Copyright The Malta Historical Society, 2005.

Source: Melita Historica. [Published by the Malta Historical Society]. 4(1965)2(137-139)

Recent Publications and Book Reviews 1965

PAUL CASSAR, B.Sc., M.D., D.P.M., F.R.Hist.S., "Medical History of Malta". Wellcome Historical Medical Library, London 1965. xi. 586.

The image of Malta has always been associated with the art of healing. In prehistoric times it was divination, prognostication and medication practised in the wonderful temples above and below ground that attracted worshippers from the Mediterranean littoral. During the long rule of the Knights Hospitallers, the hospitals of Malta acquired fame throughout Europe and the standard of sanitation in the Island was admired and followed' by many countries. In recent times Malta has, on more than one occasion, served humanity in the field of medicine and hygiene; during the First World War, Malta earned the name of "Nurse of the Mediterranean". Today the medical services of the Island compare favourably with, those of other nations.

Dr. Cassar covers all these centuries' in his work and brings into perspective and relief the highlights of the progress made in the practice of medicine in our country. He deals with the major aspects of medical discipline: preventive, clinical and administrative, to each of which he imparts a lively meaning and a vivid expression. He demonstrates how every aspect of medical practice in Malta was the result of current circumstances, or of repercussions of foreign trends. For instance, the employment of nurses in hospitals was for a long time conditioned to the local preference for males. Even Miss Florence Nightingale's advice for the employment of female nurses in Malta was brusquely brushed aside; but the new conception regarding the nursing profession could' not but extend its influence in Malta and today female nurses are not only fully established in hospitals, but there is a thriving school for their training, comparable to the ones attached to teaching hospitals in England.

About the middle of the eighteenth century the standard of medicine in Malta was in advance of many other countries; operative surgery practised at, the 'Holy Infirmary' of Valletta was justly considered to have reached a high level of perfection. At that time there was a band' of medical men, headed by Dr. M.A. Grima, who had dedicated themselves to the art of healing and who had acquired fame and admiration for their experience and ability. Some of the surgeons of the Infirmary were pioneers in operative technique; e.g. enterrhoraphy, lithotomy, trephining of the skull, amputations. All these operations are explained for the lay reader; indeed throughout the book the author eschews technical phraseology as much as possible and writes in an easy fluent style free from abstruse speculations and theoretical discussions. In this way the domestic affairs of the Infirmary and' the doings of the consultants offer pleasant and entertaining reading.

Most of the doctors of the Infirmary had been to medical schools on the Continent. During the latter period of the Knights, Florence, Pisa and Montpellier seem to have been favourite schools for Maltese doctors, many of whom went there for Specialized or postgraduate experience; they distinguished themselves and published works which made some impression on medical circles of the time. Dr. Josephus Demarco published his "Dissertatio Phisiologica" [p.138] in Montpellier in 1744 and Dr. Joannes "Franciscus Maurin" published his "Dissertatio Chirurgica" also in Montpellier, one year later, in 1745.

The idea of proceeding abroad to widen their experience has prevailed up to this day amongst Maltese medical men; the contacts and friendships which they contracted abroad were maintained even after their return to their homeland. By such means Maltese doctors kept themselves abreast of the progress of medicine and were able to provide for the benefit of local patients new methods and new discoveries in medical practice. "Ether anaesthesia was introduced in Malta almost as early as in England", writes Dr. Cassar and he relates how that happened.

That system of training produced doctors who could hold their own amongst foreign colleagues. In fact on various occasions the advice tendered by Maltese doctors was upheld by high authorities abroad; e.g.: the report of the Royal Society of Medicine of Paris an 1781, endorsing the decision of the Medical College and Health Office of Malta regarding exhumation of corpses and burial in churches.

The author discusses some of the more common endemic diseases and gives an admirable picture of undulant fever, the study and investigations carried out in Malta and the important contribution made by our Sir Themistocles Zammit which lead to the eventual control of the disease. He also described the Influenza epidemic of 1918-1919; however he omits to mention the case of a prominent Maltese practitioner who lost his life in an effort to find a remedy for the disease, which was usually accompanied by hyperphrexia; he thought of reducing the high temperature by cold immersion. He was conscientious enough to test the remedy on himself and he obtained the best proof of its failure !

There were two diseases, leprosy and venereal disease, which constituted a social problem during the rule of the Knights over Malta. Leprosy has been in existence since time immemorial; it is said' that Santo Spirito Hospital, the oldest in the Island was originally a leprosarium in the fourteenth century, and ever since, drastic measures have been taken to contain the disease, and it was only in 1953 that segregation of patients was relinquished.

Venereal disease made its presence felt in Malta during the time of the Knights. Dr. Cassar evidently does not agree with the opinion expressed by the late Professors A.V. Bernard and P.P. Debono, i.e. that Venereal disease was introduced into the Island' by the vast number of mercenaries and soldiers of fortune who came to the relief of Malta during the Great Siege of 1565. Regulations were enacted from time to time to control the spread of the infection and to curb the blandishment of gay ladies. Treatment was offered free but conditioned to restrictions some of which were most queer, e.g. husbands were refused treatment unless they submitted a certificate from the Episcopal Curia showing that they were keeping separate bed from their wives. As if any Curia were in a position to certify that much !

The people of Malta are in a sense fortunate because for more than four centuries, since the rule of the Knights, they have enjoyed and benefited by a high standard of medical service. Even before the idea of social welfare gained ground in countries of Europe, in Malta provisions were in existence [p.139] for child welfare in 1570, for the care for the aged and infirm in 1729, and for some sort of district medical service as far back as 1492. A regular domiciliary medical service was available about the middle of the eighteenth century; some of the doctors engaged in that service were prominent in their profession. Dr. G. Locano in one of the books written by him describes himself "Medicus Pauperum". The hospitals of Malta were famous throughout Europe for the medical care and attention and for the comfort and amenities available therein, whilst the Quarantine services of the Island were far in advance of those of many other countries and served as a model institution of their kind.

The author has divided his material in groups or parts each of which is subdivided into chapters which are interrelated, a useful plan of correcting his various items and presenting them in a broad panorama of medical history. Most of the chapters constitute a treatise on the subject matter they deal with, so exhaustive and informative are they. The author enters deeply into the matter and expands on details, but is not dry or ponderous in his style; on the contrary he writes in a clear, easy, fluent and pleasant manner that keeps the reader interested and absorbed. He is very meticulous regarding sources of information and authorities for his statements; it is evident that he was very much concerned with producing a work both authoritative and informative, which he succeeded to accomplish.

The book is attractive, artistic and imposing, its publication is of a high standard. It is one of the best books ever published by a Maltese author.

Professor Joseph Galea