|Censu Tabone FRCSEd|
Malta’s pioneering ophthalmologist, politician and statesman, remembered by his grandson, Dr Paul Cauchi
On 17 March 2012, I attended the state funeral for my grandfather in Malta. He was less than two weeks away from his 99th birthday. It made me wonder why hundreds of people had turned out to attend this event and why he meant so much to the people of
Censu Tabone was born on the small
I remember asking him why he had chosen ophthalmology. His answer was simple: “because of trachoma”. Trachoma in the 1930s, 40s and 50s was endemic, especially amongst children. Its incidence in school age children in Gozo was 17.8%. The only treatment was surgical and involved removal of sub tarsal follicles by many types of instruments. He knew instinctively that this treatment was ineffective and was causing more harm than good. I remember him showing me a sort of cylindrical eyelid clamp with a rough inner surface that was used to scour the tarsal conjunctiva in a vain attempt to remove the disease. He described it as “an instrument of torture”.
Tabone’s early career was shaped by the outbreak of the Second World War during which he served as a Medical Officer. He was stationed at
The other important event that occurred during the war was his marriage to Maria Wirth whom he had met in Marsalforn, Gozo. Maria was the rock on which he built his career. She gave him the enduring support and love that provided him with the confidence to achieve his goals. I have no doubt that without Maria he would not have had the success he enjoyed.
After the war, the opportunity arose for him to travel to
On his appointment as Consultant in Malta he was one of only two ophthalmologists on the island. He enjoyed every aspect of ophthalmology, from prescribing glasses to complex operations like retinal detachment repairs and fascia lata brow suspensions for congenital ptosis. Cataract surgery was with the large Graefe corneal sections and the use of the cryophake. Most of his operations were done under local anaesthetic and he often had to shout at patients to keep their heads still!
He enjoyed squint surgery and used to light-heartedly say that it was the best advertisement for any ophthalmic private practice. Undoubtedly, he enjoyed the human contact with patients and used his charisma to instil great confidence in them. He often did not charge poorer patients, especially in Gozo. They would often pay with a dozen eggs, live rabbits or even local cheese!
“I remember asking him why he had chosen ophthalmology. His answer was simple: ‘because of trachoma’”
In 1948, he was entrusted with running an anti-trachoma campaign in Gozo. This was Tabone’s moment to prove his unshakeable conviction that this condition could be cured. This period saw the introduction of many antibiotics in medical practice. Although trachoma was classified as a virus for many years, Tabone had tried sulfa drops on some patients with great success. This spurred him on to try it more widely. Sulphonamides had been used by others previously such as Fred Loe in the
This campaign played to Tabone’s strengths. He understood the Gozitan population and knew what had to be done to provide complete coverage and compliance. His consummate skills as a politician, clinician and leader engaged local politicians and schools to allow him to run the campaign. The population of Gozo was 28,000. He targeted school children and their immediate contacts.
4,058 school children were examined, of which 721 had trachoma. 926 contacts also had trachoma. After 13 months of treatment, only 117 children still had trachoma. Only 6 cases of trachoma in school-aged children remained after a further 9 months. He presented his results to the International Congress of Ophthalmology in London in 1950. He did not get a good reception and the experts felt that his success was mainly due to the treatment of secondary infections. He was upset by this but was delighted to be proven right by the passage of time. The results were published in the BMJ in 1951 and led to an invitation to join the Expert Committee on Trachoma by The World Health Organization (WHO).
My grandfather travelled extensively with the WHO, imparting his experience and knowledge on how to run national campaigns to eradicate trachoma. He visited Taiwan many times and during one of his later visits, a doctor embraced him with tears in his eyes as he could not find a single case of trachoma to show to his students. Tabone was very proud of his achievements in the fight against trachoma and unfortunately did not live to see its complete eradication which has now become a realistic goal.
His first foray into politics came as the founder and first President of the Medical Officers Union of Malta, which protested against low pay. He was a natural politician and anyone who knew him realised the power he had to motivate and engage people to a common cause. He relished a fight if it was for a cause worth fighting for. He ran for a seat in parliament in 1962 and lost. He would have to wait till 1966 to be elected to parliament and at the age of 53 came late to this new chapter in his life. He immediately became a minister and served as Minister of Labour and Social Welfare.
In 1971, the Labour Party was elected to government with his Nationalist Party remaining in opposition for 16 years. There was a bitter political divide in
My grandfather was a family man and a devout Roman Catholic. The strength of his relationship with his wife Maria and the devotion they showed to their children remains an enduring example. They had nine children, one of whom died soon after childbirth but was never forgotten. There followed 19 grandchildren and 28 great-grandchildren. He was sad that none of his sons went into the medical profession (he did not think it was a career for a woman), but was delighted that three of his grandchildren became doctors. I was very fortunate to follow him in his specialty of ophthalmology and enjoyed many conversations about how things have changed over the years. I remember showing him a video of one of my cataract extractions using a modern phacoemulsification ultrasound probe followed by implantation of a foldable intraocular lens through a 3mm corneal incision. He just stared at the screen in disbelief at what he was seeing!
As I watched my grandfather’s coffin being carried towards a hearse in the strong spring sunshine, I realised we were just a stone’s throw from his old consulting rooms in Floriana where he saw so many of his patients. The state funeral was an appropriate tribute to a man who fitted so much into his 98 years. The reason he meant so much to the people of his beloved country was that he showed the human side of a truly great man who lived to serve.
Dr Paul Cauchi
Consultant Ophthalmologist, Southern and Gartnavel General Hospitals, Glasgow