Primitive medicine was inevitably born of instinct. Little is definitely known about the medical practices of primitive man in Malta, but it appears that medical therapy was intertwined with magico-religious practices. Based on the construction of the Hypogeum and the statuetary remains found therein, it was suggested by Sir Temi Zammit that this site served as a sanctuary in which "devotees were able to consult an oracle under the direction of numerous priesthood who among other things practised oneiromancy, that is they interpreted dreams provoked in the faithful that slept in cubicles". This practice was similar to that described in the temple-hospitals dedicated to medicine-god Aesculapius of ancient Greece. The Aesculapian cult developed throughout Greece and reached Rome in 293 BC. For nearly a thousand years the afflicted visited temples erected to the god to be healed by drugs, diet and other modes of treatment. These temples became in time well staffed health resorts, ornate with votive art and treasures donated by grateful devotees. The god's staff entwined by a serpent remains the symbol of medicine. This symbol was depicted on the 1964 series commemorating the European Congress of Catholic Doctors and WHO Commemoration stamp issue of 1988. A number of possible votive offerings depicting pathological conditions have been excavated from neolithic sanctuaries in Malta. However the most frequent pathological condition depicted in neolithic sculptures of male and female figures is gross obesity which may reflect a genetic predisposition of the Maltese to obesity and associated metabolic problems. Primitive man in Malta around 800 BC apparently came into regular contact with the semitic culture of the Phoenicians. This semitic race, and the Carthaginians after them, believed that the daily hazards of existance were caused by a multitude of malevolent spirits who permeated the universe and intervened in natural processes. These spirits were thus responsible for the onset of disease. Man's only weapon was through the magical powers of amulets - concepts which remained well until the advent of a scientific basis of medicine during the Renaissance. The helplessness of man before disease and death was poetically described during the 12th century on the tombstone of Maimuna. The Kufic characters record poetry with the following quotation "Look around with your eyes. Is there anything in the world which can stay or repel death, or cast a spell upon it?"(1) .

The Roman period furnishes us with the first written document relating to medical disease on the Islands. the Acts of the Apostles records the shipwreck of Paul of Tarsus on Malta along with the evangelist-physician Luke. During their stay in Malta, Luke records a number of miracles of a medical nature performed by Paul. He states that many sick people in the Island came to Paul and were cured. He also records two specific medical disorders. On arrival, Paul was bitten by a snake. The natives reaction to this event showed marked superstition initially believing Paul to be a murderer being punished by the gods. When nothing happened they decided that Paul was a god himself. The expected symptoms of snake-bite are described by Luke. The second specific disease recorded by the evangelist was dystentry with fever. The arrival of Saints Paul and Luke has been commemorated by a number of postage stamps, including a definitive commemorative issue in 1960. A number of stamp issues depict the statue of St. Paul casting the snake into the flames. This wooden statue was sculputed by Melchiore Gafa` in 1657. St. Luke, the physician, has given his name to the main hospital on the Islands. The hospital with St. Luke's statue in the foreground is depicted on the 6d stamp of the European Congress of Catholic Doctors series of 1964 (2).

The Modern Period saw the arrival of the Order of St. John of Jerusalem. The order of the Knights Hospitallers of St. John had its origins in Jerusalem in the early years of the first millennium A.D., when the Benedictines with the help of some merchants built hospitals to cater for the needs of pilgrims. The nursing functions of the Order is depicted on the 1970 6d stamp of the series commemorating the XIII Art Exhibition of the Council of Europe. The stamp shows the the 18th century painting of Gerald de Martigues - the founder of the Order - administering to the sick painted by Antoine Favray. Increasing harassment by the Turks necessitated changes in the organization and functions of the Order. Thus to the religious and nursing duties were added the chivalrous ones of defending pilgrims to the Holy Land. The Maltese Islands were ceeded to them in 1530 after they were ousted from Rhodes. Their arrival has been commemorated on the Definitive stamp issues of King George VI with the depiction of the Favray painting showing De L'Isle Adam entering Mdina (3). The arrival of the hospitallier knights of St. John of Jerusalem coincided with the onset of the Renaissance movement in Europe. This cultural movement, characterized by the re-awakening of ancient learning through direct knowledge of Greek and Roman authors, was not confined to the arts. It resulted in a new general outlook with emphasis on knowledge of nature and the beginning of Humanism. Observation of phenomena replaced theoretical procedure, science and medicine advanced from the dark into new territories.

The Knights concentrated their forces at Birgu, the maritime centre of Malta. There they established their first hospital. After the Great Siege, the Order commenced the building of a new city named Valletta. Grandmaster Pietro del Monte in 1574 laid the foundations for the new hospital "Sacra Infermeria". The hospital continued its function well into the twentieth century. The hospital is depicted on the 1s6 stamp of the European Congress of Catholic Doctors series of 1964 and the 11c stamp commemorating the III centenary of the School of Anatomy and Surgery of 1976. This hospital was in its heyday one of the best serviced hospitals in Europe and was favourably described by a number of foreign visitors to the Island during the seventeenth and eighteenth centuries. The pharmacy of the Infirmary was furnished with many ceramic drug containers of various shapes and sizes. Examples of these, together with a pestle and mortar, are depicted on the 10d stamp of the series commemorating the XIII Art Exhibition of the Council of Europe (4).

In 1675 the plague arrived in Malta killing 11300 persons within six months. When the epidemic ended GrandMaster Nicolas Cottoner decided to augment the medical services on the Island and founded the School of Anatomy and Surgery at the Sacra Infermeria. Nicholas Cottoner is shown tending the sick on the 2d stamp of the 1964 European Congress of Catholic Doctors series, while his memorial erected in the Chapel of Aragon in St. John's Co-Cathedral was depicted on the 2s6 stamp of Queen Elizabeth Definitive series of 1956. His bust is depicted on the 2c stamp commemorating the foundation of the School of Anatomy and Surgery. The foundation of the School of Anatomy and Surgery, commemorated by a postal series in 1976, saw the start of a scientific foundation of medicine on the Islands. The first teacher of the school was Dr. Fra Giuseppe Zammit depicted on the 7c stamp commemorating the foundation of the school. The School of Anatomy and Surgery in the eighteenth century came to acquire great renown throughout the principal cities of Europe, particularly under the directorship of Michel'Angelo Grima. The School of Anatomy was the prelude to the Faculty of Medicine at the University of Malta. Following the expulsion of the Jesuits from Malta in 1769, the Society's property including their college erected in Valletta for the education of young men in 1592 was taken over by the Order. Out of the revenues accuring from this property, a university was founded by GrandMaster Em. Pinto de Fonceca. The three faculties of Theology, Law and Medicine were established in 1769 and the School of Anatomy was incorporated in the new institution. The four hundred anniversary of the foundation of the Collegium Melitense by the jesuits was commemorated by a postal series in 1992, while the foundation of the University showing a bust of Pinto was commemorated in the 2s stamp of the Commemorations issue of 1969 (5).

The scientific era heralded by the Renaissance was maintained and strengthened throughout the 19th century after the Islands were taken over by the British. The latter part of the nineteenth and early twentieth centuries saw major advances in medical investigation, including microbiology. Malta also contributed in this advance through the discovery of the organism causing Malta or Undulant Fever and the contribution of the goat to the propagation of the disease. The cause was discovered in 1887 by a young Australian surgeon stationed with the British garrison in Malta. David Bruce, born in Melbourne in 1857, isolated the bacterium from the spleen of a dead soldier. This was named Brucella melitensis in his honour and the disease was given the scientific name Brucellosis which it still bears. A fellow Maltese researcher was Temistocles Zammit, who in 1914 proved unmistakably that the Brucella organisms were transmitted to humans from the milk of infected goats. This great doctor, archaeologist, historian and social worker was knighted in 1930 and died in 1935. In 1964 the Food and Agricultural Organization held a Congress in Malta to discuss the control of Brucellosis in the Mediterranean. A commemorative set of two stamps was issued in April 1964. The 2d stamp portrayed Sir David Bruce and Sir Temi Zammit with a microscope, while the 1s6 stamp featured a goat with an array of laboratory instruments. Zammit was also depicted on the 14c stamp of the Europa 1994 series with the theme "Europe and the Discoveries". The work of the two researchers followed on the discoveries of the early scientists, among whom the most prominent in the field was Loius Pasteur. Pasteur was a French chemist born in 1822 whose researches on the process of fermentation led to the development of bacteriology. He was alslo responsible for the process known by his name - pasteurisation - which helped control the transmission oof brucellosis in milk. The centenary of his death in 1895 was commemorated with a local stamp (6).

Medical problems during the last one and half hundred years have taken place in an international setting, with major medical problems being the result of major war conflicts and epidemic outbreaks. There has further been an international drive to combat premature death in all populations including those in under-developed countries. These efforts have necessitated the setting up of international organizations. In 1863 an agreement was made by the European Powers at Geneva establishing humane regulations regarding the treatment of the sick and wounded in war, and the status of those who minister to them. All persons, hospitals and hospital ships were required to display the Geneva Cross - a red cross or sickle on a white background. An important result of this Geneva Convention was the establishment of the Red Cross Society in 1870. The Centenary of the Geneva Convention was first commemorated by the issue of a stamp commemorative set of two stamps portraying Queen Elizabeth II and featuring the Red Cross emblem. The humanitarian efforts of the members of the Air Raid Precautions during the Second World War in Malta were depicted in the 11/2d stamp issued on the XVII Anniversary of the George Cross Award. This depicts the A.R.P. stretcher-bearers and a group of casualities beside the smoking ruins. The local Malta Red Cross Society was established in 1993, the first anniversary being commemorated by the issue of a stamp in the Commemorations series on 1994 (7).

Other organizations have been set up to address more direct medical matters. In the post-2nd World War period the world was faced with a serious threat of famine. Through the action of John Boyd Orr, an expert on nutrition, came the idea to form the World Food Board to combat this threat. This Board was the precursor of the Food and Agricultural Organisation (F.A.O.) which is the first permanent agency of the United Nations which was established. F.A.O. has organised a number of regional conferences for Europe, some of which have been commemorated on Maltese stamps (8) . Another United Nations agency commemorated on Maltese stamps is the World Health Organization as the 7c5 stamp of the 1973 International Anniversaries and the 19c stamp of the series of 1988 International Commemorations. The United Nations further set up UNICEF initially as a temporary body in 1946, and placed on a more permanent footing in 1953. The United Nations International Children's Emergency Fund was originally set up to provide emergency assistance to children in war-ravaged Europe. After 1953, its mandate was broadened and now promotes the survival, protection and developmenty of children and their mothers in such fields as health and immunization, nutrition, education, water and sanitation, and provides relief and rehabilitation assistance in emergencies including vaccines, basic medicines, medical equipment and food supplements. The 50th anniversary of UNICEF was commemorated by the 25c stamp of the 1996 series Child and Youth Welfare (9) .

The importance of the social aspect of medical care has also been realized in Malta. Thus a number of local associations have been set up to deal with various aspects of medical care, some of which have been commemorated as postal issues. These include the 75th Anniversary of the Lions International in 1993, the 50th Anniversary of the Dental Association of Malta in 1994, and the 50th Anniversary of the founding of the M.M.D.N.A. in 1995 (10) . Other medically related themes and/or congresses commemorated on Maltese postage stamps include the First European Congress of Catholic Doctors in 1964, Cardiac Health in 1972, the International Year for Disabled Persons in 1981, the Care of the Elderly in 1982, and the European Year of the Elderly in 1993 (11).

Only a few medical personalities have been depicted on Maltese stamps (12). A number of these have already been mentioned above.

1. Dr. Fra Guiseppe Zammit: b.1646 d.1740. Appointed first Professor of Anatomy and Surgery in 1676. In spite of his young age he was held in high regard as to his compitance as a physician and acted as the personal doctor to at least five GrandMasters. Gregorio Caraffa made him a member of the medical Collegium in 1648 and De Vilhena raised him to Protomedico in 1722.

2. Dr. Giuseppi Barth: b.1745 d.1818. Studied anatomy and surgery under Dr. M.A. grima in Malta after which he proceeded to Rome and eventualy to Vienna where he specialised in eye surgery. Among his patients was Empress Maria Theresa's son, the future Joseph II. He was appointed Professor of Anatomy and Physiology and Professor of Ophthalmology at the Medical School of Vienna University in 1773, and eventually earned the title of Imperial Councillor and Oculist to His Majesty.

3. Dr. John Borg MA MD: b.1873 d.1945. Qualified as a medical doctor in 1898. Became Director of the Experimental Farm of the Agricultural Society in 1898, and Superintendent of Public Gardens and plantations in 1900. Interested in Natural History, he published a number of botanical works particularly the "Descriptive Flora of the Maltese Islands" (1927). In 1921 he held the Chair of Natural History at the University of Malta.

4. Sir David Bruce: b.1855 d.1931. Qualified as a medical doctor at the Edinburgh University. He joined the Army Medical Corps in 1883 and was sent to Malta. His investigations into the aetiology of Malta Fever led to the discovery of the micro-organisms which caused the disease, now called Brucella melitensis. He continued his bacteriological investigations in Uganda proving that the tsetse fly transmitted sleeping sickness. For his work in bacteriology he was made a Fellow of the Royal Society in 1899 and knighted in 1908.

5. Sir Temistoles Zammit: b.1864 d.1935. Graduated in Medicine at the university of Malta in 1882 and later specialised in bacteriology in London and Paris. Appointed Governmrent Analyst in 1890. His main contributiuon to medicine was the discovery of the importance of the goat in the transmission of the infection Brucellosis. Zammit also gave a very significant contribution to Maltese archaeology. Among the many honours bestowed on him was the conferrment of the honorary degree of Doctor of Literature by the Oxford University.

6. Dr. Luigi Preziosi: b.1888 d.1965. Graduated in Medicine in 1910 and subsequently specialised in ophthalmology obtaining a diploma in Ophthalmology from Oxford in 1920. Was appointed Professor of Ophthalmology at the Royal University of Malta in 1924. Preziosi devised an operation to treat Glaucoma, the technique still bearing his name. He also gave an active contribution in Maltese politics.

7. Loius Pasteur: b.1822 d.1895. French chemist whose researches on fermentation led to the science of bacteriology and his investigations into infectious disease and their prevention to the science of immunology. He spent most of his life as administrator and director of scientific studies at the Ecole Normale at Paris, where he was appointed in 1857.

The Stamps issued by any country enables the researcher to trace various aspects of political and social history of the country. Many countries have honoured distinguished medical personalities by depicting them and their deeds on stamps. Some personalities have been honoured by various countries, thus Robert Koch, the microbiologist responsible for the discovery of tubercolosis, appears on postage stamps from Germany, Belgium, Danzig, Romania, Russia and Sweden. Unfortunately few Maltese medical personalities have attracted the attention of the local postal authorities and a postal set depicting medical personalities is still awaited.

1. Prehistoric Medicine: [1] The "Oracle Room" at the Hypogeum, Hal Saflieni - possible evidence of dream interpretation: (i) King George VI Definitive issue 11/2d stamp: 17 February 1938, 8 March 1943 new colours, 25 November 1948 overprinted "SELF GOVERNMENT 1947", 8 Janaury 1953 new colours (ii) Restoration on Maltese Monuments Campaign - 2c5 stamp: 15 February 1980; [2] "Sleeping Lady" from the Hypogeum - possible evidence of dream interpretation: Definitive issue 1/2d stamp: 7 January 1965 - 1970; [3] Aesculapian Symbol of Medicine: (i) 1st European Congress of Catholic Doctors series 3 stamps (2d, 6d, 1s6): 5 September 1964; (ii) Maltese Personalities series 4c stamp: 23 January 1988; (iii) International Commemorations series 19c stamp: 28 May 1988; [4] "Fat Lady" - gross obesity: (i) Europa series 1c3 stamp: 13 July 1974; (ii) Tezori ta' Malta series 20c stamp: 29 March 1996; [5] Maimuna tomb-stone. Definitive issue 21/2d stamp: 7 January 1965 - 1970

2. Arrival of Apostles Paul and Luke to Malta . [1] Arrival of St. Paul: Definitive issue 10s stamp adapted from an engraving by Gustav Dore`: 4 February 1898, 1919-20, 1921-22, overprinted "SELF GOVERNMENT" 1922 [2] XIX Centenary of Shipwreck of St. Paul: Commemorative issue 6 stamps (11/2d, 3d, 6d, 8d, 1s, 2s6): 9 February 1960; [3] Apostle Paul throwing snake in fire: (i) King George V Definitive issue 10s stamp: 1926-27 inscribed "POSTAGE", 1 October 1928 overprinted "POSTAGE & REVENUE", 20 October 1930 inscribed "POSTAGE & REVENUE" (ii) King George VI Definitive issue 10s stamp: 17 February 1938, new colours 8 March 1943, 25 November 1948 overprinted "SELF GOVERNMENT 1947", new colours 8 January 1953 (iii) Queen Elizabeth II Definitive issue 10s stamp: 23 January 1956; [4] St. Luke's Hospital, Malta: First European Congress of Catholic Doctors series 6d stamp: 5 September 1964

3. Hospitallier Order of St. John: [1] The "Blessed Gerald" administering to the sick: XIII Art Exhibition of the Council of Europe series 6d stamp: 21 March 1970; [2] De L'Isle Adam entering Mdina: King George VI Definitive issue 21/2d stamp: 17 February 1938, 8 March 1943 new colours, 25 November 1948 overprinted "SELF GOVERNMENT 1947", 8 January 1953 new colours

4. Hospitals of the Order of St. John: [1] Sacra Infermeria at Valletta: (i) First European Congress of Catholic Doctors series 1s6 stamp: 5 September 1964 (ii) III Centenary of the School of Anatomy and Surgery series 11c stamp: 14 September 1976; [2] Pharmacy Jugs/equipment: XIII Art Exhibition of the Council of Europe series 10d stamp: 21 March 1970

5. Setting up of Medical Studies: [1] Nicholas Cottoner - founder of Chair of Anatomy and Surgeryy: (i) Queen Elizabeth II Definitive issue series 2s6 stamp: 23 January 1956 (ii) First European Congress of Catholic Doctors series 2d stamp: 5 September 1964 (iii) III Centenary of the School of Anatony and Surgery series 2c stamp: 14 September 1976; [2] Setting up of School of Anatomy and Surgery: III Centenary of the School of Anatomy and Surgery Commemorative issue 4 stamps (2c, 5c, 7c, 11c): 14 September 1976; [3] Setting up of University of Malta: (i) 400th Aniversary of the "Collegium Melitense" 2 stamps (4c, 30c): 12 November 1992 (ii) 200th Anniversary of the University of Malta: Malta Commemorations series 2s stamp: 26 July 1969

6. Brucella melitensis: [1] Anti-Brucellosis Congress - David Bruce and Temi Zammit: Commemorative issue 2 stamps (2d, 1s6): 14 April 1964; [2] Sir Temistoles Zammit: Europa 1994 - Europe and the Discoveries series 14c stamp: 29 March 1994; [3] Death of Loius Pasteur: Commemorative series 25c stamp: 20 February 1995

7. Geneva Red Cross: [1] Red Cross Centenary: Commemorative issue 2 stamps (2d, 1s6): 2 September 1963; International Commemorations series 4c stamp: 28 May 1988; [2] A.R.P. during the 2nd World War: XVIII Anniversary of George Cross Award series 11/2d stamp: 15 April 1959; [3] Malta Red Cross Society - International recognition: Commemorative 1994 series 9c stamp: 10 May 1994

8. Nutritional themes: [1] Freedom from Hunger: 1 stamp (1s6): 4 June 1963; [2] FAO Anti-Brucellosis Congress: 2 stamps (2d, 1s6): 14 April 1964; [3] VI FAO Regional Conference for Europe: 3 stamps (4d, 1s, 2s6): 21 October 1968; [4] 10th Anniversary of World Food Programme: International Aniversaries series 1c3 stamp: 6 October 1973; [5] World Food Day: 2 stamps (8c, 23c): 16 October 1981; [6] 50th Anniversary of setting up of FAO: Anniversaries 1995 series 35c stamp: 21 April 1995

9. International Associations: [1] W.H.O.: (i) International Anniversaries series 7c5 stamp: 6 October 1973; (ii) International Commemorations series 19c stamp: 28 May 1988; [2] U.N.I.C.E.F.: 50th Anniversary - Child and Youth Welfare series 25c stammp: 29 February 1996

10. Local Associations: [1] 75th Anniversary Lions International: 2 stamps (4c, 50c): 4 February 1993 ; [2] 50th Anniversary of Dental Association of Malta: 2 stamps (5c, 44c): 12 February 1994: [3] 50th Anniversary MMDNA founding: Commemorations 1995 series 20c stamp: 27 February 1995

11. Other Medical Themes: [1] First European Congress of Catholic Doctors: 3 stamps (2d, 6d, 1s6): 5 September 1964; [2] Cardiac Health: 3 stamps (2d, 10d, 2s6): 20 March 1972; [3] International Year for disabled persons: 2 stamps (3c, 35c): 17 July 1981; [4] Care of the Elderly: 2 stamps (8c, 30c): 16 March 1982; [5] European Year of the Elderly: 2 stamps (5c, 35c): 23 September 1993

12. Medical Personalities: [1] Giuseppe Zammit: III Centenary of the School of Anatomy and Surgery series 7c stamp: 14 September 1976; [2] Giuseppe Barth: Prominent Maltese series 3c stamp: 12 January 1974; [3] John Borg: Prominent Maltese series 7c5 stamp: 12 January 1974; [4] David Bruce: Anti-Brucelloosis Congress series 2d stamp: 14 April 1964; [5] Temistoles Zammit: Anti-Brucelloosis Congress series 2d stamp: 14 April 1964; Europa - Europe and the Discoveries series 14c stamp: 29 March 1994 [6] Luigi Preziosi: Maltese Personalities series 4c stamp: 23 January 1988; [7] Louis Pasteur: Commemorations 1995 series 25c stamp: 27 February 1995