This is part two in a three-part series. Read part one.

Malta in the 19th century was a vastly different place compared to today. Housing was extremely basic and sanitary conditions appalling. In 1839, most of the population slept on straw and covered themselves with rags and sacks. There were no sewers or mains water supply. Most houses had no bathroom, no ventilation and few windows.

By 1851, personal hygiene standards were still incredibly low with most people continuing to be highly reluctant to wash. Such conditions inevitably facilitated the spread of diseases, some deadly, claiming the lives of almost half of the infants born every year.

As late as 1891, overcrowding in urban housing was the greatest in Valletta and Floriana with an average of over five persons per room. Begging was rife, especially in Valletta. Due to the low standards of living, parents could not afford to pay for their children’s education. Young children were required to work and earn some money for their family. Illiteracy was widespread: 80 per cent of men and 85 per cent of women aged between 45 and 50 were recorded as illiterate in a census.

During the 19th century and the first decades of the 20th, trachoma was the most prevalent eye disease in the Maltese islands. Factors contributing to the spread of the disease included the lack of personal hygiene, overcrowding in damp and insufficiently ventilated rooms and the sharing of linen and toilet utensils.

In the fight against this devastating malady, Lorenzo Manché was a pioneer. Besides combatting trachoma at the Central Civil Hospital, he gratuitously provided treatment on a daily basis to many paupers afflicted by trachoma both at his home at 33, Strada Alessandro, Valletta and at the Farmacia Mizzi located in Strada Reale, Valletta.

His efforts did not stop there. He regarded public education in personal hygiene as key to preventing and controlling the spread of trachoma. He could see that the worst hit by trachoma were the poorer classes with no sense of personal hygiene. On April 25, 1903, Manché delivered a public lecture at the Liceo, in Valletta on the subject of L’Occhio e gli Occhiali. In September 1903, extracts of the lecture were published in Clinica Oculistica in Siena, Italy. He also delivered several public lectures on ‘The Eye and Eye Diseases’.

Thousands of copies of his popular work on ocular hygiene in schools, L’Igiene dell’Occhio nelle Scuole, were distributed in Malta, Italy and England. It was also published in the newspaper Il Risorgimento  of August 1888. In 1907, he published a booklet titled Istruzioni popolari per difendersi dal Trachoma on ocular hygiene to prevent trachoma and donated about 100 copies to the Director of Public Instruction for distribution among teachers in elementary schools.

Though busy clinically combating trachoma, Manché made a significant contribution to the literature on ophthalmology. During his long distinguished career, he published numerous scientific papers on ocular diseases and ophthalmology practice and techniques in medical journals overseas, which were always well received.

Manché was chosen to represent Great Britain at the Sixth International Congress of Ophthalmology held in Milan in September 1880. He was selected as one of the four secretaries for the congress from among the 500 members present, together with Professors Landolt of Paris, Angelucci of Italy and De Keersmacher of Germany.

Manché attended other medical and ophthalmological congresses: the XI Congresso Medico Internazionale in 1894 held in Rome; the Secondo Congresso Medico Siciliano held in April 1904 in Catania; and the XI Congresso Internazionale di Oftalmologia in April 1909 in Naples.

Undoubtedly, Manché’s masterpiece was a textbook published in 1885 entitled L’Ottalmologia in Quadri Sinottici. Professors Wecker, Liebreich and Meyer, whose clinics he had attended in Paris, had encouraged him to write it. The textbook consisted of a series of synoptic charts on ophthalmology and served for many years as the standard reference work on ocular diseases for medical practitioners and students in several universities across Europe. This publication elevated Manché’s reputation to one of a leading authority on ophthalmology in Europe.

Ophthalmic Institute

On his retirement from the public service in 1907, Manché redoubled his efforts in his ongoing battle against trachoma. He provided indispensable assistance to his son, Charles Manché, himself an accomplished ophthalmologist, in establishing The Ophthalmic Institute of Malta at Ħamrun in July 1908.

The opening of the institute was favourably greeted in the local press. One newspaper editorial welcomed the inauguration of the institute, the first (and during its existence, the only one) of its kind in Malta as satisfying a most pressing need in aid of suffering humanity.

In his work, Manché had often witnessed what it meant to be poor

The mission statement of the institute was to develop and execute a philanthropic strategy to combat the spread of eye diseases, especially trachoma. Its founders were animated by a charitable and humanitarian spirit towards their fellow citizens. Thousands of paupers suffering from ocular diseases, who were treated free of charge at the institute, could only show their gratitude to Manché and his son for their charity and compassion. Manché considered the noble undertaking of the institute to be the highpoint and the crowning work of his professional career.

Helping emigrants

Ophthalmology was not the only field of interest in which Manché left his mark. With his deep sense of compassion, he took a genuine interest in the predicament of the many destitute and illiterate patients whom he treated. He was keen to explore ways how he could assist them in improving their miserable lot in life. He took an active part in public discourse about Malta’s social problems of his time, particularly emigration and education.

Many in the lower socio-economic group of the population were interested in emigrating to near and faraway countries in search of a better life. Emigration was not organised and public information and guidance on emigration was non-existent. People left Malta for places that offered work opportunities without any preparation for life abroad.

Giving evidence at the 1911 Royal Commission hearings, Manché indicated that his interest in emigration originated from his contact with potential emigrants at the Ophthalmic Institute. He used to chat with his patients about their plans when requesting a health certificate for emigration purposes. It was clear to him that people with no formal education were about to make the most important decision in their lives without knowing anything about geography and the places where they wished to settle in. Some of them thought America was as big as Malta.

Manché published a booklet in Maltese on emigration to Canada, the US and Australia with the aim of reaching those who did not speak or read Italian and English. It provided basic but useful information about these countries for prospective emigrants.

In 1907, the Acting Governor, Sir Harry Barron, appointed Manché to serve on the newly-established Malta Emigration Committee. As an eminent member of the committee, he applied his abundant energy to help the cause of Maltese migration at a time when those with political power remained apathetic to the issue. He also served as the committee’s honorary secretary for a number of years from 1912.

Manché devoted his attention to the creation of a scheme to help organise emigration on a solid foundation and in a disciplined way with the help and collaboration of the colonial government, the Church and the people. However, he rightly felt that the ultimate responsibility lay with the government.

He proposed a scheme whereby the local government would help prospective emigrants both financially and in choosing the right place to emigrate to.

He suggested that the government should provide bona fide emigrants with a free passage, an idea well ahead of its time. Eventually the government adopted such a concept some decades later when designing post-war mass emigration schemes that provided assisted passages.

Manché supported the Bishop of Malta, Mgr Pietro Pace, in the Church’s role in assisting the poor who felt that emigration was the only way out of their misery.

The bishop appointed a committee (La Lega dell’Apostolato della Preghiera) to provide moral and financial support to those most in need. It established a penny bank for prospective emigrants to save what little extra money they had in order to pay for their passage to the country of their future.

Manché recommended that emigrants should be fit and healthy before leaving Malta. He believed that good health was indispensable for the success of emigrants as their entry into the destination country and employment opportunities there depended on having a clean bill of health.

Endemic in Malta at the time, trachoma kept many prospective emigrants from trying their luck in making a living abroad. Manché examined about 1,500 trachoma cases at his home, Farmacia Mizzi and the Ophthalmic Institute.

In one of his letters to the press, Manché had written that taxpayers in 1910 were chiefly the poor peasants. But he was willing to give a good example when he wrote “having read about the proposed establishment of a fund to help Maltese emigrants, I shall be one of those persons expected to donate £5 to help those who wish to emigrate but cannot do so because they lack the financial means”.

In his work, Manché had often witnessed what it meant to be poor. On one occasion, when a group of men, women and children came forward to be allowed to emigrate, their miserable lot moved Manché to pity. Seeing that they had no decent clothing on them, he wanted to open a voluntary subscription for the purpose of providing them with clothing.

To be concluded next week