An important element of the Valletta Sacra Infermeria of the Knights of St. John was the pharmacy, known as the spezieria. Its role was to prepare the medicines to be used within the Infermeria itself, as well as in other places, such as the Order’s galleys and the slaves’ prisons. It also supplied medicaments to the nearby women’s hospital, known as the Casetta, and to deserving sick, poor individuals who lived within the community.
The Study of Pharmacy
Despite the existence of apothecaries and pharmacies in earlier times, it is likely that the academic study of this field in Malta had its beginnings with the setting up of the School of Anatomy and Surgery by Grand Master Nicolás Cotoner in 1676. Its first lecturer - the priest and physician Fra Giuseppe Zammit - taught botany amongst other subjects, and personally funded the setting up of a botanic garden in the ditch of Fort St. Elmo in 1690, where a number of medicinal plants and herbs were planted to be used at the Sacra Infermeria. This botanic garden would later be transferred to the former gardens of Bailiff Ignatius d’Argote at Floriana, becoming what we now know as the Argotti Gardens. Zammit also introduced the teaching of chemistry.
According to regulations published in 1729, students wishing to study pharmacy had to submit to an entrance examination conducted by the Chief Pharmacist of the Sacra Infermeria, who had to ensure that they could read and write in Latin, since, at the time, most books on the subject were mostly written in that language. As well as attending lectures, pharmacy students were also required to carry out work experience at the Infermeria’s spezieria. Regular absentees were expelled from the course, but those who passed their final exam would be issued with a diploma and the required licence to practice their profession.
Regulations
The earliest known regulations for the control of the pharmaceutical profession in Malta date back to when the Knights of St. John took control of the island in 1530 and were modelled on the same system that the Order had previously enforced while in Rhodes. Anyone wishing to open, buy or sell a pharmacy had to first obtain a licence from the Grand Master. The same permit was also needed if the owner intended to transfer his pharmacy from one locality to another.
Among the concessions to pharmacists was the exemption from the normally compulsory military duties, but they were also charged with the responsibility of keeping poisonous substances - such as arsenic and mercury - under lock and key, and could not sell any medicine without a doctor’s prescription. In particular, dangerous substances were not to be sold to servants, slaves, children and suspicious individuals. Any mixtures produced within the pharmacy had to be clearly marked with the date of when they were manufactured. The chief government medical officer, known as the Protomedico, fixed the prices of the various medicines being sold, and over-charging was made a punishable offence.
The spezieria at the Sacra Infermeria was managed by the Chief Pharmacist, a well-trained official who, as per hospital regulations, was required to accompany the doctors during the ward rounds to ensure that all medicines were administered correctly. A clerk would also have been employed at the pharmacy to keep precise records of what had been handed out and to whom, as well as to keep an account of supplies and remaining stock.
Medicines
Once a year, every pharmacy on the island was inspected by the Protomedico, with out-of-date medicines being incinerated, while pharmacists were liable to be fined for displaying expired substances. Most of the ingredients used in the pharmacy would have been imported, mostly from Sicily, but also occasionally from other places, including Florence, Venice, Marseilles, Madrid and Lisbon. Some of these places were well-known centres for drugs reaching Europe from the Americas and from the East. Upon their arrival in Malta, the Protomedico examined all supplies to ensure their freshness and good quality. Most of the imported items came from vegetable sources, but others were of animal origin, as well as chemical substances such as arsenic, mercury, sulphuric acid, magnesium sulphate and ammonium carbonate. Amongst some of the more unusual items were the powder of dried serpents, fragments of whale skulls, and wild boar’s teeth.
Some substances were however obtained locally, including from the medicinal herb garden at Fort St. Elmo, as well as the famous Malta Fungus, obtained from Fungus Rock in Dwejra, Gozo. This plant, which we now know is not a fungus at all, was highly prized for its supposed medicinal properties. The root was first baked in an oven, before being powdered and administered to patients mixed with honey, or as a wine infusion. It was used to treat a variety of ailments, such as apoplexy and dysentery, as well as being used to control traumatic and surgical bleeding.
Other substances were included on the basis of their folkloric value, such as St. Paul’s Earth, which was made from powdered stone chippings obtained from St. Paul’s Grotto in Rabat. This was believed to be effective in the treatment of venomous snakebites and poisons, the belief linked with the story of St. Paul’s shipwreck. It was also believed to be useful against smallpox and fevers. This substance was very highly prized and was considered a worthy present to give to distinguished personalities. The earth was administered mixed with wine, water or spirits. Similar properties were attributed to fossil shark teeth, which were believed to be imprints of St. Paul’s tongue. These were also powdered, or worn as amulets.
Medicinal Containers
The shelves of the Sacra Infermeria pharmacy would have been lined with numerous containers of all shapes and sizes, to conserve herbs and liquid or solid medicinal preparations. These containers were made from various materials, depending on the substances they were meant to store, but the most popular were the jars and vases made from majolica. The first evidence of the existence of such jars in Malta comes from an inventory of a pharmacy in Rabat in 1592. It lists over 180 such containers, although no description is given as to their shape and appearance. Sadly, none of the jars in this collection have survived the passage of time. Indeed, the earliest pharmacy majolica jars that we have in Malta belong to the 17th and 18th centuries, and once formed part of the equipment of the pharmacies of Santo Spirito Hospital in Rabat and the Sacra Infermeria in Valletta. They come in a variety of shapes and sizes, as well as being decorated with various colours and designs. Some of them even bear the coat-of-arms of the various Grand Masters during whose rule they were acquired, such as those of Alof de Wignacourt, Ramon Perellos, and Antonio Manoel de Vilhena. It seems that most of them were manufactured in Italy and Sicily.
After the departure of the Knights of St. John from Malta, the Sacra Infermeria would continue operating as a hospital under the British, then known as the Station Hospital. In 1830, Dr. John Hennen, the Inspector General of Military Hospitals in Malta, describes the still extant pharmacy with its laboratory as being in the same state as when the Infirmary was still run by the Order. He describes them as being “well adapted to their purpose and of ample dimensions”. Hennen makes reference to a number of surviving majolica jars, as well as various apparatus used for distilling, making decoctions and extracts, expressing oils, preparing ointments, powders, etc.
Sadly, the pharmacy and its laboratory were completely destroyed by enemy bombing during World War Two, when the Upper Courtyard of the Infirmary took a direct hit in May 1941, causing considerable damage to this part of the complex. Today, nothing at all is left of this once very important part of the hospital.
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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.
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References:
Savona-Ventura, C. (2004). Knight Hospitaller Medicine in Malta [1530-1798]. Malta: Publishers Enterprises Group (PEG) Ltd
Cassar, P. (1987). An outline history of pharmacy: part 3: the history of Maltese pharmacy. The Pharmacist, 16, 12-16.
Cassar, P. (1983). From The Holy Infirmary of the Knights of St John to the Mediterranean Congress Centre. Malta