The Valletta Sacra Infermeria
One of the major landmarks located towards the tip of the Valletta peninsula is the Mediterranean Conference Centre. This 16th-century structure, enjoying magnificent views across the Grand Harbour, today offers state-of-the-art conference facilities, as well as serving as an important venue for exhibitions, product launches, banquets, theatrical performances and numerous other events. Originally, however, the building was designed for a totally different function: known as the Sacra Infermeria, at one point in time it rose to fame as one of the best hospitals in the world.
The Knights Hospitaller
The Sacra Infermeria is part of the legacy of the Knights of St. John, also known as the Knights Hospitaller to reflect their original founding purpose and mission back during the time of the Crusades. In fact, the Knights can 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. Indeed, the modern version of the Order of St. John still does this work all over the globe to this very day.
A Revolution in the Local Medical Scene
As soon as the Knights came to Malta in 1530, they completely revolutionised the local medical scene. They built a new hospital in Birgu, brought with them foreign doctors, and introduced new medical concepts that had developed in Renaissance Europe. When in 1571 they officially relocated to Valletta, the decision was taken to build a new hospital there. It was to be located near the sea so as to offer the patients fresh air that would aid in their recovery, as well as being away from the noise of the main part of the city. Construction began in 1574 during the reign of Grand Master Jean de la Cassière, most likely under the direction of the Maltese architect Girolamo Cassar, although the building we know today is the product of several later enlargements and remodelling over the centuries.
The Sacra Infermeria
Within a few years, the Sacra Infermeria would achieve fame as one of the foremost hospitals of the period in Europe, with several visitors to Malta praising its excellence in records they kept of their time here. The Infirmary took in male patients of every class, whether members of the Order, civilians, or slaves, and irrespective of their nationality or faith. Once admitted, they were medically examined by well-trained physicians, before being washed, dressed, and put in a bed, which, unlike in most other contemporaneous hospitals in Europe, they did not have to share with anybody else. The bedding was cleaned and changed on a regular basis, while twice daily, patients were given well-prepared food, which they ate using utensils made from silver, a material known for its antibacterial qualities. One of the things that impressed visitors the most, however, was that the knights themselves took turns caring for the patients since this was part of their vows. This included the Grand Master himself, who visited every Friday, offering the patients food from his own hands, whilst chatting with them and offering words of comfort and consolation.
The Long Ward
The hospital was divided into a number of separate wards, mostly in an attempt to classify the sick according to their type of illness, although social and religious considerations were also a factor: there were specific spaces for knights, convicts, galley-slaves, and even non-Christians amongst others. The most impressive ward was undoubtedly the Sala Grande, or Long Ward, which was reserved for members of the Order and free men. Measuring 155 metres in length, 10.5 metres in width and over 11 metres in height, it was at that time one of the largest halls in Europe. Its floor was paved with stone slabs, while its wooden ceiling was considered "a magnificent example of 16th-century timber construction". The beds, draped with curtains in winter and mosquito nets in summer, lined the sides of the ward, although, in emergencies, hospital capacity could be dramatically increased by placing extra beds in the middle, along the length of the entire ward. Each patient had access to his own privy, located in recesses along the wall beside each bed. A row of windows on one side provided light and air, while the huge bare walls were covered with tapestries in winter. In summer, these were replaced by a set of Mattia Preti paintings depicting episodes from the Order’s glorious history.
The Great Magazine Ward
Located in the basement level directly underneath the Sala Grande, the Great Magazine Ward was reserved for galley-rowers, convicts, and the island’s considerable slave population. Slaves - both Muslim and Christian-converts - were nursed here with the same level of care and medical attention provided to the patients in the main hall above, with some minor differences: pewter utensils were used instead of silver, and the food was of inferior quality but was still relatively good and plentiful. Privately-owned slaves were also treated here, although in such cases, the cost of their treatment, and that of the food they consumed during their stay here, would be covered by their owner: it would have been in his best interests to keep his slaves healthy, if necessary even spending money in order to nurse them back to good health.
Another important ward was the Falanga, used for the treatment of patients suffering from contagious diseases. Venereal disease was also treated here. This was actually quite rife at the time, so a special section was set up for administering mercury treatment, which was the main recognised method of treating syphilis in those days. Not surprisingly, the job of administering this treatment, which involved handling of such a toxic substance, was considered dangerous for the attendants tasked with this job, but not surprisingly it was also quite risky for the patients themselves: one person who was known to suffer from syphilis was Grand Master Perellos, who was ‘cured’ from the disease but died from the side effects of the treatment he had received.
Care of Foundlings
Typical of most hospitals of the time, the Sacra Infermeria also received unwanted infants. At the rear of the hospital, close to the Falanga block, the Knights installed the Routa - a swivelling cot that opened up onto the street. This apparatus was designed to protect the identity of the person depositing the unwanted child, who would then be taken into the care of the Sacra Infermeria staff. The babies were first assigned a wet nurse paid by the hospital, and eventually given up for adoption, or placed under the charge of two female ospitaliere, who looked after them until they reached the required age to move elsewhere. When girls reached the age of 3, they were sent to stay with the cloistered nuns in Mdina until they reached the age of marriage. Boys, on the other hand, stayed until the age of 6, at which point they would be apprenticed to learn a trade of their choice.
An important element of the Sacra Infermeria was the pharmacy, known as the spezieria, although its exact location within the hospital is not known. This was where all medicine used in the hospital was prepared, and detailed records kept as to where it was going. As part of his duties, the Chief Pharmacist was required to accompany the doctors during the ward rounds, to ensure that all medicines were administered correctly. The shelves of the pharmacy would have been lined with numerous containers of all shapes and sizes to conserve herbs and liquid or solid medicinal preparations, the ingredients of which were either locally sourced or imported from overseas to ensure only the highest quality.
The School of Anatomy & Surgery
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 doctors and surgeons to study in Malta rather than having to do so abroad as was the case previously. In time, it would help produce a number of prominent Maltese surgeons, some of whom gained international renown. While initially, only theoretical lessons were taught, in the early 1700s a dissection room was built in the nearby cemetery. Autopsies of patients who passed away were held here, at the same time doubling for practical anatomy lectures for the students. Dissections were only done in winter, as in those days there were no freezers to preserve the cadavers, rendering the job impossible during the hot summer months, due to the smell of putrefying bodies. The dissection room was eventually replaced by an anatomical theatre, which still stood on the site of today’s Evans Building until its destruction by aerial bombardment during World War Two.
Despite years of excellent service, the Sacra Infermeria would go into a decline towards the end of the 18th century, as the Order’s finances suffered mainly due to events beyond our shores. It would however continue serving as a hospital under different names for the next 120 years under both the French and the British. That, however, is a story for another time.
The latest development in the long history of this historic building 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.
Cassar, P. (1983). From The Holy Infirmary of the Knights of St John to the Mediterranean Congress Centre. Malta
Savona-Ventura, C. (1997). Outlines of Maltese Medical History. Malta: Midsea Books Ltd, p.25-33