The Anglo-French conflict which occurred at the turn of the eighteenth century required the British to maintain a Mediterranean fleet in order to attack and contain the French upon this southern front. At a later date, after the war had ended in Britain's favor, this remote northern Atlantic island found itself in a strange position of having become a Mediterranean power. The Maltese archipelago situated at the strategic cross-roads of the Mediterranean found themselves, as in previous centuries, closely involved in this power struggle, and in subsequent years served as an important naval base for the British Mediterranean fleet. The Islands for all intents and purposes became a British base on 5 September 1800, though it was not until the Treaty of Paris in 1814 that the islands were officially declared as belonging "in full right and sovereignty to his Britannic Majesty". The importance of the Islands as a naval base were quickly recognized, and naturally after the British Navy began using the Malta Harbour as its base, the necessity for providing suitable shore accommodation for the sick and wounded became a pressing problem.

During the nineteenth and twentieth centuries, Malta served as an important outpost in the Mediterranean supplementing Gibraltar and Cyprus. There is evidence that British interest in Gibraltar dated to as early as the seventeenth century after the abandonment of Tangier in 1684. Britain obtained formal possession of Gibraltar and of Port Mahon in Minorca by the Treaty of Utrecht in 1713. The strategic value of the base was fully realized during the campaigns against the Directorate and Napoleon. Its usefulness as a supply base became increasingly evident, particularly in 1805, and it served as an observation base countering Villeneuve's fleet. Cyprus was given over to British control by an agreement with the Sultan in 1878. Great Britain intended to use the island as a base from which the Ottoman Empire might be protected against the ambitions of Russia, a defense then all the more important in that the opening of the Suez Canal in 1869 had made the East Mediterranean an area of great strategic importance. Malta thus served as an important link in the chain of Mediterranean bases linking the Atlantic and the Indian Oceans [1].

The medical connection between the British Navy and Malta dates to the seventeenth century when the Islands were still under the control of the Knights of St. John. In the latter half of the seventeenth century, the British naval actions were directed against Algerian pirates. By consent of the Knights, Sir John Narbrough used the Malta Grand Harbour at intervals between 1674 and 1679, so that during these years the sick and wounded from his squadron may have been admitted to the hospital of the Order at Valletta. This naval connection of the Islands with North Africa, where plague was rampant during this period, has been blamed for the plague epidemic that affected the Maltese Islands during 1675-76, though this was unlikely since the British squadron did not suffer any consequences from the disease. When Henry Teonge, then chaplain of the Assistance, visited the hospital on 2nd August 1675, he was much impressed by the scale of the great ward where "Tis so broade that 12 men may with ease walke a brast to the midst of it; and the bedds are on each syd, standing on 4 yron pillars, with white curtens and vallands, and covering, exceedinge neate, and kept cleanr and sweete: the sick served with all in sylver plate, and it contains above 200 bedde below, besyds many spacious rooms in other quadrangles within; for the chiefs cavaliers and Knights, with pleasant walkes and gardens; and a stately house for the chiefe doctor and other his attendants". Teonge also described the quarantine hospital "The Lazzaretto (a place on purpose for such as are sick of the plague or other pest ilential diseases; which in regard to the heat of that country doth often rage there:) lyes closse under their outermost wall, and is extremely neatly kept and provided for." The British were themselves unfamiliar with quarantine measures, since the system originated in the ports of the Mediterranean to which it remained almost entirely confined until the first half of the nineteenth century. During the late eighteenth century there were no lazarettos in England and ships proceeding to Great Britain from Turkish ports were obliged by an act of the British Parliament to perform quarantine at Malta and other Mediterranean ports before they were allowed to land their cargo in any part of Great Britain or Ireland. In Malta quarantine measures were enforced as early as the Middle Ages [2].

Another pre-nineteenth century encounter occurred in 1799 when units of the British Navy were aiding the Maltese uprising against the French by blockading from the sea the French troops besieged in the fortifications around the Grand Harbour. A temporary hospital was set up in 1799 to treat sailors of the British Navy who were aiding the Maltese uprising against the French by blockading from the sea the French troops besieged in the fortifications around the Grand Harbour. The company of the Goliath was attacked by a fever. The sick, numbering about 40 individuals, were landed at St. Paul's Bay and placed "in a large castle....where the whole recovered". The large castle in the vicinity of St. Paul's Bay may be considered the first temporary British Naval Hospital in Malta. Another temporary hospital was set up in a house on the shore by Captain Ball in March 1799 to house the sick sailors on his ship [3].

The large castle in the vicinity of St. Paul's Bay may be considered as the first temporary British Naval Hospital in Malta. Soon after the French capitulation on the Maltese Islands, the British set up premises to provide care to wounded and sick sailors. The initial choice fell on the old civil hospital of the Knights of St John at Vittoriosa known as the "Armeria". This had long corridors and was within easy reach of the vessels lying in the creeks of the Grand Harbour. In addition the Mediterranean Commander-in-chief Lord Nelson, who could well appreciate from personal experience the value of proper medical facilities, instructed that: "It is my particular directions the moment any of His Majesty's Ship [H.M.S. Madras] under your [Captain Schomberg] command is attacked with an infectious or inflammatory fever, that he is sent to the Military General Hospital, and not kept on board...". Nelson himself while in Malta in 1800 suffered from an attack of malaria with which he was infected early on in his career, writing "My state of health is very precarious. Two days ago I dropped with a pain in my heart, and I am always in a fever". This illness did not however appear to interfere with Nelson's amorous activities with Lady Emma Hamilton. The first illegitimate daughter of this couple, Horatia, born in January 1801 was almost certainly conceived in Malta [4].

The necessity of a "proper" naval hospital was recognized very early on during the British - Malta connection. Nelson on 7th November 1803 in correspondence to Major General Villettes wrote: "My dear General, I certainly think that the Navy ought to have had a regular Hospital at Malta, and not to have thrown the trouble of attending our Seamen on the Medical Skill of the Army; and when Sir Richard Bickerton and Dr. Snipe go to Malta, I intend they shall examine the large house opposite side to you which will be a very fit place for a Marine Hospital." That same month on the 25th, Nelson further instructed Dr. J. Snipe: "The Commissioners for taking care of Sick and Hurt Seamen and Marines, having acquainted me that they have appointed Mr. John Gray to be Surgeon of the Naval Hospital intended to be established at Malta, I am therefore, to desire you will proceed immediately in H.M.S. Narcissus to Malta, for the purpose of examining the situation and necessary accommodation of such Hospital, previous to its being occupied as such; as it has been mentioned to me by the Admirals and Captains who have served in the Mediterranean for some considerable time, that the situation of the former Hospital at Malta was particularly unhealthy, it is my directions that you do not suffer that house to be received as an Hospital, or any other which, from situation, you may judge improper; but endeavour to procure a convenient and well appointed house, in an airy and health situation for a Naval Hospital pro tempore; until such time as the Government shall take the necessary measure for building, or otherwise providing, a convenient and proper Hospital. If such accommodation cannot at present be had, you will beg Major General Villettes to allow Mr. Gray, the use of the Wards in the Military Hospital at present appropriated for the Seamen, until the necessary arrangement can be made for their reception into some other place" [5].

Dr. Snipe reported in writing on the 9th December 1803. "My Lord, In addition to my letter of the 7th instant, I beg leave to acquaint Your Lordship that, with Sir Alexander Ball, I have examined the Palace of Bighay which is a most desirable situation for a Naval Hospital, in Summer it is cooled by a refreshing sea breeze, and in Winter perfectly dry. A convenient landing place, close to the Palace, and sufficient Ground belonging to it, in a high state of cultivation, to produce abundance of vegetables for the use of the sick, and if Lemon and Orange tress were planted, the Fleet, on this station, might be amply supplied with those antiscorbutic fruit. I carefully examined every spot in and about the Harbour of Malta, and there is no situation so well calculated for a Naval Hospital as Bighay, it being nearly insulated, and some distance from any other houses. The present building is in want of much repair, and although it has the appearance, from the sea, of being very extensive, there is very little room within the walls, and could not accomodate above one hundred and sixty patients. If it is the intention of Government to have a permanent Naval Hospital at Malta, and properly prepared for every causality a Fleet is liable to, there ought to be a Hospital capable of receiving four or five hundred patients, and if Bighay is the place fixed upon, there will be required two wings to be built to the present Palace, each capable of holding a hundred and twenty patients, besides Storehouses, Kitchen, Dispensary, Wash-houses, etc. There is no part of the Service that requires more to be regarded than the choice of a proper situation for a Hospital, and the right management of it, on which the health and strength of a Fleet so much depends, for in wet and unwholesome seasons, if any infectious diseases get in into the Hospital, which probably might have been prevented by proper care, they often weaken a fleet more than the sword of the enemy."

Nelson endorsed Snipe's suggestions to the Admiralty. Ball estimated that the cost of furnishing Villa Bighi as a hospital for 150 men would amount to £5000, though Nelson believed the cost to amount to twice as much. There appeared to be no opposition from the Admiralty or the Foreign Office to transferring Villa Bighi to the Naval Authorities for use as a hospital, but Villa Bighi and its grounds were only allotted to the Royal Navy in 1822 when the various government properties were re-distributed. As a right for the surrender of that area the British authorities paid £1,6s,3p annually to the parish priest of Our Savior Chapel [6]. In the 1813 plague epidemic Villa Bighi was converted into a Plague Hospital for the sick from the Cottonera area under the direction of the physician Luigi Pisani who was the Medical Practitioner for the poor at Vittoriosa, and under the Principal Physician Dr. Gio Batta Saydon. Seventeen patients died there [7]. The property was let out on an annual basis to private individuals until March 1829, when it finally taken over by the Royal Navy after the Battle of Navarino in 1827 showed the inadequacy of the Armeria Hospital in dealing with a large number of causalities, and the wounded conveyed to the Island were confined to Fort Ricasoli [8].

In the meantime as a result of discussions between the Naval Authorities and the Civil Commissioner, Sir Alexander Ball placed the Slave Prison of the Order at St. Christopher Street in Valletta in 1803 at the disposal of the Navy for use as a hospital pro tempore. A nearby house at No.272 Strada Forni was hired at £40 annually as a residence for the surgeon in charge of the hospital. The transfer to the new Naval Hospital may have been the 1st January 1804 as on that day sick naval personnel ceased to be admitted into the Military Hospital. The Surgeon-in Charge was Mr. John Gray appointed 25th November 1803, while the Surgeon's Mate was Mr. John William Ellice appointed 22nd December. The Governor and superintending Officer was Lieut. William Pemberton appointed 21st December. The Physician in charge was Dr. Leonard Gillespie [9]. Nelson's Surgeon on the Vanguard, Mr. Michael Jefferson, was employed in the Malta hospital during 1804. By 1807 the Surgeon-in-Charge was replaced by Mr. John Allen, while the Assistant Surgeons were Mr. John Regnell and Mr. Lorenzo Zammut [10].

Detailed instructions for the conduct of hospitals on foreign stations including Malta were published in 1809. The surgeons were paid £500 annually with a free residence. They were instructed to be constant in attendance on both morning and evening visits to the sick; to act with the Agent in everything pertaining to the purchase of stores or the renting of sick quarters; to see that bedding was changed twice a week; and that each new patient was to be examined and "gently washed by a nurse", before being put to bed. If the ailment was infectious, the patient was to be given hospital clothing, old clothes being boiled or burned. Only those who could not be cured on board were to be accepted, nor were any rupture cases to be retained on shore once they had been issued with a truss. Every patient was to have a Smart Ticket, with a description of his disease by the surgeon of his ship; when discharged he was to be given a certificate or a recommendation to Greenwich Hospital. The Dispenser was to provide a Prescription Ticket for each basket of medicines placed at the head of each bed. The wards were to be kept in a state of "the most perfect cleanliness", officers and men, infectious and convalescent patients being carefully separated. Sponges and bandages were to be boiled or destroyed after use. The surgeon was given two complete sets of instruments, as well as the medicines he required. A monthly return of the state of the hospital was required, together with a description of any notable cases. Since vaccination was not yet compulsory, the surgeon was to do all he could to promote it. Finally, he was positively forbidden to practice privately, or to accept gratuities. The instructions to Agents, or Store officers, were very detailed and include specimens of the large number of forms he was expected to complete. The Dispenser was ordered to communicate with the Board only though the surgeon. His stock of drugs comprised some 70 medicines, in addition to the Necessities for the Sick which include wine, porter, sugar, rice, sago, cocoa, arrow root, oranges, lemon juice, honey, barley, splints, trusses, sponges, lint and flannel [11].

The conditions in this hospital are described in the rare memoirs of a seaman who was a patient there. George Watson has nothing but praise for the surgeon, Mr. Allen, and for one of the nurses, who "was a generous kindhearted creature, and very fit to be a nurse to sailors as she was not overburdened with delicacy, and, being of a pleasing disposition, she could accommodate herself to the healthy as well as the sick". He also describes some unusual episodes occurring in the hospital, such as the insane Marine who chased a negro round the ward with a surgeon's knife until the rest of the patients managed to overpower him, and the struggle between two one-armed patients which ended with their falling on Watson and breaking his thigh anew [12].

This building continued to serve as a naval hospital until 1st July 1819, when the naval patients were again moved to the Armeria after a decision by the naval authorities to concentrate their various departments in Vittoriosa. The Resident Commissioner of the Navy called for tenders to perform the glaziers' work required to be undertaken at the new hospital, the tenders being opened on 28th December 1818, while the nearby house No.22 on the Marina Grande was assigned as an official residence for the hospital agent (the eight rooms in the ground floor) and the surgeon (eight rooms in the upper floor) [13].

The staff of the Armeria hospital at Vittoriosa consisted of a surgeon, an assistant surgeon, a dispenser and an agent who was in charge of stores and equipment. The hospital was described as being "an airy building....well adapted to its purpose". In peacetime patients were few rarely exceeding twenty, though the hospital was capable of accommodating one hundred and twenty beds which could be increased by a further eighty to a hundred beds in an emergency. The Armeria continued to function as a Naval Hospital until the opening of the Royal Hospital Malta at Villa Bighi in 1832. The Armeria was transferred to the military authorities to serve as sick quarters for soldiers in the Cottonera area. It was subsequently used by The Royal Engineers and later by the King's Own Malta Regiment [14].

In 1829, it was finally decided to convert Villa Bighi into a naval hospital. To this aim it was necessary to expropriate the private property which was in the immediate vicinity of the hospital grounds so as to have complete control of the San Salvatore promontory. The following transactions were effected through Notary Diego Vella: # January 27, 1830: two houses, nos. 23 and 24, facing the Vittoriosa bastions situated in Vicolo Bighi, belonging to M. Agius of Valletta at the cost of 2250 Scudi (£187,10s). One of the houses consisted of two storeys with several rooms, cellar, cisterns and gardens with different trees; the other with several rooms in one floor with a cellar, a stretch of ground in four sections also with trees and cisterns, and a passage leading into the main street towards the foreshore. # July 30, 1830: large house and garden, no. 26, in Vicolo Bighi, belonging to James Mackenzie (trustie Dr. Filippo Cassar) at cost of 1400 Scudi (£116,13s,4d). # October 27, 1830: two houses, nos. 22 and 25, in Vicolo Bighi, belonging to Salvatore Piretti at the cost of £162,10s and £100,3s,4d respectively [15].

Whilst digging for the foundations, workmen uncovered some Egyptian type stele which were eventually transferred to the British Museum. Vice-Admiral Sir Pulteney Malcolm laid the foundation stone on the 23th March 1830. The stone was adjusted into place with a silver trowel in the northeast corner of the building after the gold and silver coins of the reigning sovereign were deposited under it. Reverend J.T.H. Le Mesurier, the Chaplain of the Arsenal who was also attached to the Armeria Hospital, conducted the religious ceremony. The band of H.M.S. Asia played the "God Save The King", while refreshments were served in the principal hall of the old Palace of Bighi. The inscription on the foundation stone records that the "edifice designed by Colonel George Whitmore of the Royal Engineers in concert with Vice Admiral Sir Pulteney Malcolm, Commander-in-Chief of the Naval Forces and Commissioner of the Navy in the Mediterranean" was erected at "the expense of the British Nation to serve as an Hospital for the sick and wounded Mariners in the service of the King" in the eleventh year of the Glorious Reign of George IV in the presence of the "Captains of His Majesty's Ships, the officers of the various departments of the Public Service and a great assemblage of distinguished spectators." The architect Salvatore Xerri was appointed Superintendent for the new works and as assistant he had his brother Gaetano Xerri. Following the sudden death of the former on 23rd January 1830, Gaetano Xerri was appointed instead. Mr. J.B. Collings was Clerk of the Works. The works were completed on 24th September 1832, at a total cost of £20000, and the year in Roman numerals was carved underneath the clock over the entrance of the central building - the original structure of Villa Bighi. The hospital's architecture is in modern Dorik with high floors. Under the whole building runs a wide and high passage used during the building for transportation of materials with mules. The works included the demolition of all the annexes to make room for the two wings recommended by Dr. Snipe, while the original central balcony was changed for new ones to harmonize with the architectural style. The double approach to the Villa from the shore was done away with and replaced by a path leading to the rocks below [16].

Major structural additions were undertaken at the beginning of the twentieth century when the surgical and zymotic blocks were built in 1901 and 1903 respectively. Two cemeteries had been established in the hospital grounds in 1840, one for Military Protestants and the other for Protestant patients. These ceased to be used for burials in 1900, after the Admiralty obtained an alternative site in the vicinity of the hospital. The transaction made in execution of a judgement given by the Civil Court on the 16 July 1990 (cit. no. 479) was made through Public Notary Gustavo Sciortino on the 25 August 1990. On the grounds of public utility, the Admiralty could purchase for the price of £624 6s the lands called "ta San Pietru" or "Tauru" situated within the limits of Zabbar, and consisting of several joined fields which occupied an area of 18 tummola, one mundilo and four misura including a building constructed on the land [17].

In 1840 the hospital was described as being "capable of containing 250 patients having two large and four small wards, besides rooms for officers, in each pavilion. One of the best things in the establishment is a corridor, ten feet wide and one hundred and sixty feet long, which runs through the centre of each wing ventilating it in all directions.....It receives about eight per cent of the ships' companies of the fleet yearly, being with ten thousand men, about eight hundred in the year. The mortality among the patients is extremely small, not exceeding 4 per cent of the number received, though they consist of the worst cases of the squadron. Indeed the health of the whole Mediterranean fleet is so good that perhaps it has no parallel in the world, the mortality being only, on an average, seven per thousand excluding accidents which are two per thousand" [18].

Villa Bighi had a checkered pre-British history with strong naval traditions. It was originally built on the design of Lorenzo Gafa in 1675 as the country villa of Bali Fra Giovanni Bichi, an italian knight of the Order of St. John who was the nephew of Pope Alexander VII. Fra Bichi was employed in the naval service of the Order, eventually gaining command of the Papal Fleet. He died of the plague epidemic in 1676 and was buried in San Salvatore Church close to the villa. After his death, the villa passed into the possession of his nephew Knight Fra Mario Bichi who died in 1712. The property was purchased by Bailiff Fra Giovanni Sigismondo Count of Schaesberg, but reverted to the Fra Giovanni Bichi, Mario's nephew, in 1718. Known initially as the garden and palace of SSo. Salvatore, it became known as Villa Bichi and in British times Villa Bighi. Giovanni Bichi died in 1740, and in December 1743 the Inquisitor Mgr. Paolo Passionei spent his imposed quarantine at the villa. By 1763, the villa had become the residence of John Dodsworth, the English Consul in Malta. During 1784, the Russian Agent to Catherine II submitted a request to convert the villa into a provision store for the Russian Mediterranean Fleet, but this request was turned down. In 1791, the villa was acquired by Bailiff Fra Nicola Frisari. During the rising against the French in 1798, the villa was nearly demolished for the sake of its beams and woodwork. The belief that Napoleon Bonaparte occupied the villa is false, though Napoleon did boast that he would built his palace on Bichi promontory when Europe, Asia and Africa were subjugated to his power. In 1800, the villa passed into the hands of the Civil Government, and the property was let out to private individuals on a yearly basis [19].

Bighi Hospital contributed to the nursing and medical care of casualties whenever hostilities occurred in the Mediterranean, contributing in making Malta "the Nurse of the Mediterranean". During the Crimean War that broke out in 1854, Malta became an advance station of the battlefront. On the 4th March 1854, three companies of the 28th Regiment occupied the hospital store in Bighi Hospital. The Island further served to hospitalize the numerous was casualties that were continually arriving from the battlefield [20]. Bighi Hospital also in 1863 hosted the Prince of Wales - Prince Alfred - who during his illness occupied a room in the left or west wing of the hospital overlooking the Grand Harbour. The Prince was instrumental in ordering uniforms for the hospital staff. At this time the hospital, originally under the direction of Sir John Liddell, was under the administration of Dr. Armstrong. It was described as possessing "many advantages, both of site and construction. It has spacious and pleasant corridors, which shield the patients from the too great heat of the summer midday sun and from the wet and inclemency of winter. The wards are about 30 ft. in height, and to each patient is allowed 1800 cubic feet of air. ...... The original or centre building contains the chapel, the quarters for the medical storekeeper, and two assistant-surgeons; the Deputy Inspector-General having a beautiful and commodious residence on the margin of Rinella Creek. The wings afford accomodation for the sick men and officers of the fleet, and are exemplary for their thorough ventilation, comfort and cleanliness." [21]

During the First World War (1914-1918), Bighi Hospital accommodated a very large number of the casualties from the Dardanelles, the patients being bedded down in corridors and ditches. During the Second World War, the hospital was well within the target area of the heavy bombings since military establishments surrounded it. A number of its buildings were damaged or destroyed, including the X-ray theatre, the East, West and Center Blocks and the Cot Lift from the Bighi Jetty to the Hospital. Princess Elizabeth on 23rd December 1949 visited the hospital accompanied by the late Lady Edwina Mountbatten. The medical officer in charge Surgeon Rear Admiral O.D. Brownfield received her. In 1967, during the second unexpected rundown of the British services and their employees in Malta, Bighi Hospital was on the brink of closing down. It finally closed its doors, as a hospital, on 17th September 1970 when the Naval Medical Services were transferred to David Bruce Military Hospital at Mtarfa. The last Medical Officer in Charge of Bighi Hospital was Surgeon Captain C.L.T. McClintock who commented that "I feel unhappy that after so many years of good medical service Bighi Hospital has to close down for good" [22]. In 1977 the ex-Senglea Trade School occupied the central and east blocks, while the other parts were occupied by a secondary school. In 1980 a new road complex was constructed passing from Kalkara through Villa Portelli's gardens up through Bighi center and down to Rinella. In 1984 the Central Block of the hospital was abandoned due to dangerous ceilings and the Trade School moved to the West Block. Government apartments were eventually built in the Hospital external grounds.

Hospital Ships
It is impossible to say when a navy first used a vessel specifically as a hospital ship, though there is an allegation that the Spanish Armada in 1587-1588 included fifteen of them. There is considerable information to show that the Royal Navy used hospital ships as early as 1608. There are many records of naval hospital ships in the last decade of the eighteenth century, but their use to transport naval or military personnel from the conflicts around the Mediterranean region to Malta was only recorded in the mid-nineteenth century. After the Battle of Inkerman on 5th November 1854, some of the casualties were transported to Malta on hospital ships. During the last three months of 1854, 41 vessels of one kind or another carried the sick and wounded from Crimea. Up until the First World war fully equipped hospital ships kept with the Fleet as long as they could; after engagements sailors were taken abroad for return to port and base hospital. In peacetime, the base hospital itself would frequently be one of the hospital ships. In historical naval tradition, HMHS Maine has been perpetuated in a long line of hospital ships with the earliest record dating to the late nineteenth century. In 1900, HMHS Maine became a permanent hospital ship of the British fleet and for some years was on service in the Mediterranean, either as a floating hospital or for the transport of naval and military invalids. The service of the first ship of that name ended after the ship ran aground in Scotland in 1914. Other ships converted to serve as hospital ships and given the name of HMHS Maine were commissioned during the subsequent years. In 1920, the Royal Navy purchased a coal-burner built in 1902 with a speed of eight to ten knots and converted it to serve as a permanent hospital ship. The new HMHS Maine was kept in permanent commission between 1918 and 1939, being placed under the direction of the Commander-in-Chief of the Mediterranean Station. Her normal peacetime program was to accompany the Mediterranean Fleet on its routine cruises, and between such cruises to perform duties of a base hospital ship for the submarine and destroyer flotillas at Malta. The ship was eventually broken up in 1948, having served in various stations including Malta in the post-Second World War period. Other ships were also commissioned to serve as hospital ships, particularly during times of strife. During the Gallipoli campaign (25th April 1915 - 10 January 1916) at least 22 hospital ships and some 29 troop ships, transports and similar vessels took part in transporting casualties to Imbros, Mudros, Alexandria, Malta and elsewhere. In August-October 1915, over 50000 patients were carried to Malta, Gibraltar and the UK in hospital ships. HMHS Souden, one of the hospital ships, transported a number of wounded troops from the Dardanelle to Malta arriving on the 30th May 1915. HMHS Franconia, another ambulance carrier, was torpedoed and sunk in the Mediterranean in 1915. Another hospital ship to be torpedoed in the Mediterranean on the 26th May 1917 was the HMHS Dover Castle. HMHS Goorkha was also mined on the 10th October 1917 off Malta. There were 362 survivors on board, including 17 nursing sisters. The vessel was cleared within 35 minutes and there were no casualties. She was subsequently towed into the Malta Harbour. During the Second World War, the HMHS St. Andrew and HMHS St David reached the Mediterranean in June 1943 in time for the landings at Salerno and made many journeys between Italian ports and Malta and N. Africa, sometimes stemming over 1000 miles in one trip [24].

Merchant's Seamen Hospital
The British Merchant Service was an essential part of the British Naval supremacy, and provisions were necessary to provide the treatment of Merchant Seamen. At the beginning of the eighteenth century facilities for the treatment of sick merchant seamen - The Merchant Seaman Hospital - were set up in Malta, but the hospital closed down in 1822. Sick Merchant seamen were subsequently admitted to the Civil General Hospital in Valletta. The cost of the treatment was covered by a Hospital Duty Tax levied on British vessels arriving in Maltese ports. In November 1850, a ward designated "The British Merchant Seamen Ward" was set aside in the surgical division of the Civil Central Hospital [25]. These arrangements were not ideal and problems were encountered because the sailors were generally unruly and often abused of sickness to remain ashore. A set of regulations for "Sick, Discharged, Distressed and Delinquent British Merchant Seamen" was drawn up in 1849, but seamen remained a source of trouble. In April 1881, the Visiting Physician requested the Comptroller of Charitable Institutions to introduce further measures to control these unruly and difficult patients. A former ship-chandler was appointed to enforce discipline, a measure that was attended with a degree of success [26]. Plans for the construction of a separate hospital for merchant seamen were proposed to the government authorities in July 1880. These involved the refurbishing of the quarters formerly occupied by the resident medical officer of the Central Hospital to allow the reception of twenty-five patients. The new hospital was opened on 28th March 1882. An English matron and a trained nurse were responsible for the general care of the sailors, except those suffering from venereal disease. This hospital functioned efficiently, but eventually was found to be too small for the number of patients who required admission. Plans to build a bigger hospital were submitted in June 1883. In spite of the fact that a number of shipping agents offered to contribute £100 each to defray part of the building costs, this scheme was not taken up. In May 1885, the Comptroller of Charitable Institutions proposed that the British Seamen’s Hospital should be moved to a large house in Floriana or Kordin. This proposal was not taken up [27]. In subsequent years, financial restrains caused administrative problems, so that by 1896 the hospital, which generally accommodated two patients, was being run at a loss. To mitigate this problem, the Seaman’s Hospital opened its facilities to twelve paying patients transferred from the adjoining Central Hospital. At the turn of the twentieth century (financial year 1904-1905) the average daily number of inmates was seven, costing an average 4s7d per head. The overall total number of admission during that year was 93, from whom 70 were discharged cured or relieved, seven were discharged unimproved, while there were six deaths [28].

The Seamen’s Hospital was transferred to the Zammit-Clapp Hospital (Sliema) run by the Little Company of Mary on 29th August 1911. Zammit-Clapp Hospital was built by Mrs. Emilia Zammit Clapp and her sister Miss. Mary Zammit in 1910. The completed hospital, which adjoined the nursing home run by the Little Company of Sisters, was donated to the Government on the 23rd June 1911. 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. The Seamen’s Hospital ceased to form part of the Department of Health and the Little Company of Sisters in December 1922 when the King George V Merchant Seamen’s Memorial Hospital was opened [29].

In 1922, a new hospital was opened as a memorial to the men of the Merchant Navy who died in the First World War. The King George V Hospital at Floriana was severely damaged in April 1942 by enemy action during the Second World War. It was subsequently reconstructed by funds obtained among others from the Scottish Branch of the British Red Cross, the Silver Thimble Fund, and the Nurse of Britain Gift. The rebuilt hospital was inaugurated on 30^th November 1948 when it continued to cater mainly for merchant seamen though members of service-families and civilians were also admitted. It continued to function until the hospital's closure in January 1967 [30].
 

Conclusion
The changing imperial mentality of post-war Britain, as well as her diminishing role as a World Power, resulted in a political movement to transform Malta from a Fortress Colony to an independent Sovereign State. The formal departure of the British Naval and Military Forces was effected on the 31^st March 1979. This was anticipated by the gradual closure of all medical facilities for military and naval personnel on the Islands, the buildings becoming the property of the Malta Government. Only the refurbished King George V Hospital, now named Paul Boffa Hospital after the post-war Prime Minister, and the Zammit-Clapp Hospital still maintain a medical function. The former accommodates the Radiotherapy and Dermatology Departments, while the latter serves as a Geriatric Hospital. The last medical outpost of the British Services at Hal Far now serves as a Drug rehabilitation Center.

2. B. Dal Pozzo, Historia della Sacra Religione Militare di S. Giovanni. Venezia, 1715, vol.2, p.445; G.A. Vassallo, Storia di Malta. Malta, 1854, p.682; G.E. Manwaring (ed.), The Diary of Henry Teonge, Chaplain on board his Majisty's ships Assistance, Bristol, and Royal Oak, anno 1675 to 1679. London, 1825, p.59,48; J.J. Keevil, Medicine and the Navy 1200-1900. E&S Livingstone Ltd, Edinburgh, 1958, vol.2 (1649-1714), p.114-115; J. Davy, Notes and observations on the Ionian Islands and Malta. London, 1842, p.323; J. Howard, An account of the principal Lazarettos in Europe. Eyres, Warrington, 1789, p.26

3. W. Burnett, A Practical Account of the Mediterranean Fever as it appeared in the Ships and Hospitals of His Majesty's Fleet in that Station during the years 1808, 1811 and 1813 and of the Gibraltar and Carthagena Fever, Callow, London, 1816; P. Cassar, 1971, op. cit.; C. Savona-Ventura, 1992, op. cit.; Dispatch Captain Ball to Admiral Nelson dated 31st March 1799. Brit. Mus. Add. MSS 34910, f.114. In: W. Hardman, 1909, op. cit., p.206

4. P. Cassar, 1964, op. cit., p.95-98; N.H. Nicolas, The Dispatches and Letters of Vice Admiral Lord Viscount Nelson. Henry Colburn Publ., London, 1845, vol.5 p.188-189, vol.4 p.196 197; P.D. Gordon Pugh, Nelson and his surgeons. E&S Livingstone Ltd, Edinburgh, 1968, p.5; G. Bonello, How Lady Hamilton changed the history of Malta. The Sunday Times [of Malta], 27 November 1994, p.46-47

5. N.H. Nicolas, 1845, ibid, vol.5 p.189-190, 285, 294-295; C. Lloyd and J.L.S. Coulter, Medicine and the Navy 1200-1900. E&S Livingstone Ltd, Edinburgh, 1963, vol.4 (1815-1900), p.247-252

6. N.H. Nicolas, 1845, ibid, vol.5 p.317-320; C. Lloyd and J.L.S. Coulter, 1962, ibid, vol. 4 p.247-252; J. Galea, Bighi Hospital. Civilization, 1983, 11:p.260-62

7. P. Cassar, How "Villa Bichi" became a Naval Hospital. Malta Year Book, 1971a, p.363-365; P. Cassar, 1971, op. cit.

8. C. Lloyd and J.L.S. Coulter, 1962, op. cit., vol. 4 p.247-252; T. Zammit, Malta: The Maltese Islands and their history. A.C. Aquilina & Co., Malta, 1971, p.285

9. N.H. Nicolas, 1845, op. cit., vol.5 p.294-295, 322-325, 431; C. Lloyd and J.L.S. Coulter, 1962, ibid; vol. 4 p.247-252; P. Cassar, 1971a, op. cit.

10. P. Cassar, 1971a, ibid; N.H. Nicolas, 1845, ibid, vol.5 p.439

11. C. Lloyd and J.L.S. Coulter, 1961, op. cit., vol.3 (1714-1815), p.149; P. Cassar, 1971a, ibid

12. C. Lloyd and J.L.S. Coulter, 1961, ibid, vol. 3 p.151-152,179-180; G. Watson, Adventures of a Greenwich Pensioner. London, 1827, p.187,189

13. P. Cassar, 1971a, op. cit.; J.F. Darmanin, The British Naval Hospitals in Malta with particular reference to Bighi. Archivum Melitense, 1939, 10:p.162,166.; C. Lloyd and J.L.S. Coulter, 1961: op. cit. vol.4, p.252; Malta Government Gazette, 1818, p.269

14. P. Cassar, 1971a, ibid; J. Hennen, 1830, op. cit., p.580

15. C. Lloyd and J.L.S. Coulter, 1961, op. cit., vol.4, p.252

16. P. Cassar, 1971a, op. cit.; C. Lloyd and J.L.S. Coulter, 1961, ibid, vol.4,p.252; A, zammit, Bighi Hospital - of Whitmore and Xerri. The Sunday Times [of Malta], 6^th June 1999, p.44-45

17. J. Falconer Hall: The Royal Naval Hospital, Malta. Journal of the Royal Naval Medical Service, 1927, xiii; P. Cassar, 1964, op. cit. note 4, p.97-98; Notarial Deeds: Gustavo Sciortino, deed no.26, p.301-319 dated 25 August 1900. [Deed between Rear Admiral Burges Watson and Francesca Vassallo, John Busuttil (representing his mother Caterina), Dr. Alfredo Parnis (autorny for family Meilaq, family Ventura, Savlatore Busuttil, Lucerzia Jones, Giovanna Zammit, Maria Montesin, Concetta Busuttil, Giovanna Micallef), Dr. Filippe Preziosi (representing Guiseppe Ventura), and Dr. Ruggero Leone Ganado (representing Francesca Grima).]

18. P. Cassar, 1964, ibid, p.97; Malta Penny Magazine, 24 October 1840, 59:p.233

19. P. Cassar, 1971a, op. cit., p.363-36

20. R. Grima, Military History of Malta: The Crimea Connection. Heritage, n.d.(1985), 59,p.1166-1175

21. Royal Naval Hospital, Malta, the sick quarters of his Royal Highness Prince Alfred. The Illustrated London News, 11 April 1863

22. J. Galea, 1983, op. cit., p.261-262

23. J. Leffin, Surgeons in the field. J.M. Dent, London, 1970, p.113-114

24. J.H. Plumridge, Hospital Ships and Ambulance trains. Seeley Service , London, 1975, p.18-19,28,41,45-48,56,67-69; J.A. Mizzi, 1917: hospital ship Goorkha hits mine off Grand Harbour. The Sunday Times [of Malta], 23^rd May 1999, p.46-47

25. Medical & Health Archives: LetterBook 27th May 1842 to 12th April 1847, fol.61; Medical & Health Archives: Permanent Committee 1st January 1816 to 31st December 1829, fol.155; Medical & Health Archives: Hospitals 12th January 1849 to 31st December 1850, fol.64. In: P. Cassar, 1964, op. cit., p.93

26. Medical & Health Archives: Letters to Government 9th June 1849 to 26th August 1850, fol.9-13; 1st July 1878 to 22nd March 1883, fol.321. In: P. Cassar, 1964, ibid, p.94

27. Medical & Health Archives: Letters to Government 1st July 1878 to 22nd March 1883, fol.231,530,582; 23rd March 1883 to 20th April 1888, fol.25,276. In: P. Cassar, 1964, ibid, p.94-95

28. Medical & Health Archives: Letters to Government 10th April 1895 to 31st March 1903, fol.84. In: P. Cassar, 1964, ibid, p.95; Malta Government Gazette Supplement, 8 December 1905 4867:iv-v

29. Casa Leone XIII, and the Zammit Clapp Hospital. Malta and Gibraltar Illustrated. (ed. A. MacMillan). W.H.&L. Collingridge, London, 1915, p.310-311; 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

30. P. Cassar, 1964, op. cit., p.100-101; Micallef D., Frau Trevisan. Civilization 1987, 33:p.904-906