FACULTY OF MEDICINE & SURGERY, UNIVERSITY OF MALTA Page 1 of 2 UNIVERSITY OF MALTA FACULTY OF MEDICINE & SURGERY INSTITUTE OF HEALTH CARE Prof. C. Savona-Ventura MD, DScMed, FRCOG, AccrCOG, MRCPI Associate Professor Published Books The History of Maternity Care in the Maltese Islands C. Savona-Ventura Malta, Association for the Study of Maltese Medical History 2003 232p.; 21 cm; Paperback: ISBN 99932-663-0-2 Medicine - Malta - History paginaton in e-copy version is different that in original hard copy publication The History of Maternity Care in the Maltese Islands Preface Introduction Maternity Care Services Obstetric Problems Intrapartum Management Social Aspects [ UNIVERSITY HOME | FACULTY OF MEDICINE & SURGERY |INSTITUTE OF HEALTH CARE | SEARCH ] [ FACULTY OFFICE | DEPARTMENTS | PUBLICATIONS | COURSES ] Download file://C:\Documents and Settings\User\My Documents\My homepages\new_homepage_U... 12/30/2006 The History of Maternity Care in the Maltese Islands Preface ________________________________________________________ It has been said that those who forget history will have to repeat it, since medical history by exposing the facts and results allows the development of prudence and foresight. The history of disease stretches very far back in time, for as long as man has existed he has been tormented by disease. The history of medicine considers the development of the art of healing from ancient times. The practice of medicine is in a continuous state of evolutionary progress, with today’s advances being considered outdated and outmoded tomorrow. This book reviews the evolution of maternity care in the Maltese Islands since the advent of man to the archipelago and correlates this to the contemporary midwifery being practised on the mainland. By searching for the historical roots of maternity care concepts; the book hopefully facilitates a closer understanding of present practice. The first Chapter of the book gives an overview of the maternity care being offered in Malta in the light of the developments in the speciality that were occurring in Europe. The second Chapter deals with the various maternity care services, and the professional control and training facilities of both midwives and doctors as these developed on 1 The History of Maternity Care in the Maltese Islands the Islands. The third and fourth Chapters detail the medical and obstetrical aspects of maternity care practice in the Maltese Islands throughout the centuries; while the final Chapter looks at the social and biological influences on maternity as evident from the published obstetric statistics. This book is dedicated to Professor Edwin S. Grech. Prof. Grech will go down in history as the person who had transformed the practice of obstetrics on the Maltese Islands to a scientific level, particularly after the 1977 dispute between the government and medical profession left a disastrous void in the professional services. His continuing endeavours prompted in me a love for the speciality leading to my specialisation. Prof. Grech has throughout the years acted as my teacher, mentor and friend, giving me a continuous support in my career and scientific excursions. In the words of the leading fourteenth century surgeon Guy de Chauliac “We are like children standing on the shoulders of a giant, for we can see all that the giant can see”. I should further like to express my gratitude to the University and National Library staff who have kindly assisted me in my search for sources of information. Acknowledgements are also due to the various individuals who have reviewed the work and who have with their varied comments and outlook helped to open up new dimensions to the 2 The History of Maternity Care in the Maltese Islands subject. I acknowledge the help of my wife who acted in a number of voluntary capacities - research assistant, critic and editor - throughout the project. Finally sincere acknowledgements are due to the sponsors who have made the publication of the book possible. C. Savona-Ventura 18th February 2003 3 The History of Maternity Care in the Maltese Islands Chapter 1 Introduction ________________________________________________________ When addressing the Royal College of Physicians in London in 1944, Sir Winston Churchill remarked that "the longer you look back, the further you can look forward". No branch in medicine can claim a longer history than the art of midwifery. Only 93 kilometres away from Sicily and 290 km from Northern Africa, the Maltese group of islands occupies a central position in the Mediterranean. This geographical situation has made the Islands an important meeting place for the various Mediterranean cultures throughout the ages. Though history is a continuous process without clear-cut definitions between one period and another, the history of the Maltese Archipelago can be conveniently divided into five basic periods of study. 1] Prehistory ranging from the earliest times to about the ninth century BC during which time the Islands developed a unique culture typified by the oldest Megalithic free-standing buildings in the world; 2] Ancient History leading up to the ninth century AD by which time Malta had witnessed the arrival of the Phoenicians, the Carthaginians, and the Romans; 3] Medieval History leading to the sixteenth century 4 The History of Maternity Care in the Maltese Islands that saw the Islands being incorporated under the administrative rule of neighbouring Sicily; 4] Modern History saw the arrival of the Knights Hospitallers of St. John of Jerusalem in the mid-sixteenth century and persisted until their expulsion by Napoleon Bonaparte in 1798; and 5] Contemporary History is the final phase leading to recent events when the Islands fell under British dominion until their independence in 1964. The medical history of the Maltese Islands before the mid- sixteenth century presents a general dearth of information, and any excursions into prehistory to medieval medicine must be based on archaeology. In the modern and contemporary periods, written material becomes abundantly more available allowing a deeper analysis of disease processes and developments in medical practice. Falling under the dominion of the Knights Hospitallers of St. John during the 16th - 18th centuries and under the British domain during the 19th - 20th centuries, the Islands were placed on the forefront of medical practice in Europe. The development of medical services on the Islands can therefore serve as a mirror to developments occurring in the rest of Europe, and can serve as a model for developing communities striving to address their maternity health indicators. The Maltese archaeological record relating to items of midwifery interest is scanty, but there appears to have been a preoccupation with the reproductive process. This is evidenced in the archaeological 5 The History of Maternity Care in the Maltese Islands survivals of Maltese Neolithic Man's culture that appears to have centred around a fertility cult in an effort to promote and encourage the reproductive cycle. Among the archaeological remains are a number of statuettes datable to about 3500-3000 BC which suggest features of a pregnant figurine1. These figurines may have formed part of magico- religious practices aimed at warding off evil spirits during pregnancy and labour. The preoccupation of the risks encountered by women during pregnancy and the use of amulets to ward off evil spirits continued during the Punic and Roman periods. Amulets of Phoenician-Punic deities have been found in Malta, including figurines of Bes and Thoeris. These two deities were considered by Egyptian women as protectors from evil spirits during childbirth. A probable case of a death during pregnancy has been discovered during excavations at St. Agata's catacombs, while items of a late Punic pottery from Rabat c.150 BC included baby's feeding bottles and a baby's rattle2. 1 T. Zammit and C. Singer: Neolithic representations of the human form from the islands of Malta and Gozo. J. Roy Anthropol Instit 1924, p.76, 92, 96-97; C. Savona-Ventura: Medical Mythology in Stone Age Malta. In: Facets of Maltese prehistory. (eds. A. Mifsud, C. Savona-Ventura). Prehistoric Society, Malta, 1999, pp.107-116 2 T.C. Gouder: Some amulets from Phoenician Malta. Heritage, 1978, I:311-315; T.C. Gouder: Phoenician Malta. Heritage, 1978, I:185; A. Bonanno: Roman Malta: The archaeological heritage of the Maltese Islands. World Confd Salesians, Rome, 1992, p.24 6 The History of Maternity Care in the Maltese Islands The subsequent centuries yielded little archaeological evidence pertaining to maternity. The next archaeological record pertaining to midwifery came from the excavations performed in the 15th century medieval church at Hal Millieri. Skeleton remains from this burial site included the remains of a woman aged about 16 years buried with and lying on top of a 2½-year-old child. The burial of these two individuals was probably contemporary occurring some time before c.1480. The female showed bony evidence of a past pregnancy. It is likely that the 16-year-old female was the progeny of the infant, suggesting an early age of motherhood at most 13 or 14 years3. The early age of motherhood suggested by the archaeological evidence of the 15th century further confirms the 1568 report that women commenced their reproductive life at the age of twelve years4. The majority of deliveries in the 16th century, in conformity with the times, must have been conducted in the home under the supervision of a traditional health attendant, possibly the mother of the mother-to-be, or a midwife. The first midwife known by name is the mammane 3 J.L. Pace and S. Ramaswamy: The Finds: Skeletal remains. In: T.F.C. Blagg, A. Bonanno, and A.T. Luttrell (eds): Excavations at Hal Millieri, Malta: a report of the 1977 campaign conducted on behalf of the National Museum of Malta and the University of Malta. Malta University Press, Malta, 1990, p.84-95 7 The History of Maternity Care in the Maltese Islands Czairi Coruel who was responsible for the care of the foundlings at Santo Spirito in 1554.