-THE 'MALTESE MIDWIFE

IN

,HISTORY

DR. PAUL CASSAR

MIDWIVES' ASSOCIATION OF MALTA

PURUC.-\ TION ]

Copyright Dr. Paul Cassar

Printed at 5t. Helen Press, St. Venera, Malta

FOREWARD

Since the midwife js a practitioner of normal obstetrics, she is intimately involved .in the presen'ation of life. Being so, the history of midwifery is closely linked with that of medicine.

The Midwives in Malta have established their National Association in 1974, which they affiliated to the International Confederation of Midwives in 1975. The motto of the association is: "Amor Custos Vitae" which may be translated as: "Love is the Guardian of Life".

The aim of the Midwives' Ass'.Iciation of l\fHlta is: "'1'0._ promote and advance the arllQ.~~.!!.ce oUy!iqy.:ifC<!J'~_J~:u·ailiJ!

t~fficie~~f midwiv~~_~.!!.~ ... ~~. il~p'~~~~. !!~e!! __ y-~~u~". To reach this aim, the association has decided to publish relevant studies.

Dr. Paul Cassar, besides being a psychiatrist, is also a well-known author of the historical and legal aspects of medicine. He has contributed several articles in IOCHI and foreig-n journals (Sciefltia, Melita Historica, St. Luke's H(lspilal Gm.>e/le,TlJe

Law Journal, Call1Olic Historical Review of .1 merica, British Medical Journllls, etc.) He also publislll"d a hOlik, "TIlt, MediclIl Hislor'), of Mult'J" (London, 1965).

The Midwives' Association of f\/alta fdt that it ought tll publish "The Maltese Midwife in History", the text of a lecture which Dr. Paul Cassar, deIiYcred to the Rt~fresher Course for Midwives in April l!)j.!.

Mary Vdl:l-Bondin. Found('r and President, Midwh'cs' Association of Malta.

THE MALTESE MIDWIFE IN HISTORY

The Training of Midwives , . -

The first inov~to introduce in Malta the formal teaching. of tJIe thcqry ~d PIllCOce of obstetrics to prospeCtive midwiveS were ~ade iii the late l~th century, when a s·UrgeoQ in the service of the Or:derof St. John of ]erusaJem, which then ruled over Malta,· pro~sed to start a course o~ jnstruction for mid­wives. He waS ·li#~t~~~ ADtonio~, treD (or".preni). who suggested deIiverblg lectures once a month, or more often if neCeSlf8rY, not QnJyto women who intended taking up midwifery ~ a ~r but alsO to thOse midwives who were already in practice; f,le also had in mind to give practical demonstrations on an anatomical model which he had acquired from Bologna where h~ Qad uqdergon~·his surgical training •. He submitted hiscequest to the Griuid Master to whom he remarked that on account of the unskilfulness of Maitese midwives in the exercise of their. art~ tll~y not infrequently caused injury and sometimes death to both m~ther and baby •. His hopes, however I never materialised because, according to one of the Senior Physicians of the Holy Infirmary, the main hospital of the Island, the midwives were

. ~o\ ignorant that they could ill no way derive any profit from lectures. Indeed apart from the fact that they did not underst.md haIilpl, which, .was then the· ollicial language hi Malta, they did not even.; possess. a knowledge of the fundamental principles of buman· anatomy or of the technicnl terms used in midwifery. Under tliese circumstances k-elures to mi(Jwives were deemed tp..11e IIP.t.oIJ1y liseless but also "scandalous and full of incon-

. ..: ii ..... . . vem~,~ .. ~· ., ... : . . :~ .. ;si#i:t· ot.a;iraIrs. was not unique to Malta. As late HS

~hfl·mi~~R$" ¥tUij~~ tr~ining of midwives in most European cpuntnf's co~ti~pt~. ·o~e of the prestiing issut!s in Ule. medlco­cJ.\}tufa.l: ~Aa&:i~ ·~PheJes. Some. progress, had been achieved in FraIle!!, Austri~ a~d Prussia but in England no special arrange-

5

ments had yet heen made for training midwives though pupils were being accepted for ,instruction at Guy's and at King's College hospitals.

In 1798 the Order of St. John was expelled from Malta by the armed forces of Napoleon Bonaparte. The Maltese, however, soon rose against the French and in 1800 the Maltese Islands passed under Br.tisb protection. One of the first act:. of the, British Commissioner in Malta, Sir Alexander Bali; was to reorganjse the' inediciti ' studieti ' . ~hicb ,h.a:4 ~~~; : Cib:rupted during the short French occupation of Malta. Official'injtiative for the teaching of obstetrics to' inidwives dates sinc~' ihk period when in March 1802 a" Dr: ~ FranceSco' ii.~iliri'¢g ~~ appointed I

Teacher of Obstetrics at the Women's Hospital at Vanelta to deliver lectures to' med.ical students and also to hold a separate class for miQwives who were taught in the Maltese language as they did not have a good grasp of Italian. This school was, however, abolished in later years with a consequent deterioration in the pract~ce of midwifery.

[n March 184:1 a section of the ...RL~~ after stating that. due to their ineptitude, midwives were causing the death 'of babies and their mothers, urged government:

(a) to provide a course of theoretical ,instruction for mi(Jwives,

(b). to ensure that women following this course of studies were able to read and write, and

(c) to have them trained in a clinic attached to the Maternity Wards of the general hospital under the direction of the Professor of Obstetricsl . In their report on the proposed reform of University studies, Dr. T. Chetcuti and Dr. N. Zammit recommended in 1842 the holding of lectures for midwives by the Professor of Obstetrics!.

On 4th August 1853' the Commissioners of G.bllriijr were still deploring ~e fact that "co;petes;t ~id;i;~t~;;;' 'rapidly diminishing, and that ignorant women were' assuming. ~eir duties to the serious detriment of the poor populationt'. They ascribed this state of affairs to the aoolition' of the 5ch;x,t for Midwives and recommended to government the re-establishipent of the school together with the enactment of legal measures to

6

prevent women from exercising t.he profi:ssion of midwife unkss ,they were furnished with the appropriate certificate and qualifi­cations. It was suggested that the pupjls should pay five shil­lings (25 cents), monthly and perform the duties 4lf serv:mts while resi~ing !it the hospital for instr~ction.

, Ttte school ~as reopened in 18G~, the teacher being Dr. G.

!~f1Jir'l~<ffi~.Jl!~t, c:~i?!cal material was. so ,scarce tha~ t~l~ teacher had to make" use of a girl of ten years from the medical wal'ds for d~monstr~tjoll purposes to the great consternation of the Chairman of the Board of Charity Commissioners who threHlened to report similar future occurrcnces to His Excellency the Governor.

Fresh arrangemenLs were made ill 11:155 to place the School of Midwifery at the Central Hospital of Floriana on a sure foundation but it was realised from the very start that the organisers would have to face obstacles arising from popular prejudic..-es and ;rom unnecessary "scruples" which interfered wi~ the practical training. The absence of Hnatomical models was a~lOther difficulty. It is 110t surprising, therefore, that at th:s Period, and for many years .tftcrwards, midwives were "mere attendantS capable only of uttering ejaculations and prayers, quite of their own making, while stretching forth their arms to

receive a fctus naturally expelled from the wumh, an assistance which any individual knows how to afford".

In i868 , s'ugges~ions were made to create a more efficient School of Practical Midwifery at the Central Hospital under the direction of the Senior Surgeon and Accoucher and in the follow­ing year a set of rules was submitted for approval to His Excel­lency 'the &>verDo~ by the Cumptroller of Charitable Institutions. He contemplated the selection of a better type of student, the teaching 'of bOth the theory and practice of midwifery, a qualify­ing examination and the taking of all oath by the students before being aUow~ ~ enter the p'rofession.

The provision of properly trained midwives was especially n~~"!~:~u~Ji 'a prolific place as Malta where, owing- to the "proverbial" modesty of women, t.he presence'! of a male doctor ili'the labour room was only tolerated in cases of extreme danger. It w~s," ther~fore, hoPed that as the number of adequately

'I

trained midwives one or two of them would be assigned each police district. hll his endeavour to give the scheme the

widest publicity the Comptroller of Charitable Institutions availed himself of the assistance of the parish priests and the

of the two islands to inform the public of the prospective course of studies. '

The School was opened on 2'.1:th ~ovember=~~~ .. the lecturfts delivered by Professor S.L. Pisani. the Senior SurgcQn

and .Accouchcr of the Central Hospital. The lectures, given in English and Italian, covered the principles of midwifery, tte

of puerpera! patients and the care of the newborn. During this first course there were many opportunities for the

. students to assist at normal deliveries but they were unable to attend .tny pathological labours for want of cases. The course lasted 16 months and lhe results achieved were considered by the hospital ~lUthorities to be most satisfactory.

A second course was started in JEt but the illiteracy of the applicants constituted a serious stumbling block so much so that the teacher had to limit his instruction to a few short talks in Maltese. J\fter assisting' passively at a few deliveries the pupils underwent an oral eXlIIninatiol1. No practical tests were

{.fiven.

The medical profession condemned this state of things and agitated for reform. It was suggested that pupils should be chosen from girls who had attended the elementary schools to be able 10 follow a book 011 obstetrics written in Italian. Mid­wives were accused of being a grossly ignorant lot who either failed to c~lll the obstetrician at the right time or else attempted to hasten dclh-ery of the baby causing extensive perineai taeen.­I ions to the .mother. Others even dared to pOSe as doctors prescribing medicines for menstrual pains and also pretending

"}

to corrcct_'p-!l!p'os!~i~~s o!..!i!~ !!te.~ , In Octoher 1873 a request by Professor S.L. ~ was

submitted to government (or the printing of his lectures in .book form for distribution to his pupils at the end of the cOurse but

it was not ulltil ten years later that his !!d~!f~1!2.!'1; ~as published in 1\.laltcse4• Thus, the. first book on obstetrics for Maltese prospective midwives saw the tight ahout no years ago.

8

Another course of lessons ill the Maltese language in ., prac­tical midwifery in connection with the lying-in-wards of the Central Hospital" ~ held in 1t~835. In 188ti an ana.tomical manikin ("an artificial body") was purchased by govemment for the training of pupils.

At this period a large British garrison was stationed in the Island. .A long-felt need of this army was the provision of English speaking midwives for the wives of military personnel. The wife of the Governor, Lady Sym Fremantle, suggested tile training of tile wives of soldiers in the practice of midwifery to enable each regiment to have its own midwh'es who would thus be ina position to assist one another with adequate care and nursing during deliveries.· As a result of· her endeavours, the so-called Military Midwives Class was set up for English speak­ing women. The textbook used was a translation of Professor G.B. Schembri's Maltese book on practical midwifery published in 1896 under the title of The Midwife's Guide Book.

In November 1898 Professor Schembri undertook to train another group of prospective midwives from among the soldiers' wives of the British garrison. The theoretical course was planned to last three months whjle the practical part was to stretch over a period of eight months ••

At the beginning of this century, Dr. S. Grech, Professor of Midwifery and ~ynaecology, pressed for a reform of the School but it was not until 1911; that it was placed on a sound footing when the course of midwifery was instituted under the auspices of the University and led to the Diploma of Midwife. In 1946, .however,· the three-year course again reverted to the Medical and Health Department. The midwives, who studied under this scheme, qualified in 1949. Commenting upon the quality of midwives at this period (IM9-tiS), the Chjef Govern­ment Medical Officer stated that they had at better comprehension of the part they had to ptay in giving advice to pregnant women and in spotting the initial signs of cardiovascular, renal and infectious illnesses. By 1908, midwives were "fully qualified to render' the best service" but there were not f'nough of them and a call for student-midwives failed to attract many suitable candi­dates7 In fact, out offive students, only one tompletf'd .the course

9

H,61. TIns' period .of decitne.witll .u:<aJ!JJlm~· of ~dwjves:. 'laSt~' i~r '~~me

the State RegiStered: Nurses' .. :Wb,q {V~hed. Jo studies bad to .do ~O. i~ th~ U fiitt!d Kihgdom

the examjnation of the Central Midwives Board. ~ reviv~ took in 1910 when the schOQl was re-opened on a.lst Oct6-ber at the School' fQr Nurses at st. Luke's Ho~pH:al' Under the direction a Midwifery Tutor from the 'United Kingdoni with lectures delivered by Maltese senior medical staff. The courSe was. meant for State Registered Nurses and Jastetl one' year. The students obtained practical experience in the different branches of obstetrics. The number of deliveries conducted by them fer admission to the final examination was 30 -.:. as much as was

in the United Kingdom, in France, the Federat Republic and Luxembourg. Emphasis was laid on a thorough

"""'nUl· .... "..,· of the social and community health serViceS available .Malta especially in rdation ·to child and family care. The

of the School passed by 1974 under the supervision of Maltese Midwife Teacher who holds a United Kingdom qualio

ficationll.

J. rdresher course for midwivcs was successfully held in IU14 ,It the Medical School of St. Luke's Hospital. This course obtained the approval or the Central Midwives Board.

The new feeling" of identity of the Maltese midwife found in Novcmber 1974 in the formation of The Midwives'

Association of Maita with the aim of:

holding post-gT,lliuate lectures and demonstrations; puhlishing- literature 011 midwifery and related matters; and promoting ami maintaining- the-unity of the members of the profession9.

Church the Practice ~f Midwi~ery The earliest evidence of the state control. of the practiCe.of

g'o~s back the first quarter of the l'lth century. Regulations we're published i~' ihe decrees of'the 'FYotQmediCm or Chief ·Go~;ern~leni.:· 'l\~e~icat: Officer: of"' ~ni""·AiJgust· ~~24~ 19th ju"ue i662 'and 24th' September': l'122. ''i1leSe: emictmenti:! ·were later incorporatl!d in the legal codes of 1724 and 1784.

ACCQrding to these regulations no woman was allowed to exercise the Pl'9fessioJl of midwife unless sbe bad been examined

: andapprov~ by the «;:hief Goy~rnment Medical Officer and granted tll~ requisi~e licence which she 'had ~o submit f?r renewal to each successive Chief Government Medical Qfficer soon after

.":,,'. " . his appointment.

,An official register of approved midwives was kept at the Court of 'e first midWife so far known to us by name

, , Ii' 'ii'

ili,~., ' . er who was active in 1598 10 and who had to deal, unsu~sfullYr with' a case of foot presentatioil. Much later we come across the name of another midwife -" Faotiiia

';i~ft'O! All ~e couid learn about her is that on 4th June 1635 she submitted ,a petition to the Grand Master stating that she was "burdened with daughters of marriageable age" and asking to be gran~~ a s.ite in Valletta, where she lived, on which to build a house for one of her daughters' to settle her jn marriage. A midwife formed par~ of the professional staff of the 'Women's Hospi~ ~~ y~~t~H.

One of the offences contempl;J.ted by law was the use of abOrti~cients, the penalty for which consisted in flogging and banishment: from the Island at the Grand Master's pleasure.

. Officer, ~he

'milllWi~ In,~0@Ier':t1r'"h. 'their " ,,' S~Cra~

" As early as 1575, the first :~~ta, Mgr. Pietro Duzina, enjoined the parish

priests to teach midwives how to fulfill this duty12~ These admo­nitions wer:i= repeated by the Maltese Synod of 1625.13• By the 18th century it 1'138 laid down that parish pri~ts were to examine midwives' a~ ieast~cC n year, during the Octave of Penterost and about Chnaimas tb,:ne.

~f. midwives were n~t found sufJicJe,!1tJy versed in the admi­nisi:raa~n ' of b8ptis~" by . th~' ~ishop, the pf.orish priest, wa~ ordered to ins~ ~em '~aCcuratelyand patiently"; in the ,m~time th~ were p~J~ from p~~ising midwifery" These examl~~ ~ repented ~ery tim~ ttte bisllPJ> or' his victtr paid a pastQral '1iit to'~ yaiidus parisher of the Maltese Islandsl4• On th~ occasions the midwives submitted for Inspec-

11

tion ~lld rell~~vaJ ~y' the bishop, the warrant ot th~ .f,rQ((J.weclicus

":n.~ ~t: lic~cc: ~s!led~y ~e ,~piSCOplU Curia •. l'~e p~Utes are r~~Rf4ed' ill ,t:qe: ac~!Wt., of Ute pa!itom ~,isit.Of "B'A-Paulus A1ph~~ d~ Bussan of 1714. Tpejr were iitill-inpp¢rauoD, uli#e ~s ~90~. It ~~ of 4t~er~i ~p not~ in this cOnnection tiiathi England bishops remained the licensing authorities as lat~ as the 18th century15.

Abortion w~ repeatedlY con~~:IDn~ ?~ varjo~, ~1?D:5. The synod of 1109, warned ~he f~thful that ,thePn>C~~m91f, of ~ abortion was a sin reserved ~or, the bishop while ~,nstbisllqp .Fra Vincenzo Labini reminded his flock iliat whoever waS' t~·

, ponsihle fo~ ab.;iti~~' ~~'-g~i1ty'oi '~urd~~ '~;d .. ~?~ti~;~"'~e-penalty of excommunication.

The carrying out of Cacsarc~n Section Oil del!-d pregnant women occLipied the atterrti:~~',~tth~-'~~Tc;.i professi~)li and of thc ecclesiastical authorities in Europe in the lSth ~turYi In fact, both the st~tc and the Church enacted decree~.eitfotCihg,tJfe perfor;~h~-'~itJ~e"ope~~ti~~'-t~ ~u~e'-th~jf.~ g{, .~f{ci{~: AA~ ensure i~~, ~~P.t!~!~l: Thus an edict of the l~th Jun~ 178~ by the 'Archbishop of M~lta Fra Vincenzo Labini, warned' parish priests to ensure that' Caesarean Section was p~rformed on a r~nti.Y dead pregnant woman. If no surgeon' Qf physician " .. ~, ~ ..

\ ~ne~iat~y ~y~i~~~!,~" ~h~, p'~~i~,h, P~i~~;~~', :!~' ,~~~~~~ ili~}~1~

\', of,~, ~l~c:!Wlf~J~s'~~~y",~ ... 2.!:1ti .~~~.,!f!, !!!,~~~l..~.J~,qnt;~~:~~

:1 midwife was to be found, he was obliged to, #.orbt:ibJiiiriSeJf • .- .,~ • •• __ J ..... '.~ -.: ' •••• It· •••.•• ,. ' •• ,.,' •• ~" •• : ....... , ..... ~~ .. ....,,.,,, .. ~ .. ......., .. ~.~.,..,.

; ~1l.~!~:. ~}.~ p~~~~~~y. ~~! . S~~~!!1~u'!~~!1:,~i~~ ~~ .. }~~ !@ti! .. tci .'q~"'.!2~~~<: ~~~ . These ecclesiastical injunctions remaineQ in force f~r '1;Ii~~y

years afterwards so much so that during-the cholera '~pi~~J~ of 186i midwives were said to have carried out the ~r~ti!>p "successfully in accordance with the rules of surgi~ ~tt"; however, no speci~c instances have ~n recorded~ , It 'is"'of

I . .,. ,..........~_~ ... ,,.~

interest to note that as latc as 1883 Professor S.L. Pisani in liis

',! ,!ect~~~~' ~~ S~~~7~!:~~~~,!i.~~ ,!?~~ ~j~ ~!~~~:.~~r~~f.:i~r§ .. ~ prepared !o per~'or~ th~ ?p~:~~io~ !,~,d~~" p'~~~~[l,!,.!.!~~t!n ' 'the absence of a doctqr.. ' ,',' -,': ,','

At thi~: Junctu;~·~~!ha:~~~'?~I~e',o!~~~,~jfe~ ,wWi ru~e~i--b~ another occurrence of which ''Ye find vt,iiy f~ traces" to;;Jay. ' Since ver 'ancient:· tit'neg':~m' "; i '·chir,.jbirth:';-ri~~w":aef~, themselvJj~'th~~;:i~itf!~ :~ '~t~~~il&ftirt1i<~f.~~~'! 12

",P.ll!l!l!i~o~~air., In the Maltese Islands this chair was called is-nllu ~l-qabla or maqgtllJd tal-qabla. It is not known when this chair was iQtroduced among us but it is certain that it formed part of the armamentarium of the Maltese midwife illl the 18th century.

, 'M~~birth~hair ,differed from an ordinary chair in lhe: 1'01-, '~!IitV"',*IIrii11r.f~'" ' lowwui' :·teatures: "" ..

'.~'" .' I't"io "4. .. ,e+.",:'" .. ~ .. -' " \

a) the seat was made of wood and had an aperture cul in it ill the shape of a horse-shoe;

b) the chair was provided with a back, either fixed or movable, to permit sitting up or semi-r.eclining position j and

c) an arm-rest was attached to each side of the seat so th~ll by grasping these rests during her pains the woman was able to bear down more effectively during the expulsive stage. 'The midwife seated herself on a low stool, or knelt on the

Hoor in front of the chair to receive the baby while another woman stood at the back of the chair to hold the patient in place. As the final phase of labour approached, a large earthe(lw~re

bowl (lem~ija) was filled .with straw and placed on the floor beneath,the chair so 'that if the baby was not caught in time by the receiving, hands of the midwife, as it came out of the birth canal, the infant would slip on to the soft straw inside the bowl. A variant of the lemhija procedure was the attachment of a kihd

. of drawer underneath the opening of the seat. This drawclr was made of strong cloth like a ha,mmock and was pulled out from under the seat to receive the 'baby during the last pan~s of delivery.

One of th~:!~llay'~ultages ,of ,this.type or chair was lhl~ risk of causing compression of the infant's skull as, owing to the narrowness of the seat the woman could not opcn her l,highs wide enough to allow the easy exit of the baby from her vagina; but the, most serious danger arose from the tearing of the vagina and perineum as the mid\vife could not maintain adeqll~te flexion ilf the baby's head by supporting the mother's perineum and thus allow the slow escape of the infant's head from the birth passages.

" ,?~lng to this complication ~~,:Ys.~'\l~f.. ~~l~",~!r~l~~hai'r ,,:as ~~ndemnett by Dr. Salvatore' LUIgI PIsani, Professor of Mld­'~I{ery;'Hs' employment being made illegal in 1883 by J\rt. U3,

13

Chapter Xl V I of the PoHce Laws. In spite of these sanctions, however, the usuge of the birth-chair pers;sted for 'many years aiterw<trds. It was still employed at Birkirkara atUle beginning of the present century but it began to fade out after World War 1 (1914-1918) although olle of these chuirs survived in Gozo until HI-1~ when it was burned as useless junk16• '

One of the milestones in the evolution of mi~wifery was the introduction of asepsis in tile management 'of labour and the puerperium. The first ll!edical man to advocate cleanliness and the washing of the hands of the accoticher :~iliT:cluorinated water in maternity wards was Ignaz Semmeh:Veiss ~hiie work­ing in Vienna in It'·IIL This was years before Louis Pasteur confirmed the germ theory of disease in 18(H and before Joseph Lister publisl,cd the cncourHl{illg' results of his nntiseptic met­hods and the use of carbolic acid in surgery in 1867. Antiseptic procedures, however, did nol come into general use i~ obstetrics before IS80 so much so that Professor S.L. Pisani in 1883 was still recommending to his student-midwives the smearing of their fingers with oil as a lubricant whf:n performing vaginal examjna­tions. By l!:)!JtI, however, I\Inltes\; doctors were using "antiseptic vaseline" on their hands when carrying out pOdalic versjon, while in 18%, amI probably earlier, Dr. G.B. Schembri, Profes­sor of Midwifery al our University, Laught his student-midwives that when called to attend a labour the midwife was "to clean and disinfect her hands and cut her nails". The disinfectants recommended were carbolated \,:tsci'ine, corrosjve sublimate and Condy's fluid, a !iolution or sodium permanganate in waterl ".

Ollicial insistence on the adoption of antiseptic measures <lales since 1899 when a set of "Regulations respecting mid­wives" was published in the Malta GO'lJemment Gassette of 7th August (p. 7H). These regulations laid down detailed instruc­tions as to the kind of instruments she was to carry in her bag and as to thc steps she was to follow in the vario~s stages of labour in domiciliary practice. They prescribed the use of "anti­septic preparations .. for the disinfection of the: instrumen~ and of the hands" up to her elbow; and for washing ~e peri­neum and upper regions of the thighs of the patient. Condy's fluid was recommended while u !} % solution or' noric Acid was use<l for hnthing- the hnhy's eyes imlllediately after birth.

Domiciliary Midwifery In tlie past domiciliary midwifery was associated with a

characteristic feature of Maltese domestic architecture. This is the so-called. !'hlCove" :'or "labour room" in which the woman

'f ,:.. -.••

gave birth to her offspring at home. It was a small room with a Boor area of about 1:0 m. by 1.8 m. and being just large enough to con Lain a bed. One entered it through a wide arched way-which was not provided with a door but had a c.urtain, as large· as the arched opening, whicb, when drawn across, con­cealed the bed and its· occupant from view. The "alcove" has now outlived its original purpose though it is still to be seen in some of the old village houses; but it constitutes a social and medical landmark as it reflects the shift from domicilivy mid­wifery to the maternity hospital during the present century18. In fact, while in the 1900s more children were born at home, today the trend is for pregnant women to be delivered in hospital. Since this. change became prominent about 26 years ago there has beel\.:~ .d~ine in domiciliary midwifery' so much so that

'.,.. t..:.,l ~ l i. ';' • • • '. • .'. •

when the last midwife in one of the most populated towns (Sen-glea) died in 1970 there was no one to replace her. According to statistical figures published in 1975, 98% of deliveries in Malta now tak~place in hospitals19•

~~}lfl~~?!.~f.~!{~a~,i~~~~~~Y . r~lliated by the Me~ica1 .~:,.lQD.~. P.mf.~SJOl! 9rdu~anc:e (Chap. 51 of the RevJsed Edition of the Laws of Malta 1942). This law, originally enacted in 1901, has undergone many amendments during the past 7!i years. The latest changes with regard to midwifery have resulted from Act XVIII of 1973 which brought into being the Nursing and Midwifery Board. This Board besides being a disciplinary and advisory body, is responsible for keeping a Register of Midwives licensed to practice their profession. In 1975, this Register listed the names of IB!) midwives20. The establishment of an official Register is a sig'o of the recognition that the Stat~ has accorded to the Maltese midwife and to her thorough train­ing and scientific education.

F

REFERENCES: 1. II globo, 4lh l\'larch ltHl, p. 19 2. Chetcuti, T. & Zammit N. Ruppori (/ r.ig-jullulo della com­

missione incaricata dalw Societu Medicll d'lllcoraggiamento di esaminare it prugetto di studi reiativamellte alla medi­cina, Mali:a, 1H4:2, p. 34

3. 4:. 5. 6. 7.

~.

9.

10. II.

12. 1:1. 14.

W. Hi.

] 7.

JR.

HI.

The Malta Mail, lOth October 1804, p. 3 Pistmi, S.L. l(Ueb il-Qllbla, Malta, 1883 The it-taliuGo,Jernmeut Gazette, 25th July 1883, p. 156 The Maltll Times, 25th November 1898, p. 2 Report of the Health Conditions of the Maltese Islands for Year 19ii8, Malta, HHil, p. 7 Thomson, E.A., personal cOlllmunicHtion. Midwives in Europe: Report of the Council of Europe, Strasbourg, H)51, p. 53 Programme of Refresher Course for Midwives, 220d to 26th April 197-.1. St<ltutc of Midwives ,\ssociation of Malta, 1974. Typescript. CEM 78B, fol. Mit, Cathedral Archives, Mdina Malta. Archives 1184, fol., n7 & Archives 1 HH, fol 220, National Library, Malta. Ms. Ma, fol., 58~1. National Library, Malta. Co I1S tit ntiones ill diocesulUI syllodo melivetanu, Rome, 1625 Sytlodus diocesa:lw Fr. David Cocco Palmieri, Rome 1709, p.26. Cassar, P. Medical History, 1!}(j4, 8. 220 & 235 Cassar, P. Vestiges of the P.arturition Chair in Malta, Sf.

Lllke's Hospital Gazette, 1973, 8, 58 Schemhd, G.B. The Midwife's Guide Book, Malta, 1896, p. 6f)

Cassar, P. Preg-nancy ancl Hirth in ;\raltesc Traditional Lore, Cllcslpiect" April Hllii, p. 2ii. O'Reilly Mizzi, S. The Changing $tallls of Women in Malta. Paper read at Ihe Mediterranean Symposium II, Unh'crsit),or Malta, !!Hh to 2lith June 191'6. Typescript, p. 11 Midwjyf's in Enrop ... I~"pnrl fir the Council of Europe, Slrasbourg. 19;6, p. (i

20. Mid"'iv{'s Association of Malta. Official Opening on 13th September 1975. Trpescript.