The advent of a foreign organized militia to Malta dates to the arrival of the Knights of the Order of St John of Jerusalem in 1530. Known for their hospitaller traditions, the Order soon established a hospital at Vittoriosa. This hospital was subsequently in 1574 transferred to a new building in Valletta. Rather than restricting their hospitals to members of the Order, the Sacra Infirmeria catered for the needs of all segments of the population including orphans and foundlings, and thus functioned more as a general hospital rather than a military or naval establishment.

The need of establishing a separate military hospital was felt by the French troops under the command of Napoleon Bonaparte. On the first day of the French occupation of Malta on the 12th June 1798, the French commanders established their first hospital at Mdina selectively reserved to deal with sick or injured troops [1]. The sick troops, which numbered 300, were transferred four days later to the Sacra Infirmeria at Valletta which was converted into a military hospital and renamed the Grand Hopital. The Physician-in-chief Dr. Robert who published a book in 1802 gives a full account of the Sacra Infirmeria during the French occupation. Only a few wards were considered fit to accommodate patients, while the pharmacy, the laboratory and the storerooms were inadequate. Dr. Robert carried out a number of modifications to improve sanitation, ventilation and lighting, but he condemned the Sacra Infermeria as a hospital saying "Ainsi, si l'hopital de Malte etoit si vante du temps de l'ordre, ces louanges ne peuvent tomber que sur la maniere avec laquelle il etoit administre". The wards were cleared from all incumbent objects including pictures on the walls, the bed canopies and curtains. The Falanga, previously reserved to treat venereal patients, was modified with the provision of large windows and connected to the Great Ward to increase the number of beds available for febrile patients [2]. The administration of the hospital was entrusted to four individuals, two of whom were Maltese physicians. These were entrusted to draw up an inventory of the hospital's holdings and also to provide the patient's necessities. The administration proved inept at providing for the basic necessities of the patients. Within two months, the French civil Governor Regnaud de St. Jean d'Angely commented about the lack of clothing and absence of drugs in the hospital [3].

The situation deteriorated markedly after the Maltese rose against the French in September 1798, so that provisions to the hospital became seriously low. At the time of the insurrection, there were 700 patients in the hospital. In April 1799, General Vaubois commented that "Rien n'est si affreux. Les salles sont mal-propres. .... Le jardin livre a` l'hospital est de toute nullite,....". In June 1799, Vaubois found it necessary to exhort the soldiers to come to the hospital as before, and to defend the medical staff at the hospital. He also contradicted the rumor that no drugs were to be had at the hospital. He also advised the soldiers to maintain personal hygiene by frequent baths and to safeguard their health by eating vegetables [4]. Food provisions became markedly reduced. During the first year of the blockade each patient received an average of one ounce of beef or mutton per day. This was substituted by the same quantity of horse or ass meat during the second year. Rice, beans and fish were available, but eggs were a rarity. During most of 1800 the hospital authorities had nothing to give their sick except beans [5]. With the increasing malnutrition and an increase in the number of cases of scurvy, the number of sick troops increased so that the Grand Hopital had proved inadequate to care for the number of diseased men, and other hospitals had to be improvised. By February 1799 there were 800 sick French in two hospitals. By June 1799, the hospitals were augmented to four [6]. When the French surrendered in September 1800, the sick troops who were unable to travel were transferred to Fort Manoel in charge of a French physician and surgeon, and were cared for until they were fit enough to return to France [7].

The Maltese rebels outside the fortifications, together with the British re-enforcements, similarly required the establishment of a number of hospitals to deal with the sick and injured personnel. The previously established hospitals - Santo Spirito Hospital (40 beds) and Saura Hospital (80 beds) both at Rabat - proved insufficient to cater for the medical needs of the insurgents. Churches at Rabat and Mdina were taken over for use as hospitals. These included St. Dominic Church at Rabat called the Great Hospital, St. Francis Church adjoining Santo Spirito, the Bishop's Seminary, St. Sebastian Church and St. Agata Church. In the country, the sick inhabitants were often treated in private houses. Thus at Birkirkara, Vincenzo Borg, helped by Dr. Leopoldo Bernard, converted his house into a small hospital to care for the town's residents which had increased by about 6000 refugees from the cities. Other sites, which served as hospitals for the inhabitants of the countryside, were St. Joseph Hospital at Zebbug and St. Gregory Church at Zejtun [8]. Temporary hospitals were also established for the British and Portuguese/Neapolitan forces aiding the Maltese. Thus a house belonging to Manuel Farrugia at Luqa is known to have served as a hospital for the 48th and 89th British Regiments. Compensation for the use of the site was only affected in 1824. Other hospitals were set in July 1800 at the Zejtun residence of the Dutch Consulate Count Agostino Formosa de Fremeaux and the Zabbar residence of Bishop Labini [9].

Following the capitulation of the French garrison in Valletta, the British troops marched into Valletta, and the military authorities took over the public buildings, including the Sacra Infermeria, for their use. The British transferred their 350 sick troops to the Sacra Infermeria, now named the General Hospital or Garrison Hospital or Station Hospital [10]. During the early decades of the nineteenth century the hospital was not given its due importance. In 1813, an English visitor deplored the changes that had reduced the hospital to "a place of comparable insignificance". The number of patients was seldom more than thirty or forty [11]. In 1821 on the area surrounding the upper quadrangle was being used. The Great Hall had been converted into a ropewalk, where ropes were manufactured. A few years later, a considerable section of the Long Ward and a part of the basement floor ward were let to Woodhouse Marsala wine-makers [12]. The magazine ward had been converted into an apothecary store, while the former operations room was converted into a dining room for convalescents. The pharmacy with its laboratory and the medical officers quarters still occupied their old sites. In 1826 a separate ward accommodating eighty patients was appropriated for ophthalmic patients. Other parts were allowed to fall in ruins In 1830, the hospital was considered incompatible with its function because of defective ventilation. Because of the inadequacy of the hospital by modern standards, various structural modifications were undertaken throughout the second part of the nineteenth century. The Valletta General Hospital continued to be used until the opening of new Military Hospital at Mtarfa in 1920. The building was subsequently passed on to the civil government and served, until 1940 as a Police Depot. During the Second World War, the building sustained significant damage. In the post-War period, the remaining halls served several minor functions, including that of an Examinations Hall. In 1978, the Sacra Infermeria was converted into the Mediterranean Conference Center [13].

The inadequacy of the Valletta General or Station Hospital, necessitated the establishment of a number of other smaller hospitals usually situated in relationship to the various military barracks, notably at Valletta, Cottonera, St. Julians and Mtarfa. The Valletta barracks and its environs was also served by a small hospital set up in the House of the Madonna of Manresa at Floriana. This hospital was set up in the first decade of the nineteenth century in a building meant for spiritual exercises. The plans for this hospital provoked protests by the Maltese, but in spite of these remonstrations; the hospital was set up in 1811 and was still functioning in the 1830s. The hospital consisted of a range of small rooms built around two sides of a big quadrangle. Each room contained four beds so that the hospital could house a total of sixty patients, eighty in an emergency [14]. The Cottonera region was served first by a hospital housed in the Inquisitor's Palace at Vittoriosa. This was subsequently replaced by a hospital in Fort Ricasoli where a number of high bomb-proof arcades running along the inner face of the fort were cut off from the barracks by wooden walls. These arches were subsequently divided into two floors by setting up a wooden floor. The ground floor was reserved for convalescent soldiers or other segregated patients. The upper floor was partitioned off into two wards and a surgery. This arrangement allowed for a complement of 54 beds, which could be increased to a hundred in emergencies. It was used in 1822 to shelter invalids and discharged men from regiments stationed in the Ionian Islands. The Fort Hospital ceased to function in the 1860s [15]. The medical needs of the military personnel in the Cottonera area were also served for a few years after 1832 by the Armory at Vittoriosa. This had been taken over from the British Naval Authorities after the commissioning of Bighi Naval Hospital. The establishment of the Hired Hospital consisting of two adjoining private houses a short distance away expanded the facilities of the Vittoriosa Hospital. In peacetime the Armory Hospital was capable of accommodating 120 beds which could in an emergency be increased by a further 80 to 100 beds. The building was eventually used by the Royal Engineers and later by the King’s Own Malta Regiment [16].

The Crimean War of 1854-56 served as a turning point in military medical administration. During the Crimean War Malta served as an outpost to treat wounded soldiers. The Malta Times wrote "Orders were received here from England to prepare quarters for 10,000 men. Several localities are being fitted-up; among others, the Lazzaretto and adjoining Plague Hospital, where it is said there is room for 1000 men, and the Dockyard lofts where as many men can be housed. Convents will be used if absolutely required, but not otherwise." The first wounded soldiers arrived from the Crimea in November 1854 [17]. Following the demands made on the Maltese medical military facilities during the Crimean War, the Governor Sir William Reid in 1857, on the advice of the military medical authorities in Malta, advised the British Government that the Valletta Station Hospital was inadequate and emphasized the necessity of building a new military hospital. The British Government thus commissioned a committee "with a view to determining upon what would be the best site for such a hospital, and to report, particularly on the adequacy or otherwise of the site at St. Francis Barracks, Floriana, capable of accommodating five hundred patients". The committee reported that the proposed site was too small and that an adequate site could only be found outside the Valletta fortifications. Another site within the walls of Valletta was proposed two years later on St. Michael’s Bastion overlooking Marsamxett Harbour, but the project was dropped because of the high cost for purchase of the privately-owned site [18].

Florence Nightingale in her book Notes on Hospitals first published in 1859 took up the proposal of a new military hospital in Malta. In the 3rd edition of her book dated 1863, Nightingale suggested that a new General Military Hospital should replace permanently the Valletta Station Hospital. The new proposed hospital was planned - on the pavilion principle for 300 beds, with the extensions differently arranged from any existing example. The site chosen as the most healthy in the garrison, are limited and the arrangement of the parts has to be conformed to the shape of the ground. But so flexible is the pavilion construction that it suits itself readily to this requirement. There will be six pavilions arranged side by side, each containing two floors of wards, and the whole connected by open arcades sufficient to afford shelter from sun and rain, but to leave ventilation perfectly free. The entire administration is detached and placed in front of the hospital. The walls on the sides towards the sun, and the roof, will be double to ensure coolness. The site chosen for the hospital was the bottom of Melita Street facing Marsamxett Harbour. The book included a design and block plans, which were prepared by the architect Mr. T.H. Wyatt at the insistence of the Malta Government, though it appears from a marginal note in the copy of Nightingale's book held at the National Library of Malta that the plans were made in the first instance the Comptroller of Charitable Institutions Dr. F.V. Inglott and given architectural proportions by the architect Mr. Wyatt. This new hospital remained a proposal and was never built [19].

Following her return from Crimea to England in 1856, Miss Nightingale, anxious to remedy the defects in the military medical organization that the war had shown to exist, appealed to Queen Victoria asking for inquiry. Following this appeal, the British Government agreed to appoint a Royal Commission whose terms of reference were concerned not only with the Medical Department and its organization, but extended to all circumstances affecting the living conditions and the health of the soldier. One of the four sub-commissions set up was concerned with hospital improvement - Barrack and Hospital Commission on the Sanitary Condition and improvement of the Mediterranean Stations. This Commission reported in 1863 that the four military hospitals in Malta were all badly constructed and inadequate. The Valletta General Hospital was condemned unequivocally because of its unhygienic and unhealthy situation. The Commission proposed the abolition of these establishments and the building of a new general hospital of three hundred beds at Valletta and a smaller one of 136 beds for the Cottonera region. Following the Barrack and Hospital Improvement Commission report, various plans were put forward for the new hospital in the region outside Valletta. The sites proposed by the Army authorities in Malta included the Ta' Xbiex Hill, the Ta' Brejqex locality at Santa Venera, Mriehel, and San Gwann. None of these plans came to completion. Temporary sanitary camps were often set up to house sick troops in times of epidemics such as those set up on the glacis of Fort Manoel encamping the 100th Regiment and Floriana parade-ground encamping the 4th Regiment during the 1865 cholera epidemic [20].

In the absence of a definite decision to build a new hospital, steps were taken by the military authorities to relieve the pressure from the Valletta Hospital. In 1858 a new hospital was opened at Vilhena Palace at Mdina. This first served as an ophthalmic unit replacing the set of wards set up in 1826 at the Valletta Station Hospital. Ophthalmic problems appeared to have been very prevalent among the troops during the early decades of the nineteenth century, probably resulting from trachoma infection obtained during campaigns in Egypt at the turn of the nineteenth century (1801). The infection continued to recur and spread to units that had never been present in the campaign. In the Malta garrison there were 514 cases, and these were so severe that no fewer than 107 became totally blind, while 102 others lost the sight in one eye. Between 1816-1823, ophthalmia accounted for 1463 admissions or 7.6% of all admissions to the Military Hospitals. The hospital was subsequently converted into a convalescent home. Fever cases were also transferred to this hospital. It was noted that fever cases improved significantly on transfer to this hospital, and a scheme to extend the accommodation of 88 beds to one accommodating a General Military Hospital was considered. This scheme had to be abandoned because its grounds and environs did not afford enough space to build new wards. It was turned over to the Civil authorities in 1908 and subsequently used as a tuberculosis sanitarium. H.R.H. Duke of Connaught who was at the time High Commissioner and Commander-in-chief in the Mediterranean contributed funds to help equip it [21]. In 1860 Villa Spinola at St. Julians was adapted into a 42-bed army hospital to serve the newly opened barracks at Pembroke and by serving as a sanatorium to absorb some of the overflow from Valletta General Hospital. This hospital was named Forrest Hospital after the Principal Medical Officer of the garrison serving during that year. During the First World War it received troops suffering from venereal disease. It was closed down in 1922. Venereal disease was a constant problem with all nationalities of soldiery. The Valletta hospital was used by both the French and the British to treat venereal disease patients [22].

The repeated proposals to build a new military hospital in Malta, finally were taken up in 1873. A new hospital containing four infirmaries, each capable of receiving 32 sick men was built near Zabbar Gate. The building costs amounted to £21,000 and the hospital was considered to be "one of the best hospitals in southern Europe". In 1882, the hospital grounds (wrongly labeled as belonging to the Naval Hospital) were illustrated in the Illustrated London News which also carried the experience of Lieutenant A.G. Blackburn of the 79th Highlanders wounded at the battle of Tel-el-Kebir who had written to the newspaper to bear testimony to the 'unremitting care and attention which he had received at the hands of the medical staff of the hospital, to whom, under Providence, he considers he owes his life'. The engraving was based on a photograph taken by Davison of Strada Reale, Valletta. It ceased to function in 1920 and nine years later was offered on lease to house St. Edward's College [23]. Another small fifty-bed hospital was build at St. David's Barracks at Mtarfa was build towards the end of the nineteenth century. This served to treat the soldiers' families, the troops continuing to receive treatment at the Cottonera Hospital. Plans to augment this hospital were initiated in 1912, and the new Mtarfa Hospital was opened in June 1920 when all the patients from other military hospitals were transferred there. This allowed the closure of many of the pre-First War military hospitals, including the Valletta Station Hospital, Forrest Hospital, and the Cottonera Hospital [24].

Chambray Hospital served the Gozo barracks. After the Maltese Islands fell under British dominion, the Chambray Fort built in 1749 was taken over by the British garrison. By 1830, the barracks also incorporated a small hospital of four wards capable of accommodating 20 men with a kitchen, surgery, etc. It rarely however was occupied with more than two or three individuals. Fort Chambray Hospital played a major role during the Crimean War when it was adapted for the admission of Crimean wounded and invalid soldiers. The modifications included the setting up of 30 very large wooden huts capable of accommodating 50 men each. There were a number of bathrooms and two mortuaries. The supplied equipment was of a superior quality. The staff was augmented to include a superintendent, officer-in-charge of supplies, a pharmacist and dispenser, four surgeons and 16 assistant surgeons. Fort Chambray opened its doors again for the reception of the sick and wounded during the Anglo-Egyptian armed conflict in 1882. During this conflict, the hospital proper consisted of a large building previously used as a barracks accommodating 150-200 patients. Various illustrations and a description of the Fort Hospital during this period were given in the Illustrated London News. The Fort again featured in the Military Medical History of Malta during the First World War since it served as an excellent Convalescent Depot, thus relieving the crowded camps in Malta. During October 1915 to March 1916, no less than 1579 men recovering from illness or injuries passed through the fort and were returned to active services. The medical staff at the time issued a record of their experiences in a journal entitled "The Fort Chambray Gazette". The fort closed down as a Convalescent Depot in March 1916. In 1934 it was used as a mental hospital for Gozo, a function retained until 1983. This accommodated up to 200 chronic patients. The old married quarters at Fort Chambray, which stood at some distance from the Mental disease block were adapted and the necessary repairs and renovations carried out. This section of the fort named Sacred Heart Hospital was (1937-1956) used as a leprosarium with 15 gozitan patients being transferred from Malta on the 9th December 1937 [25].

In the beginning of the twentieth century (1905) the military hospitals in Malta included (1) the Valletta Military Hospital which accommodated 232 beds and also had quarters for 65 non-commissioned officers and men of the Royal Army Medical Corps. The buildings were considered ancient and not well adapted for hospital purposes according to prevalent requirements; (2) the Cottonera Hospital accommodating 156 patients in four large wards was considered a modern building of good general design, but with globigerina floors which were considered unsuitable; (3) Forrest Hospital with 31 beds which being a hired house was not designed for a hospital and was insufficient for the needs of the regional barracks so that a considerable number of patients (20-30) were treated in tents all the year round; and (4) Citta Vecchia Sanitarium with 80 beds considered to be well fitted for treating convalescent cases. The needs of the Gozo personnel were served by the Gozo Hospital that contained 15 beds and was considered satisfactory vis-à-vis its situation, construction, water supply and drainage arrangements. The average population in the various hospitals in Malta amounted to 535 individuals or about 6% of the average population in all the different barracks and hospitals in Malta [26].

During the First World War, like the Crimean War period, Malta served as a "Nurse of the Mediterranean". From the Gallipoli campaigns 2500 officers and 55400 troops were treated in the Maltese hospitals, while from the 1917 Salonika campaigns 2600 officers and 64500 troops were treated. The years of the conflict thus required the significant augmentation of hospital beds for injured and sick troops. The number of beds in the Valletta Military Hospital were augmented from 26 beds to 340 and later to 440 beds. This augmentation was achieved by renovating disused wards and bringing the sanitary and medical facilities up to date. The Valletta Station Hospital served as a sorting base for the wounded arriving in the hospital ships prior to their being transferred to the other 30 hospitals and camps scattered over the Islands. The Valletta Hospital itself was reserved for dangerously ill cases that could not be safely moved. The principal hospitals and camps used were the commissioned Naval and Military hospitals: Bighi Naval Hospital, Valletta Hospital, Cottonera Hospital, Forrest Hospital, Mtarfa Hospital (commissioned in 1912) and Chambray Convalescent Depot. Other hospitals and hospital camps were set up including: the Hamrun Hospital, St. Andrew's Hospital, St. George's Hospital, St. Paul's Hospital (close to St. Andrew's), St. David's Hospital and St. Patrick's Hospital, St. John's Hospital (in the Sliema Primary School), St. Ignatius Hospital (in the old Jesuit College in St. Julians), Tigne Hospital, St. Elmo and Baviere Hospitals in Valletta, Manoel Hospital, the Blue Sisters' Hospital and the Ghajn Tuffieha Camp [27].

The period following the First World War, allowed for a re-organization of the military medical services on the Islands. The Mtarfa Hospital, commissioned in 1912, was opened on the 29th June 1920, even though it had been in use for some time earlier. Towards the end of the nineteenth century, Military Barracks with an adjoining Military Families's Hospital were built on Mtarfa Hill. The hospital catering only for the families of the troops housed fifty patients [28]. All the patients in the various military hospitals were transferred there and the military hospitals scattered around Malta were officially closed in the subsequent years. During the Second World War, the Mtarfa Hospital and barracks were reorganized as the 90th General Hospital and built up to accommodate a maximum of 1200 beds. An underground hospital was excavated under the military hospital. At the ends of hostilities, the 90th General Hospital was disbanded and reformed on peacetime footing as the David Bruce Military Hospital. This continued to serve the military troops, complimenting the Bighi Naval Hospital, until 1970. For the next eight years, the Mtarfa Hospital served the needs of the British military and naval personnel until its closure in 1978. The last British hospital outpost was a hospital close to the Hal Far airfield that closed with the departure of the British military and naval garrison from the Islands in 1979 [29].

1. H.P. Scicluna, Documents relating to the French Occupation of Malta in 1798-1800. Archivum Melitense, n.d., V:p.129,142

2. Robert, Memoire sur la topographie physique et Medicale de Malte, suivi de ’histoire des maladies qui ont regne dans cette ville parmi les troupes francaise, sur la fin de l’an 6, et pendant les annes 7 et 8. P. Didotlaine: Paris, 1802, p.32-37

3. H.P. Scicluna, op. cit., p.196; B. Azzopardi, Giornale della presa di Malta e Gozo. Malta, 1864, p.42; Notes sur les Ressources de la Division de l'Armee et du Port du Malte. Dispatch by Regnaud de St. Jean d'Angely to Directoire Executif dated 12 Fructidor an 6 (29th August 1798). In: W. Hardman, A History of Malta during the period of the French and British Occupations 1798-1815. Longmans: London, 1909, p.105

4. State of the Islands of Malta and Gozo on the 12th Day of October 1798. Arch. Nat., AF III.73. In: W. Hardman, ibid, p.132; Dispatches by General Vaubois to the Commissaire Ordonateur de Terre dated 30 Germinale (19th April 1799) and 6 Messidor (24th June 1799). In: W. Hardman, 1909, ibid, p.607,612

5. Robert, 1802, op. cit., p.78

6. Intelligence from People who came out of Valetta the 23rd Febraury 1799. Brit. Mus. Add. MSS 34909, fol.282. In: W. Hardman, op. cit., p.197; Dispatch Lieutenant Vivion to Lord Nelson dated 25th June 1799. Brit. Mus. add. MSS 34940. In: W. Hardman, 1909, op. cit., p.215; Robert, 1802, ibid, p.43

7. Articles of Capitulation. C.O.R. Malta, No.1. In: W. Hardman, 1909, ibid, p.320

8. P. Cassar, Medical History of Malta. Wellcome Histroical Libr.: London, 1964, p.522; P. Cassar, Medicine in Malta in 1800-1810. Contrasts, Concepts and Personalities. St. Luke's Hospital Gazette, 1971, 6(1):p.5; C. Testa, Maz-zewg nahat tas-Swar, Klabb Kotba Maltin: Malta, 1982, vol.3:p.509,604; A. Mifsud, Origine della sovranita` inglese su Malta. Malta, 1907, p.259

9. C. Testa, 1982, ibid , vol.3:p.525,716

10. Robert, 1802, op. cit., p.30

11. E. Blaquiere, Letters from the Mediterranean, London, 1813, vol.ii:p.297. In. P. Cassar, 1964, op. cit., p.65.

12. M. Ellul: The Sacra Infermeria since 1800: A historical survey. Maltese Medical Journal, 1989, 1(2):20-29

13. P. Cassar, 1964, op. cit., p.65-66; J. Hennen: Sketches of the Medical Topography of the Mediterranean. London, 1830, p.570-575; M. Ellul, 1989, ibid, p.28-29; P. Cassar, The Holy Infirmary of the Knights of St. John "la Sacra Infermeria", Med. Conf. Centre, Malta, 1992, p.68-81.

14. P. Cassar, 1964, ibid, p.98-99

15. P. Cassar, 1964, ibid, p.98.

16. P. Cassar, 1964, ibid, p.96; C. Savona-Ventura, Malta and the British Navy: the medical connection during the nineteenth century. Part 1. The establishment of the Naval Hospital at Bighi. Journal Royal Naval Medical Service, 1992, 78:p.174

17. The Malta Times, February 1854

18. Palace Archives Valletta: Despatches - Reid to Labouchere 21 November 1856, Labouchere to Reid 4 May 1857, Reid to Labouchere 24 October 1857. Letter, War Office, London to Commandant Royal Engineers, Malta 2 September 1859. In: M. Ellul, 1989: op. cit.

19. F. Nightingale: Notes on Hospitals. London, 3rd ed, 1863, p.103; C. Savona-Ventura: Malta and the 'Lady with the Lamp'. The Sunday Times [of Malta], 22 December 1991, p.30; C. Savona-Ventura: Light on the Lady with the Lamp. The Malta Independant, 4 May 1997, p.33; 11 May 1977, p.33

20. N. Cantlie: A history of the Army Medical Department. Livingstone: Edinburgh, 1974, vol 2:p.207-208; M. Ellul, 1989: op. cit., p.23-24; The Cholera at Malta: The 100th regiment encamped on the glacis of Fort Manoel. The Illustrated London News, 23 September 1865; Sanitary encampment of the troops at Malta. The Illustrated London News, 1865. In: A. Nicolas, Antique Malta: 1842-1885 A Topographical and historical catalogue of engravings and articles as depicted in the major English magazines of this eventful period. Malta, 1982

21. P. Cassar, 1964, op. cit., p.66,99,236; J. Hennen, 1909, op. cit., p.661-666; M. Ellul, 1989, ibid, p.23; A.V. Bernard, 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.xxxv; N. Cantlie, 1974, op. cit., vol.1 p.274

22. P. Cassar, 1964, ibid, p.99

23. P. Cassar, 1964, ibid, p.100; The Naval Hospital, Malta. The Illustrated London News, 1882. In: A. Nicolas, 1982, op. cit.

24. P. Cassar, 1964, ibid

25. P. Cassar, Fort Chambray - the medical profile. The Times [f Mallta], 29 January 1993, p.14-15; The Hospital at Gozo. Illustrated London News, 1882. In: A. Nicolas, 1982, op. cit.; A.V. Bernard, 1938, op. cit., p.lii

26. A.M. Davies. Report on the Prevalence of Mediterranean Fever amongst British troops in Malta, 1905. Reports of the Commission for the investigation of Mediterranean Fever. Harrison: London, 1906, Part IV: .121-123

27. M. Ellul, 1989, op. cit., p.25

28. M. Ellul, 1989, ibid, p.25; P. Cassar, 1964, op. cit., p.100

29. P. Cassar, 1964, ibid, p.100