For centuries, the disease has been considered synonymous with moral guilt. Evil struck sinful man, him which was stained with brutality or conduct contrary to religious precepts. We must however recognize that, on the one hand, the ecclesiastical authorities generated this mental approach in society, on the other they were also the expression of a social instance of "charity" of Christianity.1 and its specific attention to the attitude of Christ "doctor"2 or to the duty of mercy also towards the body: "I was sick and you visited me" (Mt 25, 36).
There has been much talk about the innovations made by the great luminaries of the medical discipline and coming from the illuminated schools in Pavia, or Gottingen or the Royal Infirmary in the United Kingdom. Few however have given the fair merit to those who can be considered the true precursors of hospital management. This innovation, came from a small island, the last outpost of Christianity in a Mediterranean at the time firmly in the hands of the Ottoman Empire: Malta. On this "rock", an Order had been installed faced the vicissitudes of its history as a true protagonist: the Sovereign Military Hospitaller Order of Saint John of Jerusalem, called Rhodes, said of Malta.
In a panorama that saw the strong contrast between Islam and Christianity, with class divisions within the "faiths" themselves, the initiatives of the Sacra Infermeria in terms of rescue and service to "Mr. Sick "can be definitive" revolutionary ".
The Order of Malta, built in the East, in Jerusalem, around the 1045, and organized in line with the needs of his time, once he moved to the "Honey Island" (Μελίτη - Malta) he managed to adapt to the its inhospitable climate and transformed from a chivalric - religious Order, devoted to custody and support of pilgrims in the Holy Land, in an Order devoted to the war on the sea and to the operations linked to these activities.
In fact the raison d'etre of the institution, since its birth, has been to accommodate the pilgrims who they came to the holy places for Christians. They were known as Hospital, Isbitariyya, even with Muslims. Their distinctive mark was a system of hospitality and service to the pilgrim of one foresight to be allowed, after the conquest of Jerusalem by the warriors of the Salah al Your3, to stay in the city to take care of Christians who had not been able to pay ten o'clock crowns that the Sultan had set as price for freedom or had been wounded during the siege of the city.
In this regard, there is a legend concerning the Saladin reported in the Notebooks on Spirituality of the Sovereign Military Order of Malta. The Condottiero would have visited the Hospital since "The praises of this their activities at the service of those in need of any faith were such that they reached the ears of Salah al Din, who wanted to verify the consistency in person. He then disguised himself as a Muslim beggar and yes he presented at the hospital door. He was immediately offered shelter and food. He accepted the first, but refused to eat for two days. On the third morning, he was asked what he wanted to eat, and he replied that would have liked the thigh (or heart according to the versions) of the Grand Master's favorite horse. While with some hesitation, the Grand Master gave the order to please the guest, who, just before that the cut was made, he intervened saying that his appetite had already been satisfied by the will of to want to please in every way4".
After the end of the Domini Latini in the Overseas, after the expulsion from Rhodes and the transfer of the Order on the Island, the Knights invested the enormous fruits of their war on the Mediterranean, in the assistance and rescue works. It is interesting to note that after the installation of the Giovannites in the 1530, one of the first structures reported in the chronicles was a hospital already active in 1533. After the Great Siege (1565) and the completion of the city of Valletta, the Order will move into the new one capital in the 1574. The first General Assembly of the Order was held in order to create a new one Holy Infirmary within the walls of the "New City".
There were many visitors to this impressive hospital work and they were favorably impressed not only for the building but for the hospitality offered. The sick were served by the younger Knights with potterysilver and every Friday they were accompanied by the Grand Master with the highest dignitaries of the Order. Then, as early as the sixteenth century, we have the striking testimony of a different culture and a different way of life feel the sick. It is undisputed that being one of the two charisms of the Order, that of the obsequium pauperum, the Knights committed themselves body and soul in ensuring that their mission did not fail. Hence the"Humble themselves" and serve the last among the last, those who did not possess even the basic good: the health.
Young offspring of the noblest families in Europe, they had the first job of kneel and clean the sores of the poor derelicts. The use of silver cutlery, as mentioned above, was one of the demonstrations of the treatise to "Our Lord the Sick", but also an expression of one practical knowledge on the part of the Health of the Order: silver had powerful bacteriostatic qualities. TO proof of this double value of the "noble" metal it must be said that the Knights, including the supreme Dignitaries did not use it for their habitual meal. 1725 pieces were counted in the 1150 of silverware in the Hospital's equipment. It is therefore in this climate of constant search for improvement of the condition of the patient who sees the greatest innovations of the Order in medical matters.
The innovations were in fact multiple, both structural and regulatory. Let's see some:
In May of the 1679, a room was built to accommodate patients thought to be contagious. This room yes he was adding to what was currently the largest hospital in Europe: well 155 meters in length for 10,5 meters in width for 11 meters in height (!). In this Great Hall it was arranged on one side of the Holy Infirmary and a row of windows provided light and air in quantity. During the winter, the walls, which were usually bare, were covered with large wooden panels or tapestries.
The innovation of the use of such furnishing accessories was not only in the "softening" of the lane, but also as a function of thermal insulation! It is not to be underestimated, however, another purpose for the which the panels were exposed: the depictions contained in the Tapestries, all aimed at magnifying the glory and the power of the Order also had a propagandistic and "visibility" content!
On the opposite side of the Great Hall there was a building called Ronta. It was a room where one was placed rotating bed on a vertical axis. This room communicated with the road outside, by means of an opening, or window created in the wall. Through this window the rejected or illegitimate newborns5 they were left in the crib for the infirmary staff to take care of them. The whole apparatus was constructed in such a way that the person who deposited the newborn could do so without being seen from within and without revealing one's identity. The children were held until they were entrusted to adoptive mothers or employed, after suitable technical training, in work activities of public utility according to their own inclination and according to their sex. Adoption was favored, in the face of strict guarantees by the foster families, always subject to inspections on the merits. Then there was the prohibition of entrusting or doing to work these youngsters outside their structures, with the exception of the consent of the Congregation6.
The effectiveness of Giovannita's assistance to the exposed was so good that between the 1787 and the 1788 there were well 212 acceptances of newborns (in 1755 the inhabitants of the island were about 74.000)7 the 0,29% on the total of the population: today's growth rate on the island (updated to 2011) is 0,359%8.
Within the Sacred Infirmary, every patient could have (and actually had) a single bed, each of these was equipped with wool mattresses with canopies and colorful curtains. When they together with blankets, were declared no longer suitable, but still usable, were distributed to the poor or, as far as possible, used to be reduced to bandages for the injured. A dutiful note that expresses the quality of the supplies of the Sacra Infermeria, is to be reserved for mattresses: it is prescribed that they are all made of wool and that they must be periodically redone by carders appointed for this purpose, originally in the organic same of the Hospital and, subsequently, with a contract on the outside.
Furthermore, linen was not provided indiscriminately: in order to guarantee public health, the hospital was provided with departments for infectious people, especially consumptive ones ("Ethics"). The linen used in these wards had to be strictly separated from that used by the other Infirm, washed separately and in suitable containers only a that intended. The same applies to crockery and various utensils. To be sure of the exclusive use of all this endowment, all the material was expected to be stamped with a mark different from that used for common departments.
In case of death of the patient, the mattress was burned and the bed disinfected, even in case it was used by a sick person of the same disease. The fear of contagious diseases was well justified if yes it took into account the very limited Maltese territory and its island status.
Those affected by "simple gonorrhea" were excluded from hospital treatment. We want to report here, a rule for admission to treatment in Falanga that draws on the moral sphere: "Neither will the admirers accept that they will not present a certificate, that their wife is in the Women's Hospital to take the same care, or a faith of the Episcopal Curia of the separation of the bull (sic!) ".
The Infirmary welcomed sick men belonging to any social class, any foreigner and of any kind I think. Non-Catholics, however, could not stay more than three days in the Great Hall, if they refused to receive religious instruction by the chaplains. Toward the end of the eighteenth century, the number of patients admitted at the hospital it was almost 4000 per year, with a mortality of 8% (compared to 20% of welfare institutes "Illuminati" of Europe).
The Sacra Infermeria, foresaw the subdivision of the sick (a form of triage ante litteram): in the Great Room the 64 patients were divided into: left side for chronic patients and right side for severe cases; in the Old Hall there were 22 beds for the rescue of civilians, members of religious communities and pilgrims suffering from medical ills; the Room for the Injured with two adjacent rooms of 29 beds for surgical cases in favor of the civilian population; there Room with 20 places for the dying. Women were not allowed to enter this lane or even approach it or any other place where the dying were; the Sala Nuova or Sala per i Flussuanti with 21 beds for patients suffering from intestinal disorders; the Hall of St. Joseph with 20 beds reserved for sick inmates; two lanes of lithotomy for patients operated on the common condition of bladder stones; the Sala dei Cavalieri with 19 beds for members of the Order who need medical assistance; two Warehouse Halls, for a total of 36 beds, designed to accommodate patients suffering from mental disorders; the Palombara so defined because it consists of a number of small rooms with 29 beds for the affected by transmissible contagious diseases such as tuberculosis and ringworm.
There were also two rooms with 19 beds for members of the Order suffering from surgical disorders; two rooms with 10 beds for surgical cases for civilians; another room with 18 beds for the mentally ill. The latter were then transferred to one of the two Halls of the Warehouse if they were a source of trouble for other patients9.
There was also a room known as the Violin. The reason for this name and for what purpose was unknown destined10; the "Kaiser" was a room from 3 beds where the patients being treated with mercury acetate were housed, administered in the 18th century for the treatment of venereal diseases.
There was, again, a room with 8 beds for non-Christians; the Median row was a room with 15 beds whose position and purpose are not known.
The Department Store had 109 beds for the slaves of the galleys, for the sailors and the disabled soldiers of the forces maritime and terrestrial services of the Order, for the disabled and for the construction workers.
Falanga had 120 beds reserved for the treatment of patients suffering from infectious or venereal diseases.
By making a calculation based on the data provided during that period, an ordinary number can be estimated of the Nurses of about 350-400.
Within the administrative framework it is worth noting that, since 1725, the medical-surgical team of rich men of experience after a traineeship in Italy and in France, consisted of:
three internal senior doctors,
three young internal doctors,
three internal senior surgeons,
two "practical" young surgeons,
six cerusici and a phlebotomist for bloodletting, which was helped by two assistants for the application of the leeches, cataplasms and vesicants.
The Pharmacy was run by a Pharmacist Chief assisted by five working Apprentices, a Reader of Recipes and a cerusic Barberotto of the enemas.
Nursing assistance was carried out by a number of Servants or Guardians, but the food was distributed from Cavalieri and Novizi, who took care of the sick during meals and each language11 he did his own duties in days set during the week based on a set shift.
While in Europe the "medical-surgeon debate" was raging, in the 1676 it was born at the Sacra Infermeria the University School of Anatomy and Surgery which became one of the most renowned in all of Europe (and one of the oldest). In this school the first lessons and the first experiments on cadavers were performed.
In the 1769 the great teacher Pinto transformed them into University: here the first female doctor will be "graduated" and she will be allowed to practice as a surgeon.
Within this school, the study of anatomy was made mandatory for all medical students and they had to participate in lectures and demonstrations during the whole year in the dissection of corpses. At the In order to facilitate this study it was decided that the bodies of the dying patients in the infirmary had to be dissected by the anatomy teacher. For those times this opportunity was a real rarity.
An interesting testimony of the cleaning and care of the lanes comes from a Her Majesty's Dragon Britannica, who in the 1687 wrote in his memoirs: "Passed through the gate, he walked around the pharmacy, very well supplied, then visited the doctors' rooms and entered the Square Courtyard. An intense one perfume pervaded it! There was a garden of orange and lemon trees. He passed them to another courtyard which he had in his turn a certain number of cedars and their sweet and fragrant perfume came fresh in every room, arranged all around. Then he proceeded to a room of 130 beds surrounded by curtains and valances. The "heads" of the beds they stood in regular order against the wall on each side of the 4 room at a distance of about one foot on the other. While between the two rows of beds there was so much space that twelve men could have walked side by side with complete peace of mind. Although there were numerous patients the atmosphere was pleasant, sweet and clean ... In another room, in addition to the beds arranged along the walls, there was a median row - placed frontally two by two, along the entire length of the lane - comfortably but without curtains or valances ... All the patients were served by the Knights with silver plates ... Despite such a tall one number of beds, was kept clean and tidy and there was no bad smell ... The kitchen - adjoining- al The Great Warehouse was in full swing. The cooks were at work, all intent on preparing food underneath the careful looks of the Knights responsible for control. There was plenty of chicken and lots of it meat, and many receptacles, plates and bowls, some of which are very large and all well arranged and cared for ... throughout honesty I can well say that I have never seen a hospital so nice and clean in the course of my life ...".
A few years later, in the 1791 the French Count De St. Priest12 so he wrote: "The hospital contains numerous large well ventilated rooms and large warehouses where, on the occasion, you can quadruple the rooms rows of beds: in these structures the unfortunates of all countries, of all religions, of all cults, are doing their best to the sick the assistance, the remedies, and the comforts of the Knights; they watch over not only the various administrative divisions, at the summit of which is one of the greatest dignities of the Order, but serve them themselves in the first person. The pottery used is almost all of silver, the simplicity of them work shows that this magnificence is not so much ostentation of luxury as the means of attention to dignity of the sick person".
To corroborate our theory on the "pioneering" approach of medical care by the Sacra Religion, we will now go on to describe the innovation brought about by the approval of the Regulations of the Sacra Infirmary, strongly desired by the Grand Master Manuel Pinto de Fonseca13 in 1725.
"Early in the morning the nurse14 makes the Visit sound in which it intervenes to make 'observe with the due to charity from the Medici the Infirm, and he has ordered the needy: he makes the Eater sound to warn all the officers, and assists the same to make every bed abide the pitance order him, and every one of the Subalterns should do his duty; and the same is done in the evening in the Visit, and Dinner."
They are foreseen sanctions for those Knights who are absent at the service of the Sacred Hospitality. The days of visit of the Novices establish that the various Languages15, of which the Order is composed, they must lend their work according to pre-established shifts16.
The shifts take place under the supervision of the Novice Master, two Commissioners and one Scrivano who he noted who was missing in the day, so that he could be admonished later. The Nurse Furthermore: "It must above all make sure to observe the due quiet, and therefore at night often visit all the beds, and Halls for the vigilance of the Guards, lights, and more ... has the authority to dismiss, and put the Guardians, or are Serve, and castigate them in the form they deserve, lacking the police and custody of the sick. He has in addition care Special of the House, called the Falanga in which the Holy Religion makes the poor children exposed, with the convenient separation of one, and the other sex under the care of three good women, and old ones doing them first to provide holy baptism, and then to nurse in the house of Balie, and to educate in the best form, procuring to place them, whether they are adults, or in Marriage, or at the service of honorable persons, and to raise part of Zitelle with due piety are reduced to a Conservatory where they pay the necessary maintenance".
An essential condition for an adequate and dignified care of Mr. Malato was also a correct hygiene.
Indeed: "The beds of the Sick are from time to time to change for the pleasant police and refer to them every evening from the Guardians, who must keep them politi. Li beds with pavilion, or cortiation are in all three hundred seventy, changing the Summer with pavilions of white canvas, those without pavilion are three hundred sixty-five. Those however used by people of suspicion of Etticia17, or else, they curl up with all of them sheets and other due robbe without any reserve ... The sheets change without reserve any second the need for the infirm, even though they had to be exchanged many times between the day. The blankets are still distinct, and separate, like the sheets, being there for Cavalieri, and for Religious, Secular, and chain, and they are a thousand, one hundred and fourteen in all. Both the sheets, like the blankets, used as they are, up to a certain sign is distributed to the poor, and poor beggars from the Prodoms18... winter for more the walls of the rooms are decorated with the tapestries of wool, which are handed over to the Liners19, who takes care of it, and these are divided into one hundred thirty-one pieces. The summer then the rooms are decorated with paintings, which are with good symmetry everywhere divided, representing many of them the Histories of the Sacred Religion, and in all ascend to the number of 85, including the Altar".
It is important to note, that in addition to an extreme sensitivity for the stillness, the dignity of the sick person, the Order he firmly held his grip on the spiritual aspects within the Holy Infirmary. In fact there is one entry in the regulation in which: "The head for the assistance of the Infirm is the Prior ... who takes care to do to reconcile all the sick ones who enter the hospital before the 24 hours, while otherwise they do not they would receive, and invite them over the Administration of the Sacraments, and assistance from the Dying to care for who in the company of the others makes his guards at night, and during the day, and confesses the sick ... Beyond that it gives from the Holy Religion an annual gratification to the Greek Papas20, who comes from his parish for to administer the Sacraments to those of his Rite, and Nation, which are found in the said Sacra Infermeria, in which from Sunday in Albis up to the Ascension, all the Sundays the Clergy of the Conventual Church of S. Giovanni, with near the Eminentissimo Grand Master, Gran Croci and Cavalieri carries processionally, and in the Great Altar of it after many pious Orations, the Gospel is sung ..."
It should also be noted that the entire hospital complex was considered "sacred" or "holy" on the assumption that in it the Lord Jesus himself was welcomed and assisted in the mystery of the sick. This is why it comes blessed and consecrated all as "church". In fact, in the Hospital there is no specific building to the oratory - except the one built in the 1719 by order of the Grand Master Perellos21 in order to conserve you the Blessed Sacrament -, but altars are erected in the single rooms of hospitalization, in perfect harmony with the Giovannite medieval structures (see which example S. Giovanni di Prè in Genoa22) in which the lane of the sick architecturally is the simple extension of the church, signifying continuity inseparable: from the altar to the service of charity, from the service of charity to the altar. In the 1787 the complex of the Sacred Infirmary was able to ordinarily host sick 563s, compared to 350 400 / 60 years earlier. In an emergency, the capacity ascended well to 914.
A structure of particular interest is the Hospice for the disabled in Floriana. The characteristic of this house (commissioned by the Grand Master Brother Manoel Pinto in 1729) was the division into two sections - male and female - who assisted the disabled, arteriosclerotic and "unsafe" spinsters. It welcomed therefore, people with no pathologies at risk, but only individuals whose only illness was basically old age. The maintenance at first, was assured by the same Gran Master, but subsequently provided for a specific endowment.
Speaking of the section of the Regulations concerning the professional figures necessary in the Hospital, it it provided for pay for doctors and surgeons even outside the Holy Infirmary. In fact, the Convent of the Discalced Carmelite Fathers at the Borgo, he had a doctor and surgeon in the pay of the Giovannites. They were also present sanitary facilities in Bormola and Isola. These, being salaried by the Order, had the obligation to write for free all the poor Inferme necessary medications, explaining the name, surname, City and street of the Infirm to inform the Commissioner. They had to visit for free all the Poor feverish and needy and accompany the appointed Commissioners when they were making their visits.
The practice in visits to the Holy Infirmary was that every day in the morning visit the doctors they had to prescribe exactly the type and quantity of food to take to each patient and for do not run the risk of misunderstandings or errors, two scribes had to be independent of each other compile the list according to what the doctor said. Once the patients had finished the two lists came approved and signed by the doctor, the scribe and the Prodomo; the latter then proceeded to transmit them one to the kitchen to arrange to prepare what was prescribed. On all this proceeding he had to to rigorously monitor the Commissioner of the Congregation on duty. The quantity and quality of the food is object of meticulous control by the Commendatore, even if food supplies are competence direct of the Prodomo. In case of contrast of evaluation between the two, the genres in question must be examined by the primary physician or secondary and accepted or rejected at its sole discretion. Furthermore, the Commendatore is in charge of supervising the supply of milk. The caretaker was also provided with surgical instruments manufactured in Paris. The king of France did not want anything missing and the wounded could to be completely reassured because the Surgeons had the best tools produced by the technique French. In the free moments of the service of the governmental, administrative and military terrestrial sector or maritime, the Cavalry Friars were obliged to lend their work in the Sacra Infermeria, a title that then used for Hospitale in both Jerusalem and Rhodes and Malta. Indeed, as mentioned, for those who wish it and, therefore, by free choice, there was also the possibility to reside periodically in the "Cammarata", residence the premises of the Sacra Infermeria.
Even with a first-rate medical and nursing staff who guaranteed a singular efficiency at the Sacred Infirmary, no Knight could feel exempt from service and dealt with service humble: helping in changing the bed, in personal hygiene, in heating food and feeding the patients or simply in keeping company and comforting the suffering there, even by praying for and with them.
Sanctions were planned for those Knights who were absent at the service of the Sacred Hospitality. The days visitation of the Novices established that the various Languages, of which the Order is composed, should lend theirs operates according to pre-established shifts. The shifts took place under the supervision of the Novice Master, two Commissaries and a Scrivano who noted who was missing in the day, so that he could be admonished in a second moment.
The vast majority of doctors come from Italy, massively from the Kingdom of Naples, above all from Sicily. At a certain point, however, one acquires the awareness of a possibility of self-sufficiency and comes decided by the Government of the Knights to set up a medical school in Malta for in - house training of medical - health personnel, which responds to the specific needs of the Archipelago and the Navy. THE Knights when they died they had to leave their body for the medical school at the disposal of the medical school a few days before the burial in order to allow "exercises" and experiments. A document very interesting found during our research is the "master's chirograph over the service of the Surgery "of the Magister Hospitalis Hierusalem. In it the Grand Master himself intervenes so that yes respect the basic parameters to practice the profession of surgeon: "Being very necessary and useful at the service of the Sacred Hospital, those who serve in surgery they were capable, well-educated, and diligent and punctual, we want, and command, that they are inviolable observe and execute the following Ordinationes. All Prattici and Barberotti of the aforementioned Spedale must be respectful, and obedient to the Medemo Surgeons, and execute all that on time; he will be ordered by those who will be mesata ... Finally the Violators to the above orders for the first, and second time they will lose the bread of that day, in which they will miss, and for the third will be with our private participation of the office, without hope of being never reintegrated."23
Another interesting intervention is related to the organization of the medical studies that are carried out at the Hospital. The Protomedico Giorgio Imbert, in charge of supervising the two chairs of theoretical anatomy and of surgery with the 16 January 1775 master chirograph, he soon identified a "supplicatio" to Grand Master Frà Francesco Ximenes de Texada24 proposing a plan of lessons and studies for the necessary approval. This was granted with resrypted on 11 March 1775 date. From it we deduce thetraining course for future doctors. The courses invariably started the 19 October and ended at the end of June. Lessons were held every day, except holidays and on Thursday and Wednesday in which l'Medical Academy. There were two teachers: the Professor and the Reader. The Professor taught anatomy in the appropriate Anatomical Theater attached to the Hospital the morning from 10 to 11 using corpses and any other useful tool for this purpose. Completed the anatomy course, proceeded with the course of surgery - always on cadaver - which ended with the treaty of obstetrics.
The reader, holder of the Cottoner chair, was consignee of the Zammit Library, he kept his lesson in the Holy Infirmary every day from the 15 to the 16: they were except, of course, the holidays and those Wednesday or Thursday in which the Medical Academy was held. The reader was given courses in physiology, pathology, semiotics, hygiene and surgical therapy.
Regarding the issue of women, we want to point out here that women were not left to themselves! They were not accepted in the Holy Infirmary, but there was a hospital dedicated to them. The name of this structure was La Casetta or Incurabile. In it were welcomed both poor and women able to pay inpatient expenses.
The number of rooms in the female hospital included: "Sala Vecchia for feverish people. Room of the smears for mercurial union. Hall of wounds for the Surgery. Room for the old, and invalid. Two rooms for the crazy ones. Room for the parturienti. The number Ordinary of the beds is to be sixty in seventy, not including the time of the mercurial anointing. "
Finally, as regards the reception of the poor exposed, should they become infirm, it will be the Holy Religion to assist them, giving them double ration of food and the best bed, doing the part of the "Pious Mother". For this structure, the same prescriptions of the Holy Infirmary were in force: "Order for a long time the Holy Religion to the aforementioned Commissarj of the Poor, who take care of that place by regulating it in the form best, and yet from them the Infants of everything necessary for La Mancha, invigilating above the good quality of the robba, and above the due police of the Sale, and service of the same ... Retains of plus the Holy Religion in the incurable saying an elderly woman, who is called Governor, who habita ivi, and has in hand all the existing linen in sheets, blankets, pillows and matarazzi, which provides the aforementioned foundation; waves has the task of giving read to those that come with the policy of Commissioner, according to their condition and infirmity, invite him not to come to visit the Infirmas that person known, and has it closed, and open at the due hours the door, and takes care above all to the police, and quiet dell'Inferme. There are four salaried servants to serve the Poor, making them the beds, and all that it is up to the servitude due. More another woman to minister the Mancia, and heat everything that makes of need and take care to always keep ready of the good consumed for all this, which may be necessary in any time. Eating is cocinated in the Sacra Infermeria where the Coco is expressly paid, and from that is transported in the morning, and in the evening in the little house not far from two slaves destined for it."
In the medical environment of that period there was also a strong need for specific training for the female staff. This also results from the fact that the Balì Frà Sigismondo Piccolomini president of the Casetta delle Donne, proposes to have the young workers do a course to make them suitable to assist them Surgeons and, apparently, from the 1728 a number of nurses specialize until one of them he even graduated in Surgery.
Coming now to food, the conviction of the beneficial and therapeutic effects of the dishes is explained in one specific section of the aforementioned Regulation. The provisions were valid both for the Sacra Infermeria and for the Incurable. "Above all else what is required by the Prodomi above the good quality of the stuff that is it is necessary to serve for the Pitanze always taking the best, and therefore they give to the Infirm excellent consumed of hens, herbs, vermicelli, rice and pisti, and all those fates of meat, which are ordered, like chicken, pigeon, poultry, veal, vitellazza, hunting, piccatiglio, frigassia, stew, meatballs, in that quantity, which agrees, besides the amendolate, where fresh, plum, and zibibbo, and any kind of refreshment allowed to the sick, as restorers, biscuits, pommes, and garnets with zuccaro, and other kinds of jams; according to the need of each; with the Knights and persons of the Dress, double Pitanza is given."
"It is requested by the Commissaries above good quality of the dishes, and therefore it is their inspezzione to try everything in that form, which they judge. The consumed is the same, which is given to the Infirm in the Sacra Infermeria. The soup such as every day it changes into soup, herbs, gnocchetti, tagliolini, rice, and more. The meat is of chicken, pigeon, poultry, veal and vitellazza, in meatballs, stew or fry-fess, besides the dishes, hunting, modified, biscuits, restorations, and other jams allowed according to the need of the Infirm, to whom every one is given fate of food in case of inapetenza."Given the therapeutic value attributed to the diet, one is required particular attention to ensure that foreign foods are not supplied both from the inside and from the outside a as set by the doctors. To discourage this possible abuse, there is even a ban on opening taverns or food shops near the Hospital buildings. All staff is empowered to this end, although the specific and explicit task is attributed to the Guardians and to the Goalkeepers. To this There is a very strict - and economically very demanding - regulation concerning the maintenance of food: in the evening nothing should be stored in the kitchens for the next day, but all thesurplus must be distributed to the "pupils" and the Poor. In addition to the obvious charitable dimension, it results clear that the maintenance of food was very difficult and a source of serious risk if it is held account of the existing climate in Malta and of conservation structures that did not allow for very short lead times for perishable food. From this point of view the regulatory insistence on quality is further understood and freshness of the ingredients of the diets. And here we can also add the fact that the bread had to be fresh from the day and in sufficient quantity to ensure even secondary use, but not less important: the crusts were used for the soups, the bony part was used for the poultices. Of the diet generally, besides bread, wine, various oils, pollen, vermicelli, egg, milk and whey were part. THE'attention given by the Knights to the Sick in the Sacred Hospital was not limited to diets and to prophylaxis. Inside the structure there was even hot water always available through a system of coal-fired stoves present in all the rooms kept lit day and night. This presence involved a evident damage to the health of patients due to carbon monoxide emissions and consumption of oxygen. In the Regulations of the 1796 the Congregation is prescribed to study the methods of realization of a centralized boiler system outside the halls, but ensuring an efficient distribution service.
Another element attesting to the great sensitivity of the Giovanniti towards the Service is the guarantee granted to the Infirm to carry out entirely confidential or even anonymous appeals, reports of defects, denunciation of abuse through a closed box with two different keys in which anyone could testify their observations and complaints. Every meeting of the Congregation had to start without fail with the opening of the box, the withdrawal and the careful consideration of what is contained therein in order to intervene as quickly and effectively as possible.
Once we have arrived, due to the need for synthesis at the end of our research, we can not but underline and reaffirm thean element of novelty brought to light in the period known today as the Enlightenment by the Regulation of the Sacred Infirmary. The discipline that today we could define bioethics, has certainly benefited from this different way of seeing Mr. Malato. With an advance of several years on the great pioneers which they can to have been Peter Frank25 or John Gregory26.
NOTES
1 See the Compendium of the Social Doctrine of the Church - Libreria Editrice Vaticana, reprint 2013.
2 See Mc 1, 32-34; 3,7-12; 5, 34; 6,54-56 in the Jerusalem Bible.
3 Ṣalāḥ al-Dīn Yūsuf b. Ayyūb b. Shādī b. Marwān (1138 - 1193), was a Sultan of Egypt and Syria and Hijaz, from 1174 to his death, with al-Malik al-Nāṣir laqab ("the victorious sovereign"). He founded the Ayyubid dynasty and is ranked among the greatest strategists of all time.
4.See. www.orderofmalta.osj.org/compendio-storico.html
5 Being an island anyway, the birth of "illegitimate" children was common practice. The clergy, moreover, condemned with mothers suffering in the flames of Hell those mothers who renounced pregnancy
6 Establishment of the Order that administered the Holy Infirmary.
7 Fonte Treccani. About 11.000 people lived in Gozo.
8 Source Indexmundi
9 Since medicine in this regard had not yet reached the point of defining special specializations, the treatment and conditions of these poor infirm were common to those of Europe, that is, practically nil. Tied to the beds, forced to isolation cells if furious, even chained in the walls if deemed uncontrollable. The concern that emerges is above all the one that does not damage the other sick people and disturb their stillness. In their regard, the only tract of true humanity is contributed by the fact that the chaplain their staff must watch with great care because the staff do not take advantage of their situation and above all strictly controls that all the patients eat their assignments every day.
10 Unfortunately, the Italian bombing during the Second World War made structures and archives partly unrecognizable and unusable.
11 The Venerable languages of the Sovereign Military Order of Malta were subdivisions prior to the loss of the island of Malta by the Sovereign Order used to identify the areas of provenance of the members of the Sovereign Militia.
12 François-Emmanuel Guignard, comte de Saint-Priest (1735 - 1821), was a French politician and diplomat during the Ancien Régime and the French Revolution.
13 Manuel Pinto de Fonseca (1681 - 1773) was Grand Master of the Order of Malta from 1741 to 1773.
14 From the Regulations of 1631: "It is of great importance that a prudent and discreet man, who is Head, Rector, and Guide in the service of the sick, is deputed to the care of the hospital and the care of the sick".
15 See the 12 note
16 Tongue of Provence: Sunday; Auvergne language: Monday; language of France: Tuesday; Italian language: Wednesday; language of Aragon: Thursday; language of Alemagna: Friday; Languages of Castile and Portugal: Saturday.
17 Tuberculosis.
18 Probi Homini
19 Probable Frenchization from the term Lingèrie. The one who was in charge of the Wardrobe.
20 To prove this care for souls, the Knights were willing to "finance the competition" orthodox!
21 Ramon Perellos de Rocaful (1635 - 1720) was Grand Master of the Order of Malta from 1697 to 1720.
22 The commendam, ie the convent and the hospitable (rooms on the ground floor), fulfilled the dual function of a maritime station on the routes of the Holy Land and hospital (hospital), initially for pilgrims and later for the sick and the needy in the city .
23 This is to reiterate the need for professionals operating on the island, which, despite belonging to important families, with professional curricula of great interest, they must necessarily "stay in place", so that there are no duplications in roles or overlapping skills, under penalty of removal from office.
24 Francisco Ximenes de Texada (1703 - 1775) was Grand Master of the Order of Malta from 1773 to 1775.
25 Johann Peter Frank (1745-1821) was a German physicist and hygienist who was a native of Rodalben
26 John Gregory (1724 - 1773), also called John Gregoire, was a physicist, moralist and writer of Scottish medicine of the eighteenth century.
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