days and was so well received by the profession that in two years it could claim that nine out of every ten doctors in Malta subscribed to it. Like its predecessor it did not deal exclusively with medical matters. Apart from being a distinguished physician, Dr. Gulia was also a renowned naturalist, and this explains the double purpose of his journal. The articles on medicine and surgery, however, far outnumber the papers on Maltese botany and on natural history. The contributions on these two subjects do not concern us, but it is interesting to know that Il Barth was a staunch opponent of Charles Darwin “che con poca lusinga alla superba razza di Adamo stabilisce per nostri avi i ributtanti macacchi ed altre bestie...” Gulia thought that Darwinism had no future, for humankind “certamente rinunzierà in eterno simile sconce Parentele.” But humankind is not so easily persuaded as Gulia imagined, and the discussion on Darwinism still goes on.
[p.25] Il Barth was unique in that it was the first medical journal to invite and to receive contributions in English from the British naval and military doctors stationed in the Island. It can boast of having had the longest life enjoyed by any Maltese medical journal. It survived long enough to make it possible for us to build up a panorama of medical and social life in Malta at the beginning of the last quarter of the nineteenth century.
Those were the days when poverty was so very distressing that the poor had to eat carob pods to appease their hunger as they could not afford to buy bread in sufficient quantities. Many children died from neglect as their mothers had to leave their homes in search of work and medical advice was sought too late when it could be of no avail and only to avoid the dreaded autopsy. The mortality statistics for the decade ending in 1873 showed that 50% of deaths were in infants and children. Overcrowding was extreme in many places in Cospicua, Senglea and Vittoriosa and we learn that eight or ten persons lived in one room “in which all the functions of life” were performed.
The streets were badly surfaced so that in summer they were covered by immense quantities of dust, while in winter they were reduced to pools full of mud. Dr. C.O. Borg, who writes on this subject, attributes the great frequency of tuberculosis and the incidence of diphtheria to the vast amounts, in the air, of particles of dust and organic matter derived from the abundance of excreta deposited in the streets by domestic animals. As a precaution against hydrophobia, dogs went about wearing a muzzle. The state of public hygiene was appalling. Sewerage was so faulty that in certain areas of the three cities the effluvia arising from the drains were so intense that they blackened silver articles in a very short time owing to the abundance of ammonium hydrosulphide that escaped from the untrapped drains. Very often the smells in the streets were so strong that people had to stop their noses with handkerchiefs to avoid inhaling the offensive odours. Ignorance of personal hygiene was not limited to the illiterate population but “even the upper classes were very backward in this respect.”
With such a background it is no wonder that the second half of the nineteenth century was marked with the frequent occurrence of endemic fevers and epidemics. Typhus first invaded the Island during the Crimean War, having carried away Prof. Schinas among its victims while he was the Chief Physician at the French Hospital at the Lazzaretto. Typhus appeared again in 1861 having been introduced into Malta by the sick crew of an Egyptian vessel. Smallpox attacked more than 7,000 individuals in 1871 of whom 700 died. Influenza which had occurred in epidemic proportions in 1836 and 1864 again broke out in 1873, but fortunately there were very few fatal cases. Diphtheria wrought havoc among children because the old generation of doctors stuck to outdated theories of the transmission of disease and took no precaution against the spread of the infection. In fairness, however, it must be said that no incentives were offered to medical men to keep themselves abreast of the times. They were badly remunerated and to this lack of encouragement the Barth attributed the reduction in the number of doctors in the Island. Thus while in 1838 they numbered 120, by 1874 they had decreased to 80, while in the same interval of time the population had increased by 30,000 souls. We can understand, therefore, why there was a lack of specialists in “all branches of medicine.”
[p.26] The lack of professional knowledge on the part of midwives was incredible. The editor, in exposing the very bad state of affairs in this kindred profession, declared that “to assert that no Maltese midwife is capable of recognising the presenting part in a labour” was to state a great though painful truth. Yet in spite of their great ignorance, these midwives did not scruple to hasten deliveries unnecessarily, causing thereby perineal lacerations, and even to attempt to correct displacements of the uterus.
So far the picture presented to us has been so gloomy, that one is apt to gain the impression that nobody cared a rap for the health of the people. Certainly few cared very much, but one who did and who never failed to raise its voice was the indefatigable Barth. It opposed strenuously the obsolete notions about the transmission of infectious diseases. In a paper on the precautions against the spread of epidemics, the journal upheld the contagious theory of cholera and ridiculed the idea, which then still prevailed among certain members of the profession, that epidemics were caused by the migration, from one place to another, of columns of air laden with the germs of cholera or smallpox or diphtheria.
The commercial classes of the community did not escape its censure when, mindful only of their own financial interests and careless about the welfare of the people, they protested on more than one occasion against the precautionary measures of quarantine imposed by the Government to prevent the spread of epidemics from the continent to Malta. With righteous wrath it attacked the midwives of its day, suggested ways and means of raising the standards of that profession and drew attention to the importance of a “Pro-Infantia” movement. It encouraged vaccination and revaccinaticn against smallpox but cautioned against the method of arm to arm vaccination because of the possible danger of conveying syphilis from one person to another (this method prevailed until 1801).
By means of a series of articles from the pen of Dr. Amabile Gulia, the journal popularised Lister’s ideas about antisepsis and disinfection. It hailed the new law enforcing burial out of cities and prohibiting the conveyance into churches of corpses of persons who had died of an infectious illness.
As cases of undulant fever were very frequent among naval personel, Dr. Gulia proposed that Fort Chambray in Gozo be turned into a naval convalescent sanatorium. This suggestion fell on deaf ears at the time, but had the editor of Il Barth been alive in 1934, he would have derived some satisfaction from seeing Fort Chambray transformed into a mental hospital to relieve the overcrowding at the parent hospital at Attard.
The founder of Il Barth was among the first physicians to introduce, in 1860, the hypodermic syringe in Malta — a means of drug administration that was invented in 1855 by a Scotsman called Wood. Dr. Gulia was very satisfied with the “splendid results” obtained with the new instrument that had metal parts of silver and a needle of gilded steel or gold — the whole costing a few shillings. In his efforts to popularise this new method among his colleagues he had to fight against the opinion held by some of them that the action of drugs, such as narcotics, introduced into the body by parenteral injection was a purely local one.
He pressed for the publication of vital statistics by the public health authorities and welcomed, in 1871, the proposal made by the Crown advocate for the establishment of a Government office of general statistics — a proposal that had to wait for [p.27] seventy-six years before it was implemented in 1947. He also recommended the collection of existing public health laws into an apposite code and stressed the need for the promulgation of new ones, among which a law relating to the use of lead in cosmetics and food utensils.
Public health matters, however, did not constitute the only topics of discussion in Il Barth. Medical memoranda and contributions on therapeutics figure prominently among its contents. Of special interest is the summary of a genetic study by Prof. Huxley of the Maltese family Calleja, nicknamed “ta’ l-erbgħa-u-għoxrin,” several members of which had supernumerary fingers and toes. The study starts with Grezzju who had six fingers in each hand and six toes in each foot. He married a normal woman and had four children, of whom, Salvu had 24 digits like his father, while George, Andrea and Maria were normal. Salvu married and had four children, of whom three had 24 digits. George also married and had two, children, one with 24 and the other with 23 digits. Maria had four children, only one of whom had 24 digits. All the offspring of Andrea (we are not told their number) were normal.
Dr. Clo. Borg writes on the treatment of diabetes with a diet restricted in carbohydrates and with the administration of lactic acid. Dr. P. Sammut of Gozo confirms the good results obtained by the lactic acid treatment in diabetes and claims to have been the first physician to treat diabetes successfully in Gozo, where previous to the use of this treatment all diabetics died of the disease.
In an article from the pen of Dr. Gavino Gulia we read of a case of undulant fever in whom recovery was attributed to the administration of very heavy doses of alcohol in the form of wine and brandy. In fact, in a week, the patient had drunk 17 bottles of wine and 2 of brandy.
“On a case of leprosy” is the title of another paper by the same author, which is still worth reading for the detailed clinical picture which he gives of the disease. A commission of twelve local physicians chosen by the Government in 1862 to state whether leprosy existed in Malta, had declared that the disease was not met with in the Island. Dr. Gulia disproved the conclusion of this commission and in his paper he adduced evidence to show that a case of leprosy had been seen by Dr. Schinas as far back as 1835. He also added a case, studied by himself, of tubercular and anaesthetic leprosy complicated by mental disorder. Following the publication of Gulia’s paper, Dr. I. Sammut and others published the case histories of other cases observed by them, and thus no doubt was left as to the existence of leprosy amongst its in the nineteenth century.
From another contribution by Gulia on diseases of the liver, we learn some of the views held by Dr. Tommaso Chetcuti, the pioneer Maltese psychiatrist,  on the aetiology of mental disorder. Chetcuti is reported to have observed that four members of a family suffered from gallstones associated with mental and neurological signs and symptoms. Two brothers had attacks of mania, a sister suffered from convulsions and their mother was choreic. This family history strengthened his belief that hepatic and biliary disorders were responsible for the causation of insanity. In fact he blamed cholelithiasis for causing suicidal melancholia and [p.28] even stated that out of every ten cases of depression, seven are preceded by diseases of the liver. The aetiology of mental disorder is as mysterious to-day as it was in Chetcuti’s time, but the association of hepatic disease with degenerative changes in the brain was well established by Kinnier Wilson in 1912. 
The temperament of the Maltese as seen by the editor of the Barth is not very flattering. He upheld the Latin origin of the Maltese but he deplored the nervous erethism which forms part of our Latin heritage. He attributed this abnormal irritability of our nervous system to many factors ranging from consanguineous marriages and the inconstancy of our atmospheric temperature to the monotony of life in Malta, the excessive consumption of tobacco, coffee and alcohol, and to overpopulation. His analysis of the psychology of the Maltese women of his time is harsh but also very amusing. Here is what he thought of them in his own words “Le donne Maltesi hanno una grande disposizione all’isterismo... L’educazione che attualmente si da alle ragazze, nelle quali si ha ogni premura di sviluppare il sistema nervoso trascurando quello dei muscoli, ne va rendendo sempre più impressionabile il sistema nervoso. Sì! la lettura di novelle, i divertimenti notturni, il sentimento della musica, lo studio di più lingue, ne vanno alterando profondamente la delicata costituzione... (Queste donne) così deboli, allorchè passano a marito, divengono cattive mogli e peggiori madri che quando non danno in sconciature, partoriscono di quei schifosi spauracchi che gli Spartani solevano precipitare negli abbissi perchè non fossero di aggravio allo stato e a se stessi. Tali matrimoni sono di rado felici ed è questa una pena meritevole del giovane che nella scelta della sposa è diretto da uno strillo al pianoforte, da una gambata al walzer o da una frase sentimentale.” And what are the horrible consequences of all this? A host of illnesses ranging from abortion to epilepsy! Fortunately time has shown that Gulia was unnecessarily alarmed about the Maltese female and that the vitality of the fair sex and her reproductive powers are not so readily undermined by the study of languages and by waltzing! Still, his scathing remarks about women are none the less valuable for they throw a revealing light on his own psychological complexes in relation to the opposite sex. He had a very poor opinion of women in general, irrespective of their nationality. Thus when he learned that four young ladies were studying medicine in the hospitals of Paris, he prophesied that few patients would go for medical advice and treatment to a woman. He wrote in his journal that the greatest obstacle in their career would be their inability to maintain professional secrecy and he declared himself in full agreement with Queen Victoria who had solemnly declared that she would never avail herself of the services of a doctor of her own sex.
La Rivista Medica
The Barth ceased publication in October 1877, and thirteen years passed before a successor, La Rivista Medica, appeared. The Rivista was a fortnightly journal written wholly in Italian. It was first published on the 15th March 1890 under the joint direction of Dr. Themistocles Zammit, of Brucella fame, and Dr. Fabrizio Borg. Among the contributors to the new journal we meet some of the outstanding [p.29] personalities in Maltese medicine and surgery, whose names and achievements are still fresh in the memory of those among us who were young not so many years ago. I will recall a few of them. Prof. Lawrence Manchè, who occupied the Chair of Ophthalmology at our University from 1880 to 1907, wrote on the treatment of the eye diseases that were prevalent in Malta at the end of the century. He stressed the need for legislation to make it obligatory on midwives to instil a 2% solution of silver nitrate in the eyes of new-born babies as a preventive measure against ophthalmia neonatorum.
In a series of short articles Dr. G.F. Inglott commented on the various cases of dystocia observed and treated by him during seventeen years of practice at Zabbar.
Dr. C. Mifsud, in a contribution on the use of faradic and galvanic electricity in perimetritis, advocated a more wide-spread use of this means of therapy which he had seen applied with great success in the clinic of Dr. Giorgio Apostoli.
Dr. S. Cassar described a case of intestinal obstruction with marked meteorism and reported how he treated his patient successfully by paracentesis of the colon, producing thereby the evacuation of the gases contained in the viscus. He warns, however, that such a measure must not be resorted to indiscriminately and that it is especially dangerous in cases where the obstruction is due to a malignant growth as it is likely to lead to the rapid dissemination of the tumour.
From his pen, also, comes a paper on the treatment of tetanus with very high doses of chloral hydrate and potassium bromide. In this manner he succeeded in curing 4 out of 7 cases of tetanus seen by him up to 1890. This use of sedatives marks a great advance on Schinas’ treatment of tetanus by mercurial inunction fifty years earlier.
Dr. F. Debono published an Italian translation of the text of a paper in English on the electrical treatment of peripheral facial palsy, which he had read at a meeting of the local branch of the British Medical Association in December 1889.
It is evident from the nature of these contributions that with the appearance of the Rivista Medica we enter the threshold of the modern period in medicine. Surgical history, however, was still being made in Malta at this time. Prof. G.B. Schembri published the case record of the first laparatomy to be done in Malta and performed by him on the 22nd November 1890 on a woman of 27 years who was suffering from an ovarian cyst. Four days later he did another laparatomy in a private house in Senglea. Both operations were completely successful. Nearly a year later, in the issue of the 15th October 1891, Schembri announced the performance of the first Caesarean section to be carried out in the Island. He operated on a woman with a restricted and rachitic pelvis, and both mother and child survived. To-day we see nothing wonderful in the survival of the mother following a Caesarean operation, but in the 1890s such an occurrence was an extraordinary event — much more so if Schembri, with his usual disregard for asepsis, did not refrain from placing the knife between his teeth when he wanted to have his hands free for manipulating the organs. In fact he is reputed to have done so on various occasions to defy his contemporary, Prof. Hamilton Stilon who, at the end of the century, had started to teach the elements of bacteriology to his students.  [p.30] Indeed, the importance of operative asepsis was only realised some years later when Dr. Salvatore Cassar was elected to the Chair of Surgery, which he was destined to hold for 26 years.
La Rivista Medica was not concerned solely with local medical and surgical developments. Robert Koch’s claim in 1890 of having prepared a vaccine against tuberculosis filled the directors of the Rivista with an unbounded optimism. In their enthusiasm they reproduced in their journal an Italian translation of Koch’s original paper which he had read at the International Medical Congress held in Berlin in August 1890. Koch’s tuberculin treatment subsequently fell into disfavour, but the Rivista did not live long enough to witness the disappointing results of a discovery that promised so much and achieved so little.
The encouraging reception which the journal had had initially on the part of the local medical profession was not sustained so that at the beginning of 1891 the directors had to confess that the contributions to the journal were not so numerous as they had been led to expect. The Rivista only managed to survive for another year, under the direction of Dr. G. Busuttil and Dr. S. Cassar, its last number appearing on the 31st January 1892.
La Salute Publica
Before leaving the nineteenth century, mention must be made of a popular medical periodical founded in April 1897 by Dr. P. Agius of Sliema and called La Salute Publica. Its aim was the diffusion of notions of hygiene and of first aid among the people, but it soon became famous for its aggressive attitude towards the government in general and the Public Health Department in, particular. This periodical makes interesting and entertaining reading but since it was not a professional journal it does not come within the scope of this paper. It will not be out of place, however, to reproduce one or two extracts from this journal to give an idea of its journalistic style and the sarcastic nature of its attacks. Here is an example: “Il Dipartimento di (in-)Sanità non si sa se sia divenuto un ramo del Manicomio, una sala da lettura, un Ufficio di fotografia, una smoking-room o un salotto da conversazione. L’Igiene si va ammazzando in Malta. Del resto il popolo dovrebbe scemare, una volta che non vuol scemare emigrando in Australia dovrebbe scemare emigrando a Patrasso, dicono le parucche grandi; il popolo di Malta è un rompistivali colla sua rapida moltiplicazione!” And elsewhere in an editorial on the prevention of epidemics, the writer says: “Inquanto all’isolamento abbiamo un Lazzaretto che serve di centro di irradiazione e di focolaio alle malattie infettive. Inquanto a isolamento abbiamo dei vecchi decrepiti alla vigilia della Demenza Senile, sprovisti dell’uso di parecchi sensi che si usano per... Per isolare, no, per corbellare il publico sì, e che si appellano guardiani di Sanità per ironia certo.”
Il Progresso Medico Chirurgico
The twentieth century has not been prolific in the production of medical journals in this country. Of the very few periodicals that have been published so far, Il Progresso Medico Chirurgico, which appeared between the 1st December 1920 and the 1st October 1921, was owned and edited by a layman, Mr. Ciro Cherubino, an Italian commercial traveller who settled in Malta and set up a pharmaceutical [p.31] business. Hence the reason why this journal carries advertisements of patent medicine. A glance at the drugs advertised reminds us of the progress achieved in therapeutics within the last thirty years. Who, for instance, in these days of antibiotics has heard of “Jodarsolo” for rheumatism, “Adrenofor” for anaemia, and “Neodrin” for skin tuberculosis; or of Prof. Bruschettini’s anti-tuberculosis vaccine to which the Genoese professor dedicated a long article in the 6th number of Il Progresso Medico Chirurgico?
The advances made in the field of therapeutics have been matched by a similar improvement in the infantile mortality rate in the Island — a subject to which Dr. Angelo Mizzi devotes two long articles. Among other things, he tells how nearly one-fourth of infants born in 1920 died in the first year of life, the principal cause of death being enteritis. A comparison with the statistical returns for 1950, as published in the report of the Medical and Health Department,  shows that there has been an appreciable diminution in this figure. In fact the infantile mortality rate for 1950 was 8.8%, but the main cause of death remains enteritis.
Of special interest is another article by an unknown writer who signs himself R.M. and who writes about the status of women in society. This contribution reveals the striking change that had occurred in men’s attitude towards women since Gulia’s critical analysis of the female sex fifty years previously. By 1920 woman is no longer the histrionic creature and the progenitor of monsters that alarmed Dr. Gulia. According to her anonymous defender of the twentieth century, she is neither an angel nor a devil, but the equal of man both morally and intellectually. She can even rise above him for with her help man may succeed in solving many of his social problems and even abolish war. The new conception of woman is that of “una forza che purificherà quella dell’uomo e si unirà a lui per condurlo verso i migliori destini.” It is sad to reflect that this idea of human progress under the guidance of woman has not come true. Still it is a beautiful dream, and we cannot but feel grateful to the unknown champion of the female sex for the hopeful vision that his pen has left us.
The journals we have considered so far were all the result of individual initiative. Efforts, however, were not lacking on the part of professional bodies to publish a medical journal. The first attempt was made by the Camera Medica in 1885, the year of its foundation, when it issued the Effemeride Medica Maltese on the 1st of June of that vear. Only one number of this periodical appeared and it contains no material of medical interest but only the speeches of Prof. Nicola Zammit and of the Lieutenant Governor W.H. Hutchinson delivered on the occasion of the inauguration of the “Camera.” The “Camera Medica” made a further attempt many years later, when on the 1st July 1922 it published the first number of La Rivista Medica — a quarterly journal that reminds us of the Rivista Medica of the previous century and which contains articles in both the English and Italian languages. I have been able to trace only the first four numbers of this periodical, the [p.32] last issue being that of June 1923. Initially it was under the joint direction of Dr. A. Mizzi and Dr. P.P. Debono, and subsequently only under the latter’s editorship. Its contributors have all had a successful professional career and up to a short time ago, several of them were still in the chairs of various professorships at our university — Dr. S. Debono, Prof. Themistocles Zammit, Prof. R. Sammut, Prof. L. Preziosi, Prof. J. Ellul, Prof. P.P. Debono and Prof. A.V. Bernard. A few of them have passed away but, happily, the majority are still with us.
This survey of Maltese medical journals has had two effects on me. First, it left me with a guilty conscience, for the contribution of my generation to Maltese medical journalism is still to come. Perhaps, the medical students of to-day who, in 1949 founded their own medical journal — The Chestpiece — have learned to appreciate the need of a medical periodical and will, it is hoped, carry on the good work when they enter the professional fold and thus shake us into journalistic activity.
Secondly, this survey has made me pause and ponder on present trends in medicine. Factual knowledge is accumulating very rapidly and the tendency is to over-estimate the new and despise the old ideas and achievements. But it behoves us to be humble for while we have come to possess more technical knowledge than our predecessors, we are not much wiser than they were as regards fundamentals. And lest a few successes in one field of medicine should make us forgetful of our ignorance in other fields, let us keep in mind the following words of Schinas which though pronounced more than one hundred years ago have lost none of their significance and wisdom: “New discoveries... have attracted the attention of many of us. But it is not the first time that we believed that we held the truth in our hands and were deceived.”
I wish to thank all those who helped me in my quest for material and especially:— Dr. J. Galea, C.G.M.O.; Prof. J. Manchè, Rector of the Royal University of Malta; Prof. V. Stilon and Dr. E. Stilon; and Miss H. Castaldi of the Royal Malta Library.
 GUTHRIE D., A History of Medicine, 1950.
 “Portafoglio Maltese” of the 14th May 1856.
 MENDS B.S., Life of Admiral Sir W.R. Mends, London, 1899.
 BIGGER J.W., Handbook of Bacteriology, 1935.
 CHETCUTI T., Rapporto sulla malattia sviluppata in Malta nella fine della Primavera e nell’estate del 1850, Malta, 1850.
 “British Medical Journal” of the 15th September 1951.
 GUTHRIE D., op. cit.
 LAFERLA A.V., British Malta, Malta, 1938, Vol. I.
 CASSAR P., Dr. Thomas Chetcuti, the pioneer Maltese psychiatrist, in “Scientia,” Vol. XV, No. 3, July-September 1949.
 WHITFIELD A.G.W. et al., Transient Disturbances of Consciousness in Hepatic Cirrhosis, in “British Medical Journal” of 3rd November 1951.
 PROF. V. STILON — Personal communication.
 Report on the Health Conditions of the Maltese Islands, Malta, 1951.