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).