Giovanni Bonello

V isitors to Malta who recorded their experiences of the island during the rule by the Order (1530 – 1798) may not have agreed about everything. But on one view they appear unanimous: the outstanding excellence of the main hospital of the knights of St John. Very likely, the most important and advanced hospital in Europe. What distinguished the Order of Malta from other chivalric institutions existing in Europe was its hospitaller character and mission. By the fourteenth century the other knightly Orders had mostly turned into vanity institutions that responded to a purely military vocation: to provide aristocratic militias to defend the Christian faith from the might of the Infidels. The Templars, the Teutonic Order, that of Calatrava, and, later, the Orders of the Golden Fleece, of St Stephen, of the Holy Spirit and several others fell in these categories. The knights of St John, on the other hand, added a unique, rming dimension to their mission: the care of the sick and the infirm.

their commanderies in Europe they established clinics, dispensaries and nursing homes for the malades. In Malta they had free hospitals running in Birgu from the very beginning, managed and financed by the Order and manned by local and foreign physicians and surgeons. The popular Maltese word for health centre, Berġa, comes from the public clinic in the Italian auberge, l’albergia d’Italia in Birgu. Probably the very first public building constructed in the new city of Valletta after the Great Siege was the Sacra Infermeria complex, today the Mediterranean Conference Centre. The seven national ‘langues’ in which the Order subdivided took it in turn to provide nursing personnel. Each day of the week a different langue sent its younger knights to tend and serve the patients in the infermeria. Hospital duty once a week remained one of the incumbencies no knight in Malta escaped. Through their nursing and religious training, the knights saw the sick patient as “their Lord and Master”.

n 1582, seven years after the building of the Infirmary, Giovanni Battista Leoni had seen it as a macchina meravigliosa and superlative ornament of the new city. The anonymous Nouvelle Relation of 1679 called it “one of the most beautiful in the world”.1 An English traveller would not be outdone “The very glory of Malta” he called it in 1739.2

Earlier, another Englishman had described the Infermeria thus: “The hospital is a vaste structure, wherein the sick and wounded lye. This so broade that twelve men may with ease walke abreast up the misdst of it, and the beddes are on each side, standing on four yron pillars, with white curtains and vallands and covering, extremely neate and kept cleane and sweete; the sick served all in sylver plate; and it contains above 300 beddes below, besides many spacious roomes in other quadrangles with it, for the chiefe Cavaliers and Knights with pleasant walks and gardens and a stately house for the chiefe doctor and other his attendants”.3

“This asylum, noted a historian, is constantly open for the reception of the sick of all countries who are treated with every possible attention and furnished with medicines and comforts of every kind. The utensils used are almost all silver”.4

A good overview of the Sacra Infermeria in its “splendid” heyday is provided by Elizabeth Schermerhorn: “Separate wards for surgical and medical cases, fever and dysentery patients isolated; ample accommodation for convalescents; a special guardian and ward for the insane (whom the cruel superstition of that day generally condemned to confinement in prisons); the luxury of single beds at a time when in most hospitals the sick lay two or three to a bed; and higher standards of comfort and cleanliness than could be found in any of the large hospitals of Europe; these were some of the points of excellence in which the Hospitallers claimed pre-eminence, quite as jealously as on the sea. They had been pioneers in hospital nursing; they had been the first to extend their ministrations irrespective of creed or nationality; the fame of their Sacred Infirmary attracted strangers to Malta, not only to study its organization and methods but to profit by them – to be nursed by knights of sixteen quarterings, and to be fed off silver”.5

I have reproduced but a few of the glowing testimonials left by those who observed closely the Malta scene: they admired the building, the medical services and treatments provided, the sumptuousness (only solid silver plates, vessels and cutlery were good enough for the patients’ meals); the fact that it was one of the very few hospitals in Europe where patients lay one to a bed; that the sons of the finest nobility in Europe attended the patients; that the hospital only employed the most highly trained physicians and surgeons, the fact that everything was extremely clean and perfumed and that the Order never skimped on nourishment and medicaments. All this went to make the Infermeria the most advanced hospital in Europe.

This positive image persisted for most of the Order’s rule over Malta. Additions to the structures and improvement to the management continuously featured on the books. But towards the end of the era of the knights, the rot started setting in. There was widespread moral decadence, there was a blurring of ideals and loss of faith, there was an erosion of the very raison d’etre of the chivalric and hospitaller Order. To compound the oppressive sense of futility and anachronism, the French revolution virtually bankrupted the finances of the Order which before had always been investing massively in the hospital. All this, cumulatively, reflected on the rather abrupt decline of the Infermeria and of anything connected with it.

The evidence of this dramatic deterioration is to be found mainly in two records, both detailed, both conceived with an agenda, but overall, credible.

The first comes from a British philanthropist and reformer who visited Malta between March and April 1786. John Howard (1726 – 1790) toured various hospitals, prisons and plague lazarettos in Europe and left a detailed report on each.6 His account of what he saw in Malta was anything but flattering.

In the long ward of the Infermeria, the ceiling had turned black “the walls hung round with dusty pictures, this noble hall makes but a gloomy appearance”. All the halls were “so dirty and offensive as to create the necessity of perfuming them”. The physician, while doing the rounds, was obliged to press a handkerchief to his face. This struck him even more forcibly when he opened some “private closets” next to each bed. The large ward at basement level “is nothing but a dark and damp arched cellar”. The physician on duty does not visit it. The kitchen of the hospital “is darker and more offensive than even the lower hall, which it adjoins”. Food is served from dirty kettles into silver bowls for the higher class patients, and into pewter ones for the poorer inmates.

There were about 520 patients when Howard visited “served by the most dirty, ragged, unfeeling and inhuman persons I ever saw. I once found eight or nine of them highly entertained with a delirious dying patient”. Many of the nurses were debtors or criminals who had taken refuge in the hospital to escape justice as the building enjoyed criminal immunity. Howard noticed that only 22 nurses had to cope with all the hospital, while there were 40 grooms to take care of the 50 horses and mules of the Grand Master, whose stables were noticeably clean. Running water flowed in the stables, but not in the hospital.

The women’s hospital, close by, was no better “a more offensive and dirty hospital for women I never visited”.

Shortly later, another source confirms all this, in even more lurid detail. The publication of the two volumes of ‘Carasi’s’ L’Ordre de Malthe dévoilé, printed in Lyons in 1790 and in German translation in Leipzig in 1793, had only one motivation driving it: to discredit and destroy the autocratic and aristocratic Order of Malta after the assertion of enlightened and democratic government thought to be a natural consequence of the French Revolution. All the two books say is coloured by massive bias, weighted by resentment, ridicule and hate. It is still uncertain who the author or authors were, though a Masonic Lodge in Marseilles has been credibly, if not compellingly, suggested as its promoter and publisher, to disseminate the ideals of the Revolution.7 All it says about the political state of Malta, its government and its institutions is to be taken with a pinch of salt. But, saving some obvious exaggerations in style and message, everything Carasi writes that the autho could double check against other sources, proved surprisingly accurate in substance. This is, in translation, the desolating picture it paints of the once-splendid Sacra Infermeria.

The first impact the hospital made on Carasi was highly negative. From the building’s basement he could only hear the clinking of chains. He thought to be near a prison, only to discover it was a hospital. Inside, how scruffily dressed the nursing attendants were struck him instantly.

Carasi approached a patient in bed and asked about his condition. “The patient complains about the inhumanity of the physicians, the bad treatment of the attendants, the bad meals and the negligence of the commander on duty. Since such complaints come from many patients in many European hospitals, one is not too surprised to hear them here as well. But still it is strange to hear them in Malta as the hospital of the knights is famous and praised all over Europe for its unique service, its rich equipment and its perfect service”.

In the basement he asked the first patient he encountered why he was chained in iron. “I am chained because I complained against an attendant. I was accused by this attendant to have ordered tobacco not through him but through his comrade. Before, I had been in the big hall upstairs, but then I was transferred down here, together with vagabonds, slaves and galley rowers. I wanted to speak to the commander of the hospital, but he did not even look at me”. The patient in the bed opposite had a bad fever and had been in a different hall before. Then, suffering one of his fever attacks, he stood up and walked around. “Immediately the attendants jumped on him and gave him some lashes with the whip, hit him until he could not walk anymore and brought him down here. Then they chained his feet and arms to his bed. In every other place where an attendant would have behaved like that to his patients, he would be punished severely and instantly dismissed from his service. But over here mercy and mildness towards the sick is unknown”.

Carasi then mentions his own experience as a patient at the Infermeria. He spent eight days there following an attack of fever. A physician came to bleed him, put a bandage round his arm and ordered a boy between eight and ten year old to cut him with a lancet. In fear and anger Carasi complained loudly. The hospital commander happened to be passing by and asked what was going on. He told him that the doctor was using him to teach the boy medicine. The commander ordered the doctor to perform the bleeding himself: “the physician now took the lancet and stuck it much deeper than was necessary. He complained again loudly to the commander who just turned his back and walked out. The patient shouted at the physician in anger and pain, but the latter calmly and cold-bloodedly bandaged his arm and left without uttering a word”.

They did not skimp on medicines – in fact Carasi received a lot; “what was lacking was attentive service and good food.” The doctors only visited the patient in the morning. If after that the patient suffers an attack or becomes paralysed, he has to wait until the next visit in the evening. The food served was minimal “it is a fact that here in the hospital of Malta almost the same number of patients die from bad nutrition as die from diseases”.

The evening before his release, a patient in a neighbouring bed was caught adding some salt to his soup. The bowl was snatched from his hands and he was chained to his bed, and carried downstairs to the confinement hall. The same treatment is reserved for anyone who questions the treatment given or when the medicine did not result in a cure. “Sometimes these attendants – or should one say, hangman’s assistants – go so far with their barbaric behaviour as to give the patients the bastinado”.

The main hall where Carasi lay was the one where the patients received the best treatment: “one can imagine the situation in the other halls and rooms”. Then Carasi puts in some comments on Maltese doctors: “To this bad treatment of the sick, one has to add the ignorance and incompetence of the physicians. It is just enough to listen to their comments to know that they have no idea of their profession. Young Maltese who have served two or three years in the hospitals of Marseilles return to their native country with empty heads but full of pride and arrogance. Many of these young local medics and physicians do not even make the effort to go abroad, but just stay at home and repeat the mistakes and errors of their superiors.” Carasi characterised the Sacra Infermeria as “a place of pain, of chains and of tombs”.8

So fade the glories of the world.

References

1. Nouvelle Relation du voyage, Paris, 1679, p.125. 2. Edward Brown, The travels and Adventures of London, 1739, p.176. 3. The Diary of Henry Teonge, August 2, 1657, Harper, 1927, p.59. 4. Louis de Boisgelin, Ancient and Modern Malta, London, 1805, Vol 1, p.38-9. 5. Elizabeth W. Scermerhorn, Malta of the Knights, Hienemann, 1924, p.193. 6. John Howard, An Account of the Principal Lazzarettos in Europe, London 1789, p.58-61. 7. Alain Blondy «Un pamphlet scandaleux» in Melita Historica, 1992, XI, 1, p.59-76. 8. Carasi, translated by Thomas Freller as The Order of Malta Exposed, Malta 2010, p. 144-9. Original Fench edition, 1790, Vol. 2, p.100-9.