Undoubtedly one of the most important developments in the history of the Sacra Infermeria was the establishment of the School of Anatomy and Surgery by Grand Master Nicolás Cotoner in 1676, enabling prospective local doctors and surgeons to study in Malta rather than having to do so abroad as was previously the case. In time, it would help produce a number of prominent Maltese surgeons, such as the celebrated Gabriele Henin, who later became the Head of the School of Anatomy and Surgery. Another distinguished surgeon and future head of the same school was Michelangelo Grima, one of Henin’s most promising students. Grima was destined to become one of the most renowned surgeons to train and teach at the Sacra Infermeria School of Anatomy and Surgery.
Michelangelo Grima was born in Valletta on 15th September 1729 and baptised three days later at the Church of Our Lady of Porto Salvo. He was the firstborn of eight siblings of Lorenzo Grima, a businessman, and Rosa neé d’Anna, the daughter of a surgeon. Grima probably obtained his early education from the Collegium Melitense in Valletta, run by the Jesuit Order, but in 1743, at the age of 14, he entered the Sacra Infermeria as an apprentice under Gabriele Henin as Chief Surgeon. Grima's decision might have been inspired by circumstances rather than because of a natural inclination towards medicine: his father having lost the substantial sum of 25,000 scudi as part of his business dealings meant that the family was in desperate need of money.
It was thus at the Sacra Infermeria that Grima gained his first experience with the medical and surgical practice, and even at such a young age, he distinguished himself. As a surgical assistant, or barberotto, he would have been required to sleep at the hospital and assist the surgeons in their work. His wages would not have been particularly impressive, and nor were his future prospects very promising, at least not unless he was able to further his studies abroad. It was for this reason that at 20 years of age, Michelangelo Grima left Malta to continue his studies in Tuscany, Italy, at the expense of the Order of St. John, despite a lack of approval or support from his family.
Education in Florence
Grima departed Malta in May 1750 and proceeded to the school of the hospital of Santa Maria Nuova in Florence, thus following in the footsteps of his mentor Gabriele Henin. This school was renowned for the quality of its professors of anatomy and surgery and was one of the first to introduce practical human anatomy through the dissection of cadavers. From letters that Grima sent to friends, such as the Gozitan Canon Agius de Soldanis, it appears that he was very happy with his professors and the healthy academic environment in the school. During his time in Florence, he experimented successfully on suturing of the intestines, and in 1754 he successfully removed the spleen from a dog, thereby confirming that this was also possible in humans when this organ had been injured by penetrating wounds of the abdomen. Grima thus became one of the early pioneers of experimental abdominal surgery.
In 1756, Michelangelo Grima received his doctorate in Medicine and Philosophy from the University of Pisa and was offered the role of dissector at the Santa Maria Nuova hospital in Florence, while in 1758, he was approved as a surgeon by the Collegio dell’Arte Medica di Firenze. Throughout this time, Grima had published a number of treaties, which earned him respect in the field and placed him among the pioneers of surgery. Despite his newfound prestige and good work possibilities in Florence, however, Michelangelo Grima had much higher hopes. He thus turned to Grand Master Emmanuel Pinto de Fonseca and asked him to grant him a scholarship to continue his studies in Paris. His request was accepted.
Paris & The Seven Years War
In 1759, the Council of the Order granted Michelangelo Grima three years in Paris to complete his post-graduate experience. This was done on the understanding that Grima would return to Malta on completion of his studies. Grima would spend a year in Paris, during which time he published his dissertation on intestinal suturing which impressed very much the surgeons of the university of that city. Titled ‘Del Nuovo Metodo di Cucire gl’Intestini’, it was an original work in which he explained the results of experiments he had carried out on suturing by means of spiral stitching during his time in Florence.
After a year in Paris, Grima decided to serve as a military surgeon with the French Army during the Seven Years’ War, which was then raging across the continent. During the course of two years working at a field hospital in Cassell, Germany, he formed “the view that war is the great school not only of traumatic surgery but of the whole of medicine”. As a result of his experiences treating wounded soldiers, he became particularly adept in the field of traumatic surgery. His experiences would later lead to him writing a book on this subject, titled ‘Della Medicina Traumatica detta Vulnerraria’, published in Florence in 1773, in which he discusses the diagnosis and describes the treatment of several types of wounds and head injuries commonly encountered on the battlefield.
An Excellent Teacher
After having thus supplemented his formal training in surgery with an intensive traumatic surgery experience in the field of war, Grima finally returned to Malta in 1763, after more than 13 years abroad. On the 26th of September of that year, he was appointed Chief Surgeon at the Sacra Infermeria, while on 27th November, he was further appointed Lecturer in Anatomy and Surgery. He was licensed to practice medicine in Malta on 3rd December 1763. With his arrival, Grand Master Pinto was encouraged to reorganise the Medical School under the leadership of Michelangelo Grima, at a time when it was attracting an ever-increasing number of both Maltese and foreign students. Grima immediately set to work. He quickly proved himself to be an excellent teacher, as well as a talented surgeon.
In those days, the accepted method of teaching consisted in the dictation of notes by the lecturer - a tiring and discouraging procedure. In order to save time, Grima wrote books on anatomy for the use of his students. He also suggested reading for the following lesson, so that his students would attend prepared for the subject. In this way, the whole course of anatomy could be completed in just one year. Grima also founded the Practical School of Medico-Surgical Operations on Cadavers and ran it on the same basis as that of Florence. He believed very much in the importance of dissections and ensured that every theoretical lecture was followed by a practical one. Grima’s method of teaching traumatic surgery was quite original; he would fire a number of pistol shots from different angles on the cadaver and then have the students extract the bullets and bone fragments embedded in the wound. He also introduced operative surgery as part of final examinations, with students carrying out operations on cadavers in front of the examiners.
A Skilled Surgeon
Whilst the School of Anatomy and Surgery was at its peak between 1765 and 1797, with Michelangelo Grima as its head, at the same time he also continued excelling in his other role as Chief Surgeon at the Sacra Infermeria. Grima was particularly renowned for his speed and accuracy: he was able to conduct a mastectomy for breast malignancy in three minutes and lithotomy to remove bladder stones in two and a half minutes. He is also known to have performed many other types of operations, including the removal of fistulas, cancers, and cataracts. One operation involved the removal of a foetus from the uterus, to preserve the mother’s life. Grima was also tasked with carrying out post-mortems of hospital patients who died of unknown causes and was thus also the pioneer of autopsy in Malta.
Much of what is known about 18th-century surgical practice in Malta comes from the writings published by Michelangelo Grima. His aforementioned 1773 publication, ‘Della Medicina Traumatica’, details the management of various types of injuries. Firearms wounds were washed with a solution of water and alcohol after all extraneous material, including the bullet, had been removed. Grima frowned upon cauterising the wound, and instead advocated ligatures, which involved using a piece of thread and binding the wounded area tightly to cut off a blood vessel and control bleeding after amputations. Bandages were then used to cover the wounds. Grima also described and illustrated the management of 15 different types of head injuries which he had encountered and managed during his time serving on the front with the French forces at Cassel. These included injuries caused by musket balls, sword blows, and following falls from a height amongst others.
Michelangelo Grima was celebrated by his contemporaries. In 1764, after successfully treating Fr. G. Ingurdo for a kidney operation, Ingurdo wrote four sonnets praising him for his achievement. Grima was also richly rewarded by the Order: Grandmaster Pinto presented him with a horse-drawn carriage so that he could travel quickly and in relative comfort to his next operation. Michelangelo Grima continued to serve the Order for 34 years, until his retirement on 2nd April 1797. He spent his final months living with his sister and her husband, drawing up his will on 20th August 1798, in which he reveals his substantial wealth: his possessions included large amounts of silverware, over 360 medical and literary books, gold buttons, and a walking stick adorned with a golden globe as a symbol of his medical profession. Michelangelo Grima died in Valletta, three weeks short of his 69th birthday, on 25th August 1798 and was buried in the crypt of the Confraternity of the Holy Crucifix in the Church of the Franciscan Minors Observants in Valletta.
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. (1969). Malta and its medical school. Chest-piece, 3(1), 11-15.
Psaila, J. V. (1972). Grima: the eighteenth century surgeon. Chest-piece, 3(5), 29-41.
Malta Medical Journal. 2006, Vol.18(4), p. 42-48
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/