Health, Plague and Society in Early Modern Malta

by Carmel Cassar

published by Kite Group, 2023

For reasons quite unclear, Maltese history has proved stingy in some areas of research, and extravagantly generous in others.

The chronicles of medicine and health stand out through the lavish attention they have received from scholars – starting from the unchallenged doyen and pioneer, Paul Cassar, on to our contemporaries Charles Savona Ventura, Carmel Lino Cutajar, George Gregory Buttigieg, and others, all inquisitive medics, not surprisingly eager to learn more about the origins and context of their calling.

But the contagion spread to non-medics too, like Carmel Cassar, a prolific professional historian who grafted medicine into the spectrum of his interests, and myself, a mere hobbyist amateur, whose extensive collection of researched writings on medical history in Malta should soon see the light.  I will not hold it against Cassar that not even one of them is listed in his wide-ranging bibliography he annexes to this book.

Cassar has all the qualifications, passion and perseverance in perfect order to tackle the topics he has focussed on in the work here reviewed. 

A professor of cultural history at the Mediterranean Institute of the University of Malta, he has dedicated a lifetime to research, writing and teaching. He has invested time and talent in Malta’s unique Inquisition archives, in the spogli of the knights of St John, and had a leading role to play in the rehabilitation of the Inquisitor’s Palace in Vittoriosa.

He has an impressive number of historical publications to his name, both books and papers in local and international cultural journals. A striking curriculum that has detracted not one iota from his humility, unpretentiousness and accessibility.

Researching the origins of medicine, of health care, of the treatment of epidemics results fascinating for more reasons than one.  For centuries, the study of medicine survived as a total fraud, imagination clothed as science. Medical universities almost exclusively taught irrational garbage.

Up to relatively recently, and for many centuries, physicians were simply charlatans dressed as quacks. They dispensed useless, often harmful, remedies – not a shred of science contaminated their dogmatic ignorance.

Medical ‘knowledge’ gravitated around egregious fictions, like the ‘humours’ of the body, the corpuscular or, alternatively, the miasma dissemination of disease (the smell of food can make you obese), superstition – epidemics as God’s peevish vendetta on errant humans.  These notions counted as indispensable aids to healing.

Medicine in Malta, up to the 18th century, stood proud of its share in this bonanza of illiteracy. Surgery thankfully fared better, though it lacked the two pillars today taken for granted as indispensable – anaesthesia and sterile asepsis.

Pseudoscience, including early medicine, also endorsed racism – apart from Arian superiority still cultivated by the Nazis and their present-day minions – also in giving racial profiles to specific demeaning illnesses. When the scourge of syphilis devastated Europe after the discovery of America, patriots in every country started playing the blame game.  Venereal diseases proved excellent carriers of xenophobia.

The French referred to the disorder as mal de Naples and the Italians paid them back by dubbing it male Francese or morbo gallico. For the Dutch, syphilis was the Spanish pox and to the Russians the Polish ailment. The Ottomans, not to be accused of racial prejudice, simply called syphilis the Christian illness.

Cassar’s book covers many aspects of the evolution of perceptions regarding the multiple epidemics, mostly plague, cholera, smallpox, scarlet fever and diphtheria which visited Malta with punctual regularity and lethal results over the centuries.

Bubonic plague, perhaps being the most voracious reaper, is amply recoded in scholarly literature, but Cassar has gone quite a few steps forward in discovering new information – always dreadful, sometimes also laughable.

Cassar’s book covers many aspects of the evolution of perceptions regarding the multiple epidemics, mostly plague, cholera, smallpox, scarlet fever and diphtheria which visited Malta with punctual regularity and lethal results over the centuries

Like when, of the two great rivals in popularity as healers during the 1676 plague epidemic, one was an illiterate blacksmith who peddled his infallible sudorifero, the other an ‘eminent’ Neapolitan surgeon who had appeared in Malta from nowhere, promising miraculous cures. Time eventually exposed him as a fraud when all the patients he had ‘cured’, raking in sacks of money, died anyway.

The Inquisitor, who in his secret reports to Rome informs us of all this, and on whom Cassar relies for the factual beef of his narrative, also felt he had to record his abysmal opinion of Maltese doctors: they distinguished themselves, mostly by their crass ignorance.

Sadly, that estimation seems to have been shared by most visitors who had reason to come into contact with early medical professionals and write down their views.

Like Pietro Parisi, a renowned physician from Sicily who in 1592 the Order commandeered to our island to save it from a devastating plague. Parisi published a long and amazing book about his Malta experiences, including his highly fault-finding opinion of Maltese doctors.

I flatter myself having written extensively about him and his book, and am delighted that Cassar too refers repeatedly to Parisi’s Cinquecento observations. Later and modern-day doctors have thankfully pulled that centuries-old reputation inside out.

Prominent in Cassar’s pages figure pharmacists – more commonly known as apothecaries in Hospitaller times. Though most of what they stocked amounted to magic hogwash – like fossilised shark’s teeth, bezoar stones from the organs of animals, the precious so-called mushroom which only grew on Fungus Rock in Gozo, mercury, powdered deer horns and vipers’ fat – they fulfilled an essential mission in society: they sold hope.

Besides medicinal herbs or spices, there is evidence that apothecaries and healers (almost exclusively women) mostly worked with the assistance of magic incantations and prayers.

Some of the better-known apothecaries feature by name, including Hettore Vitale, chief pharmacist to the Sacra Infermeria and husband of Caterina, one of the most enigmatic, contradictory and high-profile women of the Cinquecento, variously regarded as saintly benefactor and oversexed sadist slut, a favourite of my biographical attention.

 This study of medicine also provides curious linguistic insights. The author seems baffled by finding that, after medical treatment, a doctor was given a mystifying beveraggio. Cassar speculates as to what that might mean.

At a time when the services of liberal callings, like physicians, clergy and advocates, were not hired under contracts of service, remuneration usually camouflaged under nobler names, like honoraria, stipend or emolument. Sounds more genteel than Revolut, no? I still remember when grateful clients used to add: hawn dott, xi ħaga x’tixrob. Can the 1602 beveraggio reflect today’s xi ħaga x’tixrob?

Where Cassar’s book really stands out is in the depth of its profound social dimension. The facts on which that rests usually come episodically, in a lively, eminently reader-friendly manner. He avoids ending the target of one of my pet hates – books written by professors for professors.

Assertively scholarly in the fastidiousness of his trawls through the archives, and in his contextualising all the data, his focus never shifts from man, from human suffering and hope – the patient as he (not that infrequently, she) interacts with others, with authority, with prejudice, with destiny.