MEDI-SCOPE CLINICAL CASE HISTORIES AND POST MORTEM REPORTS FROM THE MALTA LAZZARETTO IN THE 18TH CENTURY

PAUL CASSAR MD BSc DPM FRHlsT S(LONOJ D.LlTT (HON. CAUSA)

Hon. Fellow of the University of Malta

he theme of this paper derives Injuries Multiple fractures from the unpublished manu­ A captive Turk, thirty years of age, died on the T script records of the Registers Skull 22 February 1794 from three wounds, received of Ships arriving in Maltese ports and during a combat at sea twelve days previously, i I. On the 28 March 1781 a soldier on a French held in quarantine from 1739 to 1801 . caused by a blunt instrument. The first was a' Clinical case histories from other warship fell and hit his head. He sustained a "simple wound" on the left side of the sternum; contusion of the right temporal muscle without the second involved the left hand with fractures of contemporary hospitals - the Holy any external wound or fracture; but the concus· the index, middle and ring fingers; the third was a Infirmary and the Women's Hospital sion of the brain and the resulting extravasation "corn plete" wound of the left thigh complicated at Valletta, Santo Spirito Hospital at of blood in its substance caused his death - and by a comminuted fracture of the upper end of the Rabat (Malta) and the Gozo Hospital this (diagnosi's) is confirmed by the extrusion of a femur near the (hip)joint. This was accompanied quantit; of blood from the corresponding ear'. - have not been met with. The by bleeding from a severed arterial trunk. It ended in gangrene - a sufficient cause for his 2. Following a fist fight on 9 November 1782 Lazzaretto case histories are the only death" ones that have reached us and, wanting among five Turks undergoing quarantine at the Lazzaretto one of them, aged thirty years, died as they are in details of their contents, Note: Nearly all those recoreded as from the blows received. Observation of the having had open and comminuted they constitute the only means of cadaver showed the discharge of a substantial improving our knowledge of the q\.lantity of blood from the right ear and from the fractures produced by gunshot died of nose - from which one necessarily infers that the gangrene. pattern of disease III Malta two . victim had been hit on the head though there hundred years ago. were no signs of an external lesion; in fact a Internal organs They occur in the form of entries contusion of the brain substance is enough to written by the attuario dell' Officio della produce an internal extravasation of blood as I. A Maltese sailor of a corsairing vessel aged Sanitd di Malta or Registrar of the confirmed by the exit of blood from the parts forty years committed suicide by shooting himself Sanitary Commissioners whose office mentioned'. with a pistol on 25 August 1781. The projectile 2 entered the left thoracic region between the third was at the Barriera at Valletta . The 3. On I November 1783 a Moslem captive of and fourth ribs near the sternum. It penetrated attuario was a layman and it is likely twenty years of age was admitted to the Lazzar· the lobe of the lung obliquely and got lodged etto with a fracture of the skull in the left parietal 9 that what he wrote was dictated to him beneath the lower end of the scapula . region caused by a ball shot from a fusil (light by the barberotto (barber-surgeon) or by musket). This caused a "natural trephine" Note: Presumably a post mortem was the physician attending the case; or, opening (of the cranium) with exposure of the performed in this case since the tract or occasionally, by the protomedico or Chief dura mater. An abscess formed under the dura and trajectory of the projectile has been so Government Physician examining the when this was incised there was a discharge of pus and cortical substance of the brain with frag­ well followed. patient. ments of bone. He died nine days after'. The text is cast in the Italian 2. On 7 August 1780 a captive Turk aged forty­ five years died at the Lazzaretto from a wound language of the period with mis­ 4. A seaman of thirty years fell from a tall mast on 10 February 1798. He hit the deck and with caused by a cutting instrument. It was situated in spellings, at times, of the names of the the impact went overboard. On being recovered the lateral side of the left knee~joint involving the organs and pathological findings. The from the sea he was deeply unconscious. He ligaments and tendons of the articulation. It was entries are here reproduced in English sustained two wounds in the occipital region - followed by swelling and inflammation (of the leg) extending to the tip of the foot. He finally but an attempt has been made to one on the left side and the other on the posterior 10 died of gangrene . preserve as much as possible' the flavour aspect of the bone. Death was due to haemor­ rhage in the substance of the brain as confirmed of the Italian original by giving, in by the issue of blood from the nostrils, the left ear some instances, an ad litteram tran­ and also from the mouth". Cancer slation. Ascribing a retrospective diagnosis Lip has created some difficulty as the Face clinical information contained in the On 4 August 1776 a French sea-captain asked On I November 1783 a French seaman aged to be admitted to the Lazzaretto to be treated for records is not always sufficient and thirty years was admitted to the Lazzaretto with a cancer of the lower lip that was still in the initial clear enough to allow identification of a a fracture of the face caused by a fire-arm. The stagesll specific disease. However, a tentative missile traversed the lower jaw, fractured its two joints, amputated the tongue from its roots and Tongue diagnosis has been attempted for the tore the mastoid muscles rendering him unable to purpose of grouping and classifying the chew. He survived for thirty-nine days dying on The Consul of Sweden in Tripoli came to various case histories. the 9 December 17837 Malta on 4 August 1778 suffering from cancer of

AUTUMN '88 9 MEDISCOPE 1 3 I LAZZARETTO CASE HISTORIES

the tongue. After undergoing the prescribed period of quarantine at the Lazzaretto, he took lodgings at the Falcon Hotel to be treated for his condition by thetirotomedieo Dr. Lorenw Theij (or Thcin). H0wever, it was found to be too diffused and the patient died soon after. He was buried in l2 pratique in the external ditch of the Lazzaretto •

Upper maxilla A Greek seaman, aged fift y years, was landed at the Lazzaretto on ' 1 0 April 1781 with a sc irrhous tumour on the right cheek and upper maxilla from which he had been suffering for the previous three years. The growth eventually "degenerated into a true carci noma. As the carcinous virus (sic) spread, the affected part became inflamed with recurrent bleedings from the mouth. In the end fever supervened and carried him Ofl'13 Note: It is not recorded what kind of treatment was carried out for the lip cancer and what was the outcome. In the case of the tongue cancer, it does not appear that any surgery was intended as Dr. Lorenzo Theij was a physician and no physician, in those days, would do any surgery. As regards A section of an 18th century map of Malta showing part of Marsamxett or the place of the patient's burial, it is Quarantil'le Harbour with Fort Manoel and the Lazzaretto (left). (Courtesy National Archaelogical Museum, Valletta). known that there were no less than six graveyards at the Lazzaretto one of vagueness of the clinical picture raises However, after a respite of eight days the fever them being reserved for Protestants the possibility that the first case was recurred with the bubo in the right groin. The and Lutherans and called the cimiterio lead poisoning from contamination of bubo was incised but although its pus was evacuated the tissue passed into a state of esteriore. the food and water on board the ship; necrosis. A copious diarrhoea supervened and he Concerning the third case, the word and that the second case was one of died of true plague. His body was burned and the virus is not used in the modern chronic bacillary dysentery with ashes thrown into the sea I". connotation of an infective agent but in secondary malnutrition and vitamin 2. The captain of a Venetian polacre arrived in the literal Latin meaning of "poison". deficienty Malta on 18 May 1786 complaining of having fallen sick during the voyage from Tripoli (in Typhus Barbary) where there was the plague. He had Medical Illnesses severe headaches. On examination there was a On 26January 1786a Venetian warship with a carbuncle in the carpal region of the left hand crew of two hundred and ten men came from Scurvy which eventually became gangrenous; a swelling Corfu and landed thirty-four sailors at the in the right parotid; and gangrenous blotches Lazzaretto suffering from putrid and malignant I. On 26 May 1782 a Venetian ship arrived from over the entire skin surface of the body - "all fever with petechiae. Only eleven of them were Bergen (Norway) which it left four months earlier evid ent signs of true plague from which he died as subsequently discharged recovered 16 on 16 January. It was carrying a cargo oflead for certified by the protomedieo". His corpse was Venice. It landed seven seamen out of a Note: There is mention of an earlier burned and the ashes thrown into the sea 19. complement of twelve to perform quarantine at patient with "malignant fever with the Lazzaretto and at the same time receive 3. A thirty-year old sailor was landed at the treatment for the scu rvy". petechiae" being admitted to the Lazzaretto from a Ragusean ketch on 18 Lazzaretto in August 1762. November 1787. He had been suffering from a 2. A Venetian warship brought a sailor offorty Since the 16th century typhus was "continuous malignant fe ver" for the previous years to the Lazzaretto on 18 February 1784 eightee n days with bouts of delirium, a sticky suffering from long-standing sc urvy but having known as the "petechial disease" and tongue, violet coloured petechiae on his trunk become worse during the past two months. He was ascribed to "corruption of the air and convulsive movements. On the ninth day of had diarrhoea, tenesmus, bloody stools, and the breath by filth" from men his illness ther~ appeared swellings of the parotid continuous fever, emaciation and a cachetic crowded in small enclosed places. glands and, although one of them was incised, the habitus. He died IS. swelling involved the internal structures (of the Were the Maltese cases louse­ neck) and " injected its poison as far as the vital Note: Though these two cases were borne? It is of interest to read in the region (the heart) causing stertorous breathing diagnosed as scurvy in the attuario's attuario's register that in February 1755 which carried him ofl·. entries, the clinical picture is not a Moor of sixty years died on board a Although no signs of plague were observed, convincing. Admittedly the diet of caique. When "viewed" by the wrote the alluario, the case was regarded as one of plague and, with the aim of protecting the public seamen, consisting mainly of biscuits protomedico he was found to be "a mere health, the cadaver, bedding and clothing were and salted meat without fresh vege­ skeleton ... eaten up by lice" 17. disposed of by burning" 20. tables and fruits, was likely to produce Plague 4. A sailor, aged forty, arriving on a French a state of sub-clinical scurvy; but in the warship from Constantinople on II April 1788 two cases under review there is no I. On 14 May 1785 a seaman from a Maltese died at the Lazzaretto on the seventh day of an mention of such common signs of corsairing galiot sickened with fever, headache illness characterised by fever, headache, dry scurvy as joint symptoms from bleeding a nd vomiting. He had a sticky tongue. A bubo tongue, an insatiable thirst, the eruption of a bubo in the right inguinal region and the around or into the joints, ecchymoses appeared in the right inguinal region but subsided after two days. Another bubo developed appearance of violet blotches in the skin. He into the skin of the lower limbs, spongy in the left groin but this, too, disappeared after finally passed into a marked delirium and died and bleeding gums, etc. Indeed the seven days and he became symptom-free. within a few hours.

MEDISCOPE 13 10 AUTUMN 'Be I LAZZARETTO CASE HISTORIES

His corpse was burned and the ashes thrown or a malignant fever, from whi ch he had been nutrition led to great weakness and death'3. into the sea'l suffering since fi ve months, on 2 March 1792. A Note: Is this an instance of viral or N ote: The problem of protecting swelling had appeared in the !'ight parotid seven days before his death. It subsided a lo.,gwith the amoebic hepatitis complicated by Maltese territory from invasion by fever before it could be incised. It reappeared alcoholic cirrhosis? plague from overseas had been an issue after a fe w days, festered and kept discharging of extreme concern for state officials pus inspite of the remedies applied. "The absorp­ Peripheral arterial occlusion and the health authorities since at least tion (of the pus) by the blood (s tream) caused a slow, continuous fe ver which led to a marasmus A sailor (age ?), admitted on 28 February 1757, the time of the Black Death of 1348. that eventually brought about his death"". Elaborate precautions in the form of a had fever for twelve days after which he deve­ N ote: Was this a case of bacterial loped necros is in the left hand and in two fingers quarantine system were later devised to of the right one with initial gangrene in his cheeks prevent "contagious" or contaminated parotitis arising from a streptococcal and in the left pinna (external ear) together with p ersons and merchandise from infection of the throat? or a malignant jaundice. He survived and was granted pratique conveying the "contagion" of plague to tumour of the gland complicated by an afi er a two months stay at the Lazzaretto". the inhabitants. Devastating invasions abscess? or an obstruction of Stensen's Note: Presumably this was a case of of the disease in 1592-3 and 1675-6 had duct by a calculus with a supervening perpheral arterial occlusion (throm­ wrought great mortality and crippled secondary infection? bosis?) . Was it a vaso-spastic disorder communications and trade. The such as Raynaud's Disease? Or an microbial origin of the illness (Yersinia Liver disease instance of ergot poisoning complic­ pestis), the rat-flea chain of conveyance ated by liver obstruction? How did the A French sailor of fift y-six years had been to humans (Rauus raUus and Xenopsylla la bouring under a "chronic indisposition" for blood supply - and to what extent - cheopis) was then unknown. In their four months before he was landed at the re-establish itself? ignorance the health authorities saw Lazzaretto to undergo quarantine on 12 July their only security in the strict isolation 1788. He had dropsy which disappeared after Heart disease complicated by alcoholism fifteen days of treatment. T his was fo llowed by ofthe plague-stricken at the Lazzaretto bouts of fever at intervals of a few days from Surgeon Pietro Galea from Valletta but li ving and the total annihilation of the which he recovered completel y. However, at Siggiewi, forty years of age, died on board the diseased corpses by fire. because of tlie long-standing " obstructions corsairing xebec on 31 December 1782. During involvin g the region of the liver and because of the previous four months - and perhaps earlier Parotitis the corruption of the bil e" due to the excessiv e - he had been suffering from recurrent short­ use of wine, he completely lost his a ppetite and ness of breath accompanied by pain in the region A Spanish seaman, twenty-six years old, died developed an aversion to food. T he lack of of the sternum and complaining of a dry distress-

The Lazzaretto today - as seen from Valletta. P. Zammit.

AUTUMN '8e 11 MEDISCOPE 13 LAZZARETTO CASE HISTORIES

ing cough. He refu sed all forms of relieving from "tertian fevers and fluxes" 30. Lazzaretto were sent to this establish­ measures; in fact, instead of availing himself of "Foul vapours" emanating from ment to assist in the nursing of their the necessary remedies, he often abused of wine 35 whic h ultimately produced inflammation and passengers crowded in restricted shipmates . suppuration in the lungs. In the end hewasseized compartments and corridors on board Cases of suspected plague were with excruciating pain in the region of the heart ships were also regarded as causative of examined by the protomedico and dealt 25 and died . 31 35 fevers . with according to his instructions . He likewise examined cases of "lung Post mort em Caesarean section Diagnosis diseases with fever" and when these On II December 1780 a woman passenger of were found to be suffering from phthisis 36 twenty-three years was eight months pregnant Physicians based their diagnosis on their clothes were burned at his order • when landed at the Lazzaretto suffering from The clinical case histories contain malignant fe ver. An Assistant Surgeon (Prauico di the account of the illness as narrated by clzirurgia ), Fedele Zammit, was sent to the Lazza­ the patient and on the observation of only fragmentary information about retto to attend to her and to be in readiness on the such clinical phenomena as the type of the type of treatment given beyond spot " to open the body in the event of the fever (tertian, quartan, etc.), skin brief references to evacuation of pus patient's death and save the baby if possible" . di sco 10 u ra tion (j au nd ice an d from incised abscesses and from the The woman died on the 13th. A Caesarean brain substance in open fractures of the Section was immediately carried out. A male petechiae), recogllltlOn of a pox, baby was extracted but he died after an hour26 swelling of lymph glands and dropsy. skull; amputation of limbs with The feeling of the pulse, the inspection gangrene or with open comminuted Note: The preoccupation of the fractures; and the removal of musket Catholic Church with the performance of urine, faeces and sputum also formed 37 balls from muscles • of Caesarean section on dead pregnant part of the diagnotic procedures. On the whole medical diagnosis was based Surgical operators were impotent in women goes back to the Middle Ages tackling internal injuries because there when the church counselled the upon personal exp erience and familiarity with similar cases. was as yet no chest and abdominal carryIng out of the operation surgery since the concepts and practice immediately after the death of the Surgeons, on the other hand, reached more rational and accurate of asepsis and anaesthesia were still a mother. In Malta an edict of the century away in the future. Archbishop Fra Vincenzo Labini diagnostic deductions because they had a good grounding in human osteology For medical cases there was little to (1788) obliged the parish priest to offer beyond phlebotomy which was perform it himself "under a grave sin" and myology; of the location and 27 useful in some instances of apoplexy in the absence of a surgeon • mutual relationships of internal organs; and a wealth of experience derived and heart disease but harmful in other conditions such as acute infections. Concepts of Aetiology from the frequent occurrence of external trauma in those days of These bleedings were carried@ut by the combats at sea. barber-surgeons. These practitioners Physicians were not familiar with the had no academic standing and could aetiology of illness for there was as yet only apply external medications but no real physiology and pathology of TreatlDent were not allowed to prescribe internal disease much less of the causal role of remedies. All this was in line with the microbes as agents of sickness. A section of the Lazzaretto, known as accepted division of the medical and of 32 The "bad air" arising from marshes the in(ermeria was set apart for the the surgical roles then prevailing in the in the Greek regions ofPatras, Nauplia treatment of the wounded by the healing profession in Europe. (Napoli in Romania) and the Gulf of barber-surgeon (barberotto) and of the Aria were blamed for the occurrence of sick by an Assistant Physician (prattico). quotidian, tertian and quartan fevers These practitioners were members of Post MortelD EXalDinations from which mariners in the Mediter­ the professional staff of the Holy ranean often suffered especially in the Infirmary of Valletta or of the Galley Patients dying in quarantine were 28 summer season • Squadron of the Order ofSt. John and buried in one of the graveyards On 20 October 1688 the Galley were sent to the Lazzaretto as the occa­ enclosed within the Lazzaretto Squadron of the Order 'of St. John, sion arose. This arrangement had complex; but before burial the body consisting of eight ships, returned to become standard practice by the 14 was "viewed" or inspected externally 33 Malta from Negroponte (Greece) with October 1684 . for any signs of "contagious" illness, the five hundred thirty two sick men At the end of their duties, this wording of the official entry being described as "one hundred seventy­ personnel had to spend a term of "after the usual viewing of the cadaver seven with fever, nineteen at the point quarantine before they were allowed to in which no signs of a contagious illness of death and three hundred and forty leave the Lazzaretto and return to their were observed" 38. The "viewing" was convalescents". The physician of the posts at the Holy Infirmary' or the done by the protomedico - a practice squadron, Dr Pietro Paolo Bonnici, Galley Squadron because they had that was already established by 166039. reported that the illnesses consisted of been in contact with passengers and It is not recorded what signs of a tertian fevers and fluxes (dysentery). crews under surveillance for the "contagious illness" the protomedico The sick were taken to the Lazzaretto possibility of harbouring "contagious" looked for but presumably these were 34 where thirty-seven of them eventually maladies . the clinical manifestations usually 29 died . When patients were numerous, a associated with bubonic plague I.e. The same squadron, on 4 October hospital attendant (serviente) from the ecchymoses in the skin and the 1691, brought three hundred and eight Holy Infirmary was also sent to nurse swellings of lymph glands in the sick meA from Corfu (Greece) of whom the sick and wounded; but, at times, inguinal, axillary and cervical regions. one hundred and eleven suffered from crew members of the ship that had These swellings, known as bubos, fevers and the rest were convalescing disembarked its injured and sick at the sometimes formed abscesses with

MED.SCOPE 13 12 AUTUMN' •• LAZZARETTO CASE HISTORIES suppuration. This clinical picture was SUDl.Iuary 14. ,\rch. 653 1, 101. 187,26. 5. 1782. co nsid ered to be so pathognomonic of 15. Arch. 653 1, fol. 314t, 18.2. 1784. plague that it could be diagnosed Twenty-t wo clinical case histories of 16. Arch. 653 1, fo l. 414t, 26.1. 1786. without the evidence of a post mortem illnesses and InJuries suffered by " 17. Arch. 6528, 10 1. 404, 5.2.1755; Arch. 6529, 101. 93 t, 4.8. 1762; Copeman, W.S. C. Doctors examination. Occasionally, however, passengers and crews admitted to the alld Disease in Tudor Times, London, 1960, one comes across records of a n a u topsy Malta Lazzaretto in the 18th century havin g"' been performed. p. 13 1. I , with four post mortem reports a re here 18. .. \ rcll. 653 1, 101. 385t, 14.5. 1785. ,\ French steersman of thirty-seven yea rs died studied and published for the first time. 19. ,\rcll. 653 1, 101. 447t, 18.5.1786. on 18 September 1750 "of an acute febrile illness These records furnish document­ 20. .. \rch. 653 1, 10 1. 553, 18. 11.1 787. li 'o m in namma tion of the lungs a nd of the li ve r ... a ti on for the reconstruction of the 2 1. .. \rcll. 653 1, 101. 569, 11. 4. 1788. as was demonstrated by the opening (of the 2~ . .. \nh. 6532, 101. 80t, 2. 3.1 792. cadavel') and by the minute observati on of the pattern of the m edica l experiences of n ,\rdl. 653 1, 10 1. 584t, 12.7. 1788. lu ngs and li ve r" 40 Ollr predecessors. I T hey reflect the health risks of life a t 24. ,\rch. 6528, 10 1. 5 13t, 28.2. 1757 a nd A laconic entry of 12 September sca in the days of sail in the Mediter­ 30.4.1757. 17 67 states that a sailor died of phthisis 2:,. .. \rcll. 653 1, 101. 2 19t, 3 1. 12. 1782. ranean two hundred years ago. and a post mortem examination was 2fi. ,\rcl l. 653 1, 10 1. 69t, 11.1 2.1 780; fol. 74t, They add to our knowledge of the performed " as a measure of greater I 1. 12. 1780 and 10 1. 76t, 13.1 2.1780. medical history of M a lta. security" to ensure that the interna l 27. Cassar, P. , T he Church on Caesarean They show how the dominant organs showed no changes suggestive of .'iecti on JI1 Malt a JI1 1867, The SI. 1.lIke·... co ncern of the Government of Malta, /fo.l/lilal (;a~ ellf (Malla), a "contagious malad y". 1968, Vol. IV, pp. through its Port Sanitary Authol-ity, 48-52. . Another brief reference to a n was the detection of cases of plague 28. ,\rdl. 6528, 101. 195, 12.8. 175 1. autopsy is that carried out in D ecember without delay and the application of 29 ...\r ch. 6526, 10 1. 38 (hack of volume), 1769 on the cadaver of the clerk of a their strict iso lation within the precinct 20. 10. 1688. French vessel who was found to have of the Lazzaretto - the only measure :)0. ,\rch. 6526, 10 1. 86,4. 10.1 69 1. d ied "of infl ammation of the lungs"41. :) I. ,\rch. 6529, 101. 462t, 10. 12. 1769. then available to prevent the intro­ T he most detailed desc ription is tha t :)2. ,\rch. 6530, 101. 50, 2.1.1771. duction and spread of plague with its of a sea-captain who, on 6 .J anuary :n Arch. 6526, 10 1. 5 (hack of volume); Arch. ca tastrophic devastation of the 1769, was found dead in his cabin when 6527, lois. 58, 95 and 101 ; Arch. 6530, fo l. 50, medical, socia l a nd economic life of the this caught fire. The record states: 2 1.1 77 1. Maltese Isla nds. :>4. ,\rcll. 652 7, 101. 197, 14.6.1743. " The cranium was opend to find out the cause of :)5. Arch. 6527, 101. 454, 13.11.1 744; 101. 63 1, death. It was ascertained that he died of apoplexy 8. 7. 1745; Arch. 6528, fol. 513t, 28.2. 1757; References li'om inhaled smoke. As a result of the 'obstructed 101. 674t, 31.10.1759; Arch. 6530, 101. 42 1, res pira ti on, there wasa blocking of the blood now 26.7.1773. in the brain so as to produce a n extravasation of I . N f,l!i.\/ri rlfgli has/men!i in quaranlellG, blood" 42 anill; tli :lIi. Arch. 653 1, lols. 35 t, 383 a nd 386, 24.4. 1785; Apa rt from plague, no other Arc hi ves 6526 to 6533, National Malta ,\rch. 6530, 101. 397, 1.4.1 778. Li hrary (:\TM L). :n ,\rch. 6528, 10 1. 23 0t, 2 1. 5. 1752; Arch. 6530, ma nifestations of "contagious" diseases ~ .. \rch. 6526, 101. 77 t, 22.7. 1661; Arch. 6528, 101. 103, 24.5. I 772. see m to have been regarded as 1(, 1. 402, 17. 1.1755; Arch. 6529, fol. 314, :1H. .\rch. 6527, lois. 14 and 249. presenting a dangerous fo cus for a n 28.1.1767. :N .\rcll. 65 26, 10 1. 9t, 17. 3.1665; Arch. 6527, outbreak on an epidemic scale. In fact a :) . .. \rch. 6531 , 101. 95 , 28.3. 178 1. 1,, 1. 230, 15.7.1743; 101. 260, 6.8.1743; 101. passenger dying aboard a ship tha t 4. ,\rch. 653 1, 10 1. 215t, 9.11. 1782. 40 1,2 1. 8. 1744; 101. 418, 6.9.1744; fol. 428, entered Malta harbour in March 1752 S. ,\n·h. 653 1, 101. 304t, 10.11.1 783. 26.9. 1744; Arch. 6528, 10 1. 16, 14.7. 1747; was diagnosed as having smallpox ye t 6. .. \rch. 6532, 101. 328t, 10. 2. I 798. ,\ rc h. 6526, 101. 65 , 24.5.1660; 101. 66t, his cadaver, following the usua l 7. .. \rch. 653 1, 101. 308, 9. 12. 1783 . 22.6. 1660; 1"0 1. 81t, 29.1.1661 ; 101. 82t, examination by the protomedico was 8. ,\rch. 6532, 101. 140t, 22.2. 1794; fol. 343 , B. 11 . 166 1; 1"0 1. 170t, I. 1.1669. decla red to have shown " no signs of a 13.5.1798. 40 ...\r ch. 6528, 101. 157, 18.9. 1750. 9. Arch. 653 1, 101. 135, 25 .8. 1781. 4 1 . ,\rch. 6529, 10 1. 383, 26.6. 17 68; 101. 415, DeL contagious illness". The same opinion 10. Arch. 653 1, fol. 46t, 7.8. 1780. 1769. was expressed in the case of a Venetian 11 . Arch. 653 0, fo l. 320t, 4.8. 1776. 4~ .. Arch. 6529, 101. 408, 6. 1.1 769. seaman who died of sm allpox in 6530, 10 1. 43 12. Arch. 424, 4.8. 1778. 4:1.. Arch. 6528, 10 1. 222, 18. 3.1752; Arc h. 6530, Sep tember 1777 I:) . Arch. 653 1, fol. 98t, 10.4.178 1. fo l. 373 , 2 1. 9.1777.

Trade and Industry (MITI) is expected ENGINEERING IN THE BLOOD to contribute about .fJ.O million to get For those of us who feel squeamish at magnitude. Fujimasa, whose work is the work under way. the thought of a spider crawling up our be ing taken very se riously b y In engineering terms the obstacles legs, how about a creep-crawlie that companies like Toyota and Hitachi, are phenomenal. Today's chips are gets inside the body and swims about in believes that within ten years it will be much too large for the control and the blood stream ? It's not a bad dream, possible to create micro-robots that can communications aspects of the micro­ nor even a good Hitchcock movie, just be injected into the body and which robot; sensors and power supplies are a so ber project dreamed up by will be able to swim through the even more so. But the truly amazing Professor Iwao Fujimasa and a team of bloodstream to the site of some prospects are those of micro-miniatur­ engineers at Tokyo University. obstruction or les ion. There they'll izing mechanical parts such as motors If you recall the micro-robots being perform an operation by remote and gears. In the USA, gear trains have devised by the Massachusetts Institute control and then swim away when the already been cut at sub-millimetre size ufTechnical Sciences for cleaning win­ job is complete. So seriously is this by lithography, but the Japanese are dows then this is just the same principle bizarre prospect being taken that the actuall y planning to make micron- scaled down another_couple of orders of Japanese Ministry of International Cont. on jJage 26

AUTUMN'SB 13 MEDISCOPE 13