The earliest evidence of man on the Islands has been dated to about 5000 BC having apparently migrated from Sicily. Primitive medicine was undoubtedly born of instinct. The cyclical pattern of nature brought about a pre-occupation of primitive man with the phenomenon of procreation and the propagation of life. In Malta, this pre-occupation of Neolithic man can be seen in the archaeological survivals of his culture. Early Neolithic man (c.5000-3200 BC) arriving from Sicily brought with him an agriculture economy, as evidenced by the carbonized grains of wheat, barley, and lentil recovered from the 'Ghar Dalam' levels at Scorba - an early Neolithic village close to Zebbieh. Man the Farmer was very much concerned with survival and very conscious of the cyclical process of reproduction of his crops and stock, and of his own species. He thus appeared to have developed a fertility cult in an effort to promote and encourage the reproductive cycle. What survives of this cult are the figurative representations around which these rites took place which included the fragmentary statuettes, which appear to emphasize the female sexual characteristics, and rubbed down animal bones which have been interpreted as phallic symbols. Late Neolithic man (3200-2000 BC) had a more progressive culture which was characterized by the enormous megalithic 'temples' scattered all over the Islands. These temples have been associated with a progressive Fertility Cult on the basis of the clay statuettes and symbols associated with the fertility deity which have been found in the various temples and tombs [1].

Fertility appeared to have been the center of Neolithic man's culture. It was also the basis of his economy. The population of the Maltese Islands has been estimated to have been about 4000 individuals, the figure being based on the number of persons that can be supported per square mile by shifting agriculture in the presence of the then local conditions. In a society in which the family had to be supported by the labour and produce of its members, the birth of a child must have been an important and special event in the lives of the family group and the community. Megalithic structures have found their way into Maltese midwifery folklore. Pregnant women from Xaghra in Gozo used to sit or squat on a large stone probably the dolmen of Sansuna to ensure a safe delivery. According to legend, a giantess with a baby in a cradle on her back carried the large stone there on her head while she held the supporting stones in either hand [2].

It has been suggested that the deity had an interest in death as well as fertility, death being looked upon as a prelude to rebirth. It is possible that the temples were copies above the ground of the rock-cut tombs of Xemxija, while the Hal Saflieni Hypogeum used as a cemetery and temple further emphasizes the link between the two. The contents of the Hypogeum side chambers revealed the human bones of about 6000 to 7000 individuals. A large number of internments were also discovered at the Brochdorff Circle Hypogeum in Gozo. At the Xemxija tombs, in use about 3100 BC, the dead were placed in a crouched position on one side with the knees drawn up to the chest, together with a few pots and perhaps a polished stone axe-amulet. The human remains appeared to have been frequently liberally sprinkled with red ochre apparently in an attempt to restore life-giving blood to the diseased [3].

Little is definitely known about the medical practices of primitive man, but it appears that medical therapy was intertwined with magico-religious practices. Based on the statuetary remains found at the Hypogeum, it has been suggested that this site served as a sanctuary in which "devotees were able to consult an oracle under the direction of a numerous priesthood who among other things practised oneiromancy, that is they interpreted dreams provoked in the faithful that slept in cubicles". This practice is similar to the temple-hospitals of Aesculapius of ancient Greece. This latter cult was associated with the snake. Possible snake representations have been found at Mnaidra and Ggantija [4]. A number of possible votive offerings have been excavated from Neolithic sanctuaries in Malta. Among these are two models of legs from Mnaidra and one of a hand from Hagar Qim. At Bugibba Temples a limb was found which showed a small conical knob on its lower part of the anterior aspect possible representing a tumour. At Gzibbu Tombs, Zebbug an incised decoration resembling two hanging arms ending in three fingered hands may represent a congenital abnormality, while a statuette from Hagar Qim depicts an example of extra fingers or polydactyly. Some of the legs of statuettes found exhibit what may be marked oedema, while a clay head shows puffed out cheeks possible representing angioneurotic oedema or bilateral parotitis such as one get in mumps. Two statuettes, from Mnaidra and Tarxien, show similar features suggesting an abdominal tumour. Both represent a female body with a great projecting abdomen, large breasts and very detailed representation of the vertebrae and ribs. In both the genitalia are well illustrated. One of these curious figurines has a number of fragments of shell stuck symmetrically into different parts. It has been suggested that these two specimens may represent an abdominal tumour or ascites, while the shell fragments may reflect the use of witchcraft or counter-irritation [5]. In the presence of a fertility cult, the grossly enlarged abdomen, the pendulous breasts and the emphasized genital features of these figurines most likely depict a pregnancy.

Pathological material from the Neolithic period has also been identified in the skeletal remains. Several bone remains found at Xemxija showed well healed fractures of the clavicle, tibia and metatarsals. The inner wall of a fragment of the shaft of the tibia was abnormally thickened, possibly a result of trauma to the outer surface of the leg. A talus showed evidence of a chronic osteomyelitis. Trauma and infection are a common feature of life, particularly in primitive cultures. The presence of well healed fractures does not necessarily suggest any surgical expertise, since bony fractures frequently heal well without any intervention further than immobilization. The adult teeth showed evidence of dental caries (8.5%) and marked attrition (59.8%). Calculus formation of variable degree was evident, while several examples of periodontal disease, abscess and healing, and healed alveolar bone was also found. Extractions, impacted teeth and cyst formation were also encountered. Two molar teeth showing a marked degree of fusion in the roots - taurodontism - discovered at Ghar Dalam were suggested to have belonged to Neanderthal Man, but this was later shown to have belonged to Neolithic man. Oral disease is intimately related to habits of diet. The low incidence of carious teeth in the series studied is similar to that reported from other European Neolithic sites. The low degree of caries and the high degree of attrition or wear of the teeth suggest a rough diet with a low proportion of fermentable carbohydrate in a sticky form [6].

The body proportions of Neolithic man in Malta have been investigated on the basis of the statuette representations and skeleton remains discovered in various localities on the Islands. The Neolithic population seems to have consisted mostly of tall powerfully built individuals, though remains of lightly built individuals have also been excavated. The facial characteristics based on statuette depictions are those belonging to a pure white race, while their skulls indicated a long-headed race presenting certain Armenoid features. The skulls appear to be representatives of the Mediterranean race. An outstanding feature of the various statues and statuettes found in the various Neolithic temples is the gross obesity depicted by the both the male and female figures. These have very prominent abdomens, often with creases representing folds of fat sometimes extending to the hips. The buttocks are large of a broad type and bulge backwards (sometimes flattened). The statuettes have abnormally fat forearms, hips and legs. These were probably idealized representations of the human form since the proportions of the figures from different sites are very similar. Other figurines depict more life-like images and probably represent portrait models [7].

The culture of this religious peaceful people came to an abrupt end when they disappeared obscurely to be replaced by Bronze and Iron Age man (2000-800 BC). This race appeared to consist of stocky medium stature. The skull features suggest a round-headed Alpine race. These people showed little sign of exceptional technical expertise or wealth further than their use of metal. During the Bronze Age, the Islands were probably relatively more thinly populated. They built for themselves a number of dolmens in which cremated remains were probably buried8. These people left pottery and clay idols, some of which are highly stylized with affinities to Mycenean idols and Anatolian and Cycladic types. Towards the end of the Bronze Age period they apparently came into regular contact with Mediterranean seafaring nations.

1. D.H. Trump: Malta: An Archaeological Guide. Progress Press, Malta, 1990, +167p.

2. B. Blouet: The Story of Malta. Progress Press, Malta, 1989, p.28-29; P. Cassar: Pregnancy and birth in Maltese tradition. Chestpiece, 1975, p.25; H. Lewis: Ancient Malta: A Study of its antiquities. Colin Smythe Ltd, Bucks, 1977, p.57

3. J.D. Evans: The Prehistoric Antiquities of the Maltese Islands. A Survey. University of London, London, 1971; D.H. Trump, op. cit. note 1, p.27,66,145-146

4. T. Zammit: The Neolithic Hypogeum at Hal Saflieni, Malta. Malta, 1935, p.58

5. T. Zammit and C. Singer: Neolithic representations of the human form from the Islands of Malta and Gozo. J Roy Anthrop Inst, 1924, 54:p.76,81,85,92,96-97; L.J. Pace: The anatomical features of prehistoric man in Malta. Royal University of Malta, Malta, 1972, p.14-15; P. Cassar: The Medical History of Malta. Wellcome Hist Med Libr, London, 1964, p.4

6. G. Pike: The human bones from the Xemxija Tombs. In J.D. Evans: op. cit. note 3, p.236-238; S. Rodgers: Note on te dentition of the Xemxija Human Remains. In J.D. Evans: op. cit. note 3, p.238-239; L.J. Pace: ibid., p.15, table 5; C. Wells: Bones, bodies and disease. Thames & Hudson, London, p.121-128

7. T. Zammit and C. Singer: op. cit. note 5, p.74-76; L.J. Pace: ibid., p.3-13

8. L.J. Pace, ibid., p.2; B. Blouet: op. cit. note 2; D.H. Trump: op. cit. note 1, p.31; L.H. Dudley Buxton: The Ethnology of Malta and Gozo. J Roy Anthrop Inst, July-Dec 1922, 52:p.168