CIVIL HOSPITALS IN MALTA

C. Savona-Ventura



The spreading cult of Christ the Healer resulted in sick-nursing beingviewed as a Christian duty. As a natural consequence of the doctrine of the Mystical Body of Christ which sees in the sick person Christ himself, the organised and skilled care of the sick and suffering developed within the framework of the Church. The Council of Aix-la-Chapelle (816 A.D.) required that every bishop should provide a house for the poor and the sick, supporting it out of Church funds. The hospital was to be near the church and under the care of a priest. Hospitals were secularized after the Reformation of the sixteenth century. The first hospital recorded in Malta was already functioning in 1372, while in the sister island Gozo a hospital was founded in 1454. The arrival of the Hospitallier Order of St. John to the Islands in 1530 resulted in the expansion of hospital services in the Islands as part of a state-organized social services system. At the end of the eighteenth century (1798) the hospitals in use during the time of the Knights of St. John included the renowned Sacra Infermeria for men and the Casetta for females, both at Valletta serving the southeastern harbour region. The rural central region of the Island was served by the medieval Santo Spirito Hospital situated at Rabat and which served poor patients of both sexes. These hospitals were supplemented by several hospices for the elderly and infirm including the 280 bed hospice for both sexes at Floriana, the 80 bed hospice for both sexes at Saura Hospital at Rabat, and the 15 bed hospice for females at Zebbug. There was also a quarantine hospital on Manoel Island. The Island of Gozo was catered for by two hospitals, one for males and one for females, both situated at Victoria [1]. The ousting of the Order by Napoleon Bonaparte in 1798 required a reorganization of the hospital services with a segregation of civil and military patients. The Sacra Infermeria was taken over by the French to be used as a Military Hospital and named the Grand Hopital. A new Hopital Civil for male civilians was established in Valletta. This segregation was further augmented during the nineteenth century under British dominion when hospital services were organized for civilians, military [2] and naval [3] personnel.

Santo Spirito Hospital (Rabat)
The earliest hospital in Malta was the Hospital of St. Francis at Rabat which in 1372 was already functioning under the rectorship of a Franciscan Niccolo` Papalla appointed by the King of Sicily. There does not appear to be any evidence of a Franciscan Minor community in Malta before 1499, and a likely hypothesis is that the hospital was run not by regular Franciscans but by lay Franciscan tertiaries under the rectorship of a regular member of the order. The main source of income for the hospital came from its real estate consisting of an appreciable amount of land and other immovable property. Mismanagement resulted in the transfer in 1433 of the hospital's administration to the Universita`, and the hospital's name was changed to Santo Spirito Hospital. In spite of this transfer, the accounts of the hospital during the medieval period show that the Church, the Universita`, and the hospital were all active constituent elements in one organic closely-linked establishment. The name Santo Spirito, commonly given to several medieval hospitals in Europe, originated with the religious order of Santo Spirito, founded by Guy de Montpelier (ob. 1208), which specialized in the setting up and keeping of hospitals particularly intended for foundlings and maternity cases. From the middle of the fifteenth century onwards Santo Spirito Hospital in Malta functioned normally caring for a number of persons, mainly too old or too poor or otherwise incapable of caring for themselves, besides foundlings and patients. Another medieval hospital for women - St. Peter's Hospital at Mdina was functioning before 1418, when it was closed down and converted into a monastery for nuns of the Order of St. Benedict. In the same year of its closure a bequest for the foundation of a second hospital was left by the wife of the Governor of Mdina [4].

In 1574 the Apostolic Delegate and Visitor-General to Malta Mgr. Pietro Duzina visited Santo Spirito Hospital and left a detailed and informative picture of its state of affairs during the mid-sixteenth century. The patients were received in the small church of Santo Spirito which contained only four beds, each accommodating two patients. The bedding consisted of a mattress filled with flax and covered with a woolen coverlet. A surgeon was attached to the hospital, while the Mdina apothecary served the hospital needs. Duzina's description suggests that the hospital management was not very satisfactory, and a set of rules for its management were put forward. Duzina suggested that a dormitory containing eight beds should be set up, each bed having a palisade, mattress, four bed-sheets and two blankets in winter. He also laid down detailed rules regarding the reception and care given to foundlings, and required the hospital administrators to submit an annual report to the bishop [5].

Subsequent pastoral visits to the Hospital suggest that Duzina's regulations and suggestions were gradually put into force. By 1580 at the latest the Hospital had its own resident apothecary with his own pharmacy at the hospital. The 1599 pastoral visit by Bishop Gargallo indicates that the patients were no longer housed in the church, but in a dormitory with eight beds. Eight foundlings were being received per year. The institution possessed four plates of pewter, two bowls, two small vessels for the administration of syrups and a cauldron. A wooden cot which revolved on its vertical axis (the ruota) to enable the anonymous deposition of the foundlings was set up by 1615. In 1667 the hospital was described to have been expanded to contain nineteen beds for men and eleven beds for women, though after 1685 no further references to male patients can be found. In 1708 an attempt was made to separate the patients by the setting aside of fever cases in a separate ward. Very extensive modifications were carried out in 1729 when the number of wards were augmented to three to enable the hospital to receive a greater number of patients. Only destitute countrywomen were admitted, while the professional staff consisted of two physicians, a surgeon, two barberotti and an apothecary. By 1778 accommodation was increased to forty beds, while the administration of the hospital became the responsibility of a board composed of the Jurats, the procurators and the medical staff, who submitted their decisions to the Seneschal for approval. During the nineteenth century, Santo Spirito Hospital remained an important establishment in the medical services of the Islands, and in 1838 was assimilated with the Civil Hospital in Valletta serving as an extension of the main hospital after its bed compliment was expanded to sixty beds. During the smallpox epidemic of 1871, it served as an isolation hospital for the duration. It was changed into a convalescent sanitarium in 1883 [6]. In 1937, it catered for medical and surgical cases which did not require specialized care, the patients coming from the central region of the Island. It also received convalescent cases from the Central Hospital in Floriana. It had 34 beds for men and 35 beds for females. The daily average number of patients during 1937 was 58. A Resident Medical Superintendent was in charge of the hospital, while the Senior Physician attached to the Central Hospital acted as a Visiting Physician. The medical cases treated in the hospital included convalescent cases of Brucellosis, subacute heart disease, diabetes and anemia. The surgical cases were mainly orthopedic ones. After 1946 most of the accommodation of the hospital was allocated to orthopedic cases which required a long stay. In 1956 it was described as having some 70 beds equally divided between male and female patients, with a number of children in each ward. The beds were arranged in a series of wards opening one off the other around the chapel. The wards were high and airy, but cold and uninviting and devoid of outlook. It was suggested that rather than its use as a chronic sick hospital, the hospital could be put to some other use such as a surgical convalescent ward, or even abandoned. It was closed down in 1967, and was eventually refurbished and restored into an Archives Museum [7].

Sacra Infermeria (Birgu & Valletta)
The arrival of the Hospitaller Knights of St. John of Jerusalem to the Islands in 1530 saw the institution of a number of new hospitals on Malta. The Knights concentrated their forces at Birgu, the maritime center of Malta. There they established their first hospital on the Island which was initially of a temporary character. In 1532, after expropriating and demolishing a number of buildings on the foreshore of the town, the building of a permanent hospital - the Holy Infirmary - was started. Besides catering for members of the Order, the hospital was also open to male civilians and also cared for orphans and foundlings. A few years after its completion the infirmary it was enlarged by the addition of another storey. While the hospital size was suitable for day-to-day requirements, it was unsuitable in times of emergency. It functioned as a regular hospital until 1575 when the Valletta Holy Infirmary was completed. At Birgu, apart from the Holy Infirmary, the Italian Knights kept a small hospital in their own auberge. This hospital was maintained until the Knights moved to their new quarters in Valletta [6].

Following the Knights victory of the Great Siege by the Turks in 1565, the Order decided to built a new fortified city guarding the major harbour of the Islands. A new Holy Infirmary was planned, the site chosen being the south-eastern side of Valletta. The building, started in 1574, consisted originally of one long ward. It was subsequently enlarged in 1583 by the addition of a new block, and remodeled in 1662 and in the eighteenth century. The number of beds varied throughout the centuries. In the late eighteenth century there were 554 single beds which could be increased to 900 in case of emergency. The majority of the beds (370) were provided with canopies of various colour hues, and woolen mattresses. The hospital wards were open for all whether members of the Order, civilians, or slaves. There was also provisions for the deposition of foundlings. The Valletta Holy Infirmary was one of the best serviced hospitals in Europe and was favorably described by a number of foreign visitors to the Islands during the seventeenth and early eighteenth centuries. The Rev. Henry Teonge in 1675 described the hospital as being "so Broade that 12 men may with ease walk a breast up the midst of it; and the beds are on each syd, standing on four yron pillars with white curtens and vollands and covering extremely neate, and kept cleane and sweet; the sick served all in sylver plate". A contemporary detailed description of the wards was made in 1687 by Mr. G. Wood. This description of the wards with canopies on four poster beds confirm the depiction of the wards shown in a 1588 engraving probably by Filippus Thommasinus and the 18th century painting of "Blessed Gerald" painted by Favray and held by the National Museum of Fine Arts. Seventeenth century depictions of the wards of the Sacra Infirmeria, including a 1650 German engraving by Christian von Osterhausen and a probably Mattia Preti painting of the "Blessed Gerald" held in the former Infirmeria, show slightly different arrangements where the beds are not four-posters but retain their canopies [7].
 
 

Towards the end of the eighteenth century a decline set in the general affairs of the Order including the Holy Infirmary's management. In 1786 the hospital was described adversely by John Howard. He wrote that "The ceiling is lofty but being of wood is now turned black; the windows being small, and the walls hung round with dusty pictures, this noble Hall makes but a gloomy appearance.... All wards were dirty and offensive, so much so that it was necessary to use perfuming, and the physician had to keep his handkerchief to his face while doing his rounds... the patients.... were served by the most dirty, ragged and unfeeling and inhuman persons I ever saw. (8) The decline of the Holy Infirmary continued during the two-year French interlude between 1798 and 1800. The French established their first hospital at Mdina on the first day of their occupation, but four days later an order was issued to reserve the Holy Infirmary, renamed Grand Hopital, for the exclusive use of their troops. The civilian patients were transferred first to the Casa delle Alunne and afterwards to the Monastery and Church of St. Mary Magdalen which became the Hopital Civil. The Holy Infirmary thus started its phase as a military hospital, a function it served also under British dominion until the 22 December 1919 when it was handed over to the Civil Government. It has subsequently been used for a variety of purposes, until in 1978 it was converted into the Mediterranean Conference Center [9].

The Casetta (Valletta)
Since the Sacra Infermeria during the period of the Knights was reserved exclusively for male patients, a need for a number of beds to care for sick women was felt. In 1625, Catherine Scapi had set apart a small house in Valletta, known as Santa Maria delle Scala for the care of poor infirm women, the house eventually being moved to different premises. This small hospital was closed down after the founder died in 1655. A new woman's Hospital known as the Casetta or Ospidaletto was re-established in Valletta by Grand Master Martin de Redin in April 1659. The running of the Casetta was left under the direction of the Governess who resided in the institution, while the medical care was left to two physicians and two surgeons. A number of female nurses and a midwife were employed in the hospital serving various functions. Alterations to the building were carried out in the early decades of the eighteenth century so that by 1727 the bed compliment was increased to two hundred, each having a canopy for privacy. The hospital's conditions deteriorated in the late eighteenth century. Under British rule, the management of the hospital was entrusted to the Presidents of the Hospitals. In 1850 the women patients in the Casetta were transferred to the newly established Central Hospital in Floriana, and the Casetta was reserved exclusively for inmates of both sexes suffering from incurable disease. The Casetta was destroyed during the Second World War, while the adjoining orphanage was demolished to make space for a new government school [Evans Laboratories] [10].

The Civil Hospital (Valletta)
Before the arrival of the French, hospital services in Valletta consisted of the Sacra Infermeria for males and the Casetta for females. These services were supplemented by Santo Spirito at Rabat. Under French rule, the civilian hospital services for males were transferred to the Hopital Civil. On the 18th June 1798, Napoleon issued Article 12 wherein it was declared that the hospitals were to be reorganized on a new system and the property accruing from closed convents was to be used for that purpose. On the 29th July 1798, the French Commissioner ordered some of the nuns and women inmates of the Mary Magdalen Asylum situated in the vicinity of the Casetta to vacate the premises. On the 21st August, the Commission of Government appointed a sub-committee of three members to report on the suitability of transferring the male civil patients to the Casetta. The committee reported that the Casetta and adjoining Casa delle Alunne - a home for illegitimate children - could accommodate 210 beds. They proposed, however, that alterations to the edifice structure should be made to separate the two sexes so that the hospital would accommodate 108 beds for males and 170 beds for females. On the 21 December 1798, 70 civilian male patients were transferred from the Sacra Infermeria to the new wards. This arrangement was short-lived, and alternative accommodation was arranged in the nearby Mary Magdalen Convent and Asylum. On the 4th May 1799, the Bishop was ordered by the French to desecrate the church of the former monastery so that this would serve as a casualty ward. The upper floor of the monastery was used as fever wards, while the lower floor housed the surgical wards and the stores. The basement housed the mental patients. The professional staff consisted of five physicians, five surgeons and two barber-surgeons [8]. With the capitulation of the French, the Hopital Civil was taken over for use by the sick Neapolitan troops, but in November 1800 reverted to civilian use. The management of the renamed Civil Hospital became the responsibility of the Presidents of the Hospitals and a set of regulations for its management were drawn up in 1802. The professional staff consisted of four Physicians, seven Surgeons, a Maestro di Fisica and four apprentices responsible for bloodletting and applying vesicants, a chirurgo d'apparecchio and a braghista responsible for applying splints, bandages and trusses, besides a number of surgical students. The pharmacy was under the direction of a Principal Apothecary and four assistants. By 1837 the wards had become overcrowded. All forms of disease were treated in the hospital with separate wards being provided for cases of scabies, cancer and ophthalmic disorders. In May 1850 the sick inmates were transferred to the newly established Central Hospital at Floriana. The former convent was in 1851 reorganized as an orphan asylum accommodating 50 boys and 60 girls aged 5-10 years. The building was destroyed during the Second World War and only the church, now used as a store, survives [9].
The Central Hospital (Floriana)
The Central Hospital at Floriana was adapted from a building built by Grand Master De Vilhena in 1734 known as the Conservatorio, set up to house pauper girls and teach them various useful crafts. It was transformed into a general hospital for both sexes in 1850 and patients from the Valletta Civil Hospital and Casetta were transferred there. In 1850 the medical staff consisted of four physicians, four surgeons, a pharmacist and two assistants. The administrative work was performed by the storekeeper and the professional staff. By 1872 it was realized that the Central Hospital had become inadequate to cater for the reception and treatment of the sick since it had become difficult to accommodate the increasing number of patients brought to it. By June 1878, the hospital population had increased to 170. A decision to admit all infectious cases of measles, scarlet fever, diphtheria and whooping cough to the Central Hospital, rather than continue utilizing the inadequate Santo Spirito Hospital, increased the problem of isolating the infectious cases. In 1885, the male surgical division was over-populated and some of the patients required to be accommodated in the corridors [11].

On the 11th November 1885, recommendations were made to replace the Central Hospital by a larger building. The plan envisaged extensive grounds for the recreation of the convalescent patients, to prevent hemming in of the hospital by private houses and enable later extension. The hospital was projected to house 354 beds, with a division for men and one for women. Operating theaters, laboratories and an out-patients block were also provided for. Communication between the various hospital blocks was to be facilitated by a tramway. These plans were shelved and the Central Hospital continued to provide a national service in spite of its shortcomings. In 1898, hospital accommodation accounted for one bed per 900 inhabitants. Various reports from the Comptroller of Charitable Institutions highlighted the inadequacies of the Central Hospital and proposing the building of a new general hospital. These recommendation were only definitely acted upon in 1927 when financial provisions were made for the establishment of a new general hospital. In 1937, the Central Hospital remained the principal general hospital in Malta, cases from Gozo being also received in special circumstances. The Resident Medical Staff consisted of the Medical Superintendent and eight Assistant Medical officers, besides a Chief Pharmacist assisted by three pharmacists. The Visiting Medical Staff consisted of two physicians, five surgeons, two accoucher-gynaecologists, two pathologists, an ophthalmic surgeon, an anesthetist, two radiologists, dental surgeon, and three medical officers responsible for venereal disease, dermatology and ENT. The hospital accommodated 253 beds - 125 for men and 128 for women with children under five years being kept in the female wards. The average daily number of patients in 1937 was 310. Other wards were available in the Poor House for incurable disease and for convalescent medical and surgical cases and cases of tracoma [12].

The site chosen for the planed new 510 bed hospital was the promontory of Gwardamangia and the foundation stone was laid on the 5 April 1930. The construction of this hospital progressed slowly for a variety of reasons including technical difficulties and Italy's declaration of war against Abyssinia in 1935. The Second World War similarly slowed down the construction of the new hospital and it was only in 1954 that the Central Hospital at Floriana could be changed into the Headquarters of the Malta Police Force. In 1956 the Central Hospital with a bed complement of 56 beds was serving as the dermatology/venerology and ophthalmology departments. It was also used as a center for the distribution of medicines to needy patients [13].

The hostilities of the Second World War required a reorganization of the medical services of the Islands. This reorganization included the establishment of several emergency hospitals to cater for the expected casualties and increase in infectious disease. By September 1939, the Department of Health was ready to provide 1,200 to 1,500 beds for casualties, as well as a 100-bed maternity hospital and special wards for cases of war neurosis. The mobilization of the Emergency Service was initiated but only put into full operation after the outbreak of hostilities with Italy. The Male and Female Surgical Departments and the Maternity and Gynaecology Departments were transferred to the Bugeja Hospital (previously the Bugeja Technical Institute) at Hamrun on the 28th May 1940. The Male Medical cases were transferred to the Birkirkara Hospital (previously St. Aloysius College, a Jesuit school) on the 26th June, while the Female Medical cases and Ear-Nose-Throat Department were transferred to the Blue Sisters Hospital (previously a private hospital run by a religious order) in July 1940. A Children War Memorial Hospital was also inaugurated in the latter hospital. Infectious disease cases were after September 1940 transferred to St. Luke’s Hospital. The Maternity Services were on the 19th June 1940 transferred to a newly constructed wing of the Adelaide Cini Orphanage at Hamurn, thus increasing the maternity beds from 16 beds at the Central Hospital to 100 in Cini Hospital. Cini Hospital continued to function as an Emergency Maternity Hospital until 1949 when St. Luke’s Hospital was completed and the maternity services could be transferred to the new wards [14].

St. Luke's Hospital (Gwardamangia)
St. Luke's Hospital was in 1927 initially commissioned to provide 350 to 450 hospital beds. The initial progress in the construction of the hospital was however slow. It was expected that the hospital would be completed by the end of 1941, but its completion was further delayed by the outbreak of the Second World War. By 1937, the projected bed compliment was increased to 510. During the war, St. Luke's Hospital sustained war damage, one block was badly bombed and one employee lost his life and several others were injured. The lower storeys, the basement and ground-floor hospital were speedily conditioned and prepared for 200 beds to accommodate contagious cases and fevers. The post-war period saw the gradual transfer of other departments to the hospital, with the medical section being first transferred in 1946. In 1957, St. Luke's Hospital was described as having a total of 546 beds made up of the following departments: Surgery (4 wards, 120 beds), Medicine (4 wards, 120 beds), Gynaecology (1 ward, 30 beds), Obstetrics 92 wards, 42 beds), Orthopedics(2 wards, 60 beds), Pediatrics (2 wards, 40 beds), Ear-Nose-Throat (2 wards, 62 beds), and a further 2 unassigned wards (60 beds). The wards had a floor space per bed of approximately 230 square feet. It was suggested however that the number of beds in the hospital should be increased to 750 beds in line with the increasing demands being made by the sick population on hospital services [15].

The post-Second World War period saw a changing attitude towards hospital care. Thus in 1953, the Chief Government Medical Officer commented that "in these islands, like in other countries, we have our own hospital problem which is becoming increasingly pressing year by year. It is due to the fact that the increased hospital-mindedness of the public has not been followed by a corresponding or relative expansion in the hospital service". This changing attitude resulted in a palpable shortage of hospital beds in the mid-1950s. The Government at the time proposed a new 500-bed hospital at Naxxar planned to incorporate a children's wing of 200 beds, 150 beds for general cases, and 150 beds for tuberculosis patients which were eventually to be re-allocated to other specialties. The Government initiated a number of discussions with various commissions, including the Economic Commission, and invited a British Medical Commission to study the proposals. The Medical Commission concluded that despite the evidence presented, the proposed new hospital was not an urgent necessity. Before embarking on a new expensive general hospital for which it will be difficult to recruit the necessary staff, the Commission proposed that it would be better to reorganize the facilities at St. Luke's Hospital and the other domiciliary medical services, and undertake a limited building program. It was considered doubtful whether the population could really sustain two acute hospitals, since there were considerable difficulties in providing the necessary trained nursing and medical staff. Also the two hospitals would have required the division of resources of the island. The proposal to build the new hospital geographically separated from the main general hospital was shelved on the basis of these recommendations [16].

The subsequent decades saw a number of extensions being made to the main hospital to accommodate the various developing specialties and the progressively increasing demands on the hospital services. Other hospitals on the Island were reorganized to serve specific functions and supplement hospital beds. King George V Hospital for merchant seamen, rebuilt after its demolition during the Second World War, had closed down in January 1967. In 1970 this hospital, renamed Sir Paul Boffa Hospital, was refurbished and opened for the management of infectious cases, dermatology-venerology and cancer cases. It also served as a short stay convalescent hospital. The main extension to St. Luke's Hospital during this period was the building in 1979 of Karin Grech Hospital dedicated to Obstetric and Gynaecological, Pediatric, Ophthalmology and Ear-Nose-Throat specialties. This new hospital, situated in the grounds of St. Luke's Hospital and thus can make full use of the main hospital's investigative and other facilities, allowed for the reorganization and refurbishment of the wards increasing the number of both medical and surgical beds. This augmentation increased the number of beds in the St. Luke’s Hospital Complex to 1100, so that in the 1986 the optimal ratio of 3.3 acute beds per 1000 population was reached. At this point it was considered uneconomic to plan for additional beds at St. Luke's Hospital and further development of the facilities at the Hospital were focused on better management and improving back-up services [17].

In the early 1990s, a policy aimed at refurbishing and reducing the number of beds at St. Luke's Hospital by building a 500 bed "extension" close to the University of Malta at a distance from the Hospital was initiated. The new hospital was scheduled for completion in 1997 and it planned that all departments would be transferred from St. Luke's Hospital to the new hospital, leaving St. Luke's as a surgical center only. Karin Grech Hospital would have housed acute psychiatric cases while cancer patients would have stayed on at Sir Paul Boffa. The proposed new hospital brought on a vociferous opposition from the medical profession and other sectors of the public. In 1997, the general hospital policy was reviewed in the light of the previous decisions and the state of the ongoing building program. After studying several options, a new policy was initiated whereby the new hospital at Tal-Qroqq, situated close to the University grounds, would increase its hospital occupancy to about 800 beds catering for all specialities, while St. Luke's Hospital will be refurbished to serve as a convalescent and elderly care hospital [18].

Gozo Civil General Hospitals
The first hospital in Gozo owed its origin to a bequest made by Francesco Bonnici on 22 February 1454. The establishment, used as a hospital for destitute sick women, was dedicated to St. Julian (but also known as the Hospital of St. John the Evangelist, of St. Cosmos and St. Damian, and Santo Spirito Hospital) and consisted in 1575 of a few dwellings near the gates of the citadel of Rabat/Victoria. On 3 May 1783 the foundation stone for a new hospital was laid at Rabat/Victoria. This new hospital named St. Julian Hospital accommodated fifty patients and received also unmarried pregnant mothers who sought refuge under its roof at the approach of labour. It was also provided with a ruota to receive foundlings. It ceased to function becoming the Gozo Seminary in 1838 when the Hospital of St. John the Baptist was extended for both sexes. The Hospital of St. John the Baptist was founded on 16 June 1719 and opened ten years later on 14 October 1729. The Hospital of St. John initially admitted only male patients and was staffed by two alternating physicians and a resident surgeon. In 1838, the old and infirm inmates were transferred to the Malta Ospizio at Floriana to make room for female patients. It afforded accommodation to sixty males and fifteen females. A home for the disabled poor aged over sixty years, with a bed capacity of 172, was annexed in 1849. The hospital changed its name to Victoria Hospital on the occasion of Her Majesty's Queen Victoria Jubilee in 1887. Structural expansion was undertaken in the last century to enable the hospital to deal with a greater number of patients. In 1937 the bed compliment of the hospital amounted to 84, 34 for men and 50 for women. The adjoining Asylum for the aged and invalid poor, established in 1851, accommodated 172 beds. A monthly consultant service for Victoria Hospital was instituted in 1946, though the resident medical staff in 1957 was described as consisting only of a medical superintendent, one resident medical officer, and a recently qualified house officer. The hospital in 1957 was described as not unattractive with several courtyards pleasantly laid out with trees and flowers. The wards were lofty, cool, old-fashioned but adequate. The bed compliment included 26 medical, 40 surgical, 12 maternity, 6 gynaecological, and 10 pediatric beds. A new hospital named Craig Hospital, subsequently renamed Gozo General Hospital in 1989, was inaugurated in Rabat/Victoria on 31 May 1975, and the old hospital was re-utilized as the Government Health polyclinic and other offices [19].
Relgious-run Hospitals
The changing attitudes of the sick population towards seeking hospitalization which occurred in the 1950s [20], initiated a trend towards the development of religious-run private-care hospital services. The first private hospital to be opened in Malta was run by the Sisters of the Little Company of Mary (Blue Sisters) and named Zammit Clapp Hospital or Blue Sisters Hospital. The hospital situated at Sliema was opened after a deed of donation in favor of the government was made by Emilia Zammit Clapp and her sister Mary Zammit on 23 June 1911. This hospital initially served as a Seamen’s Hospital. The nursing, food, attendance, washing and other services necessary for the patients were to be provided by the Sisters against payment of 2s6d a day per patient by the Board of Trade or other parties. The medical attendant, drugs, surgical instruments/appliances, clothing and bedding were to be provided by the government. This arrangement resulted in a saving in government expenditure during the first year. The government expenditure in the early years of the arrangement (financial year 1913-14) included (1) medical attendance £40, (2) drugs and appliances £4.11s3d, (3) clothing and bedding £6.7s9d, (4) divine service and spiritual assistance £20, and (5) telephone £4. In 1915, the hospital was described as a handsome building with spacious wards and corridors, private rooms, and operating and sterilizing rooms. All classes of patients without distinction of creed or country were treated in the wards. Infectious disease cases were not admitted. In November 1918, a War Memorial Ward for Children, comprising Medical and Surgical Divisions, was set up on the upper floor. Zammit Clapp Hospital ceased to function as a Seamen’s Hospital in December 1922 when the King George V Merchant Seamen’s Memorial Hospital was opened [21]. After being vacated, the hospital with only 20 beds started being used as a children’s hospital. The building was expanded in 1933 and during the Second World War was taken over for use as a Casualty Hospital for the north-western region of Malta. It also housed the Female Medical and ENT Divisions. The Children War Memorial Hospital was also incorporated in the establishment and the hospital was further expanded by utilizing the ground-floor of the adjoining Sacred Heart Convent. After the end of hostilities, the hospital was returned to the management of the Sisters of the Little Company of Mary. The services offered by the Sisters continued to expand and in 1947 started offering maternity services with a Maternity "Mary Potter" Wing being inaugurated in 1950. In 1957, it was the only privately-managed hospital of any size in the Maltese Islands with 64 adult beds and 15 maternity beds and accommodated 34 infants. It continued to expand its services and in the 1970s could accommodate 110 patients besides 16-20 maternity cases. It continued to function in this capacity until December 1980 when it was closed down. It was refurbished in 1991 to serve as a rehabilitation hospital for the elderly [22]. On 12 April 1959, the Dominican Sisters officially inaugurated another privately-managed hospital named St. Catherine of Sienna Hospital at Attard with accommodation for over 200 patients. The hospital expanded its services to maternity patients in 1961. The hospital was converted into a nursing home in 1980. A small 28 bed clinic St. Dominic Clinic in Rabat/Victoria, Gozo was also run by the Dominican Sisters. This hospital, which catered also for maternity cases, opened in September 1974 and closed down its services in November 1976 [23].
Private-run Hospitals
In 1984 a number of small day clinics in Malta were opened to cater for deliveries, notably St. James Clinic at Zabbar and Klinika Vella at Zebbug. Both clinics were established in 1984 following the closure of the religious-run hospitals in 1980. St. James Clinic started as a small maternity clinic which expanded its services to eventually offer multi-disciplinary treatment. It was upgraded to a hospital in 1996. Klinika Vella started off a two-bed affair in line with the regulations in force at the time. During the years it expanded its services and provided single room facilities for overnight patients. It also refurbished a dedicated unit specifically for obstetric patients away from the main surgical facilities. Clinic facilities offering consulting rooms for several specialists and operating theatre were made available in 1996 at St. Mark's Clinic at Msida.

The first trully purpose-built private-owned hospital in Malta was built in 1995. St. Philip Hospital must  be considered the first private hospital built according to a state-of-the-art design specifications. The letter of intent approving the project was issued by the government authorities in 1992 and a year later the Maltese company owning the hospital - Golden Shepard Group Ltd. - was formed and registered. This company brought together a group of leading Maltese enterprises together with the foreign Independent British Healthcare PLC (IBH). The "hotellier" services offered are comparable to a five-star hotel. All 75 single rooms with en-suite bathroom are air-conditioned. The maternity unit has access to 25 of the beds and is located adjacent to a state-of-the-art delivery suite and close to the operating theaters. A comprehensive antenatal, intrapartum and postnatal maternity scheme was launched in 1996.

A second private-owned hospital offering a comprehensive service was opened in 1996 in the restored 19thcentury Capua Palace at Sliema. Work on Capua Palace Hospital was approved by the government authorities in 1994 [24].


ENDNOTES

1. Based on a Report dated 13th July 1798 prepared by Dr. Vincenzo Caruana on the request of the Commission of Government under French rule. AOM 6523 B: Registers des Deliberations de la Commission du Government, fol.109-119.

2. C. Savona-Ventura: Hospitals in Malta throughout the Ages: Part III - Military Hospitals. Plexus: the Online Maltese Journal of Health and Medicine. Issue 3, Sept. 1997

3. C. Savona-Ventura: Malta and the British Navy: the medical connection during the nineteenth century. J Roy. Nav. Med. Serv., 1992-93; 78:p.171-176, 79:p.33-36,100-105

4. S. Fiorini: Santo Spirito Hospital at Rabat, Malta. The early years to 1575. Dept of Information, Malta, 1989, +199p.; P. Cassar: Medical History of Malta. Wellcome Hist Med Libr, London, 1964, p13.

5. P. Cassar, 1964: op. cit., p.23-36; S. Fiorini: A prescription list of 1546. Maltese Medical Journal, 1988/89, 1(1):p.19-31

6. P. Cassar, 1964: op. cit., p.23-36; P. Cassar: Inventory of a sixteenth century pharmacy in Malta. St. Luke's Hospital Gazette, 1976, 11(1):p.26-34

7. Annual Report on the Health Conditions of the Maltese Islands and on the work of the Medical and Health Department for the year 1937. Government Printing Office, Malta, 1938, p.34-35; Report on the Health Conditions of the Maltese Islands and on the work of the Medical and Health Department for the year 1951. Government Printing Office, Malta, 1953, p.97-98; L. Farrer-Brown, H. Boldero, J.B. Oldham: Report of the Medical Services Commission. Central Office of Information, Malta, 1957, p.22-23,33; S. Fiorini, 1989: op. cit. note 1, p.ix-x

8. The Magdalen Asylum for penitent women was established in 1609 by the Ursoline Nuns Hospitalliers who arrived in Malta in 1583. Annual Report….for the year 1937, 1938: op. cit., p.48; C. Testa: The French in Malta 1798-1800. Midsea Publ., Malta, 1997, p.183-187; C. Savona-Ventura: Human suffering during the Maltese insurrection of 1798. Storja ’98, 1998, p.54

9. P. Cassar, 1964: op. cit., p.77-82; Piano per il regolamento dell'ospedale di Malta. Malta, 1802; Annual Report….for the year 1937, 1938: op. cit., p.49-50. The Orphan Asylum was meant to replace the Floriana Conservatorio after this was taken over for use as a general hospital in 1850. Preference was given to orphans of both parents or to children who had lost their father. The institution was under the charge of a Resident Superintendent assisted by a Resident Chaplain, while the girls were taken care of by the Sisters of Charity. Children were discharged when they reached the age of 18 years. They all received elementary instruction, while the boys were also given technical instruction. The girls received training in domestic occupations.

10. P. Cassar, 1964: op. cit., p.69-76; P. Cassar: Female employees in the Medical Services of the Order of St. John in Malta. Melita Historica, 1978, 7(3):p.225-233; J. Howard: An account of the Principal Lazzarettos in Europe. London, 1789, p.58-60

11. P. Cassar, 1964: op. cit., p.83-89

12. P. Cassar, 1964: op. cit., p.83-89; Annual Report….for the year 1937, 1938: op. cit., p.30-34

13. E.P. Vassallo: Strickland. Progress Press, Malta, 1932, p.307-309; L. Farrer-Brown et al, 1957: op. cit., p.18-19

14. Annual report on the Health conditions of the Maltese Islands and on the work of the Medical and Health Department including the Emergency Medical Services for the year 1940. Government Printing Office, Malta, 1941, p.28-31; C. Savona-Ventura: Reproductive performance on the Maltese Islands during the Second World War. Medical History, 1990, 34:p.164-177

15. Annual Report….for the year 1937, 1938: op. cit., p.31; Annual report on the Health conditions of the Maltese Islands and on the work of the Medical and Health Department including the Emergency Medical Services for the year 1943. Government Printing Office, Malta, 1942, p.11; L. Farrer-Brown et al, 1957: op. cit., p.1-2,17

16. J. Galea: Report on the Health conditions of the Maltese Islands and on the work of the Medical and Health Department for the year 1953. Government Printing Office, Malta, 1954, p.10; J.O.F. Davies: Report on a hospital building progamme for Malta. Central Office of Information, Malta, 1957, p.11

17. L. Farrer-Brown et al, 1957: op. cit. note 4, p.96; Health Services Development Plan. Malta 1986-1990. Department of Health, Malta, (1987), p.39-42

18. D. Carruana-Galizia: A new hospital for Malta. Hospital Reform. The Sunday Times, 10/17 October 1993; D. Caruana Galizia: New hospital and the MAM. The Sunday Times, 12 March 1995, p.9; K. Causon: Milan's San Raffaele and Malta. The Sunday Times, 9 April 1995, p.15

19. P. Cassar, 1964: op. cit., p.90-92; S. Fiorini, 1989: op. cit., p.11; J. Bezzina: Religion and politics in a crown colony. The Gozo-Malta story 1798-1864. Bugelli Publ, Malta, 1985, p.79; Annual Report….for the year 1937, 1938: op. cit., p.50-53; L. Farrer-Brown et al, 1957: op. cit., p. 25-26; H.A. Clews: Malta Year book, De La Salle Brothers Publ, Malta, 1976, p.74

20. J. Galea, 1954: op. cit.

21. A. MacMillan (ed.) Malta and Gibraltar Illustrated. Collingridge, London, 1915, p.310; Malta Government Gazette Supplement, 22 November 1912; Reports on the Working of Government Departments during the financial year 1911-12. Government Printing Office, Malta, 1912, M:2; Reports on the Working of Government Departments during the financial year 1913-14. Government Printing Office, Malta, 1914, L:2; Reports on the Working of Government Departments during the financial year 1922-23. Government Printing Office, Malta, 1925, Q:1

22. P. Cassar, 1964: op. cit., p.408-409; A. Bonnici: History of the Church in Malta. Vol.III Period IV - 1880-1975. Veritas Press: Malta, 1975, p.119,136-137; L-Isptar Zammit Clapp Ghall-kura ta’ l-Anzjani, San Giljan 1991. Secretariat for Care of the Elderly, Malta, 1991, +8p; J.O.F. Davies, 1957: op. cit., p.4

23. P. Cassar, 1964: op. cit., p.409; A. Bonnici, 1975: op. cit., p.136-137; C. Savona-Ventura, Caesarean section in the Maltese Islands, Medical History, 1993, 37:37-55

24. Anon.: A special kind of caring. The Malta Independent, 28 July 1996, p.4; Anon.: A ramble through St. James Hospital. Galleria - The Malta Independent, 17 November 1996, p.4; R. Bugeja: A purely private affair. The Malta Independent, 30 October 1994, p.12; St. Philip Maternity Scheme: op. cit., M.J. Naudi: Pioneering building techniques used in Capua Palace Hospital. The Sunday Times [of Malta], 16 June 1996, p.44-45; Maternity Department. Capua Palace Hospital, Malta, [1996], +6p.

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