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The Administration of the Sacra Infermeria

Updated: Jan 19, 2022

Following the arrival in Malta of the Knights of St. John in 1530, the local medical scene underwent a complete transformation, especially after the construction of a major hospital in the new city of Valletta. Within a few years, the Sacra Infermeria, as it was known, would gain a reputation as one of the best hospitals of the time, due to the high standards of medical care provided to its patients, as well as the expertise of the medical, surgical, and nursing staff employed there.



Also known as the Knights Hospitaller, the Knights of St. John could trace their origins to the early 12th century, when a group of individuals founded a hospital in Jerusalem in order to provide care for sick and injured pilgrims visiting the Holy Land. Although in time the organisation also became a military as well as a religious order, what distinguished it from other similar chivalric institutions was its continued hospitaller character and mission. And they took this vocation very seriously, setting up hospitals wherever they went, providing nursing and medical care to the needy.


The Grand Hospitaller


Overall responsibility of the Sacra Infermeria rested with the Grand Master - the head of the Order - although, as had been done in Rhodes, the job of actually administering it belonged to the Grand Hospitaller, a position that was always reserved for the head of the Langue of France. The Grand Hospitaller would have been one of the highest dignitaries within the Order of St. John, thus reflecting the importance that the Knights gave to their hospital.


The job of administering the hospital was assigned to the Langue of France

The French knights were extremely proud of the privilege afforded to their nationality, and strictly guarded the rights enjoyed by the person who held this office. No other knight except the Grand Hospitaller was allowed to enter the hospital without first depositing the emblems of their office at the main gate. When in 1711, some of the Inquisitor’s officials entered the building without the required permission, they were quite unceremoniously thrown out.


The Infirmirian


One of the duties of the Grand Hospitaller was that of selecting the person appointed as the Infirmarian - a senior knight who was responsible for the day-to-day administration of the hospital. As in the case of the Grand Hospitaller, the Infirmarian was always a professed knight from the Langue of France. His job included visiting the wards day and night to ensure that all members of staff were at their posts and that everything was in order, including the meal schedule and the quality of the food being served.


The Hall of the Infirmarian at the Sacra Infermeria was unfortunately destroyed during WW2

The nature of his work required the Infirmarian to live onsite at the Sacra Infermeria. The Infirmarian’s Apartment, which was among the rooms that originally formed part of the hospital’s upper floor, is known to have been decorated with a colourful frieze running along its walls that bore the coat-of-arms of the 18 knights who held the position of Infirmarian between 1681 and 1765. Unfortunately, this hall was among that part of the hospital to have been completely destroyed as a result of aerial bombings during World War Two.


Administrative Staff


To assist the Infirmarian, the hospital also employed another two knights known as Prud’hommes, who were mainly responsible for supervising the expenditure and accounts of the hospital, as well as the scrivano, or secretary, who assisted them in their job. The linciere was in charge of the linen, laundry, and other hospital equipment, while the bottigliere supervised the Infermeria’s food and wine supplies.


The armoriere was charged with the safekeeping of the hospital's large collection of silver plates and cutlery

Another important job was that of the armoriere, who was responsible for the safekeeping and cleanliness of the silver plate used to feed the patients. The Knights are known to have spared no expense in their efforts to ensure the highest level of medical care to their patients, and regularly fed sick knights and civilians using silver plates, soup bowls, cups, and cutlery, due to the anti-microbial qualities that silver was known to possess. By 1725, the Sacra Infermeria owned 1,150 pieces of table silver - quite a responsibility for the armoriere, who had to ensure that none of it went missing.


Medical Staff


The medical staff of the Sacra Infermeria consisted of a highly qualified team of men who would usually have received training and work experience in foreign hospitals, most commonly in Italy or France, although later, following the setting up of the School of Anatomy and Surgery in 1676, students could also be prepared for a medical career locally. These included a number of resident senior and junior physicians and surgeons, as well as a number of barberotti, or barber surgeons, whose tasks included blood-letting and the application of leeches and poultices.


Among other tasks, barber surgeons carried out blood-letting and the application of leeches and poultices

Other members of staff worked at the hospital’s pharmacy, known as the Spezieria, whose role was to prepare the medicines to be used within the Infermeria, as well as in the Order’s galleys, the slaves’ prisons, and the nearby women’s hospital, known as the Casetta. The Spezieria was managed by the Chief Pharmacist, who was required to accompany the chief medical officer during the ward rounds to ensure that all medicines were administered correctly. Two pharmacy assistants, or spezialotti, prepared the prescriptions, while a clerk kept precise records of what had been handed out and to whom, as well as maintaining an account of supplies and remaining stock.


Kitchen Staff


Another important consideration for the treatment of patients at the Sacra Infermeria was the provision of a proper diet. The kitchen of the hospital, located in one of the underground parts of the complex, would have been a very busy place, preparing meals for a large number of patients, staff, and children under its care.


The hospital kitchen would have been a very busy place, preparing meals for a large number of patients, staff, and children under its care

Among the hospital employees, there would have been a cook, who was in charge of the kitchen, as well as 1 or 2 under-cooks as assistants, but the smooth running of the kitchen would also have greatly depended on a number of baptised slaves, selected from the slave prison, who also helped to prepare the food, as well as to deliver it to the various wards. Indeed, such slaves were also part of the staff of the Sacra Infermeria, tasked with carrying out all menial tasks, such as cleaning and washing.


Nursing Staff


Although a number of people were also employed as nurses, known as servi or guardiani, one of the things that most impressed visitors to the Sacra Infermeria was that the knights themselves also took turns caring for the patients since this was part of their vows. All novices were given nursing training and were expected to perform hospital duties once a week, according to a roster established between the different nationalities: each day of the week a different langue sent its younger knights to accompany the chief doctor during his rounds, as well as to serve food to the patients at mealtimes.


One of the things that most impressed visitors to the Sacra Infermeria was that the knights themselves also took turns caring for the patients

On Fridays, the Grand Master himself would turn up to do his duty and lead by example. Despite his noble background, he would sit beside the patients and offer them food from his own hands, whilst chatting with them and offering words of comfort and consolation. The idea behind this was to help them understand the importance of discipline, as well as the ethos of the Order, whilst staying true to the original founding mission of the Order of St. John all those centuries before, that of providing nursing and medical care to the needy.


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The latest development in the long history of the Sacra Infermeria came only last year, when a new augmented reality museum, titled ‘Reliving The Sacra Infermeria’, was inaugurated. The idea of an augmented reality 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.

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References:


Cassar, P. (1983). From The Holy Infirmary of the Knights of St John to the Mediterranean Congress Centre. Malta


Zammit, T. (1919). The Medical School of Malta. Proceedings of the Royal Society of Medicine, 12(Suppl), 133-142

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