3 MEDICINE IN MALTA IN 1800-1810 Contrasts, Concepts and Personalities

PAUL CASSAR S.B.ST.]., M.D., B.Sc., D.P.M., F.R.HrST.S.

Hon. Fellow of the Royal University of Malta, Consultant Psychiatrist Health Department, Teacher in Clinical Psychiatry Royal University of Malta

The British Medical Association (Mal­ shape. Its economic life was shattered, ta Branch) prize in the medical essay with impoverishment of the people. The competition for 1969 was awarded to Dr. organisation of the medical services that Paul Cassar for this paper. had evolved during the previous two cen­ turies was disrupted and replaced by The dawn of the 19th century stands makeshift hospital arrangements to meet out as a turning point in Maltese history the demand of the unexpected war crisis. -socially, politically, commercially and The period of readjustment that followed culturally. the end of the hostilities was long drawn In June 1798 there occurred an over­ out and difficult. night change from the centuries-old con­ The Royal Commissioner, Sir Charles servative and feudal government of the Cameron, who was charged with the ad­ Order of St. John of Jerusalem (1530- ministration of the Island was faced with 1798) to the short lived but hectic, liberal a daunting task. He was inundated with and egalitarian regime of the French under petitions for financial assistance from pri­ Napoleon (1798-1800). vate individuals and from public officials The Maltese masses were deeply to make good the losses they had suffered shaken as they were totally unprepared during the French occupation and to tide for this abrupt and radical transformation them over the hard times of the aftermath of their political, social and religious life of two years of war and destruction. which tore asunder their traditional atti­ tudes and beliefs. The reforms introduced The plight of medical men by the French, especially those touching the religious tenets of the Maltese, uproot­ The petitions submitted to Sir Charles ed the pattern of life of the people, ren­ Cameron included requests for the grant­ . dered the new masters unpopUlar and pro- ing of gratuities for dependents of de­ voked the islanders to rise in arms against ceased government employees; for re­ them. The outcome was two years of war, instatement to former medical posts disease and starvation and an invitation abolished by the French; for appointment from the Maltese to His Britannic Majes­ to vacant offices and for pensions follow­ ty George III to place the Island under ing retirement from the medical organisa­ his protection. Thus was ushered in the tion of the Order after many years service British period in our history (1800-1964). - even as long as fifty. There were also When the French finally capitulated requests for increases in stipends due to in September 1800 and Great Britain took the rise in the cost of living and for the over the civil and military administration removal of salary anomalies among the of Malta, the Island was in a very poor same category of medical men. Complaints 4

on this score were especially heard from rista manufactured the hernia trusses the medici dei poveri (literally "doctors under the direction of the Principal Sur­ for the poor") corresponding to the pre­ geon whom he accompanied in the ward sent District Medical Officers. rounds, morning and afternoon. He was Some of these physicians had left the always on call for any adjustment needed towns at the begining of the revolt against to the trusses of hospital patients. He was the French and joined the insurgents in paid six tari (one tari was equal to about the countryside to give their professional 1 td) for every truss - "as at the time services to the poor sick and the men of of the old government of the Order" - the Maltese battalions without receiving after the appliance was examined and ap­ any salary or any other kind of remune­ proved by the Principal Surgeon or his ration (Ordini e decreti, 1805). prattico (assistant). A case, representative of the situation At least two medical men suffered a at this period, is that of Dr. Angelo Pace demotion in their careers with the return who had entered the medical service of of peace. One of them was a Dr. Lorenzo the Order of St. John in 1760 as a medico Cassar. On the 9th September 1800 he was dei poveri for Floriana. He later joined appointed medico del palazzo (Palace Phy­ the navy as a medical officer, serving on sician) by Sir Alexander Ball in accord­ the frigates and the galleys, until he was ance with the usage that had prevailed reappointed medico dei poveri for Birgu at the time of the Order of St. John when where he remained for twenty-one years. the Grand Master, who lived at the Palace On the advent of the French in Malta his at Valletta, had his personal physician. post was suppressed and Dr. Pace threw On the 19th August 1801, however, Dr. in his lot with the insurgents and settled Cassar's post was abolished by H.E. Sir at Mdina where he cared for the orphans Charles Cameron. The other was the sur­ received into the Seminary and treated geon Antonio Cutajar of Bormla who had the sick admitted to the emergency hos­ been licensed to practise as a physician pital set up in the Church of St. Sebastian by the Medical College during the French and its adjoining house at Rabat during blockade because all the doctors had left the fever epidemic of 1800. In December that town to join the insurgents in the of this year, on the return of peace, he countryside. In November 1801 his war­ was reinstated as medico dei poveri at rant to practise medicine was withdrawn Birgu but he was not paid a salary until as in the opinion of the protomedico a year later (Ordini e decreti, 1805b). (Chief Government Medical Officer), Luigi Another instance is furnished by the Caruana, the three physicians who by then petition of Giuseppe Stivala "first phar­ had returned to practise in Bormla were macy assistant" at the Civil Hospital for sufficient to meet the needs of the inha­ men at Valletta. "At the opening of the bitants (Ordini e decreti, 1805c). gates" of Valletta. i.e. on the capitulation of the French forces blockaded inside the Decline of Hospitals fortifications of Valletta and the other towns round the Grand Harbour, the hos­ Frantic appeals for financial help pital pharmacy was completely devoid of came from the administrators of various drugs and the administrator of the hos­ hospitals as their bequests and revenues pital instructed Stivala to supply the phar­ could no longer be counted upon to pro­ macy with the necessary medicaments vide sufficient income for their mainten­ which he did "with zeal and exactitude" ance. and at his own expense and without re­ In September 1801 Dr. Gregorio Ba­ ceiving any emoluments for his work for jada, the economo (treasurer) of St. John five months. Hospital for men at Gozo, remarked on A further plea for payment came the financial losses suffered by the hos­ from the bragherista of the same hospital, pital and the insufficiency of its funds to Giuseppe Spiteri, who held the licence of meet current expenditure; on the need for barberotto (barber-surgeon). The braghe- the replacement of the beds, planks, linen 5 and other items of equipment which had the Municipality of Mdina as this body been carried away by the French. MonGY was burdened with the expense of repair­ was also required to pay for the medica­ ing the road leading to Valletta and the ments supplied to the hospital by the phar­ conduits that drained away the waters macist Orazio Aquilina. In short the hos­ that would otherwise have accumulated pital "had been reduced to such misery in the valley round Mdina (Ordini e de­ that even the issue of the little quantity creti, 1B05d). of wine which is often necessary for the In Valletta the erstwhile Holy Infir­ sick has had to be suspended". Dr. Bajada mary of the Knights of St. John was turn­ had become so disheartened by these ed into a military hospital by the French. shortages that "a thousand times" he had Under British rule the Infirmary conti­ considered giving up his post because of nued to be used for the treatment and care the difficulties he was encountering in of sick troops. At first it received sick sol­ making good the deficiencies of his hos­ diers from Egypt and from units of the pital. British Army in Italy under Sir James On the 20th July 1B02 it was the turn Craig. It was later (lB05-B) reduced to a of the Procurator of St. Joseph Hospital regimental hospital and to a deposit of at Zebbug, Malta, to complain. During the hospital stores, the rest of the building revolt of the Maltese the hospital "had remaining unused (Domeier, 1BlO). been obliged to admit and treat all the On the conversion of the Infirmary sick and wounded that were brought to into a military hospital, the male civilian it in great numbers". Mattresses and sheets patients were transferred to the nearby had been consumed; debts had been con­ nunnery and church of Mary Magdalen tracted for the maintence of the patients which came to be known as the Civil and no funds were to hand to replace its Hospital for men. In 1B02 this institution equipment. and the Women's Hospital, that dated The jurats of Mdina, who were res­ since the seventeenth century, were re­ ponsible for the administration of the organised and detailed rules and regula­ Hospital of the Holy Spirit at Rabat, tions were published for their better run­ Malta, wrote on the 12th February 1B02 ning (Piano per il regolamento dell'Ospe­ that at the time of the insurrection so dale di Malta, 1B02a). many patients had been received "that When Samuel Taylor Coleridge visit­ even the church was full of beds". All the ed the Civil Hospital during his stay in linen and clothing had been depleted Malta (lB04-5) he was struck by the pre­ having either been consumed for the use sence of a child of twelve years lying in of the patients or been requisitioned by the same bed with a man of seventy years the French troops of Mdina. It was in need in the Venereal Wards and also by the of one hundred sheets and pillows, fifty great number of holy images hanging on palliasses and twenty-five mattresses, the walls in "every staircase, by every twenty-five "white blankets for summer" bedside, in every chamber" (Coburn and thirty woollen blankets. The hospital 1962a). A British Army doctor of the time, had lost "almost all its silverware - in­ Dr. WiIliam Domeier, is more informative cluding thirty-eight bowls, twelve plates about this hospital which had to cater for and other utensils" - which had to be a population of 94,000 souls (Malta and disposed of to help finance the war effort. Gozo). It had to borrow money to buy the medi­ The set up of the hospital came under caments and pay for the maintence of the the censure of Domeier who found it ill­ sick but, what was worse, it had not re­ adapted as a healing establishment. In ceived any interests on the capital invest­ accordance with the ideas held by a sec­ ed with the bank of the MuniCipality of tion of the profession at that time, the Valletta. In fact it had been reduced to windows were kept closed to exclude such straits that it was no longer in a fresh air in the belief that air was harm­ position to admit the usual number of ful for surgical patients. Thus surgeons patients. No funds could be obtained from had to dress the sick by candle light even 6 at two o'clock in the afternnon in summer. A naval hospital was established in The professional staff consisted of 1800 in the former Armoury of the Knights four physicians and four surgeons work­ of St. John at Birgu in Strada Dietro il ing on a monthly roster. This system had Quartiere. There is no doubt, however, the disadvantage that patients entering that seamen of the Royal Navy were also the wards in the last days of the month, received into the Military General Hos­ passed, after a few days, into the care of pital at Valletta. In fact on the 19th August a different physician who often altered 1803 sick crew on H.M.S. Madras, who the whole plan of treatment. It also af­ were suffering from "infectious or inflam­ lorded occasion for rivalry among the matory fevers" were ordered by Lord Nel­ physicians and surgeons who, we are told, son to be admitted to the General Military endeavoured "to acquire practice by con­ Hospital by arrangement with Major Ge­ tradicting and blaming one another and neral Villettes, the Officer Commanding acting otherwise than their colleagues the Troops in Malta. though no better". Nelson felt that if Britain was to keep The rest of the professional staff con­ Malta, the Admiralty had to provide "a sisted of four assistant physicians and four proper naval hospital". He again returned assistant surgeons; an apothecary, a num­ to the subject on the 7th November 1803 ber of dressers and a "person who only as he did not wish "to have thrown the bleeds and cups, even one person who trouble of attending our seamen on the carries smelling bottles at the medical medical skill of the Army"; so much so visits for fear that anybody might faint that he sent Dr. John Snipe, Physician to away - and really the atmosphere is, in the Fleet, to Malta to inspect Villa Bichi some wards, in such a state that the fear with the view of establishing there a naval is not ill founded". Conditions in the hospital. Following Dr. Snipe's visit, Nel­ Women's Hospital were no better. son declared on the 20th December 1803 Commenting on the results of the that Bichi was "the fittest situation at methods of treatment employed at that Malta for a naval hospital". time in these establishments, Domeier In the meantime seamen continued to makes an observation that still holds good be treated in the Military Hospital under today anywhere in the world: "It is a ne­ the Naval Surgeon, Mr John Gray, until cessary· distinction to be' made, whether they were removed to the erstwhile Slave a patient recovers through the remedy he Prison in Strada San Cristoforo (St. Chris­ has taken or only during the time he takes top her Street), Valletta. The date of the a remedy which is not efficacious enough transfer may have been the 1st January to prevent his recovery. Physicians are 1805 as on this day sick naval personnel often too much honoured as in both cases ceased to be admitted into the Military the recovery is attributed to their skill". Hospital (Nicolas, 1845). In May 1804 Lord Nelson was again British Naval Medicine pressing for the acquisition and enlarge­ ment of Villa Bichi and its conversion into Malta's connexion with the British a naval hospital (Nicolas, 1846) but no Crown eventually led to the growth of steps were taken for many years after­ the Island into one of the most formidable wards; on the contrary, sick seamen were naval bases of the Mediterranean. This re-transferred across the Grand Harbour development not only determined the po­ to the Armoury at Birgu in 1819. litical orientation in world affairs and the Dr. J. Hennen, Inspector of Military economic pattern of the Island but also Hospitals (1821-25), describes the place as brought Maltese medicine, for the first being "an airy building ... well adapted to time in our history, in close touch with its purpose". It was capable of accom­ British medical thought and practice. At modating about one hundred and twenty this period this influence was exerted patients but in an emergency there was mainly by the medical personnel of the enough room for eighty or one hund­ navy. red or more men. In wartime all its beds 7 were occupied but in peacetime the num­ Fever was towards the end of the decade ber of patients rarely exceeded twenty supplanting the local nomenclature as a (Hennen, 1830a). more appropriate appellation. From 1804 to 1827 the hospital was At a time when the physician lacked under the direction of Dr. John Allen the refined diagnostic aids of to-day and R.N., the Principal Medical Officer. Be had nothing to go by except the subjective had been appointed surgeon to the Navy complaints of the patient, his skill as an in 1784, served under Lord Nelson and observer and his own personal experience, was superannuated in 1827. He died in it is not surprising to find that there were Malta on the 14th January 1849 at ninety­ great differences of opinion among medical four years of age, and was buried in the men with regard to the nature and aetio­ Msida Bastion Cemetery. logy of these fevers and the criteria to be J ohu AlIen was renowned for his followed in their prevention and treat­ treatment of gun shot wounds. It has ment. been sai d of him that his dexterity "in Among the physicians who at­ using his knife was equalled by, what is tempted to elucidate these problems was of equal importance, his knowledge of William Burnett - one of the first of a discerning when not to use it". He also long line of British naval doctors to worY enjoyed a good reputation for his treat­ in Malta. He was Physician and Inspec­ ment of fevers in whiCh he resorted to tor of Hospitals to His Majesty's Fleet in the lancet, "that minute instrument of the Mediterranean and Honorary Fellow mighty mischief", very sparingly (Malta of the Imperial Medico-Chirurgical Aca­ Times, 1849) demy of St. Petersburg (Burnett, 1816 a). Sick seamen of the Royal Navy con­ In May 1810 he was appointed Physician tinued to be cared for at the Birgu Ar­ to the Mediterranean Fleet which post he moury until 1832 when Villa Bichi was relinquished in October 1813 because of finally opened as an ad hoc naval hospital ill health. (Cassar, 1965a). His accounts of these fevers abound in clinical histories and reports of post­ Fevers mortem examinations. The medical know­ ledge of the time, however, was still too A survey of the diseases with which ,meagre to allow him to understand thE' naval surgeons of the British Mediterra­ aetiological factors involved arid to dif·· nean Fleet had to deal in the first decade ferentiate among the various specific of the nineteenth century reveals that pathological conditions masquerading scurvy had become almost unknown under the common phenomenon of fever among sailors thanks to the "excellent and to prescribe a rational method of regulations and unceasing care of the management and therapy. Commander-in-Chief in providing liberal Burnett's first encounter with thE' supplies of fresh meat, vegetables and fevers of Malta occurred in May 1799 lemon juice". Pneumonia and dysentery when units of the British navy came to were endemic but "fever epidemics" the aid of the Maltese to blockade from constituted the most frequent and most the sea the French troops that had been serious conditions that afflicted seamen penned by the Maltese insurgents inside and civilians alike in the British naval the fortifications around the Grand Har­ stations of Malta, Gibraltar, Port Mahon bour. He was then serving in the Goliath (Minorca) and Carthagena. when the ships company was attacked by These fevers appeared especially to­ a fever "similar to one then prevalent in wards the close of summer (end of June the Island". The Goliath's boats had been and beginning of July) and during autumn. employed in watering at Marsascala, 8. They were known by the name of the small harbour to the south east of Vallet­ place where they prevailed such as Car­ ta, when on account of a strong wind the thagena or Gibraltar Fever, etc., although boat's crew had to remain ashore all night. the more generic name of Mediterranean A few days later several of the men feH 8 ill with fever which eventually spread to lower limbs. In 1812, between the 1st some forty of the ship's company. The April and the 23rd May, one hundred and most prominent disturbances were nausea fifty-three men from the Victorious and and vomiting, headache, thirst and deli­ the Trident were treated at the naval rium; in two or three instances the paro­ hospital for fever with eight fatalities. tid glands suppurated. The ship proceded Burnett has recorded the symtomato­ north to St. Paul's Bay and the sick were logy of the then so-called "bilious remit­ landed and placed "in a large castle ... tent fever". His account of it is given in where the whole recovered". such terms as to enable the medical prac­ In the summer of 1800, Burnett titioner of to-day to pick Olit in it m.ost of joined the Maltese built ship Athenian. the clinical features of brucellosis (Report While she was being careened and fitted of the Committee ... for the Suppression at the Malta Dockyard there were many of Mediterranean Fever, 1909). Burnett cases of fever which Burnett was inclined has the merit, therefore, of being the first to ascribe to the crew's exposure to the investigator to record the clinical picture sun; however, "by a proper use of the of brucellosis or undulant fever. As lancet in the early stages joined to pur­ Burnett's book is not now readily avail­ gation, they all speedily recovered; none able it is worthwhile reproducing his died nor was one sent to the hospital description at length as it is of paramount during two years" that Burnett was sur­ importance in the history of human bru­ geon on that ship which "always continued cellosis. remarkably healthy". "The patient", writes Burnett, "com­ In October 1810, as Physician to the plains· of considerable headache with Mediterranean Fleet, he was sent by the nausea and prostration of strength; the Commander-in-Chief to Sicily and to Mal­ eyes are somewhat suffused and the ta to examine the state of health of His countenance a little flushed; the tongue Majesty's ships and the running of the is white and moist with considerable hospitals ashore. He found that the men thirst; the skin is at times moist and the of the Eagle had been quartered in a bar­ temperature but little increased; at other rack while the ship was careening. "They times it is dry and the heat pungent. The had easy access to spirits and wine", he pulse is in some cases full and strong recorded, "and committed the usual ex­ beating at the rate of 120 in the minute; cesses of sailors when on shore. The in others it is less so and in some the in­ effects of this were soon visible for about crease in velocity is scarcely perceptible; the middle of December a fever made its there is commonly constipation of the appearance amongst them and ultimately bowels and loss of appetite". This is the extended to nearly sixty of her men. The symptomatology in the type of fever which surgeon considered it at first to be purely appeared in summer. of a typhoid nature". They were admitted A more severe form occurred in the to the naval hospital where they all re­ autumn. "The patient feels a degree of covered thanks to the use of early and re­ lassitude and prostration of strength (in peated bleedings, purgation and epigast­ some the latter symptom appears very ric blistering. considerable); this is succeeded by a sense The frigate Alceste and the sloop of chillines extending along the spine and Scout also had many of their men down lumbar region which is followed by in­ with fever, involvement of the abdominal creased heat and severe headache, re­ viscera and frequent stools but they, too, ferred chiefly by the patient to the fore­ did well on the same regimen. head and temples; and in the severer cases In June 1811 it was the turn of the it extends in the course of the longitudinal men of the Pomone and the Weazle to sinus. A deep seated pain in the orbit is suffer from "the bilious and yellow fever also experienced; the eyes are sometimes of the Island" characterised by a deep unnaturally prominent with a watery in­ yellow suffusion of the skin, vomiting, flammatory appearance and impatience of pain in the epigastric region, loins and light ... There is a sense of uneasiness in 9 the epigastric region with nausea and, in tention - temperature and pulse varia-. some patients, a vomiting of a matter re­ tions, headache, pains behind the eyes, sembling bile; pains in the joints, back, profuse sweating, subicteric tinge, epi­ calves of the legs, disturbed sleep and gastric discomfort, vomiting, constipation, constipation of the bowels are amongst rheumatic pains and "typhoidal" state in the symptoms usually observed. The the more severe cases. However there is pulse for the most part is full and hard, no mention of the physical signs of the though not always, particularly when the disease, elicited by what to-day would be gastric symptoms are severe... There is the commonplace method of palpation, generally a throbbing of the carotid and such as the enlarged and tender spleen and temporal arteries with great thirst and liver; but he . refers to the lung involve­ considerable anxiety. The superior parts ment and in fact he did observe, in some of the body are sometimes covered with of the post-mortem examinations he per­ a profuse perspiration but generally the formed, the "lungs inflamed with effu­ skin is dry... If the disease be advanced sion", "adhesions to the pleura", enlarged the heat is often pungent and there is liver and, on one occasion, "spleen rather through its whole course a loathing of large" (Bumett, 1816 b). food. Severe rigors, sometimes, but not Cases of fevers of various descrip­ very commonly, precede the hot stage of tions remained the bugbear of the physi­ the disease. When the attack is violent. .. cian for a very long time. One sixth of the headache is still severe but accom­ all admissions to the military hospitals panied by stupor, disinclination to answer from 1816 to 1823 were fever cases with questions and indifference to surrounding a mortality of one in forty-five. The most objects: the eyes have... a slight yellow­ frequent was the "common continued ness; the tongue is now covered with a fever" which included the "idiopathic" or thick yelow coat or is brown and dry in "summer fever". This was so called be­ the middle, the edges having a red inflam­ cause it made its appearance with the on­ matory appearance; the prostration of set of hot weather (July to September) strength is considerable; the anxiety and and subsided as the heat diminished. It pain in the limbs greater; the uneasiness was marked by severe headache, suffused in the epigastric region is urgent; and eyes, acute pains in the chest, tenderness there is frequent vomiting of a matter re­ in the upper abdomen and bilious vomit­ sembling bile and most harassing singul­ ing. It lasted six days. tus; the pulse under these circumstances Among the civilian population fever is commonly much smaller varying from cases also formed a good proportion of 100 to 120 and often is more frequent. admissions into the Civil Hospital con­ The skin is at time moist or there are stituting one-seventh of all admissions in partial sweats and commonly a dis­ 1821-23 (1300 out of 8736) while among agreeable faector is exhaled from the per­ those treated at home deaths from fever son or linen of the patient ... There is oc­ bore to deaths for all other diseases the casionally considerable delirium which proportion of one to ten, the villages of commonly terminates in a state of coma" Mosta and Naxxar being the most heavily and death. "The train of symptoms which hit by this mortality (Hennen, 1830 b). have been first enumerated will not al­ ways be observed in the same patient... Aetiological theories In the winter months this disease is often accompanied by severe and evident inflam­ The influence of offensive exhalations mation of the lungs. In the summer and or miasma arising from marshy grounds autumn slighter affections of the lungs was invoked to explain certain outbreaks are occasionally observed but the patient of fevers in Port Mahon and in Malta. seldom complains of Ithis unless when With regard to Malta, an extensive marsh asked". did exist at the Marsa or upper part of None of the cardinal symptoms G; the harbour during the previoU3 centuries undulant fever has escaped Burnett's at- at the time of the Order of St. John; so 10 much so that the inhabitants of the near­ epidemiological ideas concerning the na­ by Casal Nuovo (Rahal Gdid, literally ture of the various fevers of the Mediter­ "New Village") had been obliged to aban­ ranean was Dr. (later Sir) William Pym don the village on account of the unheal­ (1772-1861). Pym had studied medicine at thiness of the area. At the beginning of Edinburgh University and, after a brief the 19th century this marshland was al­ period in the navy, had joined the army. most completely drained during the In 1794 he was in the West Indies where government of Sir Alexander Ball but he became familiar with the manifestations apart from distilleries established there of yellow fever during an outbreak in Mar­ by British merchants the Marsa was still tinique (1794-96) when 16,000 troops died deserted. of the disease. He then served in Sicily Sir William Burnett wrote that it had (about 1806), Malta and Gibraltar. Here been observed that ships fitting at the he was Superintendent of Quarantine at dockyard in the Marsa part of the harbour a time when it was suspected that yellow "are more subject to attacks of fever than fever had gained a foothold from Cadiz those lying out at their anchors; and in and Malaga. In 1811 he was back in Malta moving a ship, where it was prevalent, as President of the Board of Health. He into Bighi Bay (Le. near the mouth of the went to England the following year but harbour) the disease has uniformly volunteered to return to Malta in 1813 ceased". It is not unlikely that the crews when plague broke out in the Island. In of these ships were victims of malaria. 1815 he published the Observations upon In fact it was discovered, very much Bulam Fever which has been acclaimed later, that mosquitoes of the genus Ano­ as the first clear account of the disease pheles occurred in Malta and it is prob­ also known as yellow fever. He died on able that when affected ships were moved the 18th March 1861 (Dktionary of Na­ out of the range of flight of the insects tional Biography, 1896; Hennen 1830c). no further cases appeared. Pym favoured the adoption of qua­ Apart from the factor of terrain, it rantine measures while Burnett held the was also believed that attacks of fever view that the fevers of the Mediterranean were precipitated by such "exciting were "non-contagious" and that, therefore, causes" as intemperance in the use of wine quarantine could not prevent their disse­ and spirits, exposure to the sun and to mination. This provoked a reproach from night dews. Pym who, referring to Burnett's publica­ Controversies as to whether these tion, stated that "there never was a book fevers were of a "contagious" or "infec­ had a more mischievious tendency". tious" character were rife. "Contagious" Subsequent medical investigations, how­ diseases were those believed to be caught ever, proved that Burnett was right. by contact; "infectious" illnesses were those communicated by the atmosphere. Treatment Apart from the personal animosities with which they were conducted, these disputes Therapy consisted in bleeding, blis­ had practical implications of a social and tering, purgation, oral medication and economic kind. If these fevers were de­ "antiphlogistic" measures. clared "contagious", quarantine measures Bleeding was resorted to for lower­ were imposed with such attendant hard­ ing the temperature, relieving the head­ ships as isolation of patients and contacts, aches and promoting sleep. Great reliance the burning of their bedding and furniture was placed on early and liberal blood­ and the suspension of social and com­ letting. Sometimes as much as ninety mercial communications. If, on the other ounces of blood were removed over a pe­ hand, they were "non-contagious", qua­ riod of six hours with the recovery of the rantine restrictions with their irksome patient; occasionally up to two hundred consequences to the individual and the ounces were taken with "the most mark­ community were not enforced. ed advantage"; more commonly bleeding Among the opponents of Burnett's was repeated hourly with the removal of 11 thirty to forty ounces each time. The ope­ Rev. William Pargeter ration was sometimes followed by syn­ cope. The surgeon, therefore, kept a watch Another British physician flits across on the patient's pulse and 'when' this the medical stage in the very early years showed signs of sinking the bleeding was of the century in the guise of a clergy­ stopped. man. This elusive figure was Dr. WiIliam Burnett was enthusiastic about the Pargeter (1760-1810). He studied at St. beneficial results of bleeding which far Bartholomew's Hospital and graduated from "inducing extraordinary debility and M.D. from Marischal College, Aberdeen in a protracted convalescence" produced a 1786. In 1795 he abandoned medicine for "speedy restoration to perfect health". the church and entered the Royal Navy The patients themselves, far from resent­ as a chaplain. He was at the Battle of the ing it, asked for it! Burnett states that Nile on the Alexander (1798) and subse­ many of the patients felt its beneficial quently served in Malta as Chaplain of effects while the blood was flowing and the Garrison. In 1801, on the occasion of quotes one such patient as saying: "Sir, the burial in Malta of Sir Ralph Abercrom­ I am as strong as ever; I am quite well; I bie, Commander-in-Chief of the British feel the pain running out with the blood". Forces in the Mediterranean, Pargeter de­ Burnett continues: "So sensible were they livered the funeral oration at the Protes­ of this that on a recurrence of the head­ tant Chapel of Valletta. He extolled the ache they directly sent for the assistant military greatness and the "private vir­ surgeon to have more blood taken from tues" of Abercrombie and the "noble ex­ them". ploits" of the British Army in Egypt; re­ When less profuse bleeding was de­ minded his listeners of the uncertainty and sired, leeches were employed. From three transitoriness of human life and exhorted to twelve of them were applied to the them "to put on the whole armour of God" temples in severe headache or to the epi­ to ensure their triumph over death. Par­ gastric region when gastric symptoms geter retired from the navy in 1802 and were troublesome. To ensure a continuous died in Oxfordshire in 1810 (Hunter & flow of blood, a cupping glass was applied Macalpine, 1963 and 1965; Leigh, 1961). over the orifices made by the leeches by Pargeter is one of the early British which means up to twelve ounces of blood psychiatrists of the modern era and the could be procured. first British psychiatrist to come to Malta. Blistering was attended "with great We do not know, however, whether he success". Favourite plasters were empla­ took any interest in the medical affairs of strum epispasticum, emplastrum cantha­ the Island and particularly in the manage­ ridis and emplastra vesicatoria. They were ment of the insane. In his time the men­ applied to the region of the stomach, be­ tally sick were kept in the basement of tween the scapulae, on the temples, on the the Civil Hospital at Valletta where Par­ forehead and on the nape of the neck. geter must have gone pretty frequently to Great store was laid on brisk purgation, minister to sick troops. Did Pargeter ever sometimes aided by clysters for which visit this basement in the Civil Hospital Pu!v, Jalap cum submurias hydrarg, was where the more dangerous patients were prescribed. Hardly any faith was placed chained to the wall? If he did he would on drugs. Peruvian bark, antimonial pow­ not have been scandalised by this scene der, emetics and sudorifics were consi­ as the same conditions prevailed in Eng­ dered to be ineffective by some physicians land where not even very highly placed or decidedly harmful by others. The "anti­ personages were spared rough handling. phlogistic regimen" consisted in giving The case of King George Ill, the first Bri­ the patient tepid or cold baths; in spong­ tish monarch to rule over the Maltese ing his body; in the use of as few bed­ Islands, is notorious. He suffered from re­ clothes as possible to cover him; and in current attacks of mental disorder and prescribing pediluvium (footbath) to sooth was severely treated and even knocked the pains of the lower limbs. down during his long illness. 12

Pargeter was one of the early reform­ crombie (20th/21st December 1800). Dr. ers of management of the insane in Eng­ Marshall remained in the Island to enable land. In 1792 he published the Observa­ the inhabitants to avail themselves of the tions on Maniacal Disorders in which he occasion to vaccinate their children. An showed that the physical restraint of men­ Italian translation of Jenner's A Continua­ tal patients, then in common use, was un­ tion of Facts and Observations was pub­ necessary. He stressed the importance of lished in Malta, probably as a form of rapport between the physician and the health propaganda, and a number of child­ mentally sick as a salutary influence in ren were inoculated in the presence of tranquillizing patients and leading them Dr. Luigi Caruana, the protomedico or towards recovery. This was the emergent Chief Government Medical Officer, and Dr. idea that gave rise to the so-called "moral Lorenzo Cassar, the Palace Physician and treatment or management" of the insane Principal Physician of the Civil Hospital. which pervaded psychiatric therapy dur­ The experiment was a success and from ing the rest of the 19th century. then onwards vaccination against small­ Conditions in England began to im­ pox became standard public health prac­ prove in 1827 when two acts of parliament tice in the Maltese Islands (Bellet, 1801; provided "asylums" and regulated the care Cassar, 1965b and 1969). of "pauper and criminal" mental patients Dr. Walker was present at the battle (Hodgkinson, 1966). In Malta the humane in which Sir Ralph Abercrombie was fa­ treatment of the insane was ushered in tally wounded. He returned to England in ten years later when Dr. Thomas Chetcuti, 1802 and was made resident vaccinator the pioneer Maltese psychiatrist, set pa­ of the Royal Jenner,ian Society. A breach tients free from their chains and abolish­ between him and Jenner led to his resi­ ed the use of the stick to subdue excited gnation from the Society in 1806 but he patients (1838) (Cassar, 1949). continued to vaccinate until his death in 1830. Dr. Marshall was later appointed Vaccination Physician Extraordinary to George In (Fisk, 1959). Two other British physicians - Dr. Joseph Marshall and Dr. John Walker - Maltese Civilian Practice passed through Malta in the very early years of the century. It is very likely that Glimpses of the state of Maltese civi­ they met Pargeter but, in contrast to him, lian medical practice at this period may they have left an indelible mark on Mal­ be gleaned from Dr. William Domeier's tese medical history. Observation on the Climate, Manners and Not long after Edward Jenner dis­ Amusements of Malta published in London covered vaccination against smallpox in in 1810. Dr. Domeier (1763-1815) spent a 1798, the British Govemment took steps few years in the Island in the medical ser­ to introduce it to its naval and military vice of the British Army as Physician to forces and its possessions overseas. Malta Foreign Troops, probably from 1805 to was thus one of the first territories to be­ 1808 (Almanacco. 1807). He was a Ger­ nefit from this policy. man from Hanover who graduated doctor In the early days of July 1800 Dr. J. of Medicine in 1784 at the University of Marshall and Dr. J. Walker left England Gottingen. After his turn of duty in Malta for the Mediterranean. Both of them were he was admitted a Licentiate of the Col­ friends of Jenner and had obtained the lege of Physicians of London (1809) where vaccine lymph from him. When they he settled. He died in 1815 (Munk, 1878). reached Malta smallpox had broken out He was favourably struck by the mild in the fleet and Sir Alexander Ball order­ climate and the satisfactory state of the ed all men in the squadron based on Malta public health of the Island so much so that to be vaccinated. he considered it eminently suitable as a Dr. Walker eventually departed for resort for invalids and convalescents such Egypt with the fleet under Sir Ralph Aber- as those suffering from consumption, 13 dropsy, rheumatism and chronic dysente­ ophthalmology as well as "experiments in ry. He found the Island to be free of the philosophy" . "yellow fever of the West Indies and Naudi resigned the professorship in North America", of the "malignant inter­ 1834 and died three years later in his 57th mittent fever" of Italy and of the ophthal­ year "in consequence of the exertions mia and elephantiasis of Egypt. The only made by him in attending patients" dur­ epidemic that occurred during his resi­ ing the cholera epidemic of 1837 (Des­ dence here was one of smallpox which, patches 1836-37; Malta Government Ga­ however, was easily checked by a general zette 1837). inoculation with the vaccine. Another "man of talents" was Dr. Domeier was rather critical of local Luigi Caruana, Chief Government Medi­ professional standards. In his opinion the cal Officer, who was in charge of the Laz­ best Maltese physician was Dr. Cleardo zarett and the "Medical Police" but who Naudi from Axiaq (1780-1837). Naudi was spoke no English and only "very broken "acquainted with literature and a friend French". of natural history" and, what was rare in The practitioner with the widest those days, had a good command of the practice was Dr. Francesco Leone Grava­ English language. In fact he translated gna, one of the physicians on the staff of several religious and biblical writings for the Civil Hospital. He was a "reasonab18 the Wesleyan Missionary Society from good man". He later became Chief Gov­ English into Maltese (Cremona, 1940). ernment Medical Officer and a member of From 1801 he studied physics and mathe­ the Council of Health. He was carried off matics at the Malta University (Acta, by the plague of 1813 (Henner 1830d). 1800-32a). When the Chair of Experimen­ Domeier found that Maltese surgeons tal Chemistry and Natural History was were chary of performing serious opera­ instituted in June 1805, Naudi was chosen tions and only undertook to carry out to fill the post (1805-34). bleeding, cupping and blistering. Dr. Giu­ seppe Speranza, however, was "the best In October 1806 he delivered an ora­ of them". There were no dentists. tion in Italian at the Church of the Uni­ PharmaCists, too, received Domeier's versity on the occasion of the opening of strictures as they had "little knowledge the academic year. He reviewed the ori­ of chemistry, pharmacy, botany and mi­ gins and gradual growth of various neralogy". There was only one English branches of science including astronomy, chemist's shop but even this was "far navigation, physics, chemistry and medi­ from being perfect as it was run by two cine from the earliest times to the dawn army surgeons who, besides selling me­ of the nineteenth century; and records the dicines at a high price, generally under­ foundation of a "school of practical che­ stood little of pharmacy". There were mistry" and of a Botanic Garden with spe­ other army surgeons of whom some did cimens from "the four quarters of the midwifery such as Mr. Iliff, the hospital world" for the use of the medical students mate, who had the largest practice in this of the Malta University (Naudi, 1806). line. Some years after Domeier left the Island, Naudi was sent to London by the Public Medical Controversies Government (April 1812) "for the purpose of making himself better acquainted with A feature of the medical world of the regulations of the schools of medicine those days were the medical disputes in in that country and of the hospitals." He which members of the profession publicly stayed there for twenty-one months at­ engaged with one another in print - dis­ tending lectures in medicine, surgery and putes which were often spiced by person­ chemistry at St. Thomas's and Guy's Hos­ al rebukes and coloured with bitter words. pitals; a course of comparative anatomy An instance of such a controversy among and of botany at Brook's Museum; and Maltese physicians is furnished by the courses in midwifery, dentistry and polemiC on the Brunonian System between 14

Dr. Lorenzo Cassar and Dr. Gio Batta to be an admirer of William Cull en Saydon . (1710-90) and of Thomas Sydenham In 1780 John Brown (1735-1788) of (1624-89), "luminaries of the English Me­ Scotland propounded a medical theory in dical Faculty" (Guthrie, 1947). his Elementa Medicinae according to Dr. Gio Batta Saydon, born in 1773, which disease was the result of either too studied medicine at the University of Sa­ much stimulation or lack of it, especially lerno. During the insurrection of the Mal­ the latter. He, therefore, classified all dis­ tese against the French he attended the eases into sthenic or asthenic and the members of the Zurrieq battalion free of treatment consisted of giving stimulating charge. In 1801 he was medico dei poveri drugs in large doses. The theory caused at Bormla and during the plague of a stir in the United Kingdom, Germany, 1813-14 was made Principal Physician of France and Italy. It found adherents and the emergency hospital set up in Villa opponents also in Malta where a polemic Bichi for the plague stricken. dragged on for a number of years between It has been claimed that he was the the two physicians already mentioned. first doctor in Malta to recognise hydro­ After studying philosophy and the phobia. He wrote a Relazione dell'idrofo­ "medical institutions" (istituzioni medi­ bia accaduta in Malta l'anno 1809 (Report che) for two years in Malta, Dr. Cassar on Hydrophobia as it occurred in Malta continued his studies at Naples University. in the year 1809) which remained in ma­ He did his clinical practice at the Spedale nuscript form and has been lost. He treat­ degli incurabili and at the end of a course ed the sick during the smallpox epidemic of three years obtained the doctorate of of 1830 and the cholera outbreak of 1837. medicine of the University of Salerno in He died on the 1st October 1841. 1789. He specialised in teaching "the Saydon was a strenuous exponent of mutes to soeak" and after practising at Brown's theory which he defended against the Holy Infirmary of Valletta was grant­ the criticism of Cassar in a pamphlet en­ ed the warrant to practice in September titled Il sistema di Brown difeso da varie 1790 (Archives 1196.RML). On the 9th imputazioni e calunnie del Dr. Lorenzo September 1800 he was nominated Palace Cassar (Brown's System defended against Physician by Sir Alexander Ball and by the various accusations and calumnies of the beginning of 1802 he had become Dr. Lorenzo Cassar) published in Messi­ Princioal Physician of the Civil Hospital na in 1808. As in other such doctrinal dis­ of Valletta. putes of those days, Saydon's rejoinder In the same year he wrote a paper, does not go beyond abstract arguments in which he criticised and opposed the and persona! reproaches directed against Brunonian System as John Brown's medi­ Cassar who maintained that clinical ex­ cal ideas came to be called. He read it at perience coupled with the understanding a "solemn literary public meeting held in of the nature of disease constitute "the the Great Hall of the Maltese Hospital in true system, the most reliable guide and the presence of H.E. the Royal Commis­ the true mariner's compass of the prudent sioner.Sir Charles Cameron, on the 10th physician in traversing the stormy ocean June 1802". Among the audience were the of medical practice" (Il Globo 1841; Mif­ Presidents, professors and colleagues. It sud Bonnici, 1962). However, in spite of was later published in pamphlet form in Cassar's condemnation of Brown's theory, 1802 and again in 1808 (Cassar, 1802). Brunonian medicine had not yet disap­ He exposed the "errors and irration­ peared from Malta twenty years later ality" of the Brunonian concepts and pro­ (Hennen, 1830e). fessed himself a follower of the "vener­ able ancjent Hippocrates and his. succes­ Academic standards sors" whose teaching was the ",genuine result of experience and not of selfishness Domeier found that the teaching staff and bizarrerie" as happens with propoun­ of the Medical Faculty of the University ders of "systems". He declared himself consisted of only one lecturer - Dr. Lu- 15 dovico Abela - who taught all subjects The new garden was set up at Floria­ for two hours a day. To understand how na adjacent to Sarria Church on the site the University had been reduced to such of the present Government Elementary a state it must be borne in mind that Na­ School. In 1806 was published the first poleon had suppressed the University in catalogue of plants under the name of 1798 and tried to replace it by a Central Index Plantarum Horti Botanici Meliten­ School where medical subjects were not sis (Storia della societa medica d'incorag­ to be taught at all. He decreed, however, giamento, 1845; Cremona, 1967). that courses in anatomy, medicine and It is obvious from this short account midwifery were to be held at the Civil that Domeier's stay in our Island (1805-8) Hospital. When the Maltese rose against coincided with the initial phase of the re­ the French, all academic activities ceased vival of the study of botany in Malta. from September 1798 to September 1800 With regard to the study of anatomy when the French capitulated and left the and surgery, there is undoubted evidence Island. that these subjects were being taught at One of the first acts of Sir Alexander the Civil Hospital of Valletta, after the Ball, who was then President of the Mal­ revival of the University in 1802. This tese Provisional Government, was to re­ was. in a way, a continuation of the policy open the University on the 6th November laid down by Napoleon two years pre­ 1800 with Faculties in Law, Theology and viously. Medicine. The regulations of the Civil Hospital The students of medicine entered issued on the 20th March 1802 make re­ upon the academical course proper after ferences to (a) four students of Physic a preliminary study of the humanities, (allievi di fisica) who bled patients, did philosophy, mathematics and physics cupping, applied vesicants, fomentations, (Cassar PuUicino, 1958). The study of bo­ cataplasms and inunctions under the di­ tany, and of anatomy and surgery did not rection of the Master of Physic (Maestro figure in the medical curriculum and di Fisica); they accompanied the Senior Domeier remarked upon the neglect of Physician on his rounds; (b) five Licensed botanical studies and the absence of a Students of Surgery (allievi patentati di Professorship in Anatomy and Surgery. chirurgia) and (c) an unspecified number At a time when pharmaceutical reme­ of Supernumerary Surgical Students dies were mainly of a vegetable kind, a (allievi supranumerari di chirurgia). All knowledge of plants was rightly consi­ these categories of students received a dered essential both for pharmacist and salary of 15 to 20 scudi a month (one physician. In fact botany was being taught scudo = Is. 8d.) in Malta as early as the close of the 17th The following extracts from the hos­ century and a Botanical Garden was pital regulations give an indication of the planted in 1690 in the ditch of Fort St. nature of the students' training and Elmo near the Holy Infirmary for the use duties:- of medical students. It was entrusted to (a) The Senior Surgeon was allow­ Dr. Joseph Zammit, Teacher of Anatomy ed to entrust a few of the dressings to the and Surgery. The garden fell into disuse cure of some "good students to train in 1798 during the turmoil that followed them in the practice of surgery". the advent of the French to Malta. Napo­ (b) The Junior Surgeons were en­ leon, however, mindful of the necessity joined "to supervise the surgical stu­ of a Botanical Garden had decreed that dents so that they do not absent them­ such a garden was to be established in selves from the ward round or leave hos­ the viCinity of Valletta. This project was pital when on duty"; to make sure that carried into effect during the succeeding they carried out all their work and to re­ British domination when the Rev. Fr., Carlo port defaulters to the hospital authorities; Giacinto was appointed to the Chair of and finally to instruct the students in the Botany in our University by Sir Alexan­ medication and bandaging of patients. der Ball in 1805. (c) The Junior Surgeons on duty 16 was to perform "anatomical dissection for educational standards of the profession study purposes with the help of the sur­ by laying down requisites in age, train­ gical students". ing and qualifications for the different (d) The students had to "attend the categories of the medical profession. The daily ward rounds, morning and afternoon, aims of the College were only partially to carry out the orders given them by the achieved at this period with the passage Principal Surgeon. They were also to fol­ ef the Apothecaries' Act in 1815 (Hollo­ low the directions of the Junior Surgeon way, 1966). and medicate the patientts suffering from In Malta the gaps in the academical r:ngworm (tigna). teaching of the University were filled to­ (e) All the Students of Physic and wards the end of the decade by Dr. Agosti­ of Surgery had to. attend the daily lesson no Naudi, the brother of Dr. Cleardo Nau­ in anatomy and surgery. The lecturer had di already alluded to. to draw up a list of absentees every week Born in 1783 Agostino Naudi at first and submit it to one of the Presidents meant to study civil and military archi­ (two of whom formed a sort of lay hospital tecture but at twenty years of age he management committee). The Presid(;nts turned to medicine. He pursued his m8- decided upon the punishment to be dical education at the Medical Academy awa::,ded to the offender including dismis­ of Naples qualifying as physician and sur­ sal from employment. geon at the University of Salerno, being (f) The surgical students adminis­ the first among three hundred students. tered internal medicines in conformity On his return to Malta he taught with the prescriptions of the Senior Sur­ anatomy and dissection in the cemetery geon. of the Civil Hospital of Valletta in substi­ (g) They were taught the "obstetric tution to Dr. Aurelio Badat who had given art" by a Master of Obstetvics (Maestro up teaching because of senile mental decay di Ostetricia) both "orally and in writing". (1810). Naudi had to suspend his lectures (h) They were on call during the and demonstrations during the plague nlght according to a roster (Piano per il epidemic of 1813-14. regolamento dell'ospedale di Malta, 1802 Following the death of Dr. Ludovico b). Abela, Professor of Medicine (1800-15), The first men to qualify from the Naudi taught medicine privately, his newly restored Medical Faculty were students receiving the doctorate of the Aloysius Gravagna and Alexander Vella. University of Malta in 1819. From 1820 After undergoing a private examination onwards he substituted Dr. Stefano Gril­ by three examiners and sustaining a thesis let, Professor of Medicine (1815-31) who in public in the Church of the University, had become chronically ill. He also taught they had the degree of Medical Doctor botany, physiology, pathology and sur­ conferred upon them in August 1804. A gery. total of eleven medical men qualified bet­ He is alleged to have been the first ween August 1804 and July 1812. The to discover and describe the middle me­ studies were subsequently interrupted tem­ ningeal nerve for which he was com­ porarily by the plague outbreak from May mended by the Academicians of Paris and 1813 to October 1814 (Acta 1800-1832 b). granted the diploma of Insigne maestro di Shortcomings in medical studies and anatomia umana (Outstanding master of practice were not limited to Malta at this human ana tomy) by the Academy of Rome. period. They coincided, to a certain He wrote an account of the plague of extent, with what was happenning in 1813-14 in Latin. He submitted it to the England. In fact the practice of physi­ Medical Academy of Montpellier by which oians, surgeons and apothecaries was still "he was judged worthy of special and unorganised except in London; so much honorific mention". Dr. L. Barthelemy so that in 1806 the College of Physicians declared it to be "a masterpiece of patho­ tried to tackle this problem by formulat­ logy, the~apy and preventive hygiene". ing a scheme which aimed at raising the The manuscript was still extant in 1864 17 but cannot now be traced. From sketchy 1907; Naudi 1827 & 1828). references to it in contemporary medical A Professorship in Anatomy and Sur­ literature we know that it dealt with the gery was set up in 1822 with the appoint­ atmospheric phenomena and the state of ment of Dr. Gavino Patrizio Portelli (1795- public health prevailing immediately be­ 1865) to the Chair (Malta Government fore the outbreak such as the mildness of Gazette 1822). In the first decade of the the weather, the increased incidence of 19th century, Gavino Patrizio Portelli, sudden deaths which excited "public ob­ though still a youngster, was already serv­ servation and alarm", the remarkable fre­ ing in the Military General Hosp!tal at quency of hydrophobia and of intestinal Valletta under Sir William Franklm, the infestation with ascarides and earthworms Inspector of Military Hospitals, who took which were "never so general and so the boy under his patronage and encour­ numerous in the memory of man" (Hen­ aged the boy's parents to send. him to nen, 1830 f). study medicine in London - WhICh they In 1827 Naudi pub!ished a treatise on did. In London he studied under Con­ the cultivation of the silkworm to en­ stantine Carpue and then joined the 10th courage the Maltese farmer to undertake Infantry Regiment as Assistant Surgeon. this form of industry. In December 1813 he took part in the ex­ In the following year he wrote a brief pedition under Sir Thomas Graham against review, which remains in manuscript, of the French in Holland and was in the front the history of yellow fever. This disease line during the attack on the fortress of had been causing considerable anxiety to Bergen-op-zoom when he was slightly the health authorities of Malta since Oc­ wounded. In 1816 he was made a member tober 1804 when it occurred on an epide­ of the Royal College of Surgeons. He re­ mic scale at Gibraltar. Mortality was mained with his regiment until 1818 when high. Two-thirds of the inhabitants left he was called from Corfu by Sir Thomas the Rock to escape the disease and some Maitland to occupy the post of Principal of them, mostly Jews, came to Malta in Surgeon at the Civil Hospital of ValIetta the early days of the outbreak. The qua­ (Corriere mercantile, 1865). rantine regulations of Malta were tight­ By the time PorteIli became Professor ened against ships coming from infected places. Samuel Taylor Coleridge, who of Anatomy and Surgery in 1822, the aca­ was then in Malta, states that a ship from demic standards of Maltese medical men Ragusa with its crew dying of yellow had risen considerably. Pharmacists, also, fever was forced to sea from the Island had become "expert in the various phar­ (Sultana, 1969; Coburn, 1962 b). maceutical operations". In fact a British physician serving in Malta, Dr. John Hen­ Gibraltar was declared free from the nen, Inspector of Military Hospitals, de­ disease on the 1st January 1805 but the clared that "physic and surgery are not on dread of the importation of the infection a lower footing in point of respectability into Malta persisted for many years after­ in Malta than among the continental na­ wards. tions in the neighbourhood". It is true In his account of the history of yellow that surgeons were still somewhat con­ fever, Naudi traced its outbreak in Pen­ servative in treatment compared with their nsylvania in 1740 and its subsequent ap­ British counterparts but part of this fault pearance in Gibraltar with which Malt.a lay with the patients who were "so wedded was then in close and frequent commUnI­ to old practices and established usage that cation by sea. He quoted the observations the physician who should attempt any in­ of Robert Lind on the disease and ex­ novation in this respect would assuredly pounded his own ideas about its spread be left without any subjects to practise from an "infected" place to a healthy one upon". However, "modern medical and by means of atmospheric air. surgical practice" was ably taught and de­ Dr. Agostino Naudi died on the 11 th monstrated in the Civil Hospital (Hennen, November 1830 (CamilIeri 1831; Malta 1830 g). 18

Epilogue against smallpox was being widely recog­ nised; Corvisart was propagating the use The medical highlights of the decade of percussion in the diagnosis of diseases r' 1800-10 are Burnett's clinical description of the chest and heart (1808); lames Carrie of Undulant Fever; the introduction of (1756-1805) introduced the clinical ther­ vacc:nation against smallpox; the revival mometer; Laennec invented the stetho­ of the University with its Medical Faculty; scope in 1816; and a new more rational the initiation of the Government's policy approach to the management of the men­ of sending Maltese medical men for post­ tally sick was being adopted. graduate studies to the United Kingdom All these advances lay in the future and the beginning of the first contacts path of our professional ancestors - between British and Maltese medicine. British and Maltese - at the close of the On the debit side we find that acade­ first decade of the 19th century but before mical training in medicine was modest; they were to taste these benefits they were surgical practice was limited in scope; the called upon to bear the full weight of the running of hospitals was inspired by the most dreaded medical calamity of all times med;eval concept of "charity" towards - the plague that descended upon them the indigent and not by the idea of service and sorely tried them in the Malta epide­ to all members of the community; "fever mic of 1813-14; but that is another story cases" taxed the physician's time and that has already been told. efforts but their causation still eluded him; treatment, consisting mainly in bleeding and purging of the patient, was ineffectual; APPENDIX I time and energy were dissipated in abst­ ract theorising and sterile controversy. Doctoral College In assessing the men and ideas of the in the Faculty of Medicine period under review in Malta we must re­ (Collegio Dottorale member that we are judging them from nella Facolta della Medicina) the vantage point of the twentieth cen­ 1805 tury. To be fair to them we must bear in Dr. Luigi Caruana mind that the pattern of their lives mir­ Dr. Giovanni Agius rored the European intellectual and medi­ Dr. Francesco Dimech cal scene of their days and it is within this Dr. Francesco Leone Gravagna framework of time and state of knowledge Dr. Stefano Grillet that we must judge them to give them a Dr. Giuseppe Ciaja fair trial. Whatever their deficiences, Dr. Giuseppe Dingli those men did not live in an isolated cul­ Dr. Gabriele Pullicino tural backwater but were always in the Dr. Aurelio Badatt main stream of Western thought and events. Master of Anatomy and Surgery The world in which they were brought (Maestro di Anatomia e Chirurgia) up and trained was being swept away by 1806 a quarter-century of war sparked off by the French Revolution of 1789 and ending Dr. Aurelio Badatt at Waterloo in 1815. In 1810 they were un­ aware that they stood on the threshold of Master of Obstetrics a new era when budding scientific and (Maestro di Ostetricia) medical ideas would bear fruit in the fol­ 1806 lowing decades. The physiology of respi­ Dr. Francesco Buttigieg ration would be understood thanks to Lavoisier's contribution on the role of (Diario, lunario e calendario delle isole di Malta oxygen in the processes involved; the e Gozo per l'anno 1805, Malta, p. 17: Almanaeeo value of lenner's prophylactic vaccine delle isole di Malta e Gozo, Malta, 1806, p. 29). APPENDIX 11 Junior Surgeons Doctors graduating from the University (Chirurgi secondari): from 1804 to 1812 Antonio Casha Aloysius Gravagna - 1804 Giovanni Andreotti Alexander Vella - 1804 Carlo Grech Joannes Franciscus Falzon (Mosta) - 1806 Salvatore Saydon (Zurrieq) - 1807 Pharmacist Lucas Borg (Balzan) - 1809 (Aromatario~: Xaverius Micallef (Qormi) - 1809 Giuseppe Farrugia. Paolo Antonio Azzopardi (Siggiewi) (P:ano per il l'egolamento dell'ospedale di Malta. 1810 Ma!ta, 1802, pp. 1 & 2; Diario, lunaria e calendario Felix Brignone - 1812 dcl!e isole di Malta c Gozo per l'anno 1805, Malta, Joseph Galea - 1812 pp. 17.18; A!manacco delle isole di Malta e Gozo, Nh~ta, 1806, p. 29). Gregorius Gatt (Birkirkara) - 1812 Albinus Borg (Balzan) - 1812. (Acta Academ:ae Melitens:s 1800-1832, fols. 18 APPENDIX IV to 52). Naval Hospital Medical Staff 1803-4 APPENDIX III Surgeon in Charge:- Women's Hospital Medical Staff Mr. John Gray - appointed 25th No­ 1802 vember Dr. Gluseppe Ciaia (sic) Surgeon's Mate or Assistant Surgeon:­ Dr. Stefano Grillet Mr. John William Ellice - appointed Dr. Giuseppe Dingli (supranumerario) 22nd December Governor and Superintending Officer:­ Men's Hospital Medical Staff Lieut. William Pemberton - appointed 1802 21st December. Dr. Francesco Dimech Physician:- Dr. Francesco Leone Gravagna Dr. Leonard Gillespie (1758-1842) Dr. Leopoldo Bernard He was the first physician to be Dr. Lorenzo Cassar appointed to the Malta Naval Hos­ pital. He joined the Victory as 1805 Physician to the Fleet in January Senior Physicians 1805. (Medici primari): Francesco Dimech 1807 Dr. Francesco Leone Gravagna Surgeon:- Dr. Giuseppe Ciaja Mr. John Allen Dr. Stefano Grillet Assistant Surgeons:­ Dr. Lorenzo Cassar Mr. John Regnell Dr. Giuseppe Dingli Mr. Lorenzo Zammut (sic) (N:colas, N. H. The D:spatches and Letters of Junior Physicians Vice Admiral .Lo~d Viscount Nelson, Vo!. V" London, 1845, 111)' 294, 322 & 325: Gordon Pugh, P. D. Ne'- (Medici secondari 0 pratici): Dr. Emanuele Locano 5811 and H s Surgeons, Edinburgh, 1968, p. 26; A imanacco dl'lle isole di .v1alta e Gozo, Ma~ta, 1808, Dr. Salvatore Cutajar P·i I). Dr. Giuseppe Schembri References (Senior) Surgeons Acta AC:lde11liae lvleiitensis (1800-3za) fo;s. 6, 15 & (Chirurgi): 20. Arch:ves of Royal TTn:versity of Malta, De­ Dr. Aurelio Badatt partment of H·stury. Dr. Giuseppe Speranza Acta Academiae Melitensis (I800-32b) fo:s. 18, 23, Angel/) Ventura 27, 35, H cl:. .~2. 20

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