Sacra Infermeria

The Sacra Infermeria was looked after by the French langue, the largest and most important of all the langues within the Order. Its pilier was the Grand Hospitaller who actually selected the Infirmarian, the second in command officer who was in charge of the direction of the hospital. The Infirmarian was also elected from the French langue. Other officers included the prodomi, proto medico, physicians and their assistants, surgeons and their assistants, barber-surgeons, and several other personnel. The different sections that the Sacra Infermeria accommodated reflected the Order’s attempt to distribute patients according to their varying illnesses. Unlike the practice in many European hospitals, the sick at the Order’s hospital were assigned a separate bed.By 1787, the Sacra Infermeria could accommodate 563 patients compared to the 350 to 400 patients it could accommodate 60 years before. In cases of emergencies, it was also possible to accommodate up to 914 beds. By the end of the 18th century, up to 4000 patients every year were admitted to the Sacra Infermeria with a mortality rate of 8%.During the French and British periods, the function of the Order’s Sacra Infermeria was changed into an exclusively military hospital.After the First World War, the British transferred the military hospital to Mtarfa, and in 1920 the Sacra Infermeria was assigned a new function - that of Police Headquarters.During the Second World War, the Sacra Infermeria was used for the entertainment of troops such that it included a theatre, a cinema, boxing competitions as well as the Rediffusion Studios. At the end of the war, the Sacra Infermeria was taken over by the Education Department. During this time it was used as a theatre and its name was changed to the Knightshall. Parts of the same building housed the evictees from the manderaggio area, the Parcel Post Office, an Examination Hall and also as a counting hall in General Elections.The Sacra Infermeria or Palazzo dello spedale, started to be constructed in 1574. In the Order’s Council minutes of 1578 it is recorded that its construction was far from complete and that works are to be hastened.The original compound of the Sacra Infermeria at the end of the 16th century surrounded a quadrangular courtyard, later known as the Lower Courtyard (Cortile di basso) covering an area of c. 40m by 26m. Constructed at right angle to one another were two wards, the Old Ward (Sala vecchia) along the St Lazarus curtain and the Small Ward (Saletta) of c. 23m by 11m. Underneath the Old Ward is the Great Magazine Ward (Sala del Magazzeno Grande) which ceiling had been richly decorated with quadripartite cross vaults and heraldic bosses at their centre points, namely those of Grand Masters Cassiere and the Cotoners.Until the Second World War, sections of the described roofs, that on the Small Ward and part of that on the Great Ward were still intact, however, these were removed during restoration works of the Sacra Infermeria as revealed from photographic documentation.The grand balustraded staircase located to the north of the Old Ward and the Lower Courtyard led to the underlying Great Magazine Ward. At even a lower level, another equally elongated basement, simply supported on unadorned stone arches, was constructed and partly cut out of the bedrock. Incorporated in the Sacra Infermeria’s foundations were several covered passages, possibly sewers, which connected the hospital to the sea under the St Lazarus curtain.On one end of the lower courtyard there was a building of two floors which comprised a number of small rooms used as lodgings. The upper part of the building’s facade had a covered balustraded passage or loggia overlooking the courtyard. The other balustraded passages extending along the Small and Great Wards probably dates to Grand Master Nicholas Cotoner’s building phase (Mahoney 1988, 146).The Lower Courtyard was in the 1970s enclosed and is today used as a theatre.Several changes took place here owing to the several projects of the Grand Masters. A mid-17th century map of Valletta by Jan Jansson illustrates the Sacra Infermeria compound as existing at that time. (Scarabelli 2008, 22) These changes took place primarily to add more spaces necessary because of the developing needs of an active hospital as well as to enrich the architectural merits of this important public building. These cahnges included:• Grand Master Hughes de Loubenx Verdalle (1582-95) added more rooms and wards in 1582-3. At the end of the hospital, an irregularly shaped block consisting of 2 floors was built in c. 1596. This building, known as the phalanque (Falanga), received patients suffering from contagious and venereal diseases, as well as accommodated abandoned infants, and was not originally connected to the rest of the hospital. Other works included instructions in 1583 to construct a chapel in which were to be buried those who died at the Infirmary, the building of a dispensary comprising sleeping quarters for the aromatorio in 1587, new quarters for the Infirmarian in 1593, storage rooms as well as wash-rooms for the washing of clothes and linen.• Grand Master Alof de Wignacourt (1601-22), the Commendator Fra Giorgio Nibbia, a knight from the langue of Italy, constructed the church of the Madonna della Pieta’ at the Sacra Infermeria cemetery (Scarabelli 2008, 85).• Grand Master Antoine de Paule (1623-36) built more rooms in 1631-6 for the use of the Sacra Infermeria’s administration, for the storage of equipment, and also to accommodate patients with contagious illnesses possibly referring to the enlargement of the falanga block. Other works in the area of the kitchen comprised the setting up of an enclosure to use as a poultry yard. Records from 1685 note that the hospital consumed about 1,200 chickens and between 700 to 800 cockerels and pigeons every week (Critien 1946, 27).• Grand Master Giovanni Paolo Lascaris (1636-57) – During this time, enough open spaces existed within the site boundaries of the Sacra Infermeria such that in 1651 the Infirmarian of the time, Fra Nicholas de Culans St Ouen informed the Order that he spent 400 scudi to transform a small patch of rocky terrain into a garden for the enjoyment of the convalescents. It is unclear in which area this garden was located (Critien 1946, 17).• Grand Master Raphael Cotoner (1660-63) and his brother, Nicholas Cotoner (1663-80) enlarged the Sacra Infermeria with the addition of a new section in order to cope with the increasing number of admissions already reported by the Infirmarian in 1655. Works on the extension of the Old Ward in the direction of the Lower Barracca Gardens started in 1662. These works followed the plans and model schemes prepared in 1660 by a specifically appointed Commission of four knights. This new extension, known as the Great Ward (Sala Grande) was completed in 1666, creating a continuous hall of c. 155m in length, 10.5m in width, and over 11m high thereafter known as the Long Ward. So to commemorate this project, two altars placed back to back marked the point of extension of the Old Ward. The Cotoner’s project transformed the Sacra Infermeria, into ‘a superb monument of architectural skill’ (Bedford as cited in Cassar 1983, 6) and into the largest hospital in Europe of the ‘grandest interiors of the world’ (Bedford as cited in Cassar 1983, 6). The new ward was one of the longest constructed halls without any form of supporting pillars. (Borg 1973, 49-50) On the other hand, however, Critien (1946, 23) argued that architecturally these additions to the hospital transformed the original plan into the most incongruous form. • Grand Master Nicholas Cotoner (1663-80) allocated in 1669 more spaces for sick knights increasing the number of rooms from 2 to 8, and erected 2 magazines for the storage of mattresses and bed linen so that these materials could be kept in dry conditions. Other works comprised the reembellishing of the Infirmarian’s apartment windows with glazed glass panes instead of the usual wax-coated cloth (incereta). Similarly, the windows of the hospital wards were glazed. The hospital’s extension up to the private houses located under the Lower Barracca Gardens prevented the addition of openings for more light and air into the elongated ward. In 1679, the Order’s Council appointed 2 knights to report on the administrative matters and the situation at the Sacra Infermeria (Bonello 2007, 45). The Order’s eventual approval of the Commission’s recommendations in 1680 led to further alterations including the fixing of gates to the hospital’s portals, the closing of the Magazine Ward’s windows and the Dysentery Ward’s door, except for the service of the pharmacy, so to prohibit the underhand passage of fruits to the sick from the courtyard; this especially following ‘disorders’ reported at the Sacra Infermeria probably connected to dietary matters (Bonello 2007, 49). Changes by Grand Master Nicholas Cotoner also included the establishment of the Anatomy and Surgery School in 1676, which at first focused on theory similar to some parts of Europe, however in later years lectures in physiology, pathology, semiotics, hygiene, and therapeutics were also added. This school was renowned for its teaching especially in the fields of anatomy, surgery, and pharmacy. (Mahoney 1988, 147) The first Head of this school was Fra Dr Giuseppe Zammit, a priest physician and Chaplain of the Order (Galea and Fenech 1967, 731). Studying anatomy was obligatory including also practical demonstrations of the dissection of cadavers, a practice encountered in few European hospitals during the early modern period. In 1794, an anatomical theatre of a semi-circular shape was built to house these demonstrations. This theatre was destroyed during the Second World War. The same Grand Master also enacted a number of regulations to improve the Infirmary’s administration aiming towards the separation of infectious cases from other illnesses, prohibition of smoking, keeping of proper records, medical examinations of patients suspected of suffering from leprosy before being admitted at the Sacra Infermeria, and the care and upbringing of foundlings left at the hospital.• Grand Master Gregorio Carafa (1680-90) constructed a hall overlooking the Upper Quadrangle to house the hospital library. In 1687, Fra Dr Giuseppe Zammit founded this library aiming to have a large collection to support the study of medicine, surgery, botany, and anatomy (Mahoney 1988, 147). The Order’s hospital library reflects aspects on the organized medical training by the Order in Malta (Vann 2007, 24). Scarabelli (2008) however attributes the allocation of a library at the Sacra Infermeria to the Grand Masters Cotoners. The hospital’s library was an extensive one and within this library was also the portrait of the renowned anatomist Dr Hernin who died in 1754. This library was removed and incorporated to the Public Library in 1797 (Mahoney 1988, 147). Other works must have been completed by this Grand Master as the addition of his coat-of-arm at the far end of the Long Ward suggests. Within the lodging quarters, another 2 rooms were added on the upper floor to house the hospital’s linen in a less damp environment, suggesting that previously these were kept at basement level.The Sacra Infermeria’s layout at the end of the 17th century could be read in the account of G. Wood, the clerk on board His Britannic Majesty’s ship the Dragon, who visited the hospital in May 1687. Once arrived at the hospital, Wood passed through the gate and walked by the apothecary shop of the street, which was very well furnished, and the medical staff’s quarters. From next to the staff’s quarters, Wood entered a ‘square’ court in the middle of which was a garden planted with orange and lemon trees and from there he passed into another court also planted with citrus trees which sweet and fragrant smell entered every ward built around this court. He then entered a ward in which were 130 beds equipped with curtains and valances, and also visited two other wards. Once Wood passed through these wards, he visited a fourth ward located at a lower level - referring to the Great Magazine Ward - in which were another 134 trestle beds reserved for slaves. Lastly, Wood visited the hospital’s kitchen adjoining the Great Magazine Ward where he observed many fowls, large quantities of meat, as well as many basins, plates, and dishes.● Under Grand Master Ramon Perellos y Roccaful (1697-1720), in the early 18th century, the Sacra Infermeria was further enlarged extending the hospital compound onto Hospital Street, Merchant Street, and North Street; occupying the last unbuilt section of the Infirmary’s perimeter. The Perellos project comprised the construction of another courtyard of c. 24m by 24m, known as the Upper Quadrangle, built at an elevated level of c. 10.5m above the old hospital. At the centre of this courtyard a stone fountain was added and was decorated with the coat-of-arms of Grand Master Perellos. The new courtyard was built at an angle of 45 degrees to the 17th century hospital plan. The new section of the Sacra Infermeria, known as the New Infirmary (Infermeria Nuova), had its main entrance from Merchant Street. Critien (1946, 19) pointed out that part of the hospital compound seems to have already been extended to incorporate at least the corner between North Street and Merchant Street, as known from the recommendation of another Commission whose members adviced in 1679 the use of the door opposite the Camarata in Merchant Street for the admission of patients and to refrain from passing the sick through the main doorway of the hospital. Between the Upper and Lower Courtyards was another smaller courtyard, c. 309m2, set in a triangular shape along which an elongated ward was built on Hospital Street. Several buildings made of small rooms surrounded the Upper Courtyard. These newly built spaces accommodated a new pharmacy, laboratory, residential quarters for the medical staff, and for the administration. The Infirmarian’s apartment located on the upper floor, was decorated with the coat-of-arms of the 18 Infirmarians who served at the Sacra Infermeria between 1681 and 1765. These coat-of-arms formed a colourful frieze along the upper parts of the walls of the Infirmarian’s apartment. The Perellos section of the hospital was damaged during the Second World War. To express his spiritual welfare towards the sick, Grand Master Perellos built in 1712 the Chapel of the Blessed Sacrament and which was dedicated to the Most Holy Virgin. The chapel was constructed between the Great Ward and the Small Ward and an entrance directly from the Small Ward was added. Upon completion of works, a dedicatory insignia was erected to the left side wall of the chapel - ‘Sacramentorum Sacramento … honorificentius’. Besides this chapel, at the Sacra Infermeria were several other altars located at the different wards and sections of the hospital. Our Lady of Mount Carmel, the Holy Trinity, St Cosmos and Damian, St Joseph, St John the Baptist, and the Finding of the Cross were some of the dedications held by these altars.The Sacra Infermeria’s layout in early 18th century was included in the 1725 Regolamento, which document described the different spaces and uses of the hospital:● - The most well-kept part of the hospital accommodated sick and wounded knights;● - The Old Ward for civilians, other religious orders, and pilgrims;● - The Great Ward for fever and mild illnesses;● - Another ward for serious illnesses to which was adjoined a room for moribund cases;● - The ‘New’ Ward for ‘flussanti’ cases to which are also adjoined two rooms used for the cure and assistance of lithotomy cases;● - A ward of two rooms for the wounded;● - The ‘Salone’ Ward for the slaves and prisoners to which were adjoined two other rooms;● - Another ward for mental cases;● Other wards were located outside the main complex of the hospital:● - A ward for ‘Stufe’ cases;● - A ward with two adjoining rooms for the cure of venereal diseases.● Other works modifying further the Sacra Infermeria followed in the rest of the 18th century. These works included: ● Grand Master Antonio Manoel de Vilhena (1722-36). Another church with the same name of Madonna della Pieta was built next to the Nibbia church inside the Sacra Infermeria’s cemetery, also at the expense of the Nibbia Foundation. (Scarabelli 2008, 85) ● Grand Master Manuel Pinto de Fonseca (1741-73) attempts to improve the hospital standards, comfort, and to introduce into the building more fresh air towards the well-being of the sick. The Infirmarian proposed to remove 2 existing rooms located adjacent to a ‘magazine’, used to nurse the sick, due to severe dampness and darkness, so to achieve more light and air into the ‘magazine’. Grand Master Nicholas Cotoner’s School of Anatomy and Surgery was during Pinto’s rule raised from the status of lectureship to an academic status with its inclusion into the newly founded Faculty of Medicine of the University set up in 1771. (Vann 2007, 22)● Grand Master Emmanuel de Rohan-Polduc (1775-97) carried out more alterations to provide additional space to the ever-increasing number of admitted patients. The hospital, by and large, still lacked the appropriate provisions to accommodate sick men in different rooms because of their different illnesses. In 1777, the laundry was too small for the storage of linen and garments, as well as for the lack of space to hang out the washed cloths to dry. Similarly, not adequate space was allocated for the pharmacy to function appropriately, especially its stores and laboratory. This led in 1779 the Order to move the laundry to the Camerata, another building in Merchant Street opposite the Sacra Infermeria. The pharmacy was however not shifted until as late as the 19th century. Restructuring works at the ex-laundry building comprised the opening of doors and corridors connecting 3 rooms and the terrace to various wards. Including the terrace with the convalescent areas of the hospital permitted patients to relax and stroll in fresh air away from the infectious exhalations of the sick. The falanga section at the rear of the Long Ward was also enlarged. This section of the hospital was however disconnected from the wards so to prevent mercurial vapours from reaching the other sections of the hospital. Additionally, a magazine used for the storage of firewood was in 1779 cleared to be reused for the accommodation of mental patients, whom until then were housed in the other wards with the rest of the patients. A document compiled during the end of the Order’s rule includes a second, and more precise, description of the Sacra Infermeria’s wards:● - The Great Ward for cases of fevers accommodating 64 beds, separating mild and serious cases;● - The Old Ward with 22 beds for the cure of pilgrims and religious orders;● - Another ward made of two adjoined rooms for the wounded having 29 beds used for chirurgical cases;● - The Small Ward or Saletta with 20 beds exclusively kept for moribund cases;● - Sala S. Giuseppe with 20 beds reserved for sick prisoners;● - The ‘New’ Ward also known as ‘dei Flussanti’ with 21 beds used for intestinal cases;● - 2 wards for cases of lithotomy, reserved for bladder operations;● - Sala dei Cavalieri with 19 beds for members of the Order;● - 2 wards in the ex-magazzino with 36 beds;● - The Palombara or Piccionaia known so because of its layout made of several small rooms with 29 beds for suspected contagious cases;● - 2 rooms with 19 beds for members of the Order in need of chirurgical operations;● - 2 rooms with 10 beds for chirurgical interventions to civilians;● - 1 room with 18 beds for mental cases;● - 1 room known as il Violino of unknown use;● - 1 room Keiser with 3 beds for those cured with mercury;● - 1 room with 8 beds for the non-Christians;● - La Corsia, middle row with 15 beds of unknown use;● - Sala del Gran Magazzino with 109 beds for sick prisoners and slaves, invalid sailors and soldiers, and other invalid people that merited the Order’s care, and also to those who worked on constructions sites ‘coloro che lavoravano nei cantieri’; ● - La Falanga, a separate block for the cure of contagious illnesses or venereal cases with 120 beds.Several other alterations continued to transform the Sacra Infermeria in order to achieve improved ventilation, sanitation, and lighting. The falanga section was abolished and this part of the hospital was linked to the Great Ward. Other changes in how the different spaces of the Sacra Infermeria were used during British times occurred in 1821, including the use of the Great Ward as a rope-walk where ropes mainly for the use of the British Navy were manufactured, the Great Magazine Ward as an apothecary store, as well as other rooms were leased out as stores to merchants, such as the leasing of the Great Ward and part of the basement to Messrs. Woodhouse, the renowned Marsala wine merchants established in 1773 at Marsala. The hospital was restricted to those buildings around the Upper Courtyard.Substantial modifications, between 1863-82, included improvements to the hospital’s sanitary state especially of the Great or Long Ward, which had its windows – previously these were smaller and close to the ceiling to keep the wards cooler – enlarged and extended downwards to allow more light and air. Other inlets were opened into the side walls to provide additional circulation of fresh air, as well as the fixing of 7 Muir’s Ventilators in the roof. The Long Ward and Small Ward were divided into a number of partitions of 4.5m high. Externally, alterations in the Long Ward comprised the building of the open stone balcony stretching along part of the St Lazarus end of this ward. Changes to improve the wards in line with modern sanitation measures were seen last during the First World War, when the Sacra Infermeria provided 440 beds together with 14 other hospitals accommodating in all over 6,000 beds. After the First World War, the British transferred the hospital to Mtarfa at which point the Sacra Infermeria was assigned in 1920 a new function that to house the Police Headquarters. Owing to the newly assigned use, part of the Great Magazine Ward was turned into horse stalls and the Perellos fountain was removed from the Upper Courtyard.During the Second World War at the Sacra Infermeria were accommodated different uses, including for the entertainment of troops, a theatre, cinema, boxing competitions, the Rediffusion Studios. At the end of the war, the Sacra Infermeria was taken over by the Education Department to use as a theatre during which time its name was changed to the Knightshall. Parts of the same building housed the evictees from the manderaggio area, the Parcel Post Office, an Examination Hall and also as a counting hall in General Elections. After the Second World War, the Sacra Infermeria was left in a dilapidated condition and it was in dire need of restoration. In 1978-79 what was left of the hospital compound was restored under the direction of the late Perit Michael Ellul, then government architect and Head of the Antiquities Section of the Ministry of Works. The Sacra Infermeria was readapted and converted into the the Mediterranean Conference Centre. Few years after the completion of its restoration, an unfortunate accident happened in 1987 when during a conference fire broke out severely damaging the building.

After the Second World War, the Sacra Infermeria was left in a dilapidated condition and it was in dire need of restoration. In 1978-79 what was left of the hospital compound was restored under the direction of the late Perit Michael Ellul, then government architect and Head of the Antiquities Section of the Ministry of Works. The Sacra Infermeria was readapted and converted into the the Mediterranean Conference Centre. Few years after the completion of its restoration, an unfortunate accident happened in 1987 when during a conference fire broke out severely damaging the building as a result.

The Sacra Infermeria had 6 large wards each with its own altar. The largest wards were the Gran Sala which was dedicated to the Holy Trinity, Sala Nuova, Sala Vecchia, and Sala dei Feriti. (Borg 1973, 49-50) The Great Magazine Ward (Sala del Magazzeno Grande) vaulting roofing system is of pseudo-Gothic character, a rare architectural encounter in Malta possibly imported by the Order’s master masons in Rhodes (Mahoney 1988, 146).Stylized in the usual Maltese manner, the roofs of the Great Ward and that of the Small Ward had a timber ceiling rested on timber corbels like those of St Michael and St George Halls in the Grand Master’s Palace and the main hall of the Auberge of Provence. On both ceilings there were a pitched roof trussed with single tie beams and sets of rafters which were doubled by placing one on top of another to obtain the required depth of timber. It is possible that the rafters constructed by placing one shallow beam on top of another was to avoid diagonal cracks which owing to the hot temperatures the drying of wood causes cracks to appear in deeper beams weakening their load-bearing capacity. Similar to the technique of creating an insulating layer for the roof of the Auberge of Aragon, this construction method clearly underlines the thought with which such buildings were erected. (Mahoney 1988, 146) Outside, these roofs were covered by buff coloured Sicilian tiles. Such roof is an outstanding example of 16th century timber construction in Malta.Internally, the Great Ward was largely left devoid of ornamentation except for the coat-of-arms of the Order and that of Grand Master Gregorio Carafa (1680-90) placed at the end of the Great Ward and on the same wall a sculpted baroque oval aperture carved out of stone. The other similar feature on the right is of recent origins.The hospital’s main entrance was from the Old Ward at North Street in front of St Elmo’s esplanade. Other sections of the hospital were those for the treatment of syphilis, in which areas there was the stufa - a basement chamber with an oven to burn wood so to heat the 3 rooms at ground level where patients had hot-air baths and also to heat another 3 rooms in which patients rested after being exposed to hot-air treatment. On the side of St Nicholas Street was the wheel (ruota) that is a rotating window, through which unwanted babies were left at the Sacra Infermeria to be taken care of. Whereas opposite the other end of the hospital, in North Street, was also a cemetery and next to it the Nibbia chapel ((De Lucca 1999, 288).Nibbia chapel, dedicated to Our Lady of Mercy, was commissioned by Fra Giorgio Nibbia and was built in 1619. In 1731, this chapel was rebuilt in the Baroque style which design was attributed to the Roman architect Romano Carapecchia (1668-1738). (De Lucca 1999, 288) The cemetery’s plan seems to have been symmetrical as defined by its central path in line to the entrance. On one side were burials of children and on the other, down a few steps, one entered an ossuary in which were heaps of bones and articulated bodies (‘whole skeletons’) were lined against the walls (Critien 1946, 15), possibly similar to the Capuchin crypt in Floriana. In 1776, owing to the nuisance and worries of an epidemic outbreak the Order shifted the cemetery to a location outside Valletta. In 1852, the crypt of the Nibbia Chapel was decorated with human skeletons retrieved from the nearby cemetery giving it the name of Chapel of Bones. This chapel was destroyed during the Second World War and what survives today are the ruins of a small part of the cemetery where one can notice some of the memorial slabs.The Sacra Infermeria developed into a hospital complex through the Order’s rule. Its plan is unlike any of the fine hospitals found in Italy and Spain as it holds no grandeur or architectural clarity (Hughes 1956, 153). As the plan of the Order’s hospital evolved through the 17th century, it seems to have been largely influenced from that of Santo Spirito hospital in Sassia, Rome. The Order’s hospital ichnography consisted of a long ward measuring 153m by 10.6m by 9.45m high and an octagonal central space that connected a shorter ward giving to the hospital a ‘T’ shaped layout. On the contrary, Mahoney (1988, 145) argued that the Sacra Infermeria’s similarities to the hospital in Rome was not the result of imitation, however, a partial or complete accidental resemblance.

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