A new era for surgery in Malta

"The mind is not a vessel to be filled, but a fire to be kindled" - Plutarch 46-120 A.D.

Surgery is a branch of medicine that is different to the rest of the medical specialties because it involves performing manual interventions on patients. Modern surgery has evolved from the inglorious days of barber surgeons who performed simple procedures without anaesthesia to modern hi-tech surgery with all its super-specialisations.

The first documentation of surgery in Malta is from the 15th century when a barber-surgeon called Xema Girbi was elected president of the Jewish community in 1486. He was so popular that his patients campaigned for him to be removed from his office, so as to have more time for his patients.

The standards of surgery in Malta evolved to a much higher level when the Hospitaller Order of the Knight of St John settled in Malta. Their hospital, the Sacra Infermeria, had a very high reputation. The Medical School was founded in 1676 and a foundation for the teaching of surgery was established by Bali Fra Clemente Resseigner in 1775. Maltese surgeons also trained in France and Italy.

Of course, surgery was then performed without anaesthesia and speed was essential. The surgeon Michel'Angelo Grima was renowned for his skill, performing lithotomy in two-and-a-half minutes and mastectomy in three minutes.

Maltese surgeons have rendered sterling service locally and have also reached prestigious positions abroad. Michelangelo Grima published prize-winning papers on head injuries, intestinal anastamosis and splenectomy in Paris, Venice and Florence in the late 18th century. Joseph Barth was Professor of Anatomy and Physiology in Vienna until his death in 1818. He also held the first chair of ophthalmology in Europe.

In the 19th century, Malta became a British military base and many talented young surgeons worked here during the early stages of their career. Sir Thomas Spencer Wells served for six years as assistant surgeon at the Naval hospital in Bighi. He introduced ether anaesthesia to Malta in March 1847, only four months after it was first used in the United States. He is recognised as a pioneer of abdominal surgery and was appointed Hunterian Professor and president of the Royal College of Surgeons of England.

The first modern Maltese surgeon was Prof. Pietru Pawl Debono, who was the first to become a Fellow of the College of Surgeons. He was soon followed by Prof. Victor G. Griffiths and later most contemporary Maltese surgeons, though in recent years others have trained in Germany and Italy. Many Maltese surgeons have pursued very successful careers abroad.

Since Malta joined the EU, the Association of Surgeons of Malta has been entrusted with organising post-graduate surgical training. The ASM has compiled a curriculum for general surgery, emergency medicine, urology, orthopaedics and trauma, otolaryngology, ophthalmology and plastic surgery. I would like to thank all those who have worked very hard to compile this document. There are exciting developments in surgery, and this curriculum will need to be constantly revised and updated to keep up with progress.

The primary goal of the training programme is to provide the trainee with a broad knowledge base, the necessary operative and procedural skills and experience, as well as professional judgment for independent surgical practice. A further goal is to further his/her knowledge of clinical thinking and methodology, teach him/her self-criticism, critical assessment of his/her results, the ability to self-directed learning and appraisal of external clinical evidence, which leads to continued growth, expert practice and professionalism.

Surgery in Malta has entered a new era in a brand new hospital. The government recently entered an agreement with the Medical Association of Malta where it recognised the importance of post-graduate training, both to further improve the standards of patient care and also to retain new graduates and improve job satisfaction. Training co-ordinators have been appointed and structured post-graduate training will soon be established.

Mr Dingli is a consultant surgeon, president of the Association of Surgeons of Malta and secretary general of the Medical Association of Malta.