Situated in the centre of the Mediterranean being barely 93 kilometres away from Sicily and 290 km from Northern Africa – Gibraltar is 1836 km to the west and Alexandria 1519 to the East – the Maltese Islands have been an important meeting place for the various Mediterranean cultures throughout the ages. Hence for an adequate understanding of Maltese history and culture, one must not consider events in the Islands in isolation from contemporary developments in the Mediterranean basin. Maltese affairs must be viewed in relation to the broader and deeper context of European and North African history.
 
 The development of a cultural identity is closely dependant on the community’s historical past. Though history is often divided for convenience of study into basic subsections; the historical development of a community is a continuous process without any clear-cut distinctions between one political period and another. The history of the Maltese islands can be conveniently divided into five basic periods of study. The first includes the Prehistoric period ranging from the earliest times of the Palaeolithic to about the ninth century B.C. when Malta was occupied by Bronze Age Man. This period saw the development of an endemic cultural phase which lasted about two millennia characterised by the building of large megalithic structures or temples dedicated to a fertility goddess. There is no evidence that this endemic development was exported to the European or African mainland, though the Maltese community kept trade links with other Mediterranean Islands and the mainland. This culture saw an abrupt end around 2200 B.C.; and the Islands were subsequently repopulated by an entirely different people exhibiting a totally different culture. These colonizers brought with them the metallurgical technology which had previously developed around the Mediterranean basin and which apparently had not been available to the previous community. These new colonizers maintained links the Italian and Grecian mainland.
 
 The next historical phase is the Classical Period. This can be conveniently considered to date from the initial cultural connection of the Maltese inhabitants with the Phoenician maritime merchants around the eight century A.D. These initial trade contacts were eventually expanded to formal colonization and the eventual assimilation of a Semitic culture. This culture persisted right through the Carthaginian rule [initiated around 550 B.C.] and several centuries under Roman political dominance. The Maltese Islands politically fell under Roman dominance during the Second Punic War in 218 B.C. The new Roman rulers however did not forcefully impose their culture on the islands and the introduction of a Romano-Hellenistic culture was a gradual process of assimilation.  The breakdown of the Roman Empire in 395 A.D. heralded the onset of the thirds historical phase – the Medieval Period.
 
 The Medieval Period was to have a very influential role in the formation of Maltese cultural identity. This period started with the fall of the Roman Empire and was to last about a millennium heralding the arrival of the Hospitaller Order of St. John of Jerusalem in 1530. During these centuries, Malta changed hands repeatedly and was dominated by the Byzantines, the Arabs, the Normans, the Angevins, and the Aragonese. The close political and cultural association with Sicily with the cultural mix experienced during these centuries formed the backbone of the Siculo-Maltese identity with its admixture of North African and Western European identities. The ceding of the Islands to the Order of St. John resulted in a political break from nearby Sicily setting the Islands on a different historical and cultural course. The Islands thus experienced a renaissance not only in the arts and sciences, but also in its cultural identity. The Early Modern Period saw its end with the ousting of the Order from the Islands by Napoleon Bonaparte in 1798, and eventually of the French by the British in 1800.
 
 The Contemporary Period of the last two centuries have been politically and culturally intermixed with a predominantly anglophile identity, with an Italian override. These links have adapted the Maltese population to adopt a truly European culture and way of life – a link that will become even more strengthened in the coming decades following the absorption of Malta in the European Union. While the modern media and communication technology continue to promote the ongoing globalization process in the Maltese Islands, the Maltese remain a multifaceted cultural community carrying a identity baggage that predates the Medieval Period.

Disease management is as old as man himself and attempts to cure and manage disease states in the Maltese population have been identified in the archaeological records dated to five millennia ago. Linked closely to shamanism, primitive medicine was often practiced on one line by the temple priests and on the other by knowledgeable folklore healers. This situation persisted well into the subsequent centuries until medical management became tied to the philosophical concepts of disease aetiology. This led to the birth of a professional elite of persons specially trained in disease management. Evidence for such a group of professionals is furnished by a tomb slab belonging to a physicians’ guild movement excavated at Rabat, Malta dated to the second century AD. Medical training was based on a guild system of apprenticeship supplemented in some regions by centres of formal medical education and certification. One such school was the establishment at Salerno [c.100-1300 AD] in Southern Italy. Nothing is known about the medical training received by the Medieval physicians practicing in Malta, but presumably they would have received their education overseas. Maltese individuals, particularly those oping to join the surgical fraternity, may have served a period of apprenticeship locally before proceeding overseas to complete their education. By 1231, medical practice in Sicily and Malta were regulated by the Liber Augustalis promulgated by Frederick II of Sicily. These constitutions defined the medical curriculum of training preferring the teaching centres of Salerno or Naples. This situation persisted well after the arrival of the Order of St. John to Malta in 1530.

The establishment of the Sacra Infermeria by this hospitaller Order served to open up a demand for more medical and surgical practitioners on the Islands. After spending a period of apprenticeship in the Order’s hospital, the aspirants then proceeded overseas to join a medical university in Italy or France. The earliest candidates known by name include Raimondo Calamia and Antonio Manduca who registered at the University of Montpellier in 1554 and 1584 respectively. To formalise the early training and ensure the adequate provision of junior surgeons, the Order under the grandmastership of Nicholas Cottoner established in 1676 the school of anatomy and surgery at the Sacra Infermeria and appointed Fra Dr. Giuseppe Zammit as teacher. This school flourished and gain marked renown in the European sphere; serving to produce a corpus of medical professionals well-trained in basic skills who were subsequently encouraged to further their training overseas. In 1769, Grandmaster Pinto set up the Pubblica Universitá di Studi Generali with the Collegio Medico being incorporated in 1771. This new institution enabled the Islands to truly become self-sufficient in the training of fully-fledged medical and surgical physicians. This establishment has ensured that the Maltese Islands have been kept adequately supplied with physicians who in some instances have significantly contributed to advancements in medical knowledge or have given sterling service in overseas medical institutions.

The concept of further specialist training in medical practice has also a long tradition; though it was only formalised in the twentieth century. Traditionally, those Maltese individuals aiming to progress in their medical career supplemented their training by visiting centres in Europe – particularly in Italy and France. During the nineteenth century because of the political situation, the pendulum swung towards the United Kingdom and aspiring specialists joined medical centres in England and Scotland to further their training. The 1980s saw a return in exploring specialist training in the European arena with specialist trainees furthering their Maltese and British experience in centres of excellence in European centres particularly, Belgium, France, Italy, and Germany. With the entry of the Islands in the European Union, these opportunities for expanding one’s expertise have been further enhanced. In addition, the long sound tradition of medical training of Maltese medical practitioners has been utilized to establish a postgraduate training centre.