Among the many contributions of the Order of St. John to Malta was the provision of excellent medical services to the local population, particularly through the Knights’ hospital in Valletta, known as the Sacra Infermeria. Opened in the 1570s, it would go on to become one of the foremost hospitals of the period in Europe, taking in male patients of every class, and irrespective of their nationality or faith. After all, despite their later military successes, the Knights of St. John had originated as a hospitaller organisation, whose main purpose was the care of the sick and wounded, and the relief of the poor.
Typical of a Renaissance hospital, the Sacra Infermeria also received babies born out of wedlock and unwanted infants. Apart from the prevalence of venereal disease in Hospitaller Malta, which was at least partly caused by the high number of prostitutes operating in the harbour area, another inevitable result of this activity was a large number of illegitimate children, who, often considered an inconvenience, tended to be abandoned to the care of the state or church authorities, although there is no doubt that poverty, and the resulting inability to raise such children, surely also often played a part in this decision.
The custom of opening institutional foundling homes and orphanages in Europe seems to go back to medieval times and was inspired by religious values. In 1198, for example, Pope Innocent III decreed the establishment of church-sponsored foundling homes in Rome, to counter the common occurrence of unwanted infants being thrown into the river Tiber. Such institutions had become more common by the late 14th century, often administered by civic governments, confraternities, and guilds.
While many abandoned children were illegitimate, poor economic conditions also led to the abandonment of legitimate children by parents who were unable to provide for them, especially single mothers - often servants, slaves, or prostitutes - who lacked the financial resources to raise a child on their own. In some cases, parents might even have decided that giving up a child would ensure a better future for their older siblings. Thus, leaving them at a foundling hospital that could offer the infants shelter and education would be seen as an ideal option: Florence’s famous Ospedale degli Innocenti took in no less than 375,000 children between the 15th and 20th centuries.
Care of Foundlings in Malta
In Malta, formal provisions to care for unwanted babies and foundlings were introduced during the late Medieval period, when the Mdina Universita' established a system for the reception and care of such children at the Santo Spirito hospital in Rabat. Records show that in 1518, the hospital employed two wet nurses, which by 1554 had increased to 13. About eight foundlings were received annually.
With the arrival of the Knights of St. John, foundling care services were augmented at the Birgu Sacra Infermeria, and later at the Valletta hospital when the Knights transferred to the new city. Indeed, these services continued to be offered right up to the end of the 18th century. The overall out-of-wedlock baptismal rate in Malta between 1750 and 1800 was 5.1%, while in the 12-month period from 1787 to 1788, there were 212 admissions of infants to such institutions.
Although in many cases, abandoned babies were often left on the steps of a church, so that they could easily be found and delivered to the church’s care, with time, different methods started to be introduced to facilitate the process and ensure secrecy, but primarily to safeguard the health of the new-born baby. Probably the most well-known of these methods was the “ruota degli esposti” - a rotating wheel, installed to remain half inside the building and half outside on the road. A woman on the inside, alerted by a crying baby or the ringing of a bell, would turn the wheel, bringing the baby inside, where it could be cared for while the mother slipped away without being seen.
A similar contraption was to be found at the rear of the Valletta Sacra Infermeria, close to the Falanga block, enabling local mothers to leave their children to the care of the authorities without revealing their own identity. The English philanthropist John Howard, who saw this contraption with his own eyes on a visit to the hospital in 1786, claimed that the Latin words “infantium incolumitati” were inscribed on a nearby wall - a reminder of the noble intentions behind the provision of these services.
At the Infirmary, the Ospedaliera had the duty of caring for the foundlings as soon as they were removed from the “ruota”. A lead counter bearing the seal of the Holy Infirmary and placed around the neck of each foundling helped identify the baby from the rest. The Ospedaliera was also charged with the supervision of the wet nurses and foster mothers, as well as to inspect the babies every Easter to make sure that they were being well-fed and looked after. She was assisted in her job by the Sotto-Ospedaliera.
The wet nurses resided in the part of the hospital known as the Casa dei Figlioli e Figliole and were thus available at all times to breastfeed the babies, although in the event that there were too many foundlings, and it became impossible for these wet nurses to cope with them, goat's milk was also used. Before being employed at the Sacra Infermeria, the wet nurses were examined by hospital physicians to ensure that they were free of disease, and they were constantly supervised by the Ospedaliera to make sure that they were not failing in their duties. By 1779, it was also customary for the Infirmary to provide breastfeeding services to the legitimate offspring of mothers who suffered from insufficiency of their breast milk.
In addition to the hospital staff, by 1574 it was also customary to engage foster mothers, or extra-mural wet nurses. These women, who were required to be honest Christians and persons of integrity, were appointed by the Infirmarian, and were required to periodically bring the infants back to the hospital for inspection by the Grand Hospitaller.
Some of the babies taken in by the hospital would eventually be given up for adoption, but those for whom a new home could not be found were brought up by the Ospedaliera in the hospital building until they reached the required age to be transferred to other institutions. Girls were usually sent to stay with the cloistered nuns in Mdina as soon as they turned three years old, and remained at the convent until they reached ‘the age of marriage’. Boys, on the other hand, stayed on at the Sacra Infermeria until they turned seven, when they would be apprenticed to learn a trade of their choice. The Treasury of the Order met all expenses in both cases.
Clearly, this subject was considered as a very important part of the charitable work of the Order of St. John. It is true that critics of the system might have claimed that it facilitated, and possibly encouraged, the abandonment of children, but as far as the authorities were concerned, it also after all surely reduced the rate of infanticide, whilst also saving the souls of babies who would otherwise have died without receiving baptism.
The latest development in the long history of the Sacra Infermeria came only last year, when a new virtual museum, titled ‘Reliving The Sacra Infermeria’, was inaugurated. The idea of a virtual museum, which brings together history and technology, was brought about by the need to satisfy visitors’ curiosity about the building’s former history without interrupting ongoing conferences or theatre performances that are regularly held here. Now, by downloading a mobile application that makes use of augmented reality, one can once more relive the building’s former days as a hospital.
Re-Living the Sacra Infermeria is a project co-financed through the European Regional Development Fund.
Cassar, P. (1983). From The Holy Infirmary of the Knights of St John to the Mediterranean Congress Centre. Malta
Cassar, P. (1978). Female Employees in the Medical Services of the Order of St. John in Malta. Melita Historica, 7(3), 225-233.
Savona-Ventura, C. (2016). Social Services for Unwed Mothers and their Children. Malta