Whilst it is a well-known fact that during the time of the Order of St. John in Malta, the management and administration of its hospital - known as the Sacra Infermeria - was almost entirely male-dominated, as indeed was practically every other sector, it is also true that in those cases where the sick were women, female employees also played a prominent role in the medical scene. This was seen for instance in the running of the women's hospital, as well as in the state-funded care of abandoned infants. During the 18th century, some women were also trained as barber-surgeons, specifically to treat female patients: in 1765, Bali Sigismondo Piccolomini proposed the idea of training female barberotti. Thus we find that in 1772, a young woman was sent at the Order’s expense to study surgery in Florence, while a certain Teresa De Lucca was given the licence to practice as a barberotta at Nadur, Gozo, on 8th July 1782. Women were however mainly employed in three branches of the medical services.
Typical of a Renaissance hospital, the Sacra Infermeria also received unwanted infants. At the rear of the hospital building, a contraption known as the 'ruota' enabled mothers to leave their children to the care of the authorities without revealing their own identity. This consisted of a rotating wheel, installed to remain half inside the building and half outside on the road. Alerted by a crying baby or the ringing of a bell, hospital staff would turn the wheel, bringing the baby inside, where it could be cared for while the mother slipped away unseen. The Ospedaliera had the duty of caring for the foundlings as soon as they were removed from the 'ruota'. She was also charged with the supervision of the wet nurses and foster mothers, as well as inspecting 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, known as Balie della Casa, resided at the hospital 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 Sacra Infermeria to provide breastfeeding services to the legitimate offspring of mothers who suffered from insufficiency of their breast milk. In addition, by 1574 it had also become customary to engage foster mothers or extra-mural wet nurses known as Balie di Fuori. 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.
Casetta delle Donne
Despite the excellent medical services provided at the Sacra Infermeria, its wards were reserved exclusively for male patients, and since women in need of care had nowhere to go, for quite some time, the need for a number of hospital beds to care for sick women had been felt. This need was somewhat addressed in the first part of the 17th century when a certain Caterina Scappi was responsible for setting up the first local hospital dedicated exclusively to women. Known as the Casetta, it was run by the Governatrice, who resided on the premises, and was responsible for the reception of the patients, the entrance of any visitors, and the closing of the hospital gates at night. She also looked after the use of the bed linen, and the cleanliness and comfort of the sick, as well as supervising the duties of the other members of staff.
The Casetta also employed a midwife or Ostetrice, and one of the wards was reserved for expectant mothers. Other members of staff included a Barberotta, or barber-surgeon, as well as a Spezialotta, or pharmacist, who would accompany the doctors and surgeons on their ward rounds to administer any medications that were prescribed. A Spalmante was responsible for mercurial inunctions, and the anointing or smearing of the skin with an ointment containing mercury - the recognised method of treatment for syphilis during this time. Another form of treatment for syphilis was for patients to sit in so-called "sweat wards". Patients would sit in a heated room, while the Stufarola, or steam bath attendant, would tend to the heat source in the underlying chamber.
The food for the women's hospital was usually cooked and prepared by the kitchen staff of the nearby Sacra Infermeria. Nonetheless, the Donna della Mancia was responsible for warming up the food and serving it after its arrival at the Casetta. A number of Serve performed the dual role of carrying out nursing duties and domestic chores, such as making the beds and anything else that might be required to make the patients more comfortable. In addition to the members of staff already mentioned, the Casetta also had a portress and three washerwomen on the list of its employees towards the close of the 18th century.
District Medical Service
Another important job carried out within the community by females was that of the Pitanziere, or alms-givers. These were four elderly women who were tasked with visiting sick women being treated within their own homes. Every day, the pitanziere would bring them the medicaments and the food ordered by the doctor, as well as financial relief and items of bedding. Helped by four female assistants who carried the bread, they were each assigned to a specific area: Valletta, Vittoriosa, Cospicua, and Senglea. The pitanziere also distributed money to poor and crippled women who had no one else to turn to for help.
Whilst the role of males within the excellent medical services provided by the Knights of St. John has been very well-documented, the contributions by women employed within the same health services have not always been given the recognition they deserve. Although it is true that female employees were generally engaged in more junior roles, some of them rose to posts of responsibility and competence, such as the ospedaliera, the governatrice, or the barberotta. It is also clear that these women made a significant contribution particularly to generations of sick females and unwanted infants who would otherwise have suffered and succumbed to disease without anyone to provide them with comfort and relief.
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. (1978). Female employees in the medical services of the Order of St. John in Malta. Melita Historica, 7(3), 225-233.
Rozena, S. Disease and Dissection: A History of Surgery in Malta. Museum of the Order of St. John. Retrieved June 16, 2021, from https://museumstjohn.org.uk/disease-and-dissection-a-history-of-surgery-in-malta/