The Sacra Infermeria or Holy Infirmary of Malta

Founded in 1299, Malta’s Santo Spirito Hospital was more than 200 years old when the Knights Hospitalier arrived on the island and decided a new hospital was needed. Arpan Banerjee tells the story of a hospital ahead of its time.

The Knights Hospitalier were a proud military order of the Catholic Church founded in the 11th century to fight as a military force  in the Crusades and also take care of the sick. After the fall of Jerusalem, they eventually migrated to Malta in 1530 where they stayed and ruled the islands until 1798 when they were defeated by Napoleon Bonaparte.

Sacra Infermeria today: author’s photo

At the time of their arrival, Santo Spirito Hospital was the country’s main hospital, but it was outside Rabat, some distance from Valletta. The Knights Hospitaliers felt a hospital was required in Valletta, now the capital of Malta, and in 1574 they built the Sacra Infermeria or Holy Infirmary, at the northern tip of the small promontory of land surrounded by the Grand Harbour. It became one of the leading hospitals in Europe.

A modern hospital

The Sacra Infermeria Hospital had around 500 beds, but could expand to accommodate almost 900 patients if needed. Although not called such then, the Nightingale-style wards included one of the largest halls of its time. The Old Ward, as it was known, was more than 150 metres long. A small ward served the dying. In the basement was a 100-bedded ward for wounded or sick soldiers and sailors. The hospital treated not only the sick but also provided accommodation to those on pilgrimage to the Holy Land. What made the hospital unique, however, were the facilities, the most modern of the time, and high standards of care long before Florence Nightingale made known the importance of nursing.

In the seventeenth century, the hospital boasted a school of anatomy and surgery founded by the Grand Master Cotoner. Cadaveric dissection took place, which did not become a routine part of medical training until the eighteenth century and beyond in Britain. In addition, Sacra Infermeria had a wing for patients with infectious diseases and a ward for the mentally ill patients.

After the brief rule of Malta by the French, the British took over in 1800, and the hospital became an important base for wounded soldiers, as well as the local sick. It played an important role in the Crimean War and First World War due to its strategic position in the Mediterranean, south of Sicily, and known as the Station Hospital.

The Great Ward of the Station Hospital, Malta c 1906, public domain

The hospital was decommissioned in 1918 after WW1 ended. In WW2, the hospital building survived partial bombing, and after the war it served briefly  as a base for the Allied troops based in Malta. The Maltese police then took over the site. A new general hospital was commissioned in Malta in the 1920s, St Luke’s Hospital outside Valletta, and this was replaced by the current teaching hospital Mater Dei in 2007.

Today the old building of the Sacra Infermeria has been renovated internally and converted into a conference centre. The Great Hall  survives and is a reminder of the hospital’s illustrious past and important place in medical history. The Knights of St John no longer rule Malta but exist as the Sovereign Military Order of Malta (SMOM) and perform a global humanitarian role and charitable work . The St John Ambulance that operates in Malta is a direct legacy of this order.

Dr Arpan Banerjee is a retired consultant radiologist from Birmingham. He is currently the Chairman of the International Society for the History of Radiology and a past Chairman of the British Society for the History of Radiology. His latest book project was co-editing and contributing to the Pioneers in Radiology Worldwide at the time of Wilhelm Conrad Röntgen.

References

https://en.wikipedia.org/wiki/Mediterranean_Conference_Centre

Mediterranean Conference Centre

https://whc.unesco.org/en/list/131/  City of Valletta

Major-General Sir David Bruce, K.C.B., F.R.S. Nature 129, 84–86 (1932). https://doi.org/10.1038/129084a0

 

Bringing X-rays to the front

Edwin Aird describes how Marie Curie created radiological cars to take X-rays to the battlefront in Word War I.

In 1914 at the beginning of the First World War, Paris was under threat of invasion from Germany. The situation was sufficiently alarming that the French Government moved to Bordeaux. And Marie Curie moved the precious 1 gm of radium that she had isolated to deposit in a bank in Bordeaux in a very heavy lead pot.

Once the radium was safe, Curie returned to Paris, where one of her daughters took her to visit a hospital to see the war wounded. Curie quickly realised the potential value of having X-rays near the battle front for surgeons to use. As her daughter Eve Curie wrote: A luxury, the magic arrangement whereby a rifle bullet or fragment of shell could at once be discovered and localized in the wound.”

 She already understood the properties of X-rays, but taught herself their application, production and development, fluoroscopy (not so called at the time), and the components of X-ray systems, generators, transformers etc. To get the X-ray machines to the front, however, meant mobile units or radiological cars. And they did not yet exist. So she created them.

Les Petites Curies

Founding director of the Red Cross Radiology Service, Curie built her first radiological car from a large Renault. She persuaded wealthy acquaintances and the Union of Women of France to help her build a fleet of 20 radiological cars. They became known as Petites Curies. Her daughter Irene, (who later received a military medal and won a Novel prize herself with her husband, F. Joliot) assisted in the field.

The image shows Marie Curie's level of involvement with the mobile X-ray machines.

Marie Curie at the wheel of one the Petites Curies, the mobile X-ray machines she created

The conditions under which Curie worked must have been horrendous, but she played down the overall impact of the noise/smells/dangers. Eve Curie said: “She was never to speak of the hardships and dangers to which she exposed herself during those four years… She showed her working companions a careless and even gay face…The war was to teach her that good humour is the finest mask of courage”.

 According to Marie Curie herself, during these years it had been possible to X-ray approximately 900,000 injured people. She wrote: “Towards the end of 1918 there were more than 500 fixed and semi-fixed radiological stations in service in the hospitals of the territory and in the armies with a further 300 mobile devices on cars, on sterilisation trucks and motor surgical ambulances. Approximately 400 radiologists served these devices, aided and partly replaced by auxiliary personnel, including manipulators trained at the Institute Curie.”

Marie Curie died in July 1934 from pernicious anaemia, which she attributed to the high X-ray exposures she received during the war.

She remains one of the few people to receive two Nobel Prizes and the only woman to do so. The French Academy of Sciences rejected her membership in January 1911 – only months before her second Nobel Prize. It never elected her. Otherwise, her brilliance, drive and public service were widely acknowledged. In total, she received 8 major prizes, 16 medals, 104 titles and authored 483 papers.

Marie Curie and her daughter Irene

References and further reading

  • Curie, Maria, “La Radiologie et la Guerre” (in French) : Marie Curie. Librairie Felix Alcan 1921
  • Curie, Eve, “Marie Curie”: (1938, Windmill Press Surrey)
  • Van Tiggelen, Rene (Brussels), “La Grande Guerre 1914-1918”
  • Simthsonian Magazine Oct 2017
  • Jogensen, TJ BJR Papers: “Marie Curie and Pierre Curie and the discovery of radium” by Eve Curie BJR July 1950;” Marie Sklodowska Curie 1867-1934” by Claud Regaud BJR, Sept 1934
  • Thomas, Adrien, “The first 50 years of military radiology 1895-1945” European J Radiology 2007; 63: 214-219
  • https://www.pbs.org/newshour/science/the-day-marie-curie-got-snubbed-by-the-french-science-world

Edwin Aird is retired Director of Medical Physics at Mount Vernon Hospital, Northwood with more than 40 years in NHS as  researcher, teacher and examiner.