Professor Charles Savona-Ventura is a well-known author who has published a significant number of writings on various aspects of Malta's medical history both on specialised journals as well as on books.
This volume brings together a number of articles or chapters about the history of maternity care in Malta.
The format adopted is roughly the same - the author goes back to antiquity, then follows the theme through the Roman and subsequent times, down to the times of the Order and then through the British period.
The first chapter deals with the importance that fertility issues had on primitive societies when fertility was the economic basis of survival of that community. This led to fertility being given a religious dimension.
The second chapter looks at the varying attitudes towards sexuality and the consequences such as venereal disease and out-of-wedlock pregnancies.
The third chapter examines the history of maternity care including the establishment of clinical services.
The fourth chapter examines the various complications that may affect the pregnant woman.
The fifth chapter gives a short history of care of the child over the centuries while the final chapter examines the management of gynaecological conditions that may affect the woman.
Malta had in the third millennium before Christ what is called a fertility economy which led to a unique density of temples in an area of 313 sq km - no less than 43 temples have been identified.
The architectural structure of these temples consists basically in five oval rooms representing the female form with the principal altar representing the head and the entrance resembling the vaginal orifice.
Fertility is the theme of mural depictions and this was accompanied by statuettes represent8ing obese women interpreted as representing the goddess of fertility. Contrary to what some might think, this was not restricted to Malta but common in the Mediterranean basin up to Austria. The temple period lasted for about two millennia starting at around 4100 BC and ending abruptly at about 2500 BC.
In time, the Mother Earth goddess became the goddess of love - the Sumerian Innin, the Assyro-Babylonian Ishtar, the Egyptian Isis, the Phoenician Ba'lat, the Sidon-Canaanite Astarte, the Carthaginian Tanit, the Grecian Hera and lastly the Roman Juno.
Shrines to this goddess of love in her various forms can be found in various sites in Malta with the Tas-Silg temple at Marsaxlokk above all. Apart from Astarte venerated at Tas-Silg, there are traces of veneration of Isis as well.
From veneration of Isis the author skips centuries and tells us about infidelity. On 10th April 1487, Michele Farruge of Zebbug forgave both his wife Antonia and the Noble Peri Johannes de Mazara the injury done to him by their adultery. De Mazara seems to have been quite an active fellow. Two months later, on 27 June 1487, he reconciled himself with Stephanus Seychell over a similar matter and the husband actually ended up thanking the nobleman for taking care of his wife.
Prostitution was present even then and the Santo Spirito Hospital in Rabat is known to have catered for prostitutes as early as 1496. During the period 1542 - 1576, thus including the Great Siege, infants were born to a number of prostitutes at Mdina including Isabella ta Hapap, Ioanna Iordaina, Agatha ta Sihaytira, Margarita Pauli, Vella Sandar and Luchia ta Xiffi.
When the Knights came to Malta from Rhodes they were followed by a number of prostitutes and in 1588 the German scholar Hieronymus Megiser, who visited Malta in 1588 reported the presence of many courtesans and mistresses, including most beautiful Italian, Spanish, Greek, Moorish and Maltese women.
Having lost the battle to prohibit prostitutes from Valletta, Grand Master la Cassiere was actually deposed. Subsequently, three institutes were set up in Valletta - one for virgins, one for penitent prostitutes and one for their offspring.
By 1631, prostitutes were banned from living in what today we call St John's Street, Merchants Street (St James Street) and Republic Street (St George's Street).
Despite the efforts by the church and by the Inquisitors and the burning of witches, sexuality prevailed. Coleridge says that the knights each had a family under his patronage "and to him the honour of a sister or a daughter was sacrificed as a matter of course... In nine times out of then this patron as the common paramour of every female in the family."
With the arrival of the British in 1800 what we were later to call puritanism, a prudish attitude to sex in general became mainstream. An Ordinance was issued in 1861 and survived, with amendments until 1930. But the Second World War brought about an increase of promiscuity in Malta, mostly through foreign soldiers through their interaction with barmaids. The 1960s then looked at sex as good fun.
The rise in promiscuous sexuality brought about an increase in venereal diseases and out-of-wedlock pregnancies.
The origin of syphilis is still disputed. The first epidemic of syphilis occurred in Europe at the end of the 15th century. Travellers were blamed, prostitutes were blamed, soldiers were blamed and Columbus was blamed.
It seems that France was the likely starting point during the 1495 Italian campaign by French king Charles VIII (hence it was called Morbo Gallico). But the French called it the Neapolitan disease, the Moscovites the Polish sickness, the Poles called it the German sickness and some even blamed Columbus for bringing it from the New World.
In Malta, the treatment of the morbo gallico was reserved for a small building known as the Falanga next to the sacra Infermeria then a new ward was set up inside the Infermeria itself. In 1787, for instance, a total of 356 patients, including 193 foreigners, were registered.
Those found suffering from gonorrhea were managed on an outpatient basis but married men were only treated if their wives presented themselves for treatment.
An anonymous author wrote in 1679 that "there is no place in the whole world where venereal disease attacks faster and spreads easier than in Malta for here it is a compound of all the poxes in the world."
Another 'fruit of sin' were children born out of wedlock. The earliest mention of foundlings at Santo Spirito Hospital dates to 1518. During the period 1776-1786 out of 134 out-of-wedlock offspring, 62 (46%) belonged to women from outside Valletta, suggesting that unwed women from outside Valletta went there for the delivery to conceal their pregnancy. A similar high rate is recorded in Rabat, Gozo.
However, it was apparently accepted that engaged couples did not remain chaste before marriage. For the period 1750-1798, 26% of couples who applied for marriage dispensations had premarital sex. Pre-marital pregnancy rates for Balzan (4.9%) and Siggiewi (5.8%) are lower than reported in Protestant England and Catholic France.
An inventory of a Maltese pharmacy in 1592 lists a number of preparations that could be considered abortifacient, including buqexrem which is not considered as abortifacient today.
In 1788, Bishop Labini published an edict against the termination of pregnancy. The edict considers as guilty of abortion not only those who maliciously obtained it but also cruel husbands who ill-treated their wives and careless mothers who during pregnancy did heavy work, went for long walks, did not taste food, went dancing and were indiscreet in their fasts. Parish priests were to urge their parishioners to give alms to poor pregnant women so they could buy food and medicines.
A section of the book deals with the control of maternity care. Pregnancy and birth were always considered a natural process but serious complications can arise leading to the death of the mother and the child.
Traditionally, the state allowed the midwife freedom to pursue her activities while the church tried to ensure good moral practice.
The first move by the authorities to control the practice of midwifery was made by a decree issued in 1624. The French made it obligatory for the midwife or the doctor to present certificates of the birth within 24 hours at the municipality under penalty of suspension of practice.
The practice of midwifery was plagued for a long time by the low level of education of most midwives, despite the efforts by the authorities to raise this level. Practising midwifes frequently occupied themselves with an alternative occupation: in 1908 two midwifes from the Second Sanitary District were found to be occupying their spare time retailing groceries.
In 1574-75 the Apostolic Delegate Mgr Pietro Dusina insisted with parish priests to ensure that midwives knew how to baptize infants 'in casu necessitatis' - this was understandable, given the high rates of still birth and high newborn mortality.
In the cholera epidemic of July 1867, Archbishop Gaetano Pace Forno issued a circular to parish priests to remind the clergy that it was their duty to order medical practitioners to perform Caesarian operations so that no opportunity was lost of saving the offspring. When no physician was willing to perform the operation, the clergy were bound to call in a midwife or another expert person or perform the operation themselves. Saving the souls of the infants was paramount.
C. Savona-Ventura
Caring for Calypso's Daughters
Malta University Press
2013
298pp