Tuesday, 2 September 2014

Holy Infirmary, Valleta

In 1571 the Knights of St John transferred their Convent (headquarters and seat of government) from Birgu (Vittoriosa) across the Grand Harbour, to the new city of Valletta. At the General Chapter of the Order held on 7th November 1574, during the magistry of Fra' Jean de la Cassiere (1572-82), the decision was taken to build a new conventual hospital, 'in order to provide a house or the needs of the sick who up to the present have been uncomfortably cared for at the infirmary at Birgu.'  The site chosen for the new hospital was a prominent position at the south-eastern side of Valletta, above the St Lazurus Curtain, near the entrance to the Grand Harbour.

The new hospital, which would be known as the Sacra Infermeria (Holy Infirmary), was built around a courtyard,  like the Order's great hospital at Rhodes. This building was later referred to as the Lower Courtyard or Cortile di basso. The two main wards were built at right angles, the one fronting St Lazarus Curtain was in later years known as the Old Ward or Sala vecchia, the other retained the name of Small Ward or Saletta throughout the existence of the hospital. On the other two sides of the quadrangle were a series of small rooms on two floors. The main entrance was on the North Street facade of the Old Ward, facing the esplanade of Fort St Elmo. The scale and ambition of the new hospital, and the prominence of its position  near the entrance of the Grand Harbour reflected the scared duty of caring for the sick that was at the heart of the Order of St John's identity, the duty that gave the Order its original name and which remained fundamental to the Order's  vocation.


The work and direction of the Holy Infirmary expanded greatly during the rule of Grand Master Fra' Hughes de Loubenx Verdale (1582-95). From this time on the hospital also oversaw the charitable activities of the Order; the house of unwanted infants, the hospital for women, and the refuge for prostitutes, as well as treatment outside the hospital for less serious diseases, and for poor law relief for the Maltese and the Rhodians who had followed the Knights. The hospital at Birgu (Vittoriosa) had not catered to pilgrims, few of whom passed through Malta, or or the Maltese population who had their own  hospital at Rabat. So the work of the conventual hospital at Valletta was a significant departure from the hospital at Rhodes, which had not served the Greek population.

On 4th February 1660 a decision was taken by the Order of St John to enlarge the hospital, the first stone being laid by Grand Master Fra' Raphael Cotoner (1660-63). The expansion was completed by 1666, under the rule of his brother Fra' Nicholas Cotoner (1663-1680). The Old Ward was extended in the direction of Old Hospital Street, the new extension being known as the Great Ward or Sala Grande. The join between the old and the new wards was marked by two altars placed back to back in the area where the Saletta joined the two wards at right angles. The Old Ward and the Great Ward from then on formed one continuous hall, later referred to as the Long Ward.

 At 155 metres in length, 10.5 metres in width and over 11 metres in height the Long Ward was at that time one of the largest and most impressive interiors in all of Europe. This magnificent room has a wooden coffered ceiling and its floor was paved with stone slabs. Along the walls are niches which served as latrines for the patients. Those in the Old Ward have rectangular recesses in the sides which seem seem to have been used as cupboards. The windows along the top of the wall adjoining St Lazarus Curtain provided light and air. At the far end of the hall, immediately below the ceiling are the coats-of -arms of the Order of St John and of Grand Master Fra' Gregorio Caraffa (1680-90).


In winter, the walls of the Long Ward were hung with tapestries and the beds were draped with curtains. In summer the curtains were replaced by mosquito nets and the tapestries were replaced by a series of paintings by Mattia Preti (1613-99), depicting scenes in the history of the Order of St John.( By 1881 only one of these painting had survived, illustrating Grand Master Pierre d'Aubusson in the act of venerating the Relic of the right hand of St John the Baptist. This canvas hung at the back of the hall).

It is recorded that there were 85 paintings hanging in the Holy Infirmary, including the altarpieces of the various wards.All of the larger wards were provided with an altar for the spiritual comfort patients. The altar in the Great Ward was dedicated to the Holy Trinity, that of the New Ward to Our Lady of Mount Carmel and of the Ward for the Wounded to Saints Cosmas and Damian. Other wards had altars dedicated to St. Joseph, the Finding of the Cross and St. John the Baptist.

 The number of beds in the hospital varied over the years. In 1787 its complement of beds was 563, which could be increased to 914 in an emergency, by placing 351 extra beds in the corsie or free middle space along the length of the six largest wards.  These beds were for single occupancy, in an era when many hospitals imposed a regime of bed-sharing. The Great Ward had 64 beds for the use of  patients with a fever, the acute cases being ranged on one side and the chronic cases on the other. The Old Ward had 22 beds for the treatment of civilians, members of religious communities and pilgrims with medical illnesses. The Saletta or Small Ward had 20 beds for the terminally ill. No women were allowed to enter this ward, not even close relatives of the patients.

Under the length of the Long Ward, beneath ground level runs the Sala Magazzeno Grande or Great Magazine Ward. This ward has an exquisite cross vaulted ceiling and heraldic bosses at the centre points where the groin meets the top.These bosses show in relief the Lion Rampant of Grand Master Fra' Jean de la Cassiere and the Cotton Plant of the Grand Masters Raphael and Nicolas Cotoner alternating with bosses of the Cross of the Order. The Great Magazine Ward is reached by the gradual slope of a grand balustrated staircase that descends in two flights from near the northern end of the Long Ward. The Great Magazine Ward had 109 beds for the use of sick galley slaves, for invalid sailors and soldiers from the Order's land and sea forces,and also for a few disabled men "who deserved well of the Order" and a small number of shipyard workers.


At the back of the Great Ward but not communicating with it was a block known as the Falanga which was built c1596 and enlarged in 1636 that had 120 beds. This ward was meant for the reception of patients with contagious and venereal diseases. The section reserved for the treatment of syphilis was made up of two sections, the Stufa (stove) and Falanga proper. The Stufa was a basement room containing the stove that heated the rooms above.Three rooms on ground level were where patients received hot water baths and on the first floor where the patients were taken to rest after the hot air treatment. The Falanga proper had five rooms for patients receiving mercury treatment for the same disease.

The Sacra Infermeria had other specialized wards, in advance of the normal practice at the time. The Sala per i Feriti or Ward for the Wounded  had beds for 29 civilian surgical cases. The Sala Nuova or New Ward had 21 beds for patients suffering from dysentery. The Sala di San Giuseppe or St Joseph's Ward had 20 beds for sick convicts.There were two Lithonomy Wards for patients operated on for the removal of bladder stones. The Sal dei Cavalieri of Knights' Ward had 19 beds for members of the Order of St John suffering with medical ailments. The Palombara (Dovecot) consisted of a number of small rooms wit 29 beds for contagious diseases like tuberculosis and ringworm. Two wards with 19 beds for members of the Order with surgical complaints and two rooms with 10 beds for civilian surgical cases.

One room with 18 beds was reserved for the mentally sick. In 1779 it was recommended that they be transferred to a magazine that had up to then been used for the storage of wood, as these individuals were a source of disturbance to other patients. The basement magazine had windows that opened onto Wells Street at the back of the Infirmary. Passers by used to stop and taunt the inmates and goad them into reaction. This part of Wells Street became known as the "Street of Lunatics."

In May 1679 a further room was added for the reception of patients suffering from contagious diseases and in 1687 a hall was built to house the hospital library. At the rear of the hospital close to the Falanga block was the Routa (wheel). This was a room containing a cot revolving on a vertical axis. The room communicated with the street outside by means of an aperture in the wall.Through this opening babies born out of wedlock or unwanted infants, referred to as eposti and bastardi were deposited to be take care of the the Infirmary staff. The whole apparatus was contrived to protect the identity of the person depositing the  unwanted infant.

Further enlargement of the Holy Infirmary was carried out in 1712, during the rule of Grand Master Fra' Ramon Perellos y Roccafull. These additions comprised the Upper Quadrangle bounded by Hospital, North and Merchants Streets with the main entrance or Porta principale opening onto Merchants Street. The courtyard was surrounded by the pharmacy, its laboratory and residential quarters for the medical staff and lay administrative officials. This became known as the New Hospital or Infermeria Nuova. In the centre of the Upper Quadrangle was a stone fountain decorated with the escutcheon of Perrelos y Roccafull that supplied water to the kitchen, pharmacy and the laboratory.

The supreme head of the Infirmary was the Grand Master. He visited the hospital every Friday "in procession", where on arrival he donned an apron to serve the sick and distribute food and medicines to the poor gathered in the courtyard. Ceremonial visits of the whole Convent in procession took place on Feast Days and on Maunday Thursday and on the Sundays between Easter and Ascension, when the Grand Master and other high dignitaries of the order laid aside their symbols of rank as they entered the Infirmary to attend Mass in the Great Ward. Every evening after Vespers, the priest and the clerici also came in procession to the "palace of the sick" to recite the ancient prayer which dated back to at least the time when the Order was at Acre:

       Seigneurs Malades, pries pour pais que Dieu la mande de ceil 
           en terre.
       Seigneurs Malades, pries pour le fruit de la terre que Dieu le multiplie en
          telle maniere que saincte eglise en soit servie et le peuple soustenu.
       Seigneurs Malades, pries pour l'apostell de Rome et pour les
          cardennaus et pour les patriaches et pour les arcevesques et
          pour les evesques et les prelats,-

and for the king of France, and of Germany, and of England and the King of Cyprus and of Jerusalem - that "God may give them peace and the will to conquer the Holy Land." The 'Lords the Sick' were also asked to pray for all pilgrims and for all Christians travelling by sea, that God would conduct them all in safety; and for all Christians who had fallen into the hands of the Saracens, and for all those who had given alms to the Hospital; and for the souls of their own  mothers and fathers, and for their benefactors; and finally, begging that the good God would give them peace, the petition closing with the Pater Noster.

The Great Ward of the Hospital
From the 1584 Edition of the Statutes

The official head of the Infirmary was the Grand Hospitaller, Pilier of the Langue of France. This position was one of the highest dignities in the Order of St John. The French knights were so jealous of this privilege that they "acknowledged no superior authority but that of the Grand Hospitaller", who alone was permitted to enter the infirmary without leaving at the door the insignia of his office, a requirement to which all others, of no matter what rank were required to submit. Not even the Inquisitor was permitted to set foot within the Infirmary without prior permission.

Fra' Joseph de Limerie Des Choisy
Grand Hospitaller 1729
(St Johns Church, Clerkenwell)

It was the prerogative of the Grand Hospitaller to appoint the Infirmirian who was the senior knight responsible for the day to day administration of the hospital. The Infirmirian had an apartment on the upper floor of the Infiremeria Nuova emblazoned with the coats of arms of eighteen Infirmerians who had governed the hospital from 1681-1765. These armorial bearings ran in a frieze beneath the ceiling around the wall of the apartment. The Infirmerian was a professed knight who like the Grand Hospitaller belonged to the French Langue. He had the dinner and supper bells rung to summon all the officials who ensured that the food was properly served to the patients and that the beds were clean and comfortable.

The Holy Infirmary was professionally staffed by well qualified and experienced medical and surgically trained staff, who had often studied abroad in Italy, and in France. Regulations drawn up in the 17th century stipulated that three doctors and one surgeon must sleep in the Hospital every night. By 1725 the  professional staff consisted of three resident senior physicians, three resident junior physicians, three resident surgeons, two junior surgeons (practtici) six barber-surgeons (barberotti) and a phlebotomist for blood-letting who was helped by two assistants for the application of leeches, cataplasms and blisters. The principal surgeons and physicians served in teams in the hospital for a month at a time, overlapping with their successors for three days. They visited the wards daily and recorded on a tablet, which hung at the head of each bed, the food and remedies prescribed. A general consultation was obligatory once a week for all doctors and their salary was docked if they failed to attend it. A medical school was opened by the Jesuits in 1595, and  in 1676 the Holy Infirmary became a teaching hospital, with its own School of Anatomy and Surgery, established by Grand Master Nicholas Cotoner. Nursing was carried out by fourteen so-called servants or guardians (servi or guardi). Forty-four baptized slaves and Turks selected from the slave prison were forced to do the cleaning, washing and all the other menial work..

The distribution and serving of food to the sick at meal times was the duty of the novice knights. Service in the hospital was obligatory once a week for all novices at the Convent with members of each Langue having  a day of the week in which they were on duty. At the stroke of the big bell of St John's each morning the knights on duty processed to the hospital. The Langue of Provence was on duty on Sundays, Auvergne on Monday, France on Tuesday, Italy on Wednesday, Aragon on Thursday, Germany on Friday and Castille on Saturday. While there were knights who voluntarily  nursed the sick, the regular visits were confined to feeding the patients. A small table, covered with a cloth and with water and salt upon it was placed beside each bed. The food was brought into the middle of the ward where an official read out the name of each patient and the diet he had been ordered, which was then carried to the bedside by a knight. Great emphasis was placed on the importance of a proper diet in the care of the sick. Rice, vermicelli, herbs and chicken were provided for the very ill, while the stronger patients were offered meat.pigeon, game sausage and potatoes.

The knights and civilians were provided with silver soup bowls, cups, spoons, and plates, however the slaves and convicts were only given pewter utensils. The silver was provided to the Infirmary at various periods by the Langues of France, Italy and Aragon and also the Common Treasury. When the Order was still at Rhodes, the Arangonese knight Fra' Giovanni de Villaragut, Castellan of Amposta, had endowed the Infirmary with a yearly sum of money to meet the comfort of the sick including the provision of silver plate. It is for this reason that the crest of the Commandery of Villaragut was chosen in 1684 to mark the Holy Infirmary silver to facilitate its identification and safeguard against theft. By 1725 the Holy Infirmary possessed 1150 pieces of table silver but in 1795 owing to the financial predicament of the Order at that time part of this plate had been sold.

Reporting to the Infirmirian, were two knights called Prud Hommes or Comptrollers who were in charge of the expenditure of the hospital. They also distributed alms, soup and old linen to the poor and supervised the management of the hot baths and mercurial anointing. The Prud Hommes  had their own secretar(scrivano), who noted everything that concerned their work in separate books. They supervised the work of the  linciere who was a secular, in charge of the linen, furniture, laundry and hospital equipment, making sure that everything was properly maintained and repaired. A steward or butler (bottigliere)was in charge of  the wine bread and oil etc which was supplied to the patients according to the vouchers of the comptrollers. An under clerk noted the food prescribed by the doctors and handed the list to the comptrollers. The armourer (armoriere)  was usually a servant-at-arms who was responsible for looking after the cleanliness and security of the silver plate. Two cooks, a purveyor and assistants provided meat for the allowances, which they could not receive in the kitchen until inspected by the comptrollers.

Following the capture of the Malta by Napoleon in 1798 and the expulsion of the Order of St John, the Holy Infirmary was taken over by the French for their sick soldiers and sailors. When the French left Malta two years later the former Holy Infirmary remained in use by the British garrison until 1920, when a new hospital was built at Mtarfa. The old hospital was then turned into the headquarters of the Malta police. At the outbreak of World War 2 in 1939 the police evacuated the building which was hit and severely damaged by the aerial bombardment. Of the great complex of hospital buildings, only the Great Ward, the oldest part of the Holy Infirmary survived. It is used today as The Mediterranean Conference Centre.

www.mcc.com.mt/