SPECIAL ARTICLE Vincent (C˙ ensu) Tabone, an Ophthalmologist and a President of the Republic of Malta Robert M. Feibel, MD incent Tabone may be unique in the history of ophthalmology. He practiced ophthal- mology for 40 years in his homeland, the Republic of Malta. During that time, he be- came well known as a pioneer in the international effort to eradicate trachoma world- wide. At age 53, he began a long and successful political career as a member of parliament, Vthen as a cabinet minister, and, finally, as the democratically elected president of the Republic. He was active in European diplomacy and made important contributions at the United Nations. He may be the only ophthalmologist who has made great contributions in the field of medicine and in the democratic development of his country. Arch Ophthalmol. 2012;130(3):373-377 The Republic of Malta is an archipelago of Tabone received his medical degree and small islands in the center of the Mediter- a degree in pharmacy in 1937; he then be- ranean Sea, between Sicily and Tunisia. Vin- gan his practice as a general physician. As cent (C˙ ensu) Tabone was born on March was the custom at the time, he worked at a 30, 1913, on Gozo, the second largest of the pharmacy, where patients came to con- 3 islands of Malta.1 He was the youngest of sult with him. He remembers that his first 10 children. His father, a physician and sur- patient had conjunctivitis. Life as a gen- geon working as a governmental medical eral physician was demanding, and the pay officer, died when Tabone was only 9 years was low. He wished to specialize in oph- old. As a result, he was brought up in mod- thalmology because of the high incidence est circumstances. of trachoma in Gozo, but there were no All Gozitan natives who wanted to ad- ophthalmologic training opportunities in vance in the world had to leave the island Malta (Paul Cauchi, FRCOphth, consul- for further education, so at age 11, Tabone tant ophthalmologist and grandson of Ta- was sent to a Jesuit boarding school on the bone; oral communication; May 10, 2010). main island of Malta.1 Despite being un- When World War II broke out in Sep- happy away from his family, he spent 6 years tember 1939, Tabone immediately volun- in school there and was an excellent stu- teered for the Royal Malta Artillery regi- dent; Latin and history were his favorite sub- ment and was commissioned as a lieutenant jects. At school, he learned English and Ital- in the medical service. He served as a regi- ian, which were in common use in Malta mental medical officer at various military at the time. hospitals on the island for the duration of In 1930, when he was 17, he enrolled the war; after a year of service, he was pro- in the University of Malta to become a phy- moted to the rank of captain. As the war sician like his father and his 2 older broth- moved away from Malta in 1944, his army ers. The 7-year term of study consisted of duties were less onerous and his final hos- 3 years to complete the Bachelor of Sci- pital posting gave him the chance to be- ence degree, followed by 4 years of medi- come an ophthalmic trainee with a British cal school. Tabone took an early interest ophthalmologist, an opportunity that might in politics; while at the university, he ran not have been possible if not for the war.1 unsuccessfully (losing by 1 vote) to be- Tabone was demobilized from the come president of the Student Represen- armed forces in 1946 and was awarded a tative Council. scholarship that allowed him to travel to England for postgraduate training. Ini- Author Affiliation: Department of Ophthalmology and Visual Sciences, tially, he was a house officer at the Washington University School of Medicine, St Louis, Missouri. Moorfields Eye Hospital in London and ob- ARCH OPHTHALMOL / VOL 130 (NO. 3), MAR 2012 WWW.ARCHOPHTHALMOL.COM 373 ©2012 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/26/2021 tained his Diploma in Ophthalmic norance of the causes and treat- pioneering expert in this field. The Medicine and Surgery in 1947 from ment of the disease by physicians and main conclusions that he learned and the Royal College of Physicians of the lay population. For example, in subsequently taught worldwide were London and the Royal College of Sur- 1901, 72% of all patients treated at as follows: eradication of trachoma in geons of England. He then attended the Ophthalmic Institute of Malta countries where it is endemic re- the University of Oxford, taking a had conjunctival afflictions, of which quires a detailed, nationwide cam- 2-month course with Professor Ida most were trachoma. Trachoma was paign underwritten and supported by Mann; there, Tabone earned his Di- the leading cause of ocular disease the government, and simply treat- ploma in Ophthalmology. He stud- in the islands, even more than cata- ing individuals on a case-by-case ied ophthalmic surgery at Adden- ract. On Gozo, 30% of all families had basis will not work. Prospective and brooke’s Hospital in Cambridge. at least 1 member affected.3,4 universal screening, compulsory Overall, he spent a year in England. In 1948, the government of Malta notification of the presence of tra- After returning to Malta, he still felt established a program to send an oph- choma, and compulsory treatment the need to obtain a fellowship in ad- thalmologist to Gozo to develop a free of charge for all infected per- dition to his 2 diplomas; he took a program to evaluate and treat tra- sons must be provided. Careful epi- correspondence course from Edin- choma with the use of sulfon- demiological findings must be re- burgh University in Scotland for the amides, which had been introduced corded to document the extent of the specialized degree in ophthalmol- into the treatment of trachoma a de- incidence of trachoma and to show ogy that was not available from the cade earlier. Tabone was appointed the progress of the eradication cam- Royal College of Surgeons of En- to this position and became a con- paigns. Extensive public education gland. In 1949, he worked at the sultant at the Gozo Hospital. He ex- must be used to inform the popula- Royal Infirmary in Edinburgh for 2 amined 4058 schoolchildren and tion of the necessity for this cam- months and took the written exami- found 721 cases of trachoma, an in- paign; the importance of personal and nations to obtain the Fellowship of cidence of 17.8%. Oral sulfon- communal hygiene and sanitation the Royal College of Surgeons of Ed- amides, sulfa drops, and sulfa oint- must be stressed. The incidence of tra- inburgh, specializing in ophthalmol- ment were used as treatment. The choma in school-aged children was ogy (Vincent Tabone, MD; written results of this campaign were excel- found to be 4-fold that of adults; be- communication; September 5, lent: after 2 years of treatment, the in- cause children serve as the reservoir 1949). Tabone was the first Mal- cidence was reduced to 6 cases for recurrent infections, children and tese national to obtain this fellow- (0.15%). However, when Tabone pre- infants should be treated preferen- ship (Records of the Royal College sented his data at the XVI Interna- tially. His treatment of choice was sul- of Surgeons, Edinburgh, Scotland; tional Congress of Ophthalmology in fonamides taken orally, which he written communication; Novem- London in 1950, his findings were re- found more effective than when used ber 16, 2010). ceived with doubt. Some of the older topically. He also used aureomycin With these impressive creden- ophthalmologists were skeptical of his (chlortetracycline hydrochloride) or tials, Tabone became one of Malta’s results, still convinced that no cure terramycin (oxytetracycline) topi- leading ophthalmologists for the next for trachoma existed; they argued that cally. The most serious problem he 40 years. He performed all types of Tabone was curing only the second- encountered in implementing his ophthalmic surgeries, including cata- ary infections.5 Tabone published his campaign was adherence to the treat- ract surgery using Graefe sections results in the British Medical Journal ment program; hence, Tabone al- and the cryophake, retinal detach- in 1951.6 This article gained atten- ways emphasized that teachers or ment surgery using diathermy and tion in the field of trachoma re- school physicians should adminis- scleral buckle, strabismus surgery, search and was subsequently re- ter the drugs on a regular basis. He and a wide range of oculoplastic sur- printed in 2 other journals dedicated was concerned about reinfection rates gery. He was a strong proponent of to trachoma (one in French and the and advocated that the length of an using local anesthesia in surgery other in Italian) and thus gained bet- antitrachoma campaign should be no rather than the more commonly used ter credence and publicity for his con- less than 3 years. He noted that the general anesthesia and was one of the clusions. Tabone continued to work use of mechanical and surgical meth- first ophthalmologists to introduce on this project in Gozo for more than ods of treatment of trachoma would contact lenses into the country (Paul 10 years; in his last report, in 1960, become unnecessary in the vast ma- Cauchi, FRCOphth; written com- he found the incidence of trachoma jority of patients and predicted that, munication; September 24, 2010). in the school population to be 0.3% eventually, the disease could be abol- Trachoma was a huge problem in (Vincent Tabone, MD; written com- ished,7 a goal that is nearing fruition Malta.