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The Decline of the Sacra Infermeria

The arrival in Malta of the Knights of St. John in 1530 would lead to a complete revolution in the local medical scene, particularly following the establishment of the Sacra Infermeria in Valletta. Within a few years, it would achieve fame as one of the foremost hospitals of the period in Europe. Visitors to Malta who recorded their experiences of the island during this time did not always agree about everything, but on one view they appear unanimous: the outstanding excellence of the Holy Infirmary. A historian wrote that “… This asylum is constantly open for the reception of the sick of all countries, who are treated with every possible attention and furnished with medicines and comforts of every kind”. In 1739, an English traveler called it “the very glory of Malta”. This positive image persisted for most of the Order’s rule over Malta, as improvements and additions to the hospital were regularly being made, but towards the end of their era, the rot had clearly started to set in.

The positive image of the Sacra Infermeria persisted for most of the Order’s rule over Malta, but towards the end of their era, the rot had clearly started to set in.

Indeed, towards the closing stages of the 18th century, a general decline started to set into the affairs of the Order. The reasons for this decline were varied. The Ottoman Empire was no longer considered a major threat to Christian Europe, piracy in the Mediterranean was being gradually suppressed, and some European powers were establishing a peaceful co-existence with their traditional enemies. In short, the Knights of St. John were losing their raison d'être. The liberal ideas spreading throughout Europe, and especially in France, found their way into the island, giving dangerous ideas to many idle young knights - the Order started rotting from within. To make matters worse, the French Revolution led to all the rich estates of the French langues being confiscated, pushing the Knights to the brink of bankruptcy.

This decay was soon to be reflected also in the administration of the Sacra Infermeria, and the conditions prevailing here at the turn of the century were vastly different from those of its former days. In 1786, the noted English philanthropist John Howard visited Malta's hospitals and recorded his impressions in a book titled 'An Account of the Principal Lazzarettos in Europe'. His account of what he saw in Malta was anything but flattering and is one of the first indications of the decline of the Order's hospital. According to his report, in the Long Ward, the ceiling had turned black, and most of the hospital spaces were so dirty and smelly that they had to be regularly perfumed. In fact, doctors doing their rounds were forced to press a handkerchief to their face to ward off the unbearable stench.

The 1786 report about the state of the Sacra Infermeria by the English philanthropist John Howard is one of the first indications of the decline of the Order's hospital.

The Magazine Ward was nothing but a dark, damp cellar, while the cleanliness of the kitchen was also criticised. Many of the nurses, whom he described as “the most dirty, ragged and unfeeling and inhuman persons I ever saw", were debtors or criminals who had taken refuge in the hospital to escape justice, since the building enjoyed criminal immunity, and there were clearly nowhere near enough of them to deal with the number of patients. He noted that there were only 22 nurses for about 520 patients. By contrast, there were 40 grooms to take care of the 50 horses and mules of the Grand Master. Running water flowed in the stables, but not in the hospital. The nearby women’s hospital - the Casetta - fared no better. According to Howard, “a more offensive and dirty hospital for women I never visited”.

Only four years later, another visitor to the hospital, Sir Richard Colt Hoare, echoed Howard’s words, claiming that "only a few devout and perhaps penitent knights still observe the ancient custom of attending the sick in person". The financial situation of the Sacra Infermia worsened to the extent that at one point, the Grand Master was forced to order the melting down into silver coins of all the hospital’s silverware, to help the Knights meet their many financial commitments.

The financial situation of the Sacra Infermia worsened to the extent that at one point, all the hospital’s silverware had to be melted down into silver coins, to help the Knights meet their financial commitments.

Some years later, another source confirmed all of this in even more shocking detail. A certain Carasi recounts how on his first visit to the hospital, he initially mistook it for a prison. He was immediately struck by the scruffy appearance of the nurses, who were very inhumane in their treatment according to a patient he spoke to. Although he confessed that such complaints were commonplace among many patients in many European hospitals, it was strange to hear them in Malta, due to the high reputation in which the hospital had once been held. The food served was minimal as well as horrible, and Carasi claimed that almost the same number of patients died from bad nutrition as from diseases. The doctors only visited twice daily, so that if the patient suffered an attack of some sort, he would have to wait until the next visit before he was seen to.

In the basement, Carasi discovered a patient who was chained to his bed, simply because he had not gone through his attendant when buying his tobacco. In revenge, the attendant moved him from the upper ward and placed him with the slaves and galley rowers. Carasi also witnessed a feverish patient who received several lashes with a whip before being chained, because he had got out of bed and started walking around while delirious. He also reserved harsh criticism for Maltese doctors, accusing them of being arrogant, ignorant, and incompetent, with many of them not even bothering to make the effort of studying abroad, being content instead to simply repeat the mistakes and errors of their superiors.

Carasi reserved harsh criticism for Maltese doctors, accusing them of being arrogant, ignorant, and incompetent.

Finally, he also talks of his own experience at the Sacra Infermeria, where he spent several days after suffering from a fever. A doctor came to bleed him, put a bandage around his arm, and ordered a boy of no more than 10 years old to cut him. In fear and anger, Carasi complained loudly to the hospital commander who happened to be passing by that the doctor was using him to teach the boy medicine. The commander ordered the doctor to perform the bleeding himself, whereupon the doctor took the lancet and stuck it much deeper than was necessary. The evening before his release, a patient in a neighbouring bed was caught adding salt to his soup. The bowl was snatched from his hands and he was chained to his bed and carried downstairs to be confined. The most concerning thing was that Carasi was being treated in what was supposedly the best ward, so he did not even want to imagine what the rest of the hospital was like. He characterised the Sacra Infermeria as “a place of pain, chains, and tombs”.

Despite these issues, the former Sacra Infermeria would continue to serve as a hospital, albeit as a military one, during both the French and British periods, and did undergo major improvements, particularly during the course of the 19th century. It would be eventually closed down in 1921, more than three and a half centuries after it had first opened its doors!


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.



Bonello, G. (2016). The decline and fall of the Sacra Infermeria. The Synapse, 15(2), 7-8, 10

Maltese Medical Journal. 1989, Vol. 1(3), p. 20-29

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