MALTA MILITARY HOSPITALS
1915-1917

FOREWORD
     The history of the Hospitals in Malta during this War is likely to prove of interest to many patients who have been here, as also to their friends and relatives. It is a plain and unvarnished tale (compiled with much care by Lieutenant-Colonel J. C. Robertson, C.M.G., C.I.E., I.M.S., my invaluable Sanitary Officer, and Major G. R. Bruce, R.A.M.C.) of good work commenced in ample time which proved capable of meeting the heavy demands made. I believe the organization was good, the secret being decentralization. Everyone had his work given to him to do and was left to carry it out as he though best. I can never speak too warmly of the help given to me throughout by Lieutenant-General Sir Alfred Keogh, G.C.B., Director-General of the Medical Services. Overwhelmed with work, driven at times to his wits’ end to meet the requirements of Malta and elsewhere, he never for one moment slackened in his efforts to give Malta the assistance required. To him we owe a deep debt of gratitude, and on our part we endeavoured never to give unnecessary trouble.

     From the commencement of our labours, I was exceptionally fortunate in those who were working with me. The people in Malta, ladies and gentlemen, came to my aid in a manner I shall never forget. The British Red Cross Society and the St. John Ambulance Association in Captain Stockings, P. Tindal Robertson, Esq., Lieutenant-Colonel Ashley, C.B.E., and Sir Courtauld Thomson, Kt., the Y.M.C.A. in Mr. Wilson and Mr. Wheeler, sent out first rate men of business with carte blanche as to spending money; and later on the Scottish Church and the Church Army came into the field doing excellent work. Nor must I omit to mention the excellent concerts given by the local talents, assisted by singers from the Opera, who have their services gratuitously - Chevalier Lancellotti, the Impresario, with his excellent trio, doing his utmost to aid in the good cause. I have not a doubt that the health of the patients benefited enormously from the valuable help given by those philanthropic associations. Concerts and entertainments, the Halls, Huts and Marquees, full of games, books and newspapers, with ample food for body as for mind, kept the patients in hospital and camp and away from the numberless drinkshops with which Malta abounds. The work dond by the Ladies’ Committee under the chairmanship of Mrs. Radcliffe was beyond all praise. Only those who were in Malta from the commencement of our work know what this means. The foundations were laid in May, June and July, 1915 – those were the three months on which all our future work rested – and if the building later on proved sound and equal to all requirements, it was entirely owing carefully to the laid foundations. My Acting C.E., Colonel Seaman’s, local knowledge was invaluable. He never failed me in every promise he made. He buoyed up my courage when the croakers warned me of want of water, of the spreading of enteric fever and other horrors that never came to pass. He formed beautiful camps with gardens out of rock ground and built two huge tanks at Nadur to face any future danger of a water famine. Without his help, my task would have been hopeless.

     As regards the Medical Staff, this history tells how we carried on somehow under abnormal conditions and how our confidence in ourselves was justified, my thanks being greatly due to the good work by Lieutenant-Colonel Sleman, V.D., R.A.M.C.(T.), and his able Staff Officer, Lieutenant-Colonel Cumming, C.B., R.A.M.C. But at last, in the beginning of August, 1915, came the time when Sir Alfred Keogh considered we should have a Surgeon-General to see that proper War Office regulations were carried out, and we found in Surgeon-General sir Hayward Whitehead, K.C.B., the same ability and charm of manner that his successor, Major-General Sir Thomas Yarr, K.C.M.G., C.B., possesses. From that time to the present time all worked smoothly, everyone doing his or her best to carry out the instructions issued. The influx of Medical Officers joining for the War was great; the work of almost all these temporary R.A.M.C. Officers was undeniably good, in many instances very good. The excellent work done by the distinguished consultants who were sent out to Malta, in stimulating and helping their junior colleagues, is difficult to over-estimate; the net result of their enlightened policy has been that the patients in the Military Hospitals in Malta have had even greater advantages than those in a great Metropolitan teaching hospital, as here the resident medical officers were for the most part men of much wider experience.

     The Medical Staff, Medical Women, Sisters and Nurses, have done work beyond all praise and have gained a name for themselves in Malta that they may well be proud to have earned. Nor must I forget to add a kind word for the excellent work done by the R.A.M.C. rank and file from first to last. Let me add a kind word for the arduous services performed by the Transport. Time after time the men drove from daybreak into the late hours of the night with never a word of complaint, always careful to diminish the sufferings of the patients. To them the wounded and sick are greatly indebted. Lastly, let me offer an expression of gratitude to the Clergy, for Chaplain, Priest and Minister all alike vied in their ministrations, and a nobler set of men never came together than those who found themselves in Malta. In hospital, in pulpit, or in taking part in the men’s recreations, they were always at their best, gaining the love and respect due to good men. I cannot conceive a more interesting task, or one that any man advanced in years should be more grateful for than the work that has been entrusted to me. Kind words, kind faces everywhere – we have been a very happy family, working entirely on our own.
     The Navy and Army in Malta carried on as one, never interfered with from home; on the contrary, receiving every help and encouragement in their power from the War Office, the Admiralty, and the Colonial Office. I can only say in conclusion that I am glad I came to Malta, if it was only to help the country in the organization of these hospitals, for which we received the kind commendations of General Sir Archibald Murray, G.C.B., which were warmly appreciated by all those connected with the hospitals.
METHUEN
Field-Marshal.


INTRODUCTION
Medical work in Malta during the early months of the war
     That Malta should become the home of one of our largest systems of war hospitals was quite unexpected in the early months of the war, and it was not until May, 1915, that badly wounded cases from the Gallipoli expedition began to pour into Malta. The origin and early evolution of the war hospitals are of most importance in any account of their history for it can be shown that, at a time when the needs were most urgent, difficulties in supplies, transport and equipment greatest, and staff most deficient in numbers, the authorities in Malta were able to meet every present call and yet were provident enough to prepare for future contingencies. It is well, however, first to recount briefly the events preceding and bearing on the formation of the hospitals, and also to remark on the conditions of climate and health which Malta could offer to her sick and wounded guests. Shortly after the outbreak of hostilities in August, 1914, the majority of the regular R.A.M.C., including officers, were withdrawn from Malta for duty elsewhere, their places being taken by 4 officers and 193 other ranks of the 1st City of London Field Ambulance (T.F.), and 4 officers, R.A.M.C. (T.F.). The medical work in the early months of the war consisted in the care of ordinary cases of sickness among the garrison and varied but little from that of peace time. To treat the sick there were provided as before the war 278 beds in the following four hospitals:- Cottonera, the main medical and surgical hospital, 167 beds; Imtarfa, 55; Forrest, 20; and Valletta, including 26 beds for local troops, 36 beds.

Health of British Troops in peace
     These 278 beds of late years had more than met all the requirements of the garrison, and, in view of the extensive use that has been made of Malta as a hospital centre, it is well to emphasise the excellent health enjoyed by the British garrison. For example, during 1913, of a garrison of 6,336, the average number in hospital was only 116, an average sick-rate of 18 per 1,000, with a death rate of 2.21 per 1,000, comparing very favourably with a sick rate of 19 per 1,000 and a death rate of 2.6 per thousand for troops in England, while in India the corresponding figures were 29.6 and 3.26 per 1,000 for the same year. This very satisfactory state of affairs had only come about in recent years, and was dependent mainly on three factors: (1) the almost complete disappearance among troops of Malta or Mediterranean Fever since the discovery in 1905 of goats’ milk as its principal cause; (2) the gradual fall in the enteric group of diseases, due to improved sanitation and the spread of inoculation; and (3) the gradual removal of troops from old and unhealthy barracks into modern buildings such as Imtarfa, St. Andrew’s, and Tigne Barracks, situated in the most healthy parts of the island, and now converted into first class hospitals.

Health of Civil Population
     On the other hand, in spite of many sanitary improvements, a considerable amount of preventable disease still exists among the native population of over 200,000; Mediterranean Fever and Enteric Fever are still prevalent, about 400 cases of each being reported annually. The death rate for 1913-14 was 23.56 per 1,000, showing, however, some improvement, for example, on an average death rate of 26.38 per thousand for the decade 1895-1904. Accordingly, in a small and densely populated island like Malta, where association between the civil population and the garrison is of necessity close, there are always elements of potential danger. These increased with the influx of troops into Malta fresh to the climate soon after war began, and were intensified when the hospitals and hospital camps were formed. It may be noted now that the precautions that were taken both by military and civil authorities proved adequate, and that there has been no spread of disease on the one hand from the civil population to hospitals and troops, or on the other hand from the hospitals when overflowing with cases of dysentery and enterica to the civil population.

Climate of Malta
     The climate, except during the really hot months from July to September, is temperate, and with proper precautions can be made quite bearable, for even then there is often a cool sea breeze. The bug-bear of Malta is the occasional damp air and wind from the south-east called the sirocco, which causes a feeling of lassitude and inertia to come over all, and the longer one resides in Malta the more is this felt. In spite of this, however, the climate is on the whole excellent, and English residents are often met with who have enjoyed robust health in Malta without a holiday for many years. A great advantage also is the complete absence of local malaria. Malta had to be used as a hospital base from sheer necessity, but it is well to emphasise that it could offer to its thousands of sick and wounded patients a favourable and even health giving climate.
     As regards the account of the hospitals which follows, every acknowledgement must be made to Lt.-Col. J. C. Robertson, I.M.S., C.M.G., C.I.E., who devoted much time to the collection of the material for Part I, and had actually started the report when he was hurriedly ordered off for duty elsewhere. Grateful acknowledgement is also due to Officers in charge of Departments, Officers Commanding Hospitals, the Officials of the Voluntary Societies, and other who have furnished much of the information necessary for the report.

Preliminary arrangements in Malta and Reception of first rush of wounded.
     The first intimation that Malta might be required to take an active part in the medical work of the war was a cable from the G.O.C. Egypt dated February 24th, 1915, enquiring what hospital accommodation was available surplus to requirements. In reply 500 beds were offered at once, but information was received from the authorities in Egypt on March 3rd that these beds were not required. In spite of this the imminence of important operations in Gallipoli made it likely that Malta would be required to accommodate sick in a hurry and by order of His Excellency the Governor immediate steps were taken to arrange preliminaries for the expansion of existing military hospitals and to select the most suitable buildings for establishing new ones. Accordingly a complete scheme to extend the existing beds to 3,000 beds for sick and wounded in Malta, and to provide 500 beds for convalescents at Fort Chambray in the neighbouring island of Gozo, was prepared and forwarded to the G.O.C. Egypt and to the War Office for sanction on March 14th. At the same time necessary alterations in existing hospitals were executed to provide the 500 beds already promised to Egypt. Arrangements were made to enrol civil medical practitioners and civil hospital orderlies of the local St. John’s Ambulance Brigade. A ladies’ committee was formed to organise voluntary aid among the civil population for nursing, cooking, and the reception of minor cases, if necessary, in private houses.

Reception of 500 Venereal cases from Egypt
     Meanwhile, during these preparations for receiving sick and wounded, enquiry was made from Egypt on March 19th whether Malta could receive 500 venereal cases. The reply was in the affirmative, and within a fortnight the cases arrived, much to the annoyance of the people in Malta. These of course were special cases requiring separate accommodation. Although the time was short all arrangements were completed. Forrest Hospital, which had already been used for contagious disease, and could be completely isolated, was expanded to 178 beds; and four blocks of Imtarfa Barracks were quickly evacuated by troops and converted into a temporary hospital to receive the remainder of the cases. Hospital equipment had not arrived from England but, though barrack beds and bedding had to be largely used, the needs and comforts of the sick were adequately met, beds being lent by His Excellency and other persons in Malta. At this early date – April – 824 beds were ready for British troops in the following four hospitals: Cottonera, 281; Forrest, 178; Imtarfa, 355 and Valletta, 10.

Rush of Wounded to Malta after Gallipoli Landing
     Meanwhile events were moving quickly. At first the G.O.C. Egypt in acknowledging receipt of the Malta scheme for 3,000 beds stated that beyond the 500 venereal cases already received he did not anticipate that Malta should be required, but that, should the need arise, he would use Malta at once. In spite of this reply the authorities in Malta decided to proceed with their preliminary plans for accommodating 3,000 cases, and the wisdom of this policy was quickly proved. On the 9th of April the G.O.C. Egypt cabled accepting the original offer of 500 beds in Malta and also stating that he had asked the Secretary of State for War for instructions regarding the further 3,000. On the 13th the War Office sanctioned 1,200 beds. The memorable first landing at Gallipoli, with its attendant rush of casualties, took place on the 25th April, and on the 29th the G.O.C. Egypt cabled if 1,000 sick and wounded could be received in Malta, and on the 30th if additional 600 cases could be sent, and then later a further 1,000 cases. The prudence and foresight of the authorities in Malta now received their reward, for all these and additional demands were fully met. The first convoy of 600 cases from the landing arrived in Malta on the 4th of May, 400 more on the 5th; and 640 on the 6th. On that date the number of sick and wounded reached 1,962; on the 12th, 2593; and before the end of the month, upwards of four thousand. The resources available, both military and civil, were taxed to the utmost, and, without the previous preparations which had been going on steadily for nearly two months, the situation could hardly have been dealt with. The various activities concerned, affecting besides the R.A.M.C. nearly every military department, and calling for the hearty co-operation of the civil population, will now be described.

Housing of Early Cases
     The first and most pressing problem was how the early cases arriving in May and the thousands of future cases, which it was now certain that Malta would be asked to receive, were to be housed. Before the end of April Cottonera had been expanded from 167 to 277 beds by utilising the verandahs and the R.A.M.C. barrack room. Valletta Hospital, once the principal hospital of the Knights of St. John, and until recent years the main military hospital, was expanded to 200 beds by renovating disused wards and bringing their sanitation up to date. These two hospitals were very quickly required to expand again, and before the end of the month Valletta Hospital had expanded first to 340 beds and finally to 440 beds, while Cottonera Hospital expanded to 314 beds. Meanwhile the Military Families’ Hospital was removed from Valletta Hospital to the Auberge d’Aragon where it still remains.

Opening of Imtarfa and St. Andrew’s Hospitals
     Imtarfa and St. Andrew’s Barracks were early chosen as being most suitable for hospitals. Both buildings were of recent date, contained every modern improvement in barrack construction, and were splendidly situated – Imtarfa on a hill near the centre of the island, and St. Andrew’s on rising ground above St. George’s Bay; in addition, they were well away from any large centre of population. During April these two barracks were vacated – Imtarfa, as noted, was already housing 350 venereal cases, the last being discharged on June 13th – and handed over to the Royal Engineers, later on to the Barrack Department to be dismantled, cleaned and colour-washed, and then to be provided with such hospital equipment as was available. By the end of April the work was well in hand, and in early May, with the certainty of the beds being urgently required, the alterations were pushed on with the utmost speed. St. Andrew’s was handed over to the R.A.M.C. on the 6th of May and on May 12th received 300 patients. Of the 792 beds for men and 53 for officers then prepared, 200 were proper hospital cots, 30 were gift beds, and the remainder were barrack beds. Meanwhile St. Andrew’s was pushing on its preparations for expansion to 1,158 beds, including 60 beds for officers in the Officers’ Mess, and at the end of May 1,134 cases had been admitted. Imtarfa Hospital was gradually evacuating the venereal cases, and on May 17th received its first convoy of 221 wounded, followed by 248 next day and by 147 on the 23rd. Some of the married quarters at Imtarfa had also been prepared to admit cases of infectious disease during April.

Opening of Tigne and St. George’s non-dieted Hospitals
     From the cables received from Egypt on the 30th April, regarding the first cases to be sent, it appeared that many of the cases would be very slightly wounded, for whom fully equipped and dieted hospitals were not essential. Accordingly, Tigne and St. George’s Barracks were chosen for the reception of these cases. Tigne Barracks, recently built, and in construction very similar to St. Andrew’s, is delightfully situated on the promontory forming the northern boundary of the Marsamuscetto Harbour. St. George’s Barracks, though of older date, but still in good repair and well up to date as regards its sanitation, is also splendidly sited on the northern aspect of the bay bearing the same name. Orders were issued on the 1st of May for both barracks to be vacated and to be prepared for minor cases, as non-dieted hospitals, with barrack equipment. Few changes were necessary, Tigne receiving 370 cases, while St. George’s received its first convoy of 237 similar cases on the 6th, followed shortly after by two other convoys.

Additional Accommodation required
     The task set these two hospitals was not an easy one, for the cases required much care and attention; it was soon recognised that the majority of cases arriving were seriously wounded, and required to be housed in fully equipped hospitals; later on, indeed, both Tigne and St. George’s became fully equipped. The part played by Valletta, Cottonera, St. Andrew’s and Imtarfa Hospitals has already been described, but more beds were urgently required; therefore it was necessary to look in other directions for help. Meanwhile a cable had been sent home asking for the necessary equipment and staff up to 4,000 beds to be sent out with all haste. Preparations were made to establish other hospitals, Tigne, Floriana, Bavière, and Hamrun, which were all opened in June; but other valuable beds were obtained at once. The Mother Superior and Nursing Sisters of the Little Company of Mary (Blue Sisters) offered their services and beds in their hospital, and nursing home Casa Leone XIII, and the adjoining Clapp Zammit Hospital. These hospitals being fine modern buildings, up to date in every sense of the word, the offer was gratefully accepted. A small monetary grant was made, the hospital being opened on the 6th May as the Blue Sisters’ Hospital, with 50 beds for officers. At the same time an admirable arrangement was made with the Naval Authorities whereby all existing naval and military beds were pooled and made available for either service according to need. In this way approximately 200 most valuable beds in the fine naval hospital at Bighi were obtained at once.
     In addition, many offers from private individuals were received to put up cases of minor sickness and convalescents in their own houses. Owing to difficulties of administration and shortage of staff these offers were regretfully declined, but one desires to note here the universal wish to help. For a similar reason the Governor’s Palace could not be used.
To sum up then, at the end of May over 4,000 cases had been admitted from Gallipoli, many severely wounded, and had been accommodated in the following hospitals:- Valletta, Cottonera, Imtarfa, Tigne, St. Andrew’s, St. George’s, Bighi, and Blue Sisters’.

Shortage of Medical Staff during May, 1915.
     As great a problem as the housing of the patients in the early history of the Malta hospitals was the scarcity of doctors, nurses, and orderlies. The staff on the island was constituted on the basis of peace requirements and consisted in April, 1915, of 9 Medical Officers, 14 Nurses, and 220 R.A.M.C. rank and file, a number utterly unable to cope with the rush in May. Although 1,200 beds were sanctioned by the War Office on April 17th, and further 1,800 beds on April 30th, the first of the new staff did not arrive until May 7th, and meantime convoys were arriving fast. Accordingly, prior to their arrival the deficiency had to be met from local sources, 27 civilian doctors, 11 nurses, and 65 nursing orderlies of the Malta St. John’s Ambulance Brigade volunteering for duty in the hospitals. Their help was urgently required and, though naturally inexperienced, they gave very valuable assistance when most needed. There was a general shortage of staff, as for example Tigne received on 4th May 370 cases, and on 6th May 200 cases, the staff consisting of 1 Regular Medical Officer, 6 Civilian Surgeons, 1 R.A.M.C. and 12 civilian nursing orderlies. It happened by a lucky chance that the Scottish Women’s Serbian Unit, consisting of 4 Medical Women, 8 Matrons, 30 fully trained nurses and 20 V.A.D.s arrived in Malta on May 4th and offered their services pending their departure in one fortnight. They were distributed between Valletta and Bighi Hospitals, where the most seriously wounded had been sent. Their help up to the time of their departure on May 20th was most valuable and opportune, and did much to tide over the difficult period in early May prior to the arrival of staff from England. The first to arrive were 39 nurses on May 7th, followed by 25 officers and 158 men, R.A.M.C.; subsequently reinforcements of medical personnel came steadily so that by the end of May there were in the island 82 officers, 219 nurses, and 798 rank and file, R.A.M.C. The responsibilities of the Deputy Director of Medical Services, Colonel Sleman, V.D., of his Staff Officer, Lt.-Col. Cumming, C.B., and of the Officers Commanding Hospitals were then heavy indeed, for it must be recognised that the new staff, however willing, were mostly without experience of the work and necessary routine of military hospitals. However, this deficiency was largely discounted by the great zeal and enthusiasm shown by all concerned, regardless of regular meals and sleep, and it was remarkable who soon the staff became efficient in their new roles. It may be truly said that from the beginning, in addition to being adequately housed, every patient was adequately cared for.

Difficulties of Departments
     Further grave difficulties which had to be overcome in the early months were those of supply and transport, equipment and engineer work; for the necessities of hospitals are in every way more complex than those of healthy troops. The departments concerned, the Army Service Corps under Major Lewis-Hall, A.D.S.&T., and Major Falkner, O.C. Supplies; the Army Ordnance Department under Colonel Spencer, C.M.G., A.D.O.S.; and the Royal Engineers under Colonel Seaman, C.M.C., Acting C.E., had been preparing quietly before the rush, and quickly rose to meet the emergency. It must be remembered also that all these departments were under-staffed at this time, in many cases non-commissioned officers having to do the work ordinarily undertaken by officers.

Supplies and Transport
     As regards food the natural resources of the island could not be depended upon to any great extent except for fresh vegetables and fruit. Malta, indeed, for its size of 91 ½ square miles, is one of the most thickly populated islands in the world, and, though the peasants make the most of the three fifths of the island which is under cultivation, the greater part of the food supply for the towns and the British residents and garrison is imported. The Army Service Corps possessed in March a 4 ½ months’ reserve for approximately 1,000 patients and steps were taken in April to increase this reserve to meet requirements of 7,000 patients and 5,000 convalescents, also to obtain whatever supplies were available locally. Eggs and chickens were a great problem, having to be shipped from Egypt, Tunis or Italy. Too often, unfortunately, the quality was inferior. Milk had to be obtained in tins from England. Not until June 15th did hospital supplies arrive regularly from England, and then only in sufficient quantity to meet the current demands. It was not until November that a sufficient reserve could be maintained. Transport at the beginning was an equally difficult problem; for all that the Command possessed before the rush were one large tractor engine, one motor ambulance, six light tractors (two being out of order), one motor car, and 80 draught animals. In May six Ford Ambulances arrived; in June 24 Fords and six motor lorries. Without the help of 30 private motor cars which were generously lent the work of transporting the wounded in the early days could hardly have been accomplished. Eventually a thoroughly efficient and adequate mechanical transport service was established.

Army Ordnance Department
     The Army Ordnance Department at the outset had also of necessity to extemporise largely as regards hospital equipment and clothing; until supplies came from England local purchases had to be resorted to. For example, 2,000 mattresses were bought in Valletta besides large quantities of shirts, pyjamas, and other articles of clothing. The workshops at Ospizio expanded at once and were devoted to the manufacture of all kinds of hospital equipment. The ability and ingenuity displayed in the making of many highly specialised articles such as splints, fracture cradles, sterilisers, and dressing waggons, to mention only a few from a long list, must be thoroughly recognised. As with other departments, the actual shortage did not last long, for in a few weeks stores began to arrive from England and local purchases were scarcely necessary.

The Royal Engineers
     In the early rush the works undertaken by the Royal Engineers, with a greatly reduced staff of officers and foremen of works, were essential to the success of the hospitals. It says much for the skill and foresight of those in charge that the alterations and new works, undertaken of necessity in the utmost haste, and with whatever materials were in store or could be purchased locally, have in most cases thoroughly stood the test of time. Without a prize ship, which was brought in about the beginning of the war and supplied a large quantity of joists, baths, water pipes, lead pipes, linoleum, etc., the Royal Engineers would have been hard pressed for the necessary stores. In March work was begun in the long ward of Valletta Hospital, 505 feet in length, which had been in disuse and disrepair for many years. All the sanitary fittings, the ablution rooms, the baths, the kitchen, had to be re-provided, and the lighting and ventilation were greatly improved. The barrack room at Cottonera was converted into a ward and a sanitary annex provided. Work also was undertaken at the Blue Sisters; Hospital and very extensive work was started in April at St. Ignatius College, which had lain disused for many years and was in very bad condition. Engineer work was necessary also at Tigne, St. Andrew’s, and St. George’s, all of which had to receive patients in May. The engineer work necessary varied of course in the different hospitals, but included such services as the provision of sanitary annexes, bathrooms, ablution rooms, and kitchens; the fitting up of operating theatres, X-ray rooms and dispensaries; the provision of electric light and gas for lighting and cooking; also the cleaning, colour-washing and painting of buildings. The work necessary for the immediate reception of patients was accordingly sufficiently hard to tax all resources, but meantime work had to be carried out in other buildings, etc., as they were chosen, such as St. Elmo School, the Hamrun Institute, the Auberge de Bavière and Floriana Barracks; soon also the difficult problem of the camp hospitals had to be solved.

Voluntary help
     A notable feature also from the outset was the valuable help rendered by the ladies of Malta and the Joint Committee of the British Red Cross Society and the St. John’s Ambulance Association. At the suggestion of His Excellency the Governor a ladies’ committee had been formed to organise voluntary aid early in March. A second committee was formed in April under the auspices of the St. John’s Ambulance Association, a subscription list being started by the Daily Malta Chronicle to provide gifts and medical comforts for the wounded. At the end of April an Assistant Commissioner of the British Red Cross and Order of St. John, Captain Stockings, arrived to organise all the local voluntary aid. On May 3rd an important and very largely attended meeting of the ladies of Malta was held in the Palace. Addresses were delivered by His Excellency the Governor, His Grace the Archbishop of Malta, and Captain Stockings. The ways and means of providing the most efficient help were thoroughly explained; His Excellency also decided that the two ladies’ committees should amalgamate to avoid overlapping and any waste of energy and resources, the whole being under the general direction of the Red Cross Assistant Commissioner. Valuable services were soon rendered in many directions which could not be undertaken in the ordinary work of the hospitals. For example, a band of ladies met each hospital ship, welcomed every wounded or sick soldier to Malta, and provided him with refreshments; let it be sais that their energy never flagged in spite of the broiling heat of the docks in summer or the cold in the winter months. In hospital each soldier received a greatly appreciated ‘welcome’ parcel of tobacco, matches, stationery, etc. A large sewing party eked out the hospital supplies by providing such articles as pyjamas, shirts, and socks.
 
     Voluntary nurses and orderlies were quickly taught, and at the beginning gave most needed assistance in hospitals. A band of searchers sought out, for the benefit of relatives at home, information of the killed and missing from their comrades. The stocks of the hospitals were assisted by medical comforts of every description. The Marchesa Scicluna generously lent her beautiful seaside residence, Dragonara Villa, near St. George’s Bay, as a convalescent home for 20 officers, and provided for 12 months £100 a month for its upkeep. These earlier activities continued and were extended in such directions as the provision of tea-rooms, excursions in motor cars and a motor launch, numerous entertainments, and some time later the establishment of Red Cross kitchens. These extras provided by the Red Cross and their voluntary workers, while most welcome to the individual sick or wounded man, did much to lighten the labours of the hospitals, and without exaggeration may be truly said to have hastened recovery and convalescence. It may be noted here that His Excellency the Governor on June 10th publicly thanked the people of Malta for giving up, in the interests of the patients, one of their most cherished customs, the ringing of the church bells in the neighbourhood of the hospitals.

     Among the institutions which were started during the Gallipoli Campaign for the benefit of the convalescents three may be specially mentioned. In May, 1915, the Hon. E. And Mrs. Bonavia felt that a tea-room to provide rest and refreshment for sick and wounded able to get about was an urgent need in Sliema, owing to the founding of so many of the new hospitals in that district. Having received the approval of the Ladies’ Committee and some slight financial backing from the British Red Cross Society, Mrs. Bonavia, with a band of helpers, opened a tea-room on May 21st in part of the premises of the Sliema branch of the Union Club, which were generously lent. The site on the Sliema front was excellent, being in the immediate neighbourhood of several hospitals and on the main road to the more distant group of hospitals around St. Andrew’s and St. George’s. The tea-rooms proved a great success, being crowded daily, and especially at the orchestral and other concerts which were given twice weekly. During the 29 months of its existence the Hon. E. Bonavia, C.M.G., estimates that over 50,000 men have been served, a tribute to the popularity of the institution and to the hard work undertaken by the voluntary workers.

     During October the Committee of the Soldiers’ and Sailors’ Institute, with the assistance of the late Miss Graham, who gave £200, converted the Gymnasium in Valletta into an institute for convalescents, and also for members of the Navy, Army, and Allied Forces. A library, reading and writing-room, a refreshment bar, a billiard table, and a fully equipped stage were provided. Free weekly entertainments have been held without a break and, reckoning whist drives, etc., the institute has afforded rest and entertainment to not less than 80,000 men since its foundation. The Valletta Gymnasium has become one of the most popular places of entertainment in the island for convalescents and the services generally, and may well be considered a worthy predecessor of the Vernon Institute which will shortly be erected on the same site.

     In the autumn of 1915 it was felt that some place for amusement, rest, and refreshment was urgently required for the thousands of convalescents from the hospitals grouped around St. Andrew’s and the convalescent camp at All Saints. Accordingly, £2,000 out of a large sum of money, generously sent from Australia through the Australian Red Cross Society, was devoted to the erection of a fine stone building on a central site between St. Andrew’s and St. Paul’s Hospitals. The building, designed by and erected under the supervision of the Royal Engineers, and capable of seating 2,000 persons, was opened by His Excellency the Governor in January, 1916, as the Australian Hall. At first under the dual management of the Y.M.C.A. and the British Red Cross Society, the Australian Hall, in May 1916, was handed over entirely to the latter society, subject to the control of the Australian Hall Committee. From its opening, the Australian hall has been a magnificent success, catering exactly, as its promoters desired, for every need of the convalescent soldier. Each evening some special attraction is provided, such as a first class concert, a whist drive, boxing matches, or dramatic performances; during the day the Hall is open for refreshments, games, reading, writing, and rest. The amount of real good done by the Australian Hall and other similar institutions such as the Tea Rooms established in Valletta by the Scotch Church, under Mrs. Mackinnon, the Connaught Home in Floriana, and the various Y.M.C.A. tents, has been incalculable.


Necessity for further expansion – Origin of St. Paul’s Hutment Hospital
     We now return to the actual history of the hospitals. Sufficient accommodation had been provided for the arrivals during May, but the necessity of establishing additional hospitals was now apparent and buildings were chosen for a total expansion up to 7,000 beds. Sir Frederick Treves, G.C.V.O., and Sir Courtauld Thomson, Kt., Red Cross Commissioner for the Mediterranean, arrived in Malta at this time and gave valuable assistance in many ways. As an alternative to some of the buildings which he considered unsuitable owing to structural difficulties, isolated position, etc., Sir Frederick Treves recommended the erection of huts for 2,000 beds on the Marsa, a site on low lying ground near the Grand Harbour. Accordingly, authority for huts, stone built rather than of wood, for that number was cabled for, and in addition His Excellency urged upon the War Office the desirability of raising the accommodation to 10,000 or 12,000 beds, a number which it was considered inexpedient to exceed because of possible shortage of water. In response to the request 34 modern huts of the special War Office pattern for hutment hospitals were sent out from England but, owing to many unforeseen delays, the first beds were not ready for occupation until the end of September. The authorities in Malta, in view of local knowledge, abandoned the Marsa site – indeed the great November storm completely flooded the Marsa to the depth of over two feet in four hours in the night time – and a fine site for the future hospital (St. Paul’s) was chosen near the musketry ranges at Pembroke. Meanwhile several buildings were chosen and works commenced for their opening as hospitals during June; the Hamrun Institute, Floriana Barracks, the Auberge de Bavière, and Tigne Barracks, the last-named already a non-dieted hospital; work at St. Ignatius was being hurried on, and early in June a convalescent camp was opened at All Saints.

Opening of Hamrun Hospital
     The building situated on the western outskirts of Hamrun, soon to be called Hamrun Hospital, was built in 1912 as a technical school, and except for the basement had not been used. Though splendidly built and tiled throughout much engineer work was necessary, as there were few sanitary conveniences owing to its normal use. Baths, sinks, ward annexes, a hot water system, a kitchen with lift to dining-room, and electric lighting had hastily to be provided. Eventually, when all the work was complete, a first class hospital, though small, was produced. The hospital was equipped in early June for 106 beds, and received its first patients on June 10th, every bed being filled in less than an hour. Hamrun Hospital was run at first under the aegis of the British Red Cross Society, which defrayed the maintenance charges, providing also drugs and dressings. The nursing duties were performed by the No.1 Mediterranean Nursing Unit – a voluntary body of ladies organised by Lady Ian Hamilton. An officer of the R.A.M.C. was in charge. The hospital was a success from the very beginning, and later in November, 1915, was entirely converted into an officers’ hospital with 80 beds, for which it was eminently suitable. In the same month Hamrun came entirely under the military authorities.

Opening of Bavière Hospital
     The Auberge de Bavière has an ancient and honourable history, having been the headquarters of the Anglo-Bavarian Knights of St. John. Immediately before the war it had been used as headquarters for the Command Paymaster, and previous to that as an Officers’ Mess. Before it could be used cleaning throughout was necessary; the roofs of certain rooms had to be renewed, and the usual sanitary fittings had to be erected. The hospital was ready for opening on June 15th with 100 beds, later increased to 130 in July. In spite of its smallness Bavière Hospital did excellent work, for from the beginning many surgical cases of a very severe type were admitted, and shortly afterwards it specialised in the reception of surgical injuries of the head and spine. Bavière Hospital is also conveniently situated in Valletta itself, facing directly the Marsamuscetto Harbour; around it is a slummy district, but no ill effects were traced to that factor.

Opening of Floriana Hospital
     Floriana Barracks, situated near the Porta Reale of Valletta, consists of three large barrack blocks, built within recent years, a suite of 12 casemate barrack rooms of much older construction, and the usual offices. On June 3rd orders were received to turn these barracks into a hospital; the infantry battalion left on the 5th of June; on the 7th equipment began to arrive, and on the 9th the first batch of patients, 249 in number arrived, followed by 110 on the 10th and 236 on the 14th, the whole proceeding being a splendid example of hustle and activity accomplished by a small and enthusiastic staff. The great majority of the cases were severe surgical requiring in many cases early operative treatment. As an example of the strain of work it may be mentioned that, on arrival of one convoy, two operating tables were hard at work from 4 p.m. till 3 a.m. next morning, and again from 7 a.m. until 2.a.m. the following morning. Floriana Hospital was equipped with 600 beds, and these in the early months were practically full. The site was exceedingly convenient being close to both the Marsamuscetto and Grand Harbours, each of which was then in use for disembarkations. The well ventilated and well lit barrack rooms made excellent wards for 25 cases each, the N.C.O.’s bunk becoming a duty room, and the ablution rooms and water closets being converted into convenient sanitary annexes; convalescent and minor cases did exceedingly well in the casemate wards. The Officers’ Mess became a home for the sisters, and the adjoining residences of the Commanding Officer and of the C.R.E. were shortly afterwards turned into a hospital for 30 sisters.

Opening of St. Ignatius Hospital
     St. Ignatius also became ready during June, and towards the end of that month was being equipped for 155 beds; but the first batch of 84 cases was not received until July 2nd. The alterations necessary – the building, previously a Jesuit College, had been vacant for eight years – were here of a most extensive description, for the whole building required to be re-drained, cleaned throughout, and provided with sanitary annexes, gas cookers, and electric light. An operating theatre and X-ray room were soon fitted up, and what eventually proved a thoroughly complete and compact surgical hospital was provided.

Opening of Tigne Hospital
     Tigne Barracks was converted from a non-dieted into a fully dieted hospital during June. The barracks, four blocks with three storeys each, recently erected to accommodate the R.G.A., were almost ideal for the purpose, each floor possessing four rooms, which became 12-bedded wards, two small rooms which were turned over to the sisters and the orderlies respectively, and sanitary conveniences, which became good hospital annexes. In addition there was the advantage of the sea on either side and a site that was well away from civil buildings. The hospital opened on June 14th with 600 beds, and soon afterwards the Officers’ Mess, finely situated, overlooking the sea, became an officers’ hospital with 40 beds, that number being increased later. The married quarters were utilised as quarters for sisters and orderlies. From the outset Tigne was marked out as a surgical hospital, at that time the work being exceedingly heavy. On one day 97 severe surgical cases arrived, the staff working for 48 hours on end, while at another time 216 cases were received, all requiring immediate attention.

Opening of All Saints’ Convalescent Camp
     In order to release patients from Tigne, when being converted into a fully dieted hospital, All Saints was opened about this time as a camp for convalescent patients. This camp, finely situated on ground rising well above the sea, about 5 miles north-west of Valletta, had been used as a camp in peace time; but the ground was rough and rocky. Only two permanent buildings existed which could be used for stores. On June 8th the Commandant, Lieut.-Col. Mabin from New Zealand, arrived with orders to prepare a camp for 1,000 convalescents; later to expand to 1,600. He and his staff worked with a will, on June 12th admitting their first batch of convalescents from Tigne, 420 in numbers. On June 19th the numbers had risen to 600, and on June 29th over 1,000 men were in camp. In the early days of All Saints the difficulties to overcome were manifold; the levelling of the ground, much of the surface drainage and the actual erection of the camp were accomplished by the convalescents themselves. The Royal Engineers helped with the erection of two kitchens, ablution and drying rooms, and the necessary sanitary work. The difficulties increased soon afterwards with the almost complete failure of the water supply, pending the construction of a 5,000-gallon tank by the Engineers. Water had to be laboriously carted from St. George’s Barracks, and the water ration was limited to 1 gallon per head for almost a month. Happily no ill results were ascertainable from the shortage, and the sea bathing, in which all who were fit could indulge, helped to save the situation. A regular routine was quickly established; only a skeleton staff was maintained, and practically all the camp work was undertaken by the convalescents themselves. Parades for bathing, Swedish drill, and route marches were established, and soon a stream of men fit in every way began to flow away from All Saints and return to their units at the front.

Medical situation in Malta in June, 1915
     The situation in June may be summarised by stating that it was largely a period of preparation and expansion. Sick and wounded arrived to the number of over 2,000, but, by dint of evacuation of over 1,000 each to England and to Egypt, at the end of June there were just over 4,000 sick and wounded in the Malta hospitals, a number less than at the end of May. To accommodate these over 6,000 beds were in existence in 14 hospitals, a tribute to the energy and resource of every department. Deficiencies in transport, stores, and equipment were rapidly made good. The staff of the hospitals was being greatly increased and during June rose for the whole island to 117 Medical Officers, 300 nurses, and 752 rank and file.


General Features
     We now pass to a period of increased activity and expansion from July to September, which witnessed the establishment of the camp hospitals of St. David’s and St. Patrick’s, the conversion of the schools of St. Elmo and St. John into hospitals, the opening of part of St. Paul’s Hospital, the transformation of St. George’s into a fully dieted hospital, and the formation of the large convalescent camp hospital at Ghain Tuffieha. At no period during their history have the hospitals been busier, for badly wounded were still arriving in large numbers, and in addition there appeared a new feature, numerous cases of the dysentery and enteric group of diseases which proved such a curse on the Peninsula. Only too often also the wounded presented the complication of one or other of these diseases. The wisdom of the Malta authorities in urging early extension was more than ever apparent, for the older hospitals, having gained much in experience and efficiency, could adequately accommodate the most serious cases; while each new hospital as it was formed could serve its apprenticeship in the reception of minor cases. During these three months the number of beds increased from just over 6,000 to 13,093.

Opening of St. David’s Hospital
     The first of the new hospitals was St. David’s, splendidly situated close to St. Paul’s and All Saints’ on rocky ground sloping down to the sea. The site had already been used for a camp, but extensive work had to be carried out by the Royal Engineers, such as the fixing and concreting of tent pegs for the large hospital marquees, the construction of the main roads, paths, and gardens; the surface drainage of the camp, the building of the kitchens, ablution places, baths, and stores. After a period of very hard work, the ground being exceedingly uneven and rocky, the hospital was ready to receive nearly 500 patients towards the end of July; in August it was fully equipped for 1,000 beds. The cases received were at first mild surgical and convalescents; but like all other hospitals St. David’s was soon busy with the ever increasing stream of dysentery and enteric.

Opening of St. Patrick’s Hospital
     St. Patrick’s Hospital in equipment, size, and general features was similar to St. David’s, except that here it was necessary to work on the virgin soil of farm land which, however, had already been so terraced according to the Maltese fashion as to provide a fairly suitable pitching ground for the hospital marquees. St. Patrick’s had not the advantage of a site close to the sea, but the ground was open and easily drained; the important point, however, was that it was available when needed. Luckily a large farm house went with the farm, and with few alterations provided excellent stores on the ground floors. The rooms above were turned into a Sisters’ Mess. Very much the same kind of engineer work as at St. David’s had to be carried out. Special features were the erection of a fine recreation hall for patients, 80ft by 40ft, and the establishment of a highly successful little sewage farm for kitchen and ablution sewage. St. Patrick’s was ready to receive patients on August 15th, when 466 minor walking cases were transferred from other hospitals, the policy being to house as far as possible all the severer cases under stone roofs. By the end of August St. Patrick’s was practically full, 978 of its thousand beds being occupied.

Partial Opening of St. Paul’s Hospital
     During this period part of the hutment hospital of St. Paul’s was completed at Pembroke, though not without much unavoidable delay. Experience has shown that the stone huts, favoured by those with experience of local conditions, would have been more quickly constructed besides being more efficient and economical in the long run; for the hospital huts, having no verandahs and no proper roof ventilation, were not at all suitable for the hot months. The Royal Engineers provided concrete bases for all the huts, a large stone kitchen, water carriage throughout the entire hospital, and electric light. The first convoy of 153 patients arrived on September 25th, but the full complement of 792 beds was not ready until the end of October. At the beginning St. Paul’s, being on the water carriage system, was largely used for cases of dysentery and enteric.

Opening of St. Elmo Hospital
     Among the happiest selections of buildings suitable for conversion into hospitals were two Civil Government Schools, St. Elmo and St. John’s, generously lent by the Civil Government. St. Elmo was handed over in July for equipment and necessary alterations to the Military Authorities, and the school children were comfortable housed in the old barrack rooms of Lower St. Elmo. The building, situated at the north of the Grand Harbour, overlooking the breakwater, was converted into an ideal temporary hospital. It possessed a basement, which provided store rooms, kitchen, officers, and quarters for the personnel, and two floors, the school proper, tiled throughout, splendidly ventilated with spacious exterior and interior verandahs running right round each side of the wards. Certain alterations were of course necessary, such as the provision of electric light and sanitary annexes, the fitting up of the kitchen and store rooms, but St. Elmo Hospital started with everything in its favour for becoming par excellence a surgical hospital; not only does it look clean, but it possesses the quality of being easily kept surgically clean. The hospital opened on August 12th with 218 beds, but very soon more beds were needed and, by dint of using the fine verandahs, another 100 beds were found. That such a small building should comfortably and adequately house so many sick, not to mention the nursing orderlies, shows what can be accomplished by method and economy of space. From the first St. Elmo specialised as a surgical hospital and it still remained so when the rush of dysentery and enteric cases made most of the other hospitals medical. Much fine work has been accomplished there; in one series of 531 operations only six deaths occurred, a tribute surely to the operative skill and nursing powers of the staff.

Opening of St. John’s Hospital
     The St. John’s School in Sliema had only been recently completed and for a short time had been used as barracks for troops. These left on August 22nd, and on the 1st of September sufficient work had been accomplished to allow St. John’s to open fully equipped to receive 400 patients. Just as at St. Elmo, everything here about the building was favourable for conversion into a really first class hospital from the start. The excellent sanitary arrangements already existing required little change; electric light was provided; a kitchen was fitted up with gas cookers in the basement, which also served to provide dining-room, stores, and dispensary; an operating theatre, X-ray room, and range of baths were also fitted. The 50 school-rooms, built on two floors around a quadrangle, made excellent wards for 400 patients, and when later the fine verandahs were also used, sufficient accommodation was found for 510 cases. Here again one was equally surprised by the economy of space accomplished; yet every department of the hospital was comfortably, adequately and conveniently housed. In addition, the excellent ventilation and lighting throughout made the wards always bright and cheerful, and must have contributed much to the happy atmosphere always so apparent at St. John’s. Although eminently suitable for surgical work, owing to the flood of medical cases, in its early stages St. John’s had perforce to become a largely medical hospital.

Opening of St. George’s as a fully dieted Hospital
     During this period St. George’s, which had been doing most useful work as a non-dieted hospital, became fully equipped; at the end of July the beds, 840 in number, were needed for acute cases, and convalescents could now be accommodated elsewhere. The alterations required immediately were not extensive, as the kitchens, bathrooms, and drainage already in existence required little additional work. Although less recent than St. Andrew’s or Tigne, the buildings were in good repair and made excellent wards. St. George’s Hospital occupied a large area, since the majority of the wards were small, holding at that time 10 patients each; consequently the staff, considerably under numbers at first, had to work under great difficulties. As at most of the other hospitals the sick soon predominated over the wounded at St. George’s. The excellent site above St. George’s Bay and the abundant opportunity of roaming about the sea shore made this hospital exceedingly healthy, and pleasant for convalescence.

Opening of Ghain Tuffieha Convalescent Camp Hospitals
     Additional rooms for convalescents became an urgent need in August, as otherwise the hospitals would have been crowded out and unable to admit fresh cases. The problem was solved by the choice of Ghain Tuffieha, situated 10 miles directly west of Valletta in a charming valley near the sea, with hills on either side. Ghain Tuffieha had already been used as a camp in peace time, partly by the army and partly by the navy, being in great request as a summer holiday resort both by officers and men. There is abundant room for exercise and games of every description; the bathing facilities are unrivalled, and the summer heat is greatly tempered by a cool breeze; in fact Ghain Tuffieha was eminently suitable for making men, softened by wounds or sickness, hard and fit for service. At first there were many difficulties as regards organisation and equipment, but these were quickly overcome by Lt.-Col. Maurice, R.A.M.C., officer in charge, and an enthusiastic staff. Three camps were formed in the first place with a central headquarters, thus unifying the procedure as regards discipline, supplies, and treatment, etc. The Engineers provided kitchens, ablution rooms, and necessary sanitary conveniences, the convalescents themselves also setting to work with a will to do much to improve the amenities of the camp. Route marching, drill, and Swedish exercises were instituted, whilst games and entertainments were encouraged. During August there was room for 2,000 convalescents, but this number increased to 3,000 in September.

Summary of Events, July to September, 1915
     It is now possible to review the happenings of July, August and September as a whole. The period covered the fiercest fighting which took place on the Peninsula, such as the landing at Suvla, and also witnessed the onset of the rising tide of sickness which was to ravage our troops much more than enemy wounds. How Malta met the cry for accommodation by expansion and formation of new hospitals has just been described. During these three months over 22,000 sick and wounded were disembarked in Malta, the numbers actually in hospital gradually rising from just over 4,000 at the beginning of July to a total of 10,157 on September 30th. To meet this rush 13,000 beds in hospitals, convalescent camp hospitals, and the fit for service camp had now been provided, but the margin of empty beds was none too large for safety. In fact only by means of returning during these three months 3,500 to Egypt fit for service, and by transferring 13,000 for further treatment to England, were the hospitals able to keep pace at all with the constant demands; during one week indeed, September 9th to 16th, over 3,000 casualties and sick arrived, and in the last week of September nearly 3,000. The position of the Malta hospitals in the lines of communication could now be clearly focussed; those who could recover from their wounds or sickness within a reasonable time spent their entire period of treatment and convalescence in Malta; the permanently unfit, or those requiring long periods of convalescence were hurried back to England as quickly as hospital ships could be found to take them; the dangerously wounded or sick received adequate treatment in Malta. It was only the most rigorous practice of these principles by all concerned, aided of course by steady expansion, which prevented the Malta hospitals from becoming choked and temporarily useless.

Nature of cases, July to September, 1915
     During this period also a high proportion of the cases could be classified serious, wounded at first predominating, then dysentery and enteric. The wounded were nearly always septic, many badly so, but thanks to the protective inoculation given often on the beach under fire, or on the hospital ship, only a few cases of tetanus or gas gangrene occurred. At the field ambulances, the casualty clearing stations, and during the several days on board the hospital ships, it was not possible to do much more than perform operations essential for saving life, and to apply first aid treatment to others. The arrival of a convoy therefore meant a period of the hardest work to everyone concerned, until every patient could be admitted, cleaned up, bathed, examined, dressed or operated on when necessary; but what the wounded men needed most on arrival in hospital was a really good sleep, and it was remarkable how great an improvement the first few days’ rest in Malta accomplished. The rush of dysentery and enteric cases, also wounded complicated by one or other of these diseases, only increased the already heavy burdens of the staff; for both diseases tax every energy of the attendants and, in addition, the finest nursing qualities are required to obtain good results. That a high measure of success was obtained is proved by the very low mortality from these diseases. To cope with the emergency, for it amounted to such, it was decided to turn Imtarfa, which was rapidly expanding to 1,050 beds, entirely into an infectious hospital mainly for the dysentery and enteric group of diseases; in addition, infectious diseases of any other type brought to Malta or arising in Malta were isolated in the married families’ blocks. St. Andrew’s, St. George’s, and St. Paul’s were almost exclusively used for dysentery and enteric cases, and extensive accommodation was set aside at Floriana, Tigne, and Cottonera Hospitals; but at that time practically every hospital had to admit and treat infectious bowel diseases, for they dominated the whole picture. The introduction of this large mass of infectious disease into the island and the difficulty, in fact impossibility of effectual isolation, increased greatly the anxieties and work of all concerned, more especially as the nursing orderlies were mostly inexperienced and untrained. However, although a certain small number of orderlies, nurses and doctors inevitably contracted infection, there is no proof that these diseases spread to any extent among the rest of the garrison, or among the civil population; at any rate there were no epidemics, a fact which speaks volumes for the precautions taken.

Medical Staff, July to September, 1915
     The medical personnel, though the hospitals were still understaffed for the work involved, had been steadily rising from July to September, and at the end of that period there were for the 13,000 beds, 240 medical officers, 567 sisters and V.A.D.s, as well as 1,760 rank and file of the R.A.M.C. Surgeon-General Sir H. R. Whitehead, K.C.B., F.R.C.S., arrived as Director of Medical Services in July. Medical officers could now avail themselves of the valuable experience of the consultants – Col. Sir J. Purvis-Stewart, K.C.M.G., C.B., and Col. G. L. Gulland, C.M.G., on the medical, and Col. Sir Charles Ballance, K.C.M.G., C.B., Col. Charters-Symonds, C.B., and Col. W. Thorburn, C.B., on the surgical side, who had arrived for duty in Malta. X-ray sets had been installed and were in good working order at Valletta, St. Andrew’s, Cottonera and Tigne Hospitals, additional sets being arranged for. The arrival of the dysentery and enteric cases put too heavy a strain on the existing laboratory at Valletta, and the new laboratory Imtarfa; there was also a shortage of trained workers at the time. Steps were taken to form new laboratories in the most useful centres and to obtain skilled workers from England. Dental work was now being undertaken at Valletta Hospital and additional surgeries and workers in this valuable field of preventative medicine were being arranged for. In addition the medical officers met together in conference to discuss their difficulties and to learn from the experience of others methods of treatment of disease and wounds that were novel to them.

     By this time the hospital staffs in Malta had largely become organised; they had served their apprenticeship, overcome many of their earlier difficulties and now knew more or less what was expected of them. Meanwhile, the various departments, Supplies and Transport, Ordnance and the Royal Engineers had equally been expanding and were practically able to meet all calls. The British Red Cross Society in addition to their previous activities had turned a large house in St. Paul’s village into a fine tea room, within convenient walking distance for the convalescents of Ghain Tuffieha Camp Hospitals, and later for those of Melleha; another tea room at St. Julian’s Bay was also opened by the same society. Other voluntary services such as the Y.M.C.A., the Church Army and the Scotch Church had all alike risen to the occasion by providing church tents and halls, tea rooms, tents for recreation, reading and writing. Concert parties were brought out from England or recruited locally; while a great amount of good was being quietly accomplished by the chaplains of the various denominations.


Further Expansion of Hospitals Required
     The period October, 1915 to March, 1916, was marked by the closing events of the Gallipoli campaign and by the initiation of hostilities in Salonica. With the demands for beds from Gallipoli as insistent as ever and the prospects of beds being required by the Salonica army, the authorities in Malta had perforce to continue the beds already in being and to look for means of extension; the approach of winter also removed for the time-being anxiety as regards the water supply. The number of beds equipped gradually rose from 13,000 at the end of September, 1915, to 20,040 in March, 1916, the additional beds being mainly found by the provision of the new hospitals – Manoel, Spinola, Ricasoli, the expansion of Ghain Tuffieha, the provision of a new convalescent camp hospital at Melleha, the opening of Fort Chambray, in Gozo, for convalescents, and by the use of the Governor’s Palaces at Verdala and San Antonio for convalescent officers and sisters respectively. No new hospitals have been established apart from the above in Malta; in future, additional beds, when needed, were obtained by the improvement and extension of existing hospitals.

Opening of Manoel Hospital
     Manoel Island is a most convenient site for a hospital, because, situated in Marsamuscetto Harbour, it is easy of access by a bridge joining it to the mainland, and at the same time it is capable of complete isolation. Originally the Knights of St. John had built a Fort on Manoel, which was occupied by the British when they took Malta. Later the Fort was dismantled, and about 40 years ago wooden barrack huts, built on stone supports, raised on concrete bases, 35 in number, were erected on the northern slope of the island facing Sliema. Of late years these huts were only used by a small detachment from the neighbouring Infantry Battalion at Floriana. The buildings of the Fort, reconstructed to some extent, were utilised as officers’ mess, stores, barrack rooms, and married quarters. On the Valletta side is a large quarantine station for contacts from infected ships, an infectious hospital and a quarantine station for cattle, all belonging to the Civil Government, and cut off from the military part of the island.

     When in October, 1915, it was decided to utilise Manoel Island, the accommodation provided did not look very promising. However the Royal Engineers repaired, colour-washed, and painted all the old huts, and an advance party of R.A.M.C. proceeded to disinfect them and get rid of the vermin. 28 huts were prepared for patients, and seven were utilised for operating theatre, dispensary, coffee bar, etc. The buildings around the barrack square were turned into stores, offices, quarters for sisters and detachment, also an officers’ mess. The first patients to arrive were 50 cases of scabies on November 5th, and these, as infectious cases, were isolated in tents. During November the work of equipping went on steadily and orders were received to raise the accommodation to 1,000 by erecting 38 marquees on the parade ground between the hutments. It was well that this accommodation was ready, for on December 3rd 195 patients were admitted, 96 more on the 4th, 128 on the 6th, 88 on the 7th, 226 on the 8th, and 205 on the 9th, a total of 938 admissions within a week, the whole involving a heavy strain on a new hospital and a fresh staff, for the patients and the hospital equipment practically arrived simultaneously. Among the patients were a number of Indian troops for whom special cooking arrangements had to be made.

     In addition part of the civil quarantine station had been handed over by the Civil Government to act as a military quarantine station for cholera, plague, typhus, or smallpox, should cases of these diseases and their contacts be disembarked in Malta. Beds were urgently needed for officers in December, and permission being granted, for two months, December 1915, to February 1916, Division 2 of the quarantine station was used as an officers’ hospital and equipped with 80 beds. For a short time the sisters’ quarters and mess were turned into a small infectious hospital for sisters, until during February it was transferred to St. George’s. On various occasions also Manoel Hospital has been used to accommodate shipwrecked crews and passengers.

Special utility of Manoel Hospital as the main Military Quarantine Station
     Such is a short account of the origin of Manoel Hospital, one of the most interesting of the Malta war hospitals, on account of the multifarious uses to which it has been put. All the scabies cases of the island have been accommodated there, also contagious diseases of a special class; it has been usefully employed in the treatment of general medical and surgical cases; but throughout Manoel Hospital has been ready at a moment’s notice, if required, to play the part of a large quarantine station. Typhus, cholera, plague and smallpox, are all alike most serious diseases, and their introduction into a crowded civilian population might be attended with the gravest consequences. The authorities at an early date in the history of the Malta hospitals determined that the first line of defence should be the small island of Comino, practically a bare rock between Malta and the neighbouring island of Gozo, which possessed a small Civil Government hospital built for cholera. This was ready for 50 patients, with accommodation in tents for 200 contacts. Against the use of Comino was its inaccessibility, (for days together in winter it may be impossible to land) its small water supply and consequent limits of accommodation. It was later felt that Manoel Island was more suitable in every way, and a most complete scheme was approved early in 1916 whereby, should an infected ship arrive, actual cases of the disease up to the number of 30 could be received by the civil infectious hospital; while Divisions 1, 2, and 3 of the Lazaretto, as well as the hutments and marquees of the hospital, with accommodation for nearly 1,200 and ample opportunities for expansion, could be vacated at a moment’s notice by their ordinary inmates, and used for the reception of any additional cases and contacts. Comino was also to be ready as a standby should an infected ship land cases only and not contacts. In furtherance of the scheme the sanitary arrangements of the military portion of Manoel Island were thoroughly modernised as the hospital was steadily improved until now it is one of the most complete and efficient in the island. Luckily Manoel Island has not been required as a military quarantine station, but, had it been, the notice would have been of the shortest; where plague and cholera are concerned, it is necessary to be both forewarned and forearmed.

Opening of Spinola Hospital
     In October, the need of an additional hospital made the authorities choose a site at Spinola, on St. Julian’s Bay, in Sliema, where formerly a Fort had stood. For a week or two it had been used as a base detail camp, but as a hospital extensive alterations had to be made. The Fort consisted of four empty gun emplacements, three magazines, one married quarter and a few small buildings. Around the Fort was a moat; between the moat and the sea was a very rough and irregular rocky glacis. It was decided to use the glacis for pitching hospital marquees, a most arduous task, as all the sites had to be built up, in some places as high as seven or eight feet. The Fort itself was adapted for administration and stores; for example, the kitchen was provided in a wide passage in the centre of the Fort; the underground magazines became linen, pack, and clothing stores; a dining hall, also an ablution and bathroom were made in the two large gun emplacements. Much ingenuity was employed in the utilisation of every existing building. The final result was the provision of an efficient general hospital capable of receiving by the end of December 1,022 patients. As a matter of fact Spinola was not required to take in sick and wounded until the end of January, 1916, and then only up to the number of 169; its period of greatest use was not to come till some considerable time later.

Opening of Ricasoli Hospital
     The alarming rush of casualties from Gallipoli during September and the grave possibilities of the future made expansion imperative at the time, so it was accordingly considered that use could be made of the barrack rooms and parade ground of Ricasoli. In its favour were a healthy site, close to the sea at the southern entrance of the Grand Harbour, its isolation and its convenience for disembarkations. Accommodation was found for 800 patients, 224 in eight barrack rooms and 576 in tents pitched on the large parade ground. The hospital was prepared and equipped during October, received its first convoy on November 6th, and up to the end of the month 503, mostly sick, were admitted. During December, 1915, and January, 1916, 942 were admitted, but after the 27th of January no further cases were sent there. The bloodless evacuation of Gallipoli had by this time markedly reduced the numbers of sick and wounded arriving and the Salonica expedition had not as yet started to use Malta to any extent. Accordingly Ricasoli and also Spinola were closed as general hospitals at the end of March; they had served their purpose for the time being.

Fort Chambray Convalescent Depot, Gozo
     An interesting incident in the history of the Malta hospitals was the use of Fort Chambray in the neighbouring island of Gozo as a convalescent depot for 400 rank and file from October, 1915, to March, 1916, to act as an outlet for the over-crowded camp of All Saints. During that period 1,579 men passed through the camp and were returned to active service. Perched on the summit of the hill above Migiarro, the port of Gozo, Fort Chambray was erected by the Knights of St. John in the 17th century, then, modernised in the 19th century, was latterly used as a barracks by British troops in the summer. Having the initial advantage of a good building and an excellent healthy site, Fort Chambray eventually proved quite a success in its new role. The story of the early trials and struggles of the small but enthusiastic staff is fittingly recounted in their own journal “The Fort Chambray Gazette.” Its isolated position, entailing much difficulty in sending supplies, made the closure of Fort Chambray certain as soon as it was no longer required in March, 1916.

Opening of Melleha Convalescent Camp Hospital
     Towards the end of the year 1915, the question of room for convalescents again became urgent. It was not considered advisable at that time to expand Ghain Tuffieha beyond 3,790 beds and accordingly another camp hospital for convalescent patients had to be chosen. No convenient site could be obtained near Valletta; therefore Melleha camp, in peace time used for training purposes, was chosen. It is situated 11miles from Valletta on rocky ground rising with a gentle slope from the sea shore of Melleha Bay. In its favour were its extremely healthy site, its isolation from the civil population and the easy access to the sea for bathing; against it was its distance from Valletta, entailing long journeys for the transport of equipment, supplies and patients; but the excellence of the site more than counter-balanced these drawbacks. Ultimately intended to expand to 3,000 beds, a start was made with the first 1,000 in November 1915, the Royal Engineers providing the essentials, preparation of sites for marquees, kitchens, ablution places, etc. On January 19th, 100 hospital beds and 500 convalescent beds were ready and on January 30th the whole of the first camp was completed. Patients began to arrive on January 31st, and they shortly amounted to 1,050 all told. A start was made with the second camp but only 250 beds were got ready. As at Ghain Tuffieha everything was done to keep the patients busy, happy and contented; but the main idea of getting them fit for service by route marching, physical drill and useful work within the camp was never neglected.

Use of Verdala and San Antonio Palaces as Convalescent Homes
     During this period Verdala Palace, finely situated on the high ground overlooking the Boschetto Gardens, was converted into a convalescent hospital for 30 officers in December, 1915, and San Antonio Palace with its extensive and beautiful gardens became in January, 1916, a welcome rest home for 60 nurses from the military hospitals and also from the naval hospital at Bighi. Although their existence in the new role was short the Palaces served the purpose well; especially was the restful atmosphere of San Antonio appreciated by the nursing staff, many of whom were thoroughly run down, after the exhausting work of the past seven or eight months.

October 1915 – March 1916. Patients and Medical Staff
     With the onset of winter the nature of the cases received in Malta changed considerably. Dysentery and enteric cases diminished and could be adequately isolated in the special hospitals set aside for them; but in their place came trench fever, numerous cases of frost bite, especially after the terrible storm of November in Gallipoli, and rheumatism. Wounded of course came in large numbers both from Gallipoli and later on from Salonica, but now the proportion of severely wounded and badly septic cases had greatly decreased. The hospitals were now more or less adequately staffed, there being in Malta, in January, 1916, 334 medical officers, 913 nurses and V.A.D.s, besides 2,032 rank and file of the R.A.M.C. All had gained greatly in experience, and it may be fairly claimed that the longer established hospitals were by this time most efficient and thoroughly well equipped in every way.

Summary of Events
     From October, 1915, to March, 1916, the hospitals in Malta passed through several phases. During October and November sick and wounded arrived from Gallipoli averaging about 2,000 weekly, and towards the end of the year it was necessary to use Malta for sick and wounded from the Salonica expedition. In one week, December 2nd to 9th, no less than 6,341 sick and wounded arrived, and, when it was known that Gallipoli was about to be evacuated, with almost 15,000 beds occupied, there was only a margin of 3,000 beds in Malta. Christmas, 1915, was therefore a very anxious time for the authorities, and indeed plans were fully prepared for sudden and emergency expansion; but our bloodless withdrawal completely relieved all fears and also marked the close of one phase of the hospitals. After January, 1916, the arrivals of sick and wounded fell very considerably; only 600 were received in February, and 1,5000 in March, for at that time the health of the troops in Salonica was good, and there was not much fighting. With a steady stream of convalescents or unfit men proceeding to England, and fit men going back to duty, the end of March found the hospitals with 20,000 beds but only 4,000 patients.
The importance of Malta as a hospital base for the time being had therefore diminished considerably, and there appeared little likelihood that the hospitals would shortly again be required as urgently as in the previous summer.


Period April to June, 1916
     Malta as a hospital base during April, May and June, 1916, passed through a period of comparative inactivity. In view of the small requirements at the time of the Salonica army it was considered advisable at the end of March to effect a considerable reduction in the number of beds from 20,090 to 12,000. Floriana Hospital was closed, being again used as a barracks; Ricasoli Hospital and Fort Chambray Convalescent Depot were closed; All Saints Camp was transferred to Spinola Hospital which was closed; while drastic reductions were made in most of the other hospitals and convalescent camp hospitals. The result of this policy was that only a few of the hospitals were really shut down; the others, being left with a substantial nucleus of staff and equipment, were ready to expand again on short notice. A gradual reduction also took place in the medical staff until in June 140 medical officers, 420 nurses and V.A.D.s with 1,857 R.A.M.C. rank and file remained for the 12,000 beds. At the end of March the officers and other ranks of the 1st City of London Field Ambulance left Malta for duty elsewhere, having rendered yeoman service throughout, but especially in the first rush before the arrival of medical reinforcements. The officers had held with conspicuous success important appointments such as Officers Commanding Hospitals, while many non-commissioned posts had been filled by temporary promotions of the rank and file. During March the D.M.S., Surgeon-General Sir H. R. Whitehead, K.C.B., received another appointment and was succeeded by Surgeon-General Sir Thomas Yarr, K.C.M.C., C.B. As for patients the total numbers in all hospitals, convalescent camps, etc., gradually fell to 3,000 in the third week of May, but then began slowly to rise towards 5,000 at the end of June. At the same time the arrivals of sick and wounded from Salonica gradually increased from 857 in April, 1,709 in May, to 3,636 in June, a significant prelude of the activity to come.

Rush of Malaria Cases from Salonica, commencing July 1916
     The medical authorities, however, in Malta were aware that cases of malaria were becoming frequent amongst our troops in the fever stricken valleys in which they were operating. The rush which began in July was therefore not unexpected; the weekly arrivals from Salonica quickly rose from 718 in the first week of July to 1,982, 2,605 and 2,587 in the three succeeding weeks. As it was anticipated that the need for accommodation might be greater than ever, arrangements were at once made for the expansion of the existing hospitals. The available beds were raised from 12,000 to 15,486 in July, on the 3rd of August 13,000 of these being occupied. The requirements of the Salonica army increased by leaps and bounds, but the authorities in Malta were able as in 1915 to rise to the occasion, until eventually 25,570 beds had been equipped in hospitals, convalescent camp hospitals and the awaiting passage depot, a number exceeding the highest limit reached during the previous year by 5,500 beds. During the busiest period a moderate margin of safety between beds ready and beds required was always maintained; had it been necessary a scheme was in readiness whereby further accommodation up to 27,000 beds could have been provided.

Value of previous experience of 1915
     The rush of 1916 was by no means such an anxious time as the summer of 1915, all departments concerned having gained much experience of the special requirements of hospitals. Anxiety as to the water supply had also been greatly allayed by the insertion of additional machinery at Tal Hlas capable of pumping an extra million gallons every 24 hours, and by the erection of two large 1 ¼ million gallon tanks at Nadur; both of these services will also be of much benefit to Malta after the war. The Army Service Corps was well provided both with food supplies and transport, while the Army Ordnance Department had large stores of hospital equipment at hand. The works executed by the Royal Engineers in the hospitals and camps during the previous year required as a rule little modification to meet the present need for expansion. The medical authorities also had now behind them a very complete organisation. Although patients and staff had become greatly reduced, care had been taken to keep a working nucleus of every branch. Accordingly, the work of re-opening and expansion proceeded quickly and smoothly. As a matter of fact a very complete scheme for utilising present accommodation to its greatest advantage and also for expansion to 27,252 beds had been carefully prepared during the previous winter by Lt.-Col. J. C. Robertson, C.M.G., C.I.E., I.M.S., Consulting Sanitary Officer for Malta, and Lt.-Col. A. De C. Scanlan, C.M.G., R.A.M.C.; during the present expansion this scheme proved of great value.

Voluntary help
     The voluntary institutions, which had done so much for the men both inside and outside the hospitals, were again of great assistance. The British Red Cross and Order of St. John under the Commissioner for Malta, Lt.-Col. Frank Ashley, C.B.E., had now become a large and important organisation and, while continuing all previous activities, was able to enter upon new ones. Special mention must be made of the valuable services rendered by the Red Cross invalid kitchens, which were established altogether in six hospitals, Floriana, Valletta, Tigne, St. Andrew’s, St. George’s, and Imtarfa; the invalid kitchens at St. David’s and St. Patrick’s Hospitals were completed but never used owing to the closure of these hospitals in May, 1917; another kitchen was erected at Cottonera Hospital and is now in use. A series of first class concert parties brought out from England by the Red Cross and the Y.M.C.A. did much to cheer the sick and convalescents throughout the island. The Y.M.C.A. had its familiar and popular tents in many of the convalescent camps and hospitals and was able to increase them as required; the Church of England Hall and the Orkney Island Hut at Ghain Tuffieha; the Church Army, the Scotch Church, and other similar organisations were all able to continue and add to their previous good work. Special mention may be made of three fine buildings opened during this period to provide refreshments, recreation, reading and writing rooms, etc., - the ‘Big Drum’ at St. Julian’s Bay, under the auspices of the Church Army, in the founding of which the Reverend Mr. Reed took a great interest, the Y.M.C.A. institute at the Sliema landing of the Marsamuscetto Ferry, and the British Red Cross Society’s Tea Rooms in the centre of Valletta. In the spring of 1917 the latter society also opened two similar institutions, which immediately proved of the greatest benefit; Marfa Palace, lying at the water’s edge on the extreme north of the island, was turned into a fine tea room and club for the Melleha convalescents, while a non-commissioned officers’ mess at Ghain Tuffieha was similarly transformed for the convalescents there. The Y.M.C.A. also opened a large recreation hut overlooking the Marsamuscetto Harbour on the Valletta side. Many ladies of the island were largely absorbed in one or other of the spheres of activity covered by these societies. The numerous amateur concert parties of the previous year also continued their welcome work. All had learned by experience what was wanted and did it.

Some details of the expansion required, Summer and Autumn, 1916
     It is unnecessary to go into all the details of the expansion which may be seen in the Appendix, while a short description of each hospital has already been given in Part 1. During July 3,486 additional beds were obtained mainly by increasing accommodation at Imtarfa Hospital from 1,130 to 1,449 beds, St. Andrew’s Hospital from 1,070 to 1,437, St. George’s Hospital from 920 to 1,102, St. Patrick’s Hospital from 500 to 890, St. David’s Hospital from 400 to 960 beds and the convalescent camp hospitals at Ghain Tuffieha from 2,750 to 4,000 beds. Next month, August, with the requirements of the Salonica army increasing rapidly, the hospitals rose in numbers from 15,486 to 20,414 beds. St. George’s, St. Andrew’s, and Imtarfa Hospitals yielded 850 more beds by the erection of hospital marquees on their parade grounds, a scheme carefully out the previous winter. Ghain Tuffieha Camp Hospitals expanded to the limit of 5,000 beds, a number now made possible by an improved water supply. Melleha Camp Hospitals were gradually rising to 2,000 beds; All Saints’ Camp was re-installed in its old site with room for 1,650 fit for service men; Spinola Hospital was equipped again with 300 beds to begin with. The total number of beds in September and October rose to 24,486; hospital marquees were erected for 400 on the parade ground of Tigne Hospital; Spinola Hospital expanded from 300 to 1,168 beds; Melleha Camp Hospitals rose from 1,474 beds to the full complement of 2,000 beds; an additional ‘Fit for Service’ camp was established at All Souls near the Pembroke Ranges for 1,000 men and attached to All Saints. Floriana Hospital was re-opened in September with 704 beds, an expansion to 1,304 beds by erecting hospital marquees for 600 on the parade ground being ordered shortly afterwards. With minor expansions at Manoel, the Blue Sisters’, and Forrest Hospitals, the beds now available remained in the neighbourhood of 25,000 until April, 1917.

     Accordingly, during this period no new hospitals were started, the wiser policy being followed of adding extra beds where required, to already satisfactory organisations. Some of the older hospitals expanded to well over 1,000 beds, in certain cases to nearly 2,000 beds; but the results entirely justified the experiment, both as regards internal economy and efficiency. Extensive improvements were carried out in many of the hospitals by the Royal Engineers, more especially at Floriana, St. Andrew’s, St. George’s, and Manoel Hospitals. The camp hospitals were made much more comfortable and efficient by the gradual insertion of concrete bottoms for the hospital marquees and by the provision of dining tents near their kitchens. The tent expansions at Cottonera, Imtarfa, St. George’s, St. Andrew’s, Floriana and Tigne Hospitals were most carefully thought out as regards every medical and sanitary detail, when completed being models of their kind. The convalescent camp hospitals at Ghain Tuffieha and Melleha were also greatly improved and rendered more comfortable during this period.

Numbers in Hospital, July 1916 to August 1917
     During the period July, 1916 to April, 1917, the numbers of sick and wounded actually in hospital showed a gradual increase from 5,000 at the beginning of July, 12,910 on August 3rd, 14,149 on September 7th, to 20,994 officers and other ranks on October 23rd, the largest number actually in the hospitals, convalescent camps, etc., at any one time. The numbers fluctuated in this region until the end of November, falling to 14,000 in December, about which figure they remained until the end of April, 1917. As in the previous year the Malta hospitals formed an important link in the line of medical communications; when opportunity offered unfit men were returned to England, fit to Salonica, so that the hospitals were never allowed to become overfilled.

Nature of Sick and Wounded
     As for the patients, the sick were greatly in excess of the wounded. Malaria was the predominating cause of sickness; then followed dysentery and enteritis; the enteric group of diseases, thanks to inoculation and other preventative measures, did not yield many cases; other diseases incidental to campaigning such as trench fever and rheumatism were of fairly frequent occurrence. The wounded were not as a rule so severely injured or so seriously ill on their arrival as in the previous year, for the conditions were entirely different. In the Gallipoli campaign speaking generally, the more quickly, except for certain cases as abdominal wounds, a wounded man passed through the Field Ambulance, the passage to the beach, the journey to the hospital ship, and then his three or four days voyage, the better it was for him when he reached a general hospital in Malta. Salonica on the other hand was some distance from the fighting zone, and possessed well equipped base hospitals. Accordingly, the seriously wounded and indeed all wounded received sufficient treatment to enable them to bear the journey to Malta in safety and comfort; in many cases they were only evacuated in order that room might be found for others in the Salonica hospitals.

Work of various Hospitals
     As before, Imtarfa Hospital remained the principal infectious hospital of the island, and continued its excellent work of the previous year. Apart from Imtarfa it was now possible to concentrate all the remaining cases of dysentery and kindred diseases in Cottonera, St. Andrew’s and Tigne Hospitals where isolation measures to prevent their spread was completely organised. St. Elmo, Cottonera, Bavière, St. Ignatius, St. George’s and St. John’s Hospitals received most of the wounded and surgical cases, although sick were also numerous in each; in the remaining hospitals cases of sick predominated. A few figures illustrate this well; during the year ending April 30th, 1917, Cottonera, a mixed hospital, received 2,867 sick, but only 308 wounded cases; St. George’s received 6,527 sick and 281 wounded; of a total of 3,511 admitted to Spinola 3,507 were sick; St. Andrew’s Hospital admitted 9,292 cases of whom only 41 were wounded; St. Ignatius received 926 sick and 310 wounded.

Medical Staff from July 1916 to April 1917
     As regards staff it has already been stated that large reductions had necessarily been made during the spring of 1916 of both medical officers and nurses. When the rush began in July, 165 medical officers and 403 nurses were available for the 12,000 beds, as compared to a maximum number during the previous winter of 360 medical officers and 913 nurses. The number of R.A.M.C. rank and file had not been reduced so much, there being 1,827 as compared with 2,415 in February, 1916. With nearly 13,000 patients in hospital at the end of July, both doctors and nurses passed through a most strenuous time; indeed so short-handed were the hospitals that a few individual medical officers had for short periods to look after as many as 150 sick and wounded. Early application had been made to England for additional medical officers and nurses, but at the time they could ill be spared. At the beginning of August, however, 42 medical women arrived in Malta for duty, a most welcome reinforcement and an innovation attended in every way with the happiest results; eventually in November they reached the total of 76. To meet deficiencies of medical men, additional civil surgeons were also obtained from the Maltese medical profession up to the number of 26. The female nursing staff remained short-handed during July, August and September, additional help from England only arriving to any appreciable extent in October, when their numbers rose from 427 to 592; in December they reached a maximum of 625 for the period. The need for R.A.M.C. rank and file was not so urgent at the beginning, but to meet later requirements they were increased to a maximum of 2,378 in January, 1917. It may be noted that never at any time could the hospitals be fully staffed in accordance with the army schedules, so that when their beds filled up it was necessary to work under great pressure.

Special Departments of Medicine and Surgery
     Much attention was devoted to the special departments in medicine and surgery. Well equipped and well staffed laboratories did excellent work in the following centres: Valletta, Imtarfa, Tigne, Cottonera, St. Andrew’s and St. George’s Hospitals; in addition every effort was made to encourage the individual medical officer by setting up a small laboratory equipment in other hospitals. Special departments for diseases of the eye were established in St. George’s, Valletta and Cottonera Hospitals; ear, nose and throat work was centred at St. George’s; a mental clinic was started at Cottonera Hospital. The X-ray work of the island had developed considerably during the previous winter and the centres at Valletta, Tigne, St. Andrew’s, Cottonera, St. Ignatius and Floriana Hospitals remained. Dental work expanded greatly during the year, surgeries being maintained at Valletta, Tigne, St. Andrew’s, Floriana Hospitals, Ghain Tuffieha and Melleha Camp Hospitals. Medical officers were able to avail themselves of the valuable experience of consultants: Col. Sir A. E. Garrod, K.C.M.G., and Col. H. H. Tooth, C.B., C.M.G., on the medical side, with Col. Sir Charles Ballance, K.C.M.G., C.B., and Col. W. Thorburn, C.B., on the surgical side. Altogether the medical life of the hospitals was a very live thing; all alike were intensely interested and anxious to gain experience; consequently the medical conferences which took place every fortnight in the University were largely attended and proved of great benefit.

Reduction of Hospitals, April to August, 1917
     During April, 1917, the sinking of hospital ships caused a rearrangement of hospital policy in the Mediterranean, whereby it was determined to establish sufficient general hospitals in Salonica to meet practically all requirements. Orders were received in Malta to equip five general hospitals for duty in Salonica; for this purpose St. Patrick’s, St. Paul’s, St. David’s, Floriana and Spinola Hospitals were selected. Extra equipment was provided by the Ordnance Department and medical officers, nurses, and R.A.M.C. personnel were drawn from other hospitals sufficient to bring them up to strength. During May these five hospitals left for Salonica and, with Ghain Tuffieha Camp Hospitals reduced to 3,000 beds, the equipped beds in Malta fell from 25,522 to 17,816. Still further reductions were made during June, July and August; the tent expansions at Tigne, St. George’s, Imtarfa, Cottonera, and St. Andrew’s were closed; also Melleha Camp Hospitals and All Souls ‘fit for service’ Camp; Bavière, Hamrun and Blue Sisters’ Hospitals were shut down. These reductions left 12,932 beds all told in hospitals, the convalescent camp hospital and the awaiting passage depot.

Result of new policy – great reductions in numbers of patients in Malta
     At the end of April the new policy showed itself at once; the total arrivals of sick and wounded were 603 for all May, as compared to 2,543 for April. During June only 37 were disembarked; 842 arrived in July and 401 in August. The result of this was bound to be reflected in the numbers actually in hospital; at the beginning of May there were 14,537 sick and wounded in the island, but as opportunity offered these have gradually returned to England or to their units until at the end of August there remained 5,465 all told in hospitals, convalescent camp hospitals or the awaiting passage depot. A corresponding reduction in medical staff has also taken place, medical officers, civil surgeons and medical women having fallen from 276 to 141, the female nursing staff from 545 to 302 and the R.A.M.C. personnel from 2,350 to 1,270.

Utility of Malta as a Hospital Base
     This account therefore closes at a period when the importance of the Malta war hospitals had evidently diminished. At the same time it has been clearly shown in their history that they have passed through two great phases of maximum utility. Firstly, in the Gallipoli campaign 1915, approximately 2,550 officers and 55,400 other ranks had been received for treatment, the maximum number in hospital on any one day being 16,004; it is no exaggeration to claim that an immense load of human suffering was thereby obviated and a very large number of lives saved by the prompt initial response of the authorities in Malta, and by the admirable hospital arrangements made under extreme difficulties. Secondly, from the Salonica army up to August, 1917, in round figures, 2,600 officers and nurses and 64,500 other ranks had been admitted to the Malta hospitals; the majority arrived in the summer and autumn of 1916, and but for the ready expansion of the Malta hospitals the existing lines of communication would have been sorely tried.