Regimental Hospitals And Station Hospitals Of the Malta Garrison
Army Hospitals of the Malta Garrison
The infantry regiment is the basic fighting unit of the army. In the 19th century, the regiment was an independent, self contained, single battalion organisation. It had its own surgeon and regimental hospital. When a Battalion arrived in Malta, the regimental surgeon opened his hospital in a house set aside by the barrack department, which was responsible for furnishing the hospital. The sick stayed with their regiment under the care of their surgeon. They were only transferred to the General Military Hospital in Valletta when the regiment left Malta, or during the annual rotation of the infantry which saw the closure of the regimental hospital as the battalion rotated between Valletta and Cottonera.
The role of the Malta garrison was one of deterrence. It protected the Grand Harbour so as to deny a hostile power from gaining possession and dominating the Mediterranean. The troops occupied the fortifications built by the Order of St John of Jerusalem when they were masters of Malta between 26 October 1530 and 11 June 1798. The barracks were mainly casemates. They were unsuited as habitation for the troops. They were repeatedly condemned, but no large barracks were built until after the 1860s.
The Crimean War was the catalyst for reform. In August 1861, the Barrack and Hospital Improvement Commission was directed by Lord Sidney Herbert and by Sir George Cornwall Lewis, who succeeded Lord Herbert as Secretary of State for War, to report on the sanitary condition of garrison towns in Malta. The Mediterranean Stations were inspected between September and November 1861. Captain Douglas Galton RE and Dr John Sutherland proposed a number of improvements pertaining to drainage, water supply, and sewage disposal. Ventilation shafts and windows were opened in casemates as a temporary measure until the construction of healthy barracks in well ventilated localities, set apart from the local population.
The report by Galton and Sutherland pointed out that there was no proper hospital accommodation for the sick.1 The General Hospital in Valletta, the Upper Vittoriosa Hospital, the two hired houses which made up the Lower Vittoriosa Hospital, and the Forrest Hospital in Spinola were inadequate for the garrison. Despite the recommendation for a new General Hospital of 300 beds at Valletta and a smaller one of 136 beds for the Cottonera, none were built until 1873, when the Cottonera Hospital was erected for the infantry regiments in the Cottonera District. However, on 1 March 1873, regimental hospitals were abolished and regimental surgeons ceased to exist. The Station Hospital at Cottonera remained in use together with the Valletta Station Hospital until the completion of a new military hospital at Mtarfa. This was occupied by the Royal Army Medical Corps (RAMC) on 23 June 1920. All military hospitals were subsequently shut, and the Station Hospital at Mtarfa, which became the David Bruce Military Hospital on 1 March 1951, became the sole army hospital in Malta. The RAMC handed over the hospital to the Royal Naval Medical Services in October 1962, bringing to an end the association of the Army Medical Services with the Maltese Islands.
Regimental Hospitals of the Malta Garrison 1800 – 1873
The Army Medical Department was organised on a regimental system. Each infantry regiment of 500 men and upwards had one surgeon and two assistant surgeons. In addition, there were unattached staff assistant surgeons who were placed in regimental hospitals by the Principal Medical Officer whenever the need arose. Once seconded to a regiment, staff assistant surgeons fell under the authority of the commanding officer. The surgeon was commissioned to the regiment and wore the uniform of that regiment. He was classed as a captain for pay and allowances. He had virtually no military authority and was referred to as the medical gentleman. Those with an assertive personality, however, backed by their medical position, exerted influence merely by their forceful character. Life in a regiment was "pleasant, comradeship was brotherly, and friendships firm".2
The surgeon served two masters. He was the servant of the commanding officer in all matters pertaining to the care of the sick, the dispensing of medicines and the prescribing of diets to his patients. He had to buy his own complete set of capital instruments in accordance with an official list. He also had to provide at his own expense a pocket case of minor
instruments. The surgeon visited the hospital twice daily and sick officers in their quarters. He kept a journal in which he recorded the names of the sick, their condition, and treatment. The journal kept by the surgeon was regarded as the undeniable proofs of his diligence and the best evidence of his professional ability.3
The regimental surgeon also came under the scrutiny of the Inspector of Army Hospitals. This staff medical officer was requested to inspect the hospitals as often as he deemed necessary. He was to scrutinise the diets prescribed to the patients, investigate any complaints and recommend to the commanding officer any improvements for the better care of the sick. The Principal Medical Officers of the garrison later took on the role of supervising the regimental surgeons. They wrote brief confidential reports on their abilities and on the state of their hospitals.
Thus, Inspector General John Forrest, PMO Malta 1859-1861, said of surgeon Alexander Scott Fogo RA that he was "intelligent and zealous. His hospital was always in excellent order, his duties correctly performed." On surgeon Usher Williamson Evans 2nd/15th regiment, he reported that he was a most attentive officer. His hospital was in excellent order and the medical records were correctly kept.4 The insert for surgeon Rowland Wimburn Carter 48th Foot was not so favourable. It read, that he was deficient in zeal, judgement and efficiency; in addition, he was censured for making unnecessary groundless complaints regarding the diets in the 3rd Station Hospital Aldershot.
The regimental hospital was integral to the regiment. It was for the exclusive use of that regiment as it was funded by the soldiers of the regiment. The hospital had a number of beds equivalent to 4% of the regimental strength or about 40 beds in a regiment of 800 men. A hospital was provided for each regiment, irrespective of the number of regiments in the garrison. This duplication of effort and failure to share in the overall workload fell apart in war when the small number of beds were overwhelmed and the sick had to be admitted to the General Hospital.
Each regimental hospital had its complement of staff. This included a hospital sergeant, a number of orderlies and a female nurse. Horse Guards Circular No 59 dated 1 July 1868, set the establishment of each Regiment of Infantry of the Line to one non commissioned officer as hospital sergeant, and three private soldiers as orderlies. An orderly accompanied a detachment of more than two companies whenever it was away from headquarters on duty.
A sentry stood outside the hospital. He ensured that the patients had no unauthorised visitors, that they did not leave the hospital or smuggle food and drink. He was not always effective. The Vittoriosa Hospital overlooked the neighbouring houses by which it was closely surrounded, and was not enclosed except from the front. This enabled the sick to climb up to the roof, and smuggle spirits and fruit into the hospital by means of a rope let down from the window to the street.
The hospital sergeant was appointed by the commanding officer. His qualifications were not medical. It was enough for him to be a sober soldier, steadfast in his duties, and possess a good education. He received an extra sixpence a day to his pay, paid to him half yearly in arrears. He was exempt from guard and other military duties and was retained in post at the discretion of the commanding officer. The hospital sergeant was responsible for the bedding, utensils and hospital stores and was answerable for any damage or loss. He gave the patients their medicines at the time set by the surgeon, kept the ward and patients clean, and ensured that the nurse and orderly administered the diets to the patients.
When William Lindsay became surgeon of the 18th (Royal Irish) Regiment on 28 March 1824, "a faithful friend" gave him some unsolicited advice. He warned him that the 18th Foot "... are of very bad material and very troublesome as far as their hospital concerns go. The medical department has long been rotten in the 18th and you have very odd people to deal with. The hospital sergeant is apparently a very simple and ignorant fellow - but I believe him to be the reverse, and I know that he acts as as spy upon all the actions and words of the medical officer. I therefore caution you to trust him in nothing. The apothecary, Mr Davies, you will soon understand is a very poor creature. Not a word passes in your corps that is not reported to the chief. In short follow the precept of our Divine Master, be harmless as a dove, but it will, in a peculiar manner, be hove you to be wise as a serpent. Forbid in the most positive manner the admission of female visitors to your hospital. Could you decently get rid of the present sergeant and substitute sergeant Rhodes or any other"?5
The orderly was a trust worthy soldier who received an additional four pence a day. His role was to assist the nurse by attending the sick, to administer medicines and comforts and to keep the wards clean. The nurse was a decent, sober, woman who prepared slops and comforts for the sick, cooked the victuals, and washed the hospital linen. She received one shilling a day for her labour.3
On 11 June 1855, a Royal Warrant established a Medical Staff Corps to provided trained men for the care of the sick. The Medical Staff Corps was to provide the ancillary support to a hospital of 500 patients. It was to consist of nine companies of 78 men each, but by November 1855 only about a hundred men had joined the Corps. Each company had a steward who ranked as Sergeant Major, four assistants who ranked as Sergeants, a Ward-Master ranking as a Colour Sergeant, and eight assistants who ranked as corporals. In addition it included issuers, washer men, assistant cooks, barbers and orderlies, who ranked as privates. The cook had the rank of sergeant.
The Medical Staff Corps was short lived. It had no military structure and found itself in an anomalous position in its relationship with the combatant authorities. It was succeeded by the Army Hospital Corps, which was granted complete military organisation status by Royal Warrant dated 20 September 1855. The ranks of the AHC were filled mainly by men of good character transferred from regiments. Each man passed a probationary period of three months in a military hospital before being given a permanent appointment. By January 1856, the AHC had about 700 men, but was expected to be a thousand strong. The men were divided into two classes. There were 300 First Class Orderlies at 2 shillings a day with rations, and 700 Second Class Orderlies at 1 shilling 3 pence a day. Promotion from the inferior to the superior class was based on meritorious conduct alone. The first soldiers of the AHC arrived at Malta in June 1860.
Medicines for the soldier were supplied by Government. Each surgeon was provided with one or more medicine chests depending on the strength of his regiment. The chests were drawn up in accordance with the medical regulations of the day and were deemed to contain all the drugs and surgical appliances for a regiment for a year. A surgeon had to procure at his own expense any drug or appliance that he wished to use which had not been approved for his regulation chest. He was required to submit a half yearly return to the Inspector of Army Hospitals of the medicines used during the preceding six months and what remained. The return was to be accompanied by an affidavit taken before a magistrate that none of the medicines had been converted to private use or applied to any use other than that of the regiment.
The regimental surgeon had to apply to the Inspector of Army Hospitals for a fresh stock, should this have become depleted by an unforeseen increase in illness. The reason for the extraordinary consumption of medicine was to be certified by the commanding officer. When wine was issued to the sick, a return of its consumption was to be made weekly to the Inspector of Army Hospitals. Wives and children on the strength were allowed medicines from the military chest but the privilege was not to extend to a charge on the hospital fund.
The Principal Medical Officer was required by a Circular, dated Horse Guards 1 January 1869, to scrutinise the expenditure of medicines, surgical material, and dispensary sundries used in army hospitals. Regimental surgeons were ordered to personally supervise the issue of such items. At periodic inspections PMOs were to minutely examine the prescription books to see that all articles used in the hospital had been duly and properly entered, that the person receiving the medicine was entitled by regulations to medical aid at public expense, and that the ingredients in the prescriptions corresponded to the quantities expended from the surgery stores. Less expensive items were to be prescribed when cheaper alternatives were as efficacious as expensive ones. Before approving a requisition for a further supply, the PMO had to ascertain that there was no undue accumulation of any article in store, and that such items indented for were actually required in the quantities demanded.
The hospital had to pay its own way. In 1799, the stoppages out of the pay and beer money of each non-commissioned officer, drummer and private men during their stay in the regimental hospital was four shillings a week. From 9 July 1805, a stoppage of nine pence a day was considered adequate to defray the expenses of diet in the regimental hospital. All articles of diet were procured by purchase by the regimental surgeon from the stoppage money. When this was not possible, or only obtainable at an exorbitant price, that part of the health ration was drawn from the commissariat, but in no instance was more to be drawn than was absolutely necessary for their use. A receipts had to be given by the surgeon to the commissariat.6
A not untypical demand was that submitted by surgeon R Wright RN who received this 11th day of December 1800, from Mr M L Unwin purser of HMS Foudroyant, for the use of the General Hospital at Malta - wine 280 gallons in two pipes. An other receipt stated: "received the 13 day of June 1801, from Mr M L Unwin purser of HMS Foudroyant, for the use of the sick of the said ship - sugar 20lbs".7
Deputy Inspector of Hospitals John Hennen, PMO Malta 1821-1825, in his report upon the state of the hospital funds of Malta and the Ionian Islands, dated 11 November 1822, considered a stoppage of 9d a day as "amply sufficient to defray the expense of a hospital, and in the great majority of regiments a very considerable surplus is carried to the credit of the public." According to Hennen, the costs of a full diet in the regimental hospitals at Malta was 6 and a 1/2d per man, and that of half diet 3 and a 1/2d per man. A spoon diet cost 2d per man and a milk diet was 6 and a quarter pence a day.
From the hospital fund the sick were supplied with various articles of diet according to a regulated scale. In particular cases and stages of the disease the soldier was allowed certain indulgences such as fowl, wine, and fruit which did not fall within the ordinary rate of food and which were extras. Every article purchased, to the minutest particular, was entered in a book, opposite the allotted diets, and the whole balanced and checked weekly by the commanding officer and paymaster. In 1825, the Secretary of State for War ordered the accounts of the regimental hospital to be settled quarterly, that is on 24 March, 24 June, 24 September and 24 December, instead of half yearly.
The hospital stoppages also paid for the personal washing of the patients, washing of bed linen and dresses. The wages of the servants were also defrayed from the stoppages. On Home Service the diet of the servants was also chargeable against the hospital stoppages, but on foreign service the servants received their rations like other soldiers from the commissariat.
The quota of married women allowed in a regiment by War Office Regulations was six per hundred men. All the married men and their families were placed together in one or more barrack rooms. No partitions were allowed except at night when temporary one were usually put up with blankets. Sick wives and children were treated in the barrack room. Wives and children of soldiers on the married establishment of corps, could only be admitted to hospital on the recommendation of the principal medical officer, and with the approval of the General Officer Commanding. Their husbands were charged a daily stoppage of a shilling for their wives, and six pence for each child under 10 years of age.
Under War Office instruction 1867, persons not entitled to public quarters, that is those not on the married establishment, were not to be admitted into hospital under any circumstance. Medical comforts were to be restricted to sick women and children of soldiers on the married establishment of corps, and only sanctioned where there was a hospital provision store. Medical comforts purchased under the authority of the commanding or medical officers could not be sanctioned as a public charge. The value of any article issued to wives and children of soldiers not on the married establishment of corps was to be recovered from the officers on whose certificates the issues were made.
Inspector General Thomas David Hume tried to alleviate the plight of families belonging to the Floriana barracks. In the absence of married quarters, the families were lodged in dilapidated huts on the Floriana Crown Works. In October 1862, Hume converted an existing large mess hut, and two smaller ones adjoining it on the Crown work Floriana, into a female hospital. The huts accommodated 14 patients. Very little extra expense was incurred, but much comfort was provided for the sick by his endeavour.
In March 1873, a Royal Warrant devised by Edward Cardwell, Secretary of State for War 1870-1874, abolished the system of regimental hospitals. This was replaced by a "unified system" whereby the regimental surgeon was withdrawn from his regiment and converted into a staff officer of the Army Medical Department. Henceforth the medical officer of the Army Medical Department became "attached for duty" with a regiment for a period of two or three years. The Army Hospital Corps, all patients in military hospitals, as well as soldiers attached to them for duty, were placed under the command of officers of the Army Medical Department. These replaced combatant officers in command of army hospitals.
In 1884 the officers of the Army Medical Department and the Quartermasters of the Army Hospital Corps were designated the Army Medical Staff (AMS). The non-commissioned officers and men of the Army Hospital Corps became the Medical Staff Corps (MSC). On 23 June 1898, the Medical Staff Corps amalgamated with the Army Medical Staff to form the Royal Army Medical Corps.
In 1898, the titles of hospitals changed from Station Hospitals to Military Hospitals, Women and Children Hospitals to Families Hospitals and Infectious Diseases Hospitals to Isolation Hospitals.
Floriana District – House of Our Lady of Manresa (Casa Santa) St Calcedonius Regimental Hospital
The House of Manresa, popularly known as St Calcedonius or Casa Santa, was appropriated as a barrack for 600 French troops during their
occupation of Malta. The French were replaced by Neapolitan troops when the British entered Floriana on 4 September 1800. The Casa Manresa remained in the hands of the military as there was no other suitable quarters in Floriana. At first a "very insufficient bad house" in the neighbourhood was used as a regimental hospital. This was unsuitable. The sick had to make their way to the Sacra Infermeria of the Order of St John in Lower Merchant Street Valletta, which had replaced the country house of Count Agostino de Fremeaux at Zejtun, as the General Military Hospital. With the end of the Revolutionary Wars and the anticipatory departure of the British in compliance with the
Treaty of Amiens, the House of Manresa was repaired and restored to the clergy.
The outbreak of the Napoleonic Wars in May 1803, halted the evacuation of the garrison. The casemates at Floriana were fitted up and used as quarters for an infantry regiment. In April 1805, Sir James Craig arrived at Malta with over 6000 troops to secure Sicily. This so increased the demand for accommodation, that all available large premises were utilised as billets. The convent of St Calcedonius fell once again into military use. William Anne Villettes, General Officer Commanding Troops Malta, justified his claim on the property, from the large expenditure defrayed on its restoration.8
The location of the convent in an airy and in the healthiest part of Floriana made it well suited as a hospital. It was also close to Floriana barracks. That part of the convent occupied as a regimental hospital consisted of two corridors, with a certain number of small rooms opening on to them. The wards were small and capable of holding 44 patients. They opened on each side on a long and spacious corridor that could supplement as a ward. A large yard formed part of the hospital and enclosed the cook house, privies, and dead house. The corridors were completely separated by temporary partitions from the rest of the convent and the church, which had their separate entrance. In 1813, St Calcedonius was used as a Military Plague Hospital by Inspector of Hospitals Ralph Green.
Villettes was unable to find an alternative building which could be hired out as a hospital for the Floriana Barracks. "I have not the least desire to cause offence to the clergy" remarked Villettes, "and shall readily evacuate the building if another can be found equally convenient for the essential purpose to which it is appropriated, but I know of no private house in Floriana that could be procured without much expense which meets that purpose".8 The Floriana Market, which was large enough for part of it to be utilised as a hospital, had been converted by Captain Alexander Ball RN, (1802-1810), into an administrative centre for the importation of corn. In 1826, it became an officer's mess for the resident infantry.
On 23 December 1835, the 53rd (Shropshire Regiment) moved from Floriana Barracks to Bormla. It was the last battalion to use the Casa Santa for its hospital. A regimental hospital for the Floriana Barracks was opened in the General Hospital Valletta, and the convent of St Calcedonius was handed back to the Civil Government.
Cottonera District – Upper Vittoriosa Hospital (Armeria)
The Cottonera District was served by a hospital of about 50 beds at Fort Ricasoli. It was, however, little used. On 19 December 1826, the regimental hospital of the troops in the Cottonera District moved from Fort Ricasoli to the Inquisitor's Palace. How long it remained here is not known, but in 1835, surgeon Thomas Price Lea stated that there was no hospital establishment for the 5th Regiment of Infantry stationed at Cottonera. Thus, it was necessary for the assistant surgeon to remain with the regiment, while the surgeon moved to the General Military Hospital Valletta.
The sick of 5th Foot were conveyed by boat across the Grand Harbour from Cottonera to the Valletta marina. From there, they had to make their own way to the military hospital under a broiling sun. Those too debilitated by fever were unable to walk the two miles to the hospital. In June 1849, the United Service Magazine appealed for a more humane way to convey the sick to hospital. "The walk is one of the most fatiguing", reported the journal, "we have been pained to see the suffering of the sick". In response, Staff Surgeon James Barry, PMO Malta 1846-1851, introduced "a sort of omnibus in which his sick could take air and exercise, and which could convey them from the Custom House to the military hospital".9
Surgeon Thomas Price Lea, 5th Regiment, in his annual report for 1835 refers to "an asylum for the sick" which was established at Cottonera during that year.10 This asylum was none other than the Armeria, the former armoury of the Order of St John, which had been occupied by the naval sick of the Mediterranean Fleet. The Armeria reverted to the Civil Government on completion of the transfer of stores and personnel to the new Naval Hospital at Bighi. On 3 October 1835, the Armeria was transferred to the military. The sum of £117 17 shillings had been spent to prepare it as a hospital for the troops in the Cottonera District, which until 1835 was without one. The battalion stationed at Fort Verdala Barracks transferred its regimental hospital from the General Hospital Valletta to the Armeria. The wards which it had occupied were allocated for the use of infantry regiments stationed at Floriana Barracks.11
Under the military, the Armeria was referred to as the Upper Vittoriosa Hospital. It was occupied by the two regimental hospitals of the infantry quartered at Fort Verdala and Fort Ricasoli. It had 13 wards and 108 beds. On 21 January 1848, the Head Quarters of the Reserve Battalion 69th (South Lincolnshire) Regiment moved to the Cottonera District. Three companies were at Isola Gate Barracks, two companies at St Francesco di Paolo Barracks, and a company at Fort San Salvatore.
Surgeon John Bathurst Thomson, 69th Foot, described the hospital as a large building with ample accommodation for 92 sick. It consisted of an upper and a lower flight of rooms. On the first floor were three long wards, parallel to each other, running nearly north-south along their length. The centre ward accommodated 18 beds, while those on either side of it had 20 beds. In one of the wards was a fire place in which a fire was constantly lit in the afternoon during the cold weather. The surgery and reception room were in the upper part of the hospital.14
The lower floor of the Vittoriosa Hospital had a large ward for 22 beds, with five small wards on either side. The ward was completely embedded among narrow streets of houses which cut off its ventilation and darkened all its rooms. The ground occupied by the building was on a slope and the ceiling of the ground floor rooms were nearly at a level with the higher end of the site. The ground floor was reached by descending a flight of steps to a small courtyard. Opening into the courtyard were six casemates, three on either side used as cook house, orderlies room, privy and ablutions.
At the end of the courtyard, a door gave access to a ward 74 feet long by 23 feet wide. This room had one window at the end opposite the door which opened on to a narrow street, and had a high wall opposite to it. Out of this central ward eight small wards opened, four on each side, each having one small window close to the ceiling. Over this central corridor with its cells, were the upper wards of the hospital. These were reached by an outside staircase carried up one side of the courtyard. There were three wards corresponding to the central ward and the two range of cells below. Two of the wards were on the outer side of the block. They each had five windows to the outer air along one side, and one window at the end. On the same level with these upper wards were a series of small rooms, built over those in the sunken courtyard below, for the sergeant's quarters and surgeries.
The hospital had an enclosed courtyard with a covered ambulatory on one side for convalescents. However, the mortuary was located here and the men preferred to ascend to the top of the hospital for a better view. On the roof they smoked and spat, oblivious to the fact that rain water washed all the filth down into the water tanks which supplied the hospital. There was no parapet to the roof to prevent a sick man from stumbling over the edge. On 14 May 1847, Private Robert Millar, Reserve Battalion 97th Regiment, a patient at the regimental hospital, committed suicide by throwing himself off the hospital roof.
The Report on the Barrack and Hospital Improvement Commission of 1863 condemned the hospital. "Of the total 15 wards", it said, "there were only three on the upper floor of the main building in which the sick ought to be placed at all. The remaining wards are absolutely unfit for human habitat in such a climate, and should at once be struck off the barrack list. It is better to put sick men in wooden huts or in tents on the Cavalier than expose them to risks as they incur in these bad wards".15
Close to the Vittoriosa Hospital was St James Cavalier. This had two wards with 38 beds embedded in the mass of the work. The first ward was 81 feet long and 23 feet broad. It was cut off from the external air by a wall 36 feet thick, and received its light through the door and from two narrow loopholes in the wall. The other ward was 39 feet by 18 feet and was interposed between part of the long ward and the outer air excavated out of part of the 36 foot wall.
Cottonera District – Lower Vittoriosa Hospital (Hired Houses)
This second hospital in Vittoriosa consisted of two adjoining hired private houses situated at the bottom of Strada San Giorgio, near the unhealthy dockyard creek. The houses were in a narrow lane and in the same neighbourhood, but at a much lower level than the Vittoriosa hospital. One of the houses had two floors, the other three floors. On the lower floor of No 1 house was a surgery, cook house, ablution room and coal stores. In the ground floor was the mortuary and three unoccupied cellars. The sick wards were all on the upper floors. The rooms had space for about 40 sick instead of 56, the amount allowed by regulations. The ground floor of No 2 house was occupied by private families. The buildings were unsuitable for use as a hospital. The hired houses were a temporary accommodation. In September 1873 the sick were moved to the new Cottonera Hospital which opened near Notre Dame Gate (Zabbar Gate).
Cottonera District – Cottonera Hospital
On 16 November 1870, the Collector of Land Revenue informed the Chief Secretary to the Government, that three plots of land had been purchased at Cottonera, near the Zabbar Gate. Contracts had been ratified, and the plots were at the disposal of the military authorities for the building of a new hospital. The hospital was designed and constructed by the Royal Engineers for 148 patients. It cost £21,000, including the purchase of the land.
The hospital was built on the pavilion principle where the wards were separated from the administration block. It consisted
of two end to end pavilions in two floors for 136 beds with an administration block between the wards. The advantage of the double pavilion was the ease with which a large number of sick could be superintended and nursed on the same floor. The hospital was 355 feet long, 51 feet wide, and 47 feet high. It had four wards each 128 feet long and 26 feet wide containing 32 beds with a cubical space of 1500 feet per patient. In addition, there were four small wards, two on each floor, of two beds each for special cases. In the centre on the ground floor were the waiting rooms, surgery, room for orderlies, and hospital sergeant's quarters. On the upper floor was a day room for convalescents. The kitchen and stores were in an outbuilding behind the hospital. All the pavilions were connected on both floors by open arched corridors. This veranda was 9 feet wide. It ran on each side of these wards and afforded shelter from sun and rain without interfering with the free air circulating to the pavilions.16
The basement of the hospital had a ward for prisoners, and a contagious diseases ward for six patients. The top floor had a day room for convalescent patients. The hospital had no quarters for the medical officers who had to live some distance from the sick under their charge. The Cottonera Hospital had hot water only on the ground floor. Orderlies had to carry it to the first and second floors.
On 28 August 1873, the new Cottonera Hospital replaced the hired buildings in which the sick of the three Infantry regiments in the Cottonera had been treated. In September, the hospital was handed over to the 1st/13th (Somersetshire Light Infantry) Regiment. The sick and hospital establishment of 1st/13th were transported from the Lower Vittoriosa Hospital to the Cottonera hospital.
Valletta District – General Hospital Valletta
The Hospital of the Order of St John of Jerusalem, the Sacra Infermeria, served as a Garrison Hospital. It remained in use until 1920, despite repeated calls from successive Principal Medical Officers to abandon it. It was partly administered on the regimental system. Each regiment had its own orderlies who slept in the ward with the sick.
The hospital was commenced in 1575 under Grand Master Jean de la Cassiere (1572–82). It had a simple plan resembling a monastic cloister. Initially it consisted of a quadrangle with a corridor around it. The corridor facing the Grand Harbour became the Old Ward. Rooms for a pharmacy, accommodation and administration opened on to the other three corridors. On 4 February 1660, Grand Master Raphael Cotoner (1660-1663) extended the Old Ward towards Old Hospital Street to form the Great Ward. This was completed by his brother Grand Master Nicholas Cotoner (1663-1680) who on 19 December 1674, established the first School of Anatomy and Surgery at the hospital. Extending underneath the whole length of the ward below ground level, and reached by a staircase from near the north end of the long ward, was the Great Magazine Ward roofed with a cross vaulted ceiling.
In 1712, Grand Master Ramon Perellos y Roccaful added the Upper Quadrangle measuring 24 by 24 metres. The quadrangle lay at an angle of 45 degrees to the older part of the infirmary, from which it was separated by a Triangular Courtyard. The Upper Quadrangle was bounded by Hospital Street, North Street and Merchant Street where the main entrance was situated. The large ward abutted on Hospital Street. The Upper quadrangle was surrounded by a number of rooms along its four sides, which included the residential quarters of the army medical staff. It was destroyed during the Second World War. The rooms surrounding the triangular courtyard were used as the regimental hospital of the Royal Malta Fencible Artillery.
The Long Ward did not form part of the military hospital. It was retained by the Civil Government who used it as a rope walk for the employment of convicts. These were subsequently removed, and the ward let to Messrs Woodhouse, wine merchants, who had been induced by government to make Malta their general depot for their Marsala wines. Only the wards around Upper Courtyard were utilised. Five wards and a surgery on the first floor of the building, surrounding the upper courtyard, made up the regimental hospitals. Another set of wards of 80 beds formed the Ophthalmia Hospital. Between 1 June 1863 and 16 June 1865, the British carried out substantial structural alterations, and opened out the eastern wall and formed a stone balcony for convalescents facing St Lazarus Curtain.17 After 1860 some wards were converted into a families hospital.
The sick of the infantry regiment at Floriana were admitted to the regimental hospital at the General Military Hospital. This consisted of one large and two small wards, a surgery, cook house, and a sergeant's room. There was an open gallery for convalescents to walk on. The wards of the regimental hospital had beds for between 40 and 50 patients. At first the sick lay on boards and trestles and used straw mattresses, but following the intervention of PMO Staff Surgeon James Barry, iron bedsteads were provided with hair mattresses and pillows.
Inspector General Daniel Scott, PMO Malta 1855-1857, did not consider the Sacra Infermeria a suitable building for the sick. A great portion of it was in blocks of rooms round small yards with sinks and privies in the corners, or under wards. The sewers of the privies passed under many of the rooms, so that there was always an offensive smell around these badly ventilated yards. The large back yard, surrounded with damp cellars, was itself always damp and unwholesome in appearance. It was the only place where soiled bedding could be laid out to dry and purify. The dirty linen, remarked Scott, created a vitiated atmosphere which circulates through all the wards of the hospital, a further proof that the locality alone is sufficient to condemn the place.18
The cholera epidemic of 9 June 1850 to 13 October 1850 highlighted once again the inadequacy of the General Hospital. It
infected 228 soldiers out of a garrison of 3,475 men, and killed 135 of them. The insanitary location of the hospital was implicated in the cause of the outbreak. Inspector General Daniel Scott was certain that the late outbreak of cholera in the military hospital Valletta, having drawn special attention to the probable origin of it there, the experienced medical officers of the garrison, and others versed in sanitary matters have come to the conclusion, that the concentration of the disease in the establishment may be attributable to the locality, the imperfect drainage, and the bad construction of the buildings. The site of it being low and dirty, and close to the outlet of two main sewers, and in close contiguity to badly drained streets, of which several of the dwellings occupied by filthy population, actually run in the shape of damp close cellars under the wards of a portion of the hospital.18
There was an urgent need for another hospital. The PMO held, "that the lives which were lost from cholera, originating in the hospital this season, would have been saved in a better located and better constructed establishment". Colonel Thomson, Commander Royal Engineers Malta, had proposed to abandon Strada Torre Barracks and to convert the Cavalier of St James into a general hospital for 500 patients. This would have cost £30,000. The men from Strada Torre Barracks and St James Cavalier, about 439 of them, were to be relocated in a refurbished St John's Cavalier at an expense of £17,500 to £20,000 from cost of labour and material.19
On 17 December 1855, the garrison commander, Lieutenant General Sir John Lysaght Pennefather, proposed the building of a military citadel between Floriana and Valletta. This would not only concentrate all the ordnance and commissariat stores in one fortified area beyond the reach of an attack from the sea, but also incorporate a new hospital on the higher ground of Valletta. This citadel was to be enclosed with a defensive wall. All the houses within the area were to be either demolished or reserved for military use. Inspector General Daniel Scott approved the area of Strada Torre Barracks, and St James Cavalier as an ideal location for a military hospital. The site was adjacent to the Auberge de Castille. It was elevated with free circulation of air all round it, and well drained.
The major drawback to the plan was the presence of civilians living in the area. "We might buy their streets with money but no price could compensate our loss if it were to cause vexation to the inhabitants of Valletta," observed the civil governor Major General William Reid, (1851-1858). The attachment of the people to a Sovereign State....can only be purchased and maintained by constantly considering their interests and wishes." Reid, a military engineer by profession, perceived the danger of shutting up his military in one place. "To have a small body of soldiers shut up in Valletta would not be to hold Malta in the sense the British Nation intends this possession to be held", said Reid, "for the dockyard and the naval hospital have to be protected and the harbours ought to be covered. If an enemy besieging Malta should have command of the sea and the garrison was withdrawn from the detached forts, Valletta would be raked from all sides, and with little bomb proof shelters within it, a concentrated bombardment on the small space would be terrible, owing to the falling in the roofs of the houses".20
On 30 January 1856, Reid offered to buy the roomy palace in upper Strada Mercanti, adjoining the Auberge De Castille, and to convert both the auberge and the palace into a military hospital. On 26 May 1856, a committee presided by Major General C Warren, with PMO David Scott, as one of its members, assembled to decide on a site for a new military hospital of 500 beds. The committee visited the Ta' Franconi Lunatic Asylum at Floriana, and having been assured by Dr T Chetcuti, superintendent of the asylum, that the location was a very healthy one, decided to built the hospital there. Sufficient ground existed so as not to have to incorporate the recently completed barracks of St Francis within the hospital. The patients from the lunatic asylum were to be moved to the proposed asylum at Attard which was due for completion in 1860.
In October 1856, Scott received the plans of the Military Hospital Aldershot from the Director General of the Army Medical Services. He passed these on to the Commanding Officer Royal Engineers, for him to prepare an estimate for a general hospital for 500 patients. The site of the Franconi asylum was, however, only large enough for a 300 bed hospital. To construct a 500 bed hospital based on the pavilion principle, with accommodation for the staff and various offices as laid down in the plans of the Aldershot Military Hospital, St Francis Barracks would also have to be taken over. The estimated cost of the project would rise to absorb the construction of a new barracks on the Floriana Curtain, between the two gates of St Anne and Notre Dame to replace St Francis Barracks. The alternative solution was to built two hospitals, with a two hundred bed hospital constructed elsewhere, or to find a different location altogether.
The Committee reconsidered the problem. It decided that the hospital would be built on the site of St Francis Barracks and Civil Lunatic Asylum. The proposed hospital was to be limited to 300 beds, and to contain no accommodation for sick officers. The question of building another hospital for 200 beds was placed in abeyance. The hospital never materialised.
New plans were submitted for a General Military Hospital on St Michael's Bastion. This hospital was to have 300 beds accommodated in six pavilions on two floors. The wards were to be connected by open arcades sufficient to afford shelter from sun and rain but to leave ventilation perfectly free. The administration block was to be detached and placed in front of the hospital but all parts of it were to be connected by convenient staircases with the corridors. The hospital was to overlook the Quarantine Harbour at a height of 170 feet above its level.
Major General William Reid, left Malta in 1858 and was succeeded by Lieutenant General Sir Gaspard John Le Marchant (1858-1864), who was appointed both Governor and Commander in Chief of the garrison. Concurrently, Inspector General Daniel Scott was succeeded by Inspector General John Forrest, PMO Malta 1859-1861. On 15 November 1859, Le Marchant, acting on the advice from his PMO, recommended to the Secretary of State for the Colonies, that the purchase of property for the new military hospital should be temporarily postponed. A sanatorium at Citta Vecchia, and a stone encampment for the troops at St George's Bay were more urgently needed. Le Marchant argued that a sanatorium for convalescents and the formation of a proper encampment for musketry instruction at St George's Bay were not only of "paramount importance as concern the sanitary condition and discipline of the troops in this command", but also "highly economical, by saving the large and wasteful annual expenditure which now takes place in invaliding the sick to England.21
The sick remained at the General Hospital Valletta. The Long Ward was partitioned into two wards known as 20A and 20B. The middle section comprised the dinning hall, and the chapel was used as a special ward. The medical staff consisted of two nursing sisters, each sister having 25 beds under her charge, two medical officers, a ward master, a 1st Class Orderly who had charge of all equipment and six orderlies whose duties were to assist nursing the helpless patients, to distribute the diets, and keep the wards spotlessly clean and neat. One or two orderlies were always in the ward on duty. In 1905 a house was hired at Strada Zecca, ten minute walk from the hospital, for the accommodation of ten sisters.
The virtual eradication of Malta Fever in 1906, reduced the need for the hospital. In former days, the wards would have overflowed with the victims of Malta Fever, but by 1909 there were no cases of Malta Fever amongst the military. In February 1909, the Station Hospital Valletta was handed over to the Army Service Corps as an unoccupied building. On 10 March 1909, the Warrant Officers and the Non Commissioned Officers of 30 Coy RAMC gave a Ball in the Long Ward to celebrate the anniversary of the marriage of King Edward VII to Princess Alexandra of Denmark, which had taken place on 10 March 1863. The Great Hall was transformed into a dazzling and brilliant ballroom. In 1910, the old Valletta hospital was converted into a reception station. The spare wards, offices and stores were re-appropriated and converted into wards for the Military Families Hospital and into quarters for the nursing staff.
The peace establishment of the RAMC in Malta in 1914 was 23 officers, including 2 quartermasters, 150 other ranks and 12 nursing sisters of the Queen Alexandra Imperial Military Nursing Service. The average Garrison Strength was 5,977 men. The Station and Military Families Hospital had only 36 beds, of which, all but 10 constituted the hospital of the Royal Malta Artillery. The Military Hospital Cottonera with 278 beds was the main hospital and HQ of 30 Coy RAMC. In 1920, the Station Hospital Valletta, and the hospital of the Royal Malta Artillery, with which it was co-located were shut and together with the Cottonera Hospital moved to the new hospital on Mtarfa Ridge. The Station Hospital was handed over to the civil authorities and became the Headquarters of the Civil Police.
Military Families Hospital Valletta
In 1862, Inspector General Thomas David Hume strove hard to improve the conditions of married families in the garrison. As there was yet no distant prospect for a special female hospital for the garrison, Dr Hume recommended to the local military authorities to reserve an existing large mess hut and two smaller ones adjoining it on the Crown Work Floriana into a place for sick families. In October 1862, these huts were fitted out for 14 patients. Very little extra expense was incurred by the conversion, whilst much comfort for the sick and a means for their better treatment and nursing was obtained.
In 1879, an infectious hospital of four beds for women and children was opened at the Valletta Station Hospital. In 1894, Surgeon Major General James Inkson, PMO Malta 1894-1895, stressed the great need for proper hospital accommodation for females and children, especially for cases of parturition. Puerperal fever was not then uncommon among females confined to their quarters and attended to by ignorant midwives.
In 1912, work was carried out on the Military Families Hospital which had been established at the former Station Hospital Valletta. The Military Families Hospital admitted 126 general female patients, 85 cases of confinement, and 128 children, six of whom had infantile Kala Azar. Laundry was provided for the patients at the hospital. In 1920, the Military Families Hospital was transferred to the old Detention Hospital Mtarfa. In 1951, a Families Wing was opened in the main block of the David Bruce Military Hospital Mtarfa. The old families hospital became a maternity wing for families of all three services serving in Malta.
Citta Vecchia Sanatorium
On 15 November 1859, Inspector General John Forrest reported to Le Marchant that the lack of a proper convalescent depot in the garrison, prolonged the time the sick admitted to the General Hospital took to recover. "Since my arrival at Malta" declared Forrest, "my attention has been attracted to the difficulty experienced in inducing convalescents in numerous cases of disease among the troops. Not only has this difficulty been met with in the treatment of the primary attacks, but also after its removal, the ordinary remedial agents often fail to produce such rapid improvements as might be expected when the acute stage has passed off, and the sick frequently degenerate into a slow state of chronic debility depending on local causes which change of climate alone will remove.22
Forrest proposed converting the Grand Master's palace at Mdina into a sanatorium, to which a number of selected cases would be removed. This would grant the sick the benefit of a change of air and scene, without incurring the enormous expense of returning them to England. Forrest calculated that in the four years ending 31 March 1859, a total of 1,307 soldiers had been invalided to England. The expense involved, including the necessity of sending out men to relieve them, at the rate of £12 per man, was about £15,684. A sanatorium would therefore easily pay for itself in reducing the expenditure and in improving the health of the soldiers.
On 12 June 1860, the old palace of Justice of the Grand Masters at Citta Vecchia was transformed into a convalescent hospital for officers and soldiers. The palace was leased by the military for £160 a year and took three months to convert at a cost of under £1000. It occupied an elevated location with a fine atmosphere and had good ventilation and drainage, an open ground for the patients to exercise. It had 88 beds on the second and third floors distributed among 18 wards. Wards 4, 5, 6, 7 and 8 holding 36 patients opened on to a wide terrace overlooking Valletta. The terrace was roofed with a wooden verandah to provide shade. A piece of deal plank along side each bed saved patients from stepping out of bed on to cold stone floors. The lower storey was taken up with stores, kitchens, bath room, ablution rooms, mortuary and also had a large dining hall for convalescent patients which also served as a chapel.
The sanatorium was found to be the only place, apart from Spinola Hospital, where fever cases had a fair chance of recovery. It therefore became the custom to remove such cases to Citta Vecchia with the certain expectation of immediate improvement. Ophthalmia and chest complaints did not benefit so much as fever cases by the change of air. Forrest attributed their lack of recovery, to the deleterious sudden great change of climate that the move induced.
Forrest also hired a private house at Citta Vecchia for officers suffering from ill health. During the hot summer season, the sanatorium provided considerable relief to the regimental hospitals. Ambulance wagons were used to move patients from Valletta to Mdina. These were the old Crimean Ambulances, with India rubber springs. The India rubber had, however, lost its elasticity, rendering them practically without springs.
In 1890, the increase in the strength of the garrison led to a temporary closure of the sanatorium which was used as a barrack for troops during the winter. In summer, a third of the troops slept under canvas, relieving overcrowding.
In 1895, a sanatorium for soldier's families was opened at Citta Vecchia. This women's sanatorium was taken over entirely by the War Office on 14 February 1898 and furnished, dieted, and administered as a hospital for soldier's wives and children. The establishment was intended for convalescents only and was inadequate for the nursing of acute cases. In 1898, the Citta Vecchia Sanatorium had admitted 821 patients, as compared with 581 in the previous year. Of these 535 were direct admissions from Mtarfa Barracks and Mellieha Camp, and the rest were transfers from other stations of which 66 came from Crete. In 1903 there were 22 women and 33 children in the women's sanatorium.
In 1907, owing to the reduction of troops in the command it was decided to close the hospital at Citta Vecchia temporarily.
Convalescent Hospital – Fort Chambray Gozo
The hospital at Fort Chambray, Gozo consisted of two buildings set at right angles to one other, with the main building facing east and containing two small stories. The second building was two paces away from the first. It had two rooms and was of one storey in height. The whole hospital consisted of two wards upstairs capable of holding 11 beds and two wards on the ground floor for nine beds. The hospital was hardly ever used, and had never more than two or three patients.
The hospital was situated in the southern angle of the North West Battery. Its front had an eastern aspect and almost faced directly the western or principal front of the barracks. A disused chapel, with its entrance to the east, stood along the north face of the low building.
About 64 metres away from the hospital and 18 metres from the north rampart wall was the burying ground surrounded by a rough stone wall. Burials in the fort had restarted in 1816. Previously, internment of French prisoners had taken place in a small patch of ground near the hospital in the inner portion of the west battery. This burial ground ceased to be used in 1815. An ammunition magazine occupied the South West Battery.
The bomb proof military quarters were about 15 metres from the ramparts. This barrack block had rooms running in a northern and southern direction with doors to the upper stories placed in the middle of the eastern and western fronts. The western and eastern parts of the barrack block consisted of three stories; the central part of the building into two. In 1822, married soldiers and those exercising a trade occupied the rooms of the three stories of the west side, the officers those on the east side, and the middle upper rooms were occupied as the soldier's wards.
In 1822, Fort Chambray was used as a convalescent depôt for the sick of the Ionian Islands. In his Annual Report on the diseases in the garrison of Malta, the PMO John Hennen described the difficulties he had encountered from various sources in carrying the establishment into execution. One hundred and twenty one convalescents arrived from Corfu in August and landed at Fort Ricasoli. Of these, 92 men were sent down for change of climate and 40 for ultimate discharge from the service. The men were in a deplorable state. Forty three of the worst cases were sent over to Gozo, 60 convalescents remaining at Fort Ricasoli. In October an additional 29 convalescents reached Malta from Corfu (26) and Zante (3). A total of 161 men were transferred to the Convalescent Establishment with one soldier dying of phthisis.
In January 1855, Malta became a reception centre for the ill and injured of the Crimea. The small regimental hospital at Fort Chambray proved inadequate. Thus, in March 1855, houses were hired in and around Valletta for their reception. On 4 May 1855, the barracks at Fort Chambray was repaired and fitted up as a convalescent depôt for 500 men from the Crimea. Twenty four Vienna Huts were erected at Gozo, but the huts were of poor quality, and unsuitable for the local climate. Between 21 September and 4 October 1855, 49 deaths were recorded at the military hospital at Fort Chambray, of which 13 were from cholera. The medical staff consisted of: Inspector of Hospitals Gibson James Brown, Purveyor Woodley James,
Apothecary John Herbert, four Surgeons, 16 Assistant Surgeons, and a steward of the recently formed Army Hospital Corps.
In 1882, Fort Chambray was once more prepared to receive sick and wounded from the Expeditionary Force to Egypt under the command of Sir Garnet Wolseley. Malta sent enough hospital equipment to Alexandria to set up a hospital of 400 beds in a large shed near the main wharf. In July 1882, Surgeon Major Thomas Campbell Tolmie and Surgeon Major Robert de Burgh Riordan left Malta to join the field hospital in Alexandria. The steamship Carthage was specially fitted up as a base-hospital for 220 patients on the seaboard of the Suez Canal. A large fleet of transports transferred the patients to Cyprus, Gozo, Gibraltar and England.
On 4 August 1882, medical staff left Southampton to open a hospital at Gozo. They arrived on 13 August. Brigade-Surgeon Alfred Malpas Tippets was in charge of the Base Hospital at Gozo. His second in command was Surgeon Major Edmund Maurice Downing Fitzgerald who arrived from Southampton in the twin-screw SS Tower Hill on 13 August. Two surgeons, one of which was James Maybury Beamish, and an apothecary set up equipment for a 100 beds. The task of setting up the hospital was completed by 24 August 1882.
By 23 August, the Commissariat Staff under a sergeant, four nursing sisters, and five medical officers, including an apothecary, moved to Fort Chambray. A subaltern commanded a guard detachment of 50 rank and file from the Durham Light Infantry. The former governor's house, which had been unoccupied, was adapted as a small mess and officer's quarters. Mgarr Harbour served as a landing for small boats which conveyed patients from the old Indian troopships anchored further out to sea. Two troopships arrived from Egypt with wounded at different times in September 1882.
The role of the medical staff at the Gozo hospital, was limited to the care and surgical treatment of the wounded. However, with the collapse of Pasha Arabi's army at Tel-el-Kebir on 13 September 1882, only two batches of wounded, with less than a 100 men, had arrived at Gozo. On 10 November, the convalescents were discharged, and the hospital demobilised. The medical staff and five nursing sisters went to the large Base Hospital and General Hospital near Cairo and Alexandria. They arrived at Alexandria on 23 November, where the personnel of the Gozo Hospital were dispersed.
Pembroke Camp District – Forrest Hospital St Julians
The annual instruction in musketry was held at Pembroke Camp from 1 January to 3 March, and from 5 October to 31 December. There were no facilities on site. Men and officers pitched their tents on the rocky ridge of limestone grit. The canvas was ripped by the winter gales and the pegs did not have enough grip to prevent the tents from blowing away.
The accommodation for the troops consisted only of a common circular tent occupied by six men to a tent. The men slept on boards placed on the ground or elevated an inch or two by stones. They huddled together exposed to every unnecessarily privation, often deluged with rain. In winter, the stormy sheets of rain confined the soldiers to their tent for two to three days. The effects of such exposure to damp by day and night was detrimental to their health. In summer, they were exposed to the oppressing heat so that the men could only drill in early morning or evening. The rest of the day they were confined by the heat to their tents. Each tent was provided with two basins and a bucket. They washed at the shore, but in winter it was impossible for them to carry out their ablutions by the strong swells.
The hospital for the camp consisted of one small hut and two marquees. The hut was meant to take 10 beds, but only six fitted comfortably. It was used for the care of severe cases while the mildly affected were placed in one of the marquees. The other marquee was occupied as a store for medicines, surgical instruments, medical comforts, surgical appliances and as a sleeping bay for the hospital corporal. The cook house was quite inadequate. Like others in the camp, it consisted of a wall of loose rough stones, with two or three iron bars laid along the side. In the winter gales of 1859, no fewer than eight different hospital marquees were blown down or damaged by the weather. A large quantity of medical stores were lost when the marquee was blown over.23
Le Marchant called the place a "gypsy bivouac" rather than a training establishment. On 9 February 1860, he proposed to replace it with huts instead of canvas and to built a permanent stone encampment so as to improve the general health, comfort and efficiency of the troops. The barracks was to house 1200 men and have its own hospital. The project would cost £5,258. The military paid £3,211 11s 6d for the rent of 90 acres of rough ground, £120 a year to a civilian for the use of one well, which produced bad water, and £30 for drinking water conveyed to the camp in barrels. The camp would thus pay for itself in the long term.
Building commenced in mid June 1860 under the direction of Captain Bland RE. The selected plan was one of a double row of one storied buildings with colonnades to provide shade. The revised estimated cost was 8,000 pounds. It was situated four miles from Valletta, and ranged in six block buildings facing South East and North West; four composed of fourteen rooms, and two of seven. Each room had sufficient space for 14 men. In front of each room was a veranda supported on pillars and arches. There was also a spacious mess and quarters for 30 officers. The camp at St George's Bay was named after the Pembroke family estates of Sir Sidney Herbert, Secretary of State for War (1859-1861).
In order to reduce the expenditure, it was decided not to build the new camp hospital. Instead, Spinola Palace, which was situated within a quarter of a mile of the encampment, was to be leased from the church authorities for £20 a year. This decreased the estimate by £200. On the direction of the Lieutenant General Commanding Troops Malta, Spinola Palace Hospital was named Forrest Hospital as a compliment to the PMO of the garrison. Forrest Hospital opened in October 1860. It was five miles from Valletta by road, and half a mile from Pembroke Camp. It had 42 beds distributed in nine wards. It was intended as a sanatorium and a reception centre for the sick from Pembroke barracks. It also served as a sanatorium during the summer months, as it was found better suited for patients with chest infections than the sanatorium at Citta Vecchia.
On 8 June 1900, a plot of land measuring 30.5 acres was purchased on St Julian's Hill at a cost of £3,100, for the building of a new Station Hospital. Another £141 was disbursed on an approach road for the hospital. The building was to have 140 beds for the garrison at Pembroke and the neighbouring forts. The lease on Forrest Hospital was due to lapse in 1906, and the army had planned to relinquish Spinola Palace in 1905.
In 1904, the Fourth Report of the Centralisation Sub-Committee of the Army Hospitals Committee, recommended replacing the Valletta Hospital with one Central Hospital for the island for all acute cases, "other than venereal, itch, and infectious disease". The hospital was to have 232 beds, and was to occupy St Julian's Hill. However, as this site had no tram or rail links with Valletta, it was decided to sell the land and construct the hospital at Mtarfa. The chosen site was ideally situated on high ground, had transport links with Valletta, while the adjacent infantry barracks provided accommodation for the orderlies of the RAMC, obviating the need to build them new quarters. Forrest Hospital was thus retained until the completion of the new Central Hospital, when it was envisaged to use it as a reception station for the Western District. It was still in use in August 1922, when it was earmarked for closure.
Barrack Hospital Mtarfa
Mtarfa Barracks was commenced in 1891; it was completed in 1896. Seven new two storied blocks were occupied for the first time at the beginning of the year. No sooner had the Royal Lancaster Regiment settled in, that, in July 1896, nine soldiers went down with enteric fever.
A small hospital of 42 beds was also built at the same time as the barracks. It was used for all minor cases amongst the troops stationed there and at Fort Bingemma. All serious cases were transferred to the Station Hospital Valletta. With the decline in cases of Malta Fever, the Barrack Hospital at Mtarfa was used as a sanatorium for convalescents. Ten married quarters in the barracks were set apart for families requiring change of air.
The Barrack Hospital was expanded in 1904. The Centralisation Sub-Committee of the Army Hospitals Committee recommended that the hospital should be reserved for the care of women and children, and that the men should be treated in a new Central Hospital. In 1914, the Barrack Hospital at Mtarfa had 55 beds.
David Bruce Military Hospital Mtarfa
On 19 August 1911, authority was granted for the purchase of land at Mtarfa for the erection of a new Central Hospital. The Malta garrison needed 242 beds. The Barrack Hospital had 42 beds which were increased to 62 by the removal of the RAMC orderlies to the adjacent infantry barracks. The remaining 180 beds for ordinary medical and surgical cases were to be provided by the new Central Hospital. The whole project was estimated to cost £55,000.
Accordingly, 15.5 acres of land were bought to the west of the infantry barracks for a sum of £2,661. The purchase of the land did not progress smoothly. In 1912, the army was able to gain possession of the land, after it had agreed with a litigant to deposit in court the purchase price, (£93 with 5 % interest for a year), of a disputed plot. The wrangling dragged on until October 1934, when the War Office belatedly discovered that no money had ever been deposited in court. The solicitor to the Crown Advocate had fraudulently misappropriated the cash handed to him by Command Pay Office. Thus, legal ownership of the whole site was in jeopardy, unless HM Treasury paid the land owner the purchase price with interest of 5% from 1912 to 1934.
In May 1914, it became embarrassingly apparent that the hospital with all its ancillary buildings would not fit in the acquired area. The sloping nature of the ground had made it necessary to move the main block of the hospital further up the hill, leaving insufficient terrain for the isolation block and staff quarters. Another 9.5 acres would have to be bought, at a cost of £1,000 to £1,122. The outbreak of the Great War had placed other priorities on HM Treasury, which saw no urgent need to release funds for a project that would be too late in its completion to benefit the war effort. It agreed, however, to honour the contracts entered into by the army for the realisation of the main block of the hospital. The rest would have to wait until cessation of hostilities.
On 6 January 1915, Sir Leslie Rundle, Governor and Commander-in-Chief Malta, laid the foundation stone of the new Central Services Hospital. The building was commenced on the assumption that funds would be released to build the ancillary buildings at a later stage. By April 1915, the construction of the main block of the hospital was in hand. By 31 March 1916, the sum of £17,950 had been spent, out of the provisional total of £55,000. The main building was completed during the year 1920-21 at an approximate cost of £40,000. In view of the uncertainty as to the future strength of the garrison of Malta, it was decided not to proceed with the remaining portions of the hospital. Accordingly, no provisions were included in the Army Estimates for 1921-22.
The new hospital was taken over by 30 Coy RAMC on 23 June 1920. The old Barrack Hospital at Mtarfa, adjacent to Q Block, became a Families' Hospital. The former Families' Hospital moved from Valletta in 1920. The Cottonera Hospital was shut. No quarters existed. The orderlies occupied the infantry barracks which had been vacated when the troops deployed to Chanak, Turkey. The nursing staff were accommodated in two blocks of married soldier's quarters and infant school; the sergeant and sergeant's mess and the rank and file occupied the necessary barrack rooms. The RAMC formed an isolated colony on Mtarfa ridge, eight miles from Valletta.
The infantry barracks at Mtarfa had space for 1200 soldiers. No infantry battalion could be stationed there while the hospital staff occupied the barracks. This was not a problem when Malta had only two infantry battalions, as the other barracks, namely St Georges, St Andrews, and Floriana Barracks could accommodate them. Verdala Barracks was used during the war as a Royal Ordnance Depot and was not available for troop accommodation. Floriana Barracks was not large enough to house a complete battalion; it usually detached two companies with their families to Fort Ricasoli. Moreover, to upgrade the sub-standard accommodation of the barracks would have cost over £12,000 in 1920. Two battalions were expected to return to Malta from Mesopotania and Iraq. It was therefore imperative to re-appropriate the portion of the barracks for infantry accommodation which had been allotted to the hospital.
Consequently, in August 1922, further approval was sought to have funds released for the completion of the hospital, on which £40,000 had already been spent. The isolation block, laboratories, officers' quarters, nursing sisters' quarters, married quarters, and recreational facilities had still to be established. The price of the additional 9.5 acres land had meanwhile risen from £1,122 in 1914, to £1,700 in 1922. Authority to purchase the required land was eventually granted by a reluctant Treasury on 8 September 1923. It had to be convinced that the old and sub-standard Naval Hospital on the Bighi promontory lacked the capacity to take on additional troops, and that additional beds had to be made available in a new modern hospital. HM Treasury had previously argued that the naval and military hospital were only some five miles apart; that there was ample vacant accommodation in the naval hospital for army purposes; and that with modern motor transport such a distance was not insurmountable.
In December 1926, the Joint Medical Services Committee created another impediment to the evolution of the hospital by proposing its closure, and using the Royal Naval Hospital as the sole Combined Services Hospital in Malta. Such a recommendation was anathema. Each Service was determined to maintain separate hospitals under naval and military supervision respectively. In addition, the possible expansion of the Royal Air Force in Malta, and the difficulty of access to Bighi by road from the barracks at Pembroke and Mtarfa, made it crucial to have two separate hospitals.
The new hospital had been under used. It had accommodation for six officers and 190 other ranks, but by 1927, six beds had been equipped for officers, and only 119 beds for the other ranks. A Treasury Minute dated 23 February 1927, on the Third Report from the Select Committee on Estimates 1926 paragraph 9 (Amalgamation of Hospitals), noted that "in regard to Malta, the hospital situation there has been discussed and came to the unanimous conclusion that having regard to the position of Malta as an important centre for the hospital accommodation for the sick and wounded of all the three services, it would not be practicable to provide properly adequate accommodation in the Naval hospital alone".
The outbreak of the second world war found the hospital precariously located close to Ta Qali airfield, placing it at risk from enemy bombings of the runway. On one occasion, Mrs Hamilton, wife of then Lt Col William R D Hamilton, (later Major General) was killed. On another occasion the operating theatre was hit and the theatre sisters seriously injured.
In 1941, the hospital took over its war role and changed its name to 90 British General Hospital. It increased its beds from 200 to 2000 beds by taking over the whole of the infantry barracks for hospital wards, and the pitching of tented wards on the football pitch. 90 BGH reverted back to 600 beds in late 1944.24
On 1st March 1951, the designation of the hospital changed to The David Bruce Military Hospital. The first draft of QARANC other ranks arrived in August 1952. They quickly became a popular addition to the service community.
The David Bruce Military Hospital was transferred to the Royal Navy in October 1962, when the RAMC severed its ties with the Maltese islands. From November 1962, the Navy became responsible for hospital services in Malta.
After the 1939–45 war it became evident that the size of the military force in Malta did not justify the retention of two general hospitals. The Royal Naval Hospital Bighi had a peace time establishment of 261 beds, capable of expansion in war to 354 beds, but had no maternity beds or isolation ward. The David Bruce Military Hospital Mtarfa had 235 beds, of which 53 were obstetric beds located in a wing separate from the main hospital building. The hospital had only one operating theatre which was not air conditioned, while facilities for out patients were limited.
In 1957, the working party of the Ministry of Defence Medical Services Coordinating Committee, decided on economical but not medical grounds, that Bighi should serve as the Combined Services Hospital. However, a revision of their estimates carried out in 1960 by the Manager Navy Works Malta found that their costings had been based on unreliable data.
In March 1960, a new report recommended the David Bruce Military Hospital as the future Combined Services Hospital. The recommendation was approved in January 1961, but the Defence White Paper of February 1962 outlined a naval draw down. With less troops on the island a hospital of 206 beds would be sufficient for service needs.
The final decision to move the naval hospital from Bighi to Mtarfa was taken in 1967. Rebuilding started in February 1969. This included the provision of a new air-conditioned operating suite and a ground floor out-patients complex which reflected the trend away from predominantly in-patient investigations and treatment to out-patient care. The Receiving Room was designed to operate a central records system for both in-patients and out-patients. It was close to the typing room and communicated with the consulting rooms and the waiting area. The x-ray department, pharmacy, laboratory and physiotherapy department were grouped in close proximity to the out-patients facilities. The main building also housed the large medical stores required to supply service medical centres in Malta and Libya, as well as visiting ships.
In 1965, H Block St David's Barracks, with J and K huts and the RMA mess at St David's, were earmarked as accommodation blocks for the 38 QARNNS officers, 68 Male Nursing staff, 66 Naval Nursing Auxiliaries, 2 WRNS ratings and 2 Red Cross Officers of the Combined Services Hospital, known as the Royal Naval Hospital Mtarfa. The QANNA were to live in H Block, and the male ratings in half of G Block. The classrooms for training the nursing auxiliaries were to be sited in Q block, which was adjacent to the families hospital. It was proposed for the medical and nursing officers to take over the RMA mess at St David's Barracks. Objections were raised to this scheme on the grounds that the hospital staff needed to be close to their place of work, and that transport would be required on a constant basis to ferry them to and from the hospital. It was argued for a new accommodation to be built within the hospital grounds. The proposed move of the Royal Naval hospital from Bighi to Mtarfa was delayed until the question of staff accommodation was resolved.
The hospital was formally opened on 2 October 1970 by Lady Dorman, wife of the Governor General Sir Maurice Dorman, and was taken over by the Medical Director-General (Naval) Surgeon Vice Admiral Eric Blackburn Bradbury RN.
Army hospitals evolved from the small regimental hospital in a hired house, to the palatial hospital on Mtarfa ridge for all three services and their dependents serving in Malta. The military hospitals which opened temporarily between 1915 and 1918 for the Gallipoli and Salonica expeditions are described elsewhere. Likewise the British General Hospitals which opened during the second World War between 1940 and 1943. Malta rightly deserved her epithet of the Nurse of the Mediterranean for the care given to the sick of the Gallipoli and Salonica Campaign.
All the military hospitals have now been shut or converted to civilian use. However, so long as they stand, they bear a silent witness to the struggle against disease that was fought within their walls. The sick soldier admitted to the various hospitals was thankful for the medical respite they afforded and to the medical and nursing staff who in their fight against the unknown often themselves fell victim to the illnesses of their patients.
1Galton and Sutherland Report of the Barrack and Hospital Improvement Commission on the Sanitary Conditions and improvement of barracks and hospitals at Mediterranean stations. British Parliamentary Papers London 1863.
2Bradshaw A F, Recollections of the Army Medical Department 1857. J R Army Med Corps 1923; XL: p 145.
3Instructions to regimental surgeons for regulating the concerns of the sick and of the hospital. Horse Guards Sept 1803.
J R Army Med Corps 1933; LX: pp 141-149 and pp 222 to 233.
4TNA:WO 25/3944, Confidential reports on medical officers 30 August 1860 - 6 June 1861.
5The trials of a regimental medical officer. The Army Medical Service Magazine April 1955, VII: 2; pp 38-40.
6TNA:WO 30/139, AMD miscellaneous correspondence papers and forms 1823 to 1844.
7TNA:ADM 102/521, Naval Hospitals and Hospital Ships Musters, and Miscellaneous Journals, 1 January 1800 to 31 December 1805. Quarterly book for the Naval Hospital at Malta from 17 Dec 1800 to 31 March 1801.
8TNA:CO 158/13, Villettes to Ball 18 February 1807, folio 147 - Use of St Calcedonius as a military hospital.
9United Service Magazine no 365 dated 16 June 1849.
10TNA:WO 334/12, Surgeon Lea's Annual Medical Report 5th Infantry 1835.
11TNA:WO 44/596, Memorandum respecting the exchange of property under charge of the Ordnance at Malta. London 12 August 1835.
12TNA:ADM 102/521, Quarterly book for the naval hospital at Malta from 17 December 1800 to 31 March 1801.
13TNA:ADM 102/555, Malta Military Hospital May 1802 - Jan 1804. Returns of the sick of the Royal Navy admitted to the General Military Hospital at Malta from 13 May 1802 to 2 January 1804.
14TNA:WO 334/16, Surgeon Bathurst Thomson's Medical Report 69th Foot dated 1 April 1848.
15Galton D, Sutherland J,., Report of the Barrack and Hospital Improvement Commission on the sanitary condition and improvement of the Mediterranean Stations. London 1863 p174.
How Villa Bighi became a naval hospital Sunday Times of Malta 1970, Cassar 20 Sept 1970.
Cassar P. The opening of a naval hospital 27 Sept 1970.
St Edward's College 25 years of endeavour Times of Malta 16 June 1954.
Wellcome Trust RAMC 374 o/s 18. MS Vol of hospital reports and medical summaries from British army medical staff in Malta and Gozo and the Ionian Islands 1821-22.
Wellcome Trust RAMC 659 Box 134. Photos of British hospitals in Malta 1904-1907. Group photo of the officers and nurses of Cottonera hospital 1904. Six photos of the patient's Christmas party at the military hospital Valletta 1906-1907.
Wellcome Trust RAMC 793 Box 165-166 and o/s 42. Papers of Lt Col Herbert St Maur Carter 1875 to 1954. Malta and Crete 1906-07, Album of photos of Malta 1906, Maps of Malta 1895, Two photos of Malta one endorsed near St Paul's Bay.
Wellcome Trust RAMC 1246. Group photo of some of the patients at St George's Hospital Malta 1916.
Howell H A L, The story of the army surgeon and the care of the sick and wounded in the British Army from 1715 to 1748. J R Army Med Corps vol 22 Mar 1914 pp 320-334 and 455-471.
The Malta Times and United Service Gazette 1860, Issue No 904 (14 June 1860).
Griffiths W A., History of Malta Dry docks in J F Darmanin The British Hospitals at Malta with particular reference to Bighi. Malta 1939.
TNA:WO 78/2815/2, (1896) Cottonera Hospital - plans elevations and sections of hospital.
TNA:WO 78/2876, (1861) Citta Vecchia Sanatorium - plans elevations and sections of hospital.
TNA:RG 14/34986, (1911) Mtarfa Military Hospital Malta, Military Hospital Forrest Malta, Valletta Military Hospital.
TNA:WO 265/60, (1946 Dec) British Military Hospital Mtarfa Malta.
TNA:WO 334/77, (1870 Jan-Dec) Military Hospital Forrest Malta - sick returns and reports.