Inspector of Hospitals Ralph Green And the plague in Malta of 1813
Inspector of Hospitals Ralph Green
Bubonic plague made periodic visitations to Malta. The harbour towns of Valletta and the Three Cities of Senglea (L-Isla), Vittoriosa (Birgu) and Cospicua (Bormla) were usually the first to receive the plague, from where it spread inland. It was inevitable that, when plague raged in the Levant and along the Barbary Coast, merchant vessels would at some stage facilitate its ingress into the island.
The Order of St John relied on quarantine and a vigilant Board of Health to safeguard the population. The reaction to a notification of a suspicious case to the Protomedico pursued a predictable course. A period of uncertainty or denial would be followed by panic when those who could, fled to the countryside. In so doing they carried the plague away from its bridgehead. The Board of Health assembled and introduced the necessary measures to isolate, contain and eliminate the pestilential contagion. The infected were removed to the lazaretto on Manoel Island. Fort Manoel was used to detain those who had come into contact with the sick. Susceptible goods deemed to retain the contagion were rooted out and destroyed.
The management of the plague of 1813–1814 differed in one important aspect from the previous outbreak of 1675–1676. Malta was now under a British administration with Lieut. General Hildebrand Oakes at the helm. The Board of Health had been "invigorated by a stamina of Englishmen".1 Deputy Inspector of Hospitals Ralph Green was a member of the Board of Health and acted as Superintendent of the Quarantine Department, from 1806 to 1811. He was also the Principal Medical Officer in Malta. In 1811, Green was relieved by Deputy Inspector of Hospitals William Pym. In 1813, Pym made way to Inspector of Hospitals Robert Grieves, another army medical officer. The garrison surgeon, Staff Surgeon Joseph Thomas was president of the Board of Health.
Thus, army medical officers occupied key positions in the health department of the island. Their handling of the plague was harshly criticised by Physician to the Forces Arthur Brooke Faulkner. As their measures failed to check the inroads of the malady, they blamed the government for not implementing their proposals. Physician to the Forces Robert Calvert said that "it seemed to laugh at their exertions, and jumped from house to house, and from street to street, those who had no communication together, as well as those who had, fell alike victim to its fury".2
On 3 October 1813, Lieut. General Thomas Maitland replaced the ailing civil commissioner. Maitland was not one to rule by committees. He immediately grappled with the problem, swept all aside, and channeled his boundless energies in exterminating the contagion. His unshakable belief in the righteousness of his actions brought him into disagreements with his staff medical officers, who foundered against the unassailable rock of "King Tom".3
The Pestilential Effluvium
What did the 19th century doctor do when faced with a very ill, febrile patient? He had no pocket textbook of medicine to consult. Medicine was then an art rather than a science and therapeutics still embryonic. The only guides he had were his observations, past experience and speculation. If the fever was accompanied by inflamed boils, large painful swellings of the glands of the armpit or groin, or by a petechial rash, then the patient might have the plague. But the physician had to be absolutely sure of his diagnosis, for the economic implications of declaring the existence of plague were catastrophic. Far better to err on the side of caution and proclaim the illness as typhus. In both typhus and plague, patients were very febrile, often delirious, and developed a rash, before they expired. If unsure, it was best to say typhus and allow the dead a Christian burial in their parish church, rather than a grave outside the city walls.
The early physicians did not know what caused the plague or how it was transmitted. The medical profession was divided between the contagionists and the miasmatists.
The contagionists, exemplified by Ralph Green, believed that absolute contact was necessary for infection in plague. Green maintained that the poison was always absorbed through the skin, and that quarantine was effective. "As to whether habits of cleanliness and general ease to diet and other particulars offer some protection against the infection, I should think certainly that poverty and wretchedness of diet and clothing have their influence in producing diseases, but however attentive, cleanliness will not save from the plague for the healthiest and the strongest have had it and died, and the Maltese were remarkably clean both in person and in their houses and far removed from want by poverty".4
The miasmatists, represented by Robert Calvert, associated infectious diseases with the generation of miasma and an altered state of the atmosphere confined to certain localities. This acted upon susceptible individuals, the poor or moral degenerates, such as drunkards and prostitutes who provided a fertile ground for the propagation of the illness. Calvert held that the contagion or principle of plague is diffusible in the atmosphere to a distance greater or less from an infected body, according to the climate and season of the year, and possibly to other peculiar states of the atmosphere, with which we are unacquainted; that in the spring or summer season, a single infected person is sufficient to contaminate the air of a whole city; and that those who happen to be then exposed to febrile causes, or otherwise predisposed, are the first to become its victims. That these newly infected persons generate a fresh supply of poison, increasing its strength and influence, till at length it becomes so powerful, that nothing but the winter season will entirely put a stop to it.2
The aetiology of plague lay not in miasma or contagion but in the rat and its fleas. In 1894, while working in Hong Kong during the third plague pandemic, Alexandre Yersin isolated the organism Yersinia pestis. By 1910 it became established that the flea Xenopsylla cheopis transmitted the bacterium among the black rat, Rattus rattus, and accidentally to men when infected rats die.
The Brigantine San Nicola
The official version linked the outbreak of plague in Malta with the Brigantine San Nicola. Maitland believed that the plague was "brought into Malta by a ship from Egypt, and conveyed out of that ship by a person smuggling some leather; this person and his family were the first to suffer from it".5 Inspector of Hospitals John Hennen thought that the plague, although not recognised as such, had been introduced before the arrival of the San Nicola by means of cloth "which had been in circulation in Valletta, enveloped in their original wrapper, the manufacture of Alexandria; thus showing that, in contravention of the quarantine laws, they had been brought into commerce, without being previously purified".5
The San Nicola had left Alexandria on 17 March 1813 with a crew of twelve. Two of the crew fell ill when they were a week's sailing from Alexandria. Six to ten days is the incubation period of the plague, which implies that the men were infected in Egypt. The sick were attended by their captain and his servant. On arrival at Malta on 28 March, the San Nicola was kept for a fortnight in the middle of the Marsamxetto Quarantine Harbour.
Green commented that there had been a considerable difference of opinion between the Board of Health, which exhorted the destruction of the vessel and its susceptible cargo, and the governor who balked at the compensation that would have had to be paid to its owners. Brooke Faulkner urged its removal into a temporary lazaretto at St Paul's Bay. Instead, two guard boats stayed with the ship and ensured that there was no communication with the shore. On 8 April, the governor allowed the owners to procure a fresh crew and relocate their ship to Alexandria.
The men from the San Nicola were admitted to the lazaretto after taking the "usual precautions of shaving their heads, washing themselves with sea water, and afterwards with vinegar, and leaving their clothes behind them in the ship".2 Green, in his capacity as a member of the Board of Health, examined the captain and crew, but found no signs of plague. On 1 April, roughly a week after they had tended their sick comrades, both the captain and his servant fell ill and died. Robert Calvert attributed the outbreak of plague in Valletta to the pestilential effluvium generated by those plague bodies buried at the lazaretto.
The arrival of ships at Malta with plague on board was a frequent event. Yet plague did not suddenly engulf the island on every occasion. The alleged link between the San Nicola and the appearance of plague in Valletta was coincidental.6
It is most likely that infected rats brought the plague from Alexandria in an unsuspected ship which berthed along the marina in the Grand Harbour. All the index cases occurred in the slum area of Valletta around the neighbourhood of lower Strada San Paolo and Strada Pozzi (Old Wells Street). On 16 April, the child of Salvatore Borg died at 227 Strada San Paolo. Her mother and other family members also fell ill and died. On 6 May, midwife Maria Agius, who had attended the wife of Salvatore Borg, was found dead in her house at Strada St Ursula. Grazia Pisani, a young girl who had slept in the house of the midwife also fell ill. On 7 May, boy Falzon died at 150 Strada San Paolo. On 16 May, the son and daughter of the baker Stellini died at 92 Strada San Christoforo. These early deaths were not declared pestilential. Between 12 and 31 May, Strada San Paolo had six cases of plague, Strada Pozzi, near the Sacra Infermeria, recorded 16, Strada San Nicola had 8 and Strada Ospedale reported 12 deaths.5
Physician to the Forces Arthur Brooke Faulkner and the Board of Health
Physician to the Forces Arthur Brooke Faulkner lay the blame for the dissemination of the plague squarely on the Board of Health. In his views they delayed the introduction of effective measures to counter the diffusion of the pestilential effluvium. "There were so many channels through which from the state of the quarantine defence, this insidious malady may be supposed to have crept in," affirmed Brooke Faulkner that, "it appears to me little less than mere waste of time to take any pains in tracing this event to any particular instance of laxity in the Department of Public Health. Whilst the different colleges in the continent of Europe were referred to for their opinions on the identity of the disorder, it was daily gaining ground and when finally the answers of those colleges arrived deciding upon the nature of it, a lamentable proportion of the population had already been carried off. So necessary is it to oppose with vigour the first advance of this deadly enemy and by earliest moment to be prepared against his attempts".7
Brooke Faulkner observed, "that the servants who conducted the first case of plague to the lazaretto returned in eight days and mixed at liberty with the population; that the physician who attended the case was likewise left at liberty to go through the city before being subject to any quarantine restrictions; that the public hired carriages were allowed to take fares, though lined with cotton; that for several weeks after the plague entered Valletta the intercourse among the population was more or less promiscuous; the seclusion of people within their houses not being enforced with any punctuality; that even the carter who drove the pest cart was not put under quarantine restriction for a considerable length of time in consequence of which he was in the frequent habit of going out at pleasure, and marketing for his family, the greater part of whom died of the plague. Since so many instances existed of laxity in the Department of Public Health, can it be wondered that the plague had a rapid and wide circulation?"7
Brooke Faulkner was pitiless in his criticism of the Board of Health. "Nay until the month of July was well advanced, there was not even yet a corps of twenty guards to give proper effect to any ordinances of public health. The houses of the infected inhabitants were shut up for weeks without even being purified or cleansed, although contaminated with articles of the most susceptible kind, and even living animals, whose escape it is well known as liable to carry the disease where ever they went".7
Brooke Faulkner chided the president of the Board of Health for issuing ambiguous proclamations, such as the one of 12 May 1813. In his proclamation, Thomas observed that the chief of every family who wished to adopt the recommended precautions must announce his intentions to his dependents, "who not consenting to conform thereto, under the apprehension of the rigorous punishments prescribed for the violation of the quarantine laws, will be allowed to quit the house. Thus, the grand punishment for violating any of the quarantine laws" retorted Brooke Faulkner, "was no more than that the delinquent should be allowed to quit his house, get the disease of course, and carry it about to his neighbour".7
"What despondent reflections must not such an appearance of blindness to our danger have been calculated to raise in the mind of any one duly appraised of the consequences? I confess, I saw it with horror and impatience, which caused me to take pains in pointing my sentiments freely, and with an earnestness, which considering the manner in which the offer of my advice was received, nothing but a strict and conscientious sense of my duty could have prevailed with me to do".7
Thus, concluded Brooke Faulkner, "until an adequate sanction was provided to give the law the necessary efficacy, we cannot be surprised that the multitude, ignorant of their danger, should not have been of their own accord very rigid in the observance of any rules or regulations, which from the manner of their being executed, it is possible they might have thought were not intended to be very religiously obeyed".7
Deputy Inspector of Hospitals Ralph Green and the progress of the Plague
On 19 April 1813, the Maltese Physician Francesco Lorenzo Gravagna visited the moribund 8 year old daughter of the shoe maker Salvatore Borg at 227 Strada San Paolo Valletta. The child had been ill for six days and was scrofulous. Gravagna attributed her swollen glands to a skin complaint and her rash to putrid typhus.8
On 1 May, he visited her mother who was seven months pregnant and gravely ill. Her clinical picture was more convincing. She was febrile with painful buboes in her groin. The mother went into early labour, delivered a still born child, and on 4 May followed her children to the grave. Her four year old son and her husband Salvatore Borg were also ill. Dr Gravagna was now no longer in doubt as to what he was dealing with.
The Board of Health removed the Borg family and all those known to have been in contact with them to the Lazaretto. It also strongly recommended placing an embargo on all shipping until such time as the opinion of the medical faculty with regards to the pestilential nature of the disease might be confirmed or removed by further observations. On 9 May, the malady was perceived to have made no further advances. The embargo was removed, and vessels were permitted to leave Malta with "foul bills of health".
Green informed his regimental surgeons that he had inspected the cadaver of a female who had died of plague. He urged them to be vigilant and to carry out frequent inspections of the troops, "as it was very probable from the incautious life of a soldier, some one might receive the infection and communicate it to the rest of the garrison".9
Green had previously encountered the plague while serving as an Inspector of Field Hospitals with Sir Ralph Abercrombie's army in Egypt. Plague had broken out at Aboukir in May 1801 among the wounded in the hospital. He recalled that the infected were immediately removed to the pest hospital. Everything that belonged to them, clothes, accoutrements, tents and blankets were burned instantly. Ominously, he remembered that "when the plague first appeared there was great difficulty in getting nurses to attend the sick. Most of the women refused to act. However, necessity has no law and there was an order given that they should draw lots as to who was to go on duty in the pest hospital. Among those whom it fell upon was the wife of a Mr Taylor 54th Regiment. She went to the pest hospital and died there. Her husband smuggled her clothes back into camp and in consequence he and two of his sons died".4
On 7 May, Green assembled his regimental surgeons and instructed them to draw up a few rules for the guidance of the Maltese. Members of this committee were: Mr William Stafford, 3rd Garrison Battalion, Mr Francis Wesque Dillon's Regiment, Mr James Safe 14th Regiment, Mr Griffith Jones 44th Regiment, Mr Edward Beck Royal Artillery, and Mr John Allen Principal Naval Surgeon. Two other members, Mr Joseph Thomas and Mr William Tiffin Iliff, were absent on essential duties.10
The regimental surgeons, however, found to their mutual astonishment and distress, that none of them had ever seen the plague. "From the state of our knowledge of the disease", commented William Stafford, "we could have but little to recommend, and this was chiefly to keep the bowels open by mild laxatives, to drink plenty of lemonade, to pay strict attention to cleanliness, frugality in diet and temperance in conjugal pleasures".7 The committee chaired by Arthur Brooke Faulkner drew up a number of recommendations which were relayed to the public by the Board of Health.10
Up to 13 May, the Board of Health deluded itself that the disease was completely under its control, and that the only seeds that had taken root were securely shut up within the Lazaretto. The departure of the San Nicola somewhat reassured them that the plague had gone away. Others began to doubt that plague was really amongst them and failed to implement the precautionary measures issued by the Board of Health.
To dispel the general disbelief in its existence, Deputy Inspector of Hospitals Ralph Green, Garrison Surgeon Joseph Thomas, and Apothecary to the Forces William T Iliff published a declaration affirming that "we the medical officers of the hospital staff in Malta who have seen and assisted in the examination of the bodies of several individuals who have died in the lazaretto and in the city of Valletta some of whom we saw during their illness, certify that no doubt exists in our mind that those individuals notified in all the bulletins published since 7 May as having died of plague, did die of real and malignant plague".11
By 16 May, the disease was cropping up in so many places that the Board of Health "foreseeing the difficulty of continuing to separate the diseased from the sound, came to the resolution of permitting the infected to remain in their respective houses. Such houses were, however, placed under a proper guard and kept in a state of quarantine.2
On 20 May, they recommended shutting up the entire population within their houses for 40 days. Valletta was divided into eight districts, each under the supervision of three deputies who had to inspect and report their observations to the Board of Health. The inhabitants were confined to their own district. The Maltese Provincial Battalion guarded the barriers erected to prevent the movement of people across boundaries.
Healthy members of infected families, as well as those suspected of infection, were transferred to Fort Manoel and the Lazaretto. On 21 May, Baron Benedict Muller de Friedberg took command of the sanitary cordon at Fort Manoel. As the fort became over-crowded, small wooded houses or barrache were erected in the ditches of the fort. Subsequently similar ones were placed in the ditches near Porte de Bombes and the bastions of Floriana. These huts were built against the wall about twelve feet square with sloping roofs and a small window. They were placed twelve feet apart with bars between to prevent communication, but without furniture or conveniences of any kind except what might be provided by the inmates. Joseph Thomas, supervised the opening of at least twelve of these so-called pest hospitals, which he visited at all hours, and exerted himself to the utmost of his ability to give them his continued superintendence.
The barrache were exposed to the unmitigating summer sun and the reflected heat from the bastions must have made the place extremely unpleasant to live in. All efforts were directed at decimating the contagion. Very little thought was given to the comfort of those unfortunate people. Hospital accommodation was not provided. That at Fort Manoel consisted of two small casemated ground floor barrack rooms in which 234 people died in June 1813. The three hospitals in the ditches at Floriana were of similar construction as the barrache. In these the mortality in July and August amounted to 791. A civilian pest hospital was also established on the Bighi Promontory for the sick of the Three Cities.5
When Maitland arrived at Malta in October 1813, he found the whole of Valletta and Floriana resembled more a plague hospital then a regular government. Pest houses for the reception of those with plague, existed wherever the fancy or caprice of the medical men chose to put them. The lazaretto appropriated for the purpose and Fort Manoel were left totally vacant and those infected were living so much out of the power of any human precaution to hinder them from intercourse with the well, that the only thing which astonishes me is that it ever subsided at all.12
Oakes would not allow Green or his medical staff officers to visit the civilian plague hospitals, so as not to deprive the army of medical assistance in time of need. The penalty for feeling the patient's pulse, even through a tobacco leaf, and with every possible precaution, was not less than fifteen or twenty days in close quarantine. Mr John Allen, Principal Naval Surgeon in Malta, was confined to his house for twenty five days for having felt the pulse of a man in his own department, and though after the contact he used every kind of care to prevent the absorption of the virus.13
Brooke Faulkner regarded the refusal of the garrison commander to allow him access to the Maltese hospitals an intrusion in his professional freedom and a stumbling block in the advancement of scientific knowledge. "Could I have myself ventured an opinion upon the subject in opposition to so high authority, I should certainly not have hesitated to say that the prohibition of a medical officer from visiting the sick, so far from being an eligible measure, was calculated to oppose the most complete impediment against availing the army of any benefit whatsoever from their advice, by shutting out the only satisfactory inlets to medical knowledge. If this be not admitted, it must follow, I should think, that it was of very little consequence whether medical men were employed or not".7
Oakes relented, and on 2 June allowed Brooke Faulkner and Naval Surgeon Saunders just half an hour to visit the pest hospital, and enquire of the local practitioners the kind of treatment they employed. Brooke Faulkner was aghast at what he saw. "Twenty eight patients lay in a room, some on straw, others on the floor, attended by two convicts. The sick had no change of linen and were obliged to lie either without shirts, or in their foul every day clothes. The small rooms housing the sick were neither purified nor whitewashed before fresh cases were put into them, and they became in consequence a mere hot beds of fomites".7
More and more restrictive measures were imposed on the population, but to no avail. The public were alienated from the members of the Board of Health. They could not go out to the countryside as traffic between towns and villages was banned and barriers had been erected to prevent communication. They had to abandon their cotton fields, as this cash crop was deemed a vulnerable item which retained the contagion. They could not go down to the ports to earn a living.
The Board of Health too became frustrated. It did not have the power to enforce its proclamations and the executive did not always agree to its recommendations. It felt that the public was holding its members culpable for the protraction of the epidemic. Its annoyance came to a head on 22 June 1813. The members of the Board of Health requested the civil commissioner to publish the various resolutions and suggestions that he had been given, which for whatever reasons he had deemed fit to ignore. The honorary members on the Board of Health: Ralph Green, George Moore, Agostino Portelli and Jameson Hunter, were not satisfied with the reply from Oakes. On 26 June, they asked to be excused attending further the deliberations of the Board.
Oakes had always regarded that body, composed for the majority of officers of the public health, as a purely deliberative congress. They were mistaken if they believed that he had ceded his functions as civil commissioner to them, and for saying they were humiliated with the limited power they possessed. On 29 June, Oakes dissolved the Board of Health, and replaced it with an Extraordinary Council of Health. Green and Thomas became members of this new body.
The resignation of Ralph Green from the Board of Health was not considered a gentlemanly conduct for a commissioned officer of the crown. He may have caved in to pressure to maintain an unanimous front. Whatever his reasons, his conduct did not endear him to Maitland, who rebuked him and Thomas for presuming to take upon themselves the functions of the executive government.
The Extraordinary Council of Health did not survive Maitland's rule. On 29 November 1813, he adjourned it indefinitely. In his proclamation of 23 October 1813, Maitland declared that "however much he approves the eminent exertions of the various medical departments since the plague broke out, is sorry to observe that the separate and distinct powers and duties of the several branches of these departments are by no means accurately defined or clearly understood. To prevent therefore the possibility of any collision in future or of any doubt in this important subject, he is pleased to direct that the powers of each be hereafter considered and understood to be as follows: The health of the troops composing the forces in these islands with the exception of the police force is to be under the sole supervision and care of Mr Green under the orders given to him by the commander of the forces. The health of the island in general is to be under the superintendence and guidance of the proto medico, as the Head of the College of Physicians. The lazaretto under the superintendence of the Acting Superintendent of Quarantine. Each of these officers will attend at the palace daily at 9 to make their reports."
Plague and the Garrison
In 1813 the Malta garrison consisted of the 2nd/14th Regiment stationed at Lower St Elmo Barracks, the Sicilian Regiment at Floriana, the 3rd Garrison Battalion at Floriana, De Roll's Regiment at the Auberge D' Italie Valletta, the Royal Artillery at Fort St Elmo, and the Maltese Provincial Battalion. In addition there was a naval presence in the Cottonera with its naval hospital at the former slave prison in Saint Christopher Street Valletta.
Green in his letter to the editor of the Giornale di Malta, dated 4 September 1813, states that plague made its appearance in the garrison on 28 June in a soldier of De Rolls Regiment. The soldier had been ill for 3 days with supposed common fever and died before daylight that morning. Five other soldiers in the same room were found infected and the establishment of a plague hospital became immediately necessary. This took a short while to establish as Brooke Faulkner stated that "we were at one time so ill off for a general pest hospital that medical staff officers were under the necessity of attending plague cases at the barracks under canvas."
Green was a firm adherent of oily friction as a preservative against the contagion. He was so convinced of the beneficial effects of oil that he introduced it to the rest of the garrison. He recommended that Oakes buy a sufficient quantity of the finest oil for consumption over several months, to prevent disgusting the soldiers by the smell of oil of an inferior kind. Green credited Mr Baldwin, former British Consul General in Egypt, for "making known to the world the knowledge of the preservative powers of oil during the existence of plague". He attributed the practical knowledge of the powerful effects of fumigation with sulphuric acid and nitrous acid in the sick chambers where contagious disease existed14to James Carmichael Smyth, an eminent English Physician.
Having resided in Malta for almost 12 years Green was perfectly well known to most of the inhabitants. These approached him during the continuance of the plague for advice when anything suspicious occurred in their family and "I never refused going". In his evidence to the Select Committee, Green stated that armed with the double precaution of fumigation and the oily friction he had not the slightest dread of going into the same room with a person that was dying of plague. He only went in to see soldiers in the pest hospital that were infected, "fortunately not very numerous, not above fifty altogether and all of them I saw. There was a very fine convent appropriated for the purpose and there seldom was more than one patient in one room at a time, and two fumigating lamps constantly burning in excellent lofty apartments, well ventilated, with every article necessary for the purpose of health and safety, otherwise I have no doubt the mortality would have been very considerable among the attendants"4.
On 20 July 1813, Green issued a Government proclamation entitled "On the observations in preserving from the influence of contagion such persons as may attend upon their relatives when afflicted with plague" In it he explained the measures to be taken to protect oneself from the contagion. "Fumigation with nitrous gas will be of great utility but as it is difficult to procure, a continued fumigation of strong vinegar with aromatic herbs may be substituted. Another good perfume may be obtained from throwing upon the fire small pieces of tar or pitch. Persons attending the sick ought to rub their bodies over with oil. To avoid immediate contact with the sick, they should use dresses and particular gloves of waxed and oil cloth. When obliged to approach the persons of the patients in order to administer any medicine or drink, they ought first to rinse their mouth with strong vinegar, and to suspend respiration for a little that they may avoid inhaling the noxious exhalations of the patients. The attendants ought further to avoid approaching the sick unnecessarily".15
Soldiers on guard duty were made by Green to anoint their whole body with oil. On being relieved from duty, they washed themselves with vinegar and water. "To the joint use of oil and fumigation", asserted Green, "I attribute the positive proof that a patient with plague may receive the aid of the physician and relatives or friends without risk to attendants. Several of the guards were much exposed to the contagion as they passed through the principal gates to the pest hospital or to the graves of those who died by plague, but I know but of one well authenticated instance of a British soldier using the oily friction having become infected by that disease while employed on duty at any of those dangerous posts". Brooke Faulkner was rather skeptical. "Rubbing the body with oil has no share in preventing infection. It has been employed with all the attention possible in the garrison but yet the disease made its way. It had been employed by those who attended the carrying of the dead and which I believed almost all perished".13
Plague in De Roll's Regiment
On 28 June, the Regiment of de Roll was quartered in the Auberge d' Italie when plague came knocking on their door. The regiment isolated themselves by shutting the door of the auberge looking out on Merchant Street Valletta. Brooke Faulkner commented that a barrier was placed in front of the main gate to stop soldiers from coming into contact with those in the street. He noted, however, that soldiers could still pass objects over this barrier. They were even able to shake hands with people outside, making it an ineffective barricade.
On 29 June 1813, a soldier died in the Regiment of De Rolls. Six others fell ill on the same day. Between 19 June and 20 July, De Roll's had five dead and 12 sick. On 21 July, Oakes reported to Bunbury that of the twelve sick soldiers, six were out of danger and only two fresh cases, of which one was doubtful, had occurred since 6 July among the 40 men who had been 23 days under observation. On 30 June, three more fell ill. These were admitted to the regimental hospital under the care of surgeon Francis Wesque. De Rolls lost three men between 22 and 28 July, and four were taken ill during the same period.
On 4 July a military pest hospital became operational in the Convent of St Calcedonius Floriana. The first patient from De Roll's was admitted on this day under the care of Brooke Faulkner. Further admissions followed: second admission on 8 July, third on 20 July, fourth and fifth on 21 July, sixth on 23 July, seventh on 25 July, eighth on 28 July and the ninth and final patient under his care was admitted on 2 August. The Military Pest Hospital closed in October. Up to the middle of October the garrison had lost about 26 men in total.
Plague in the 3rd Garrison Battalion
On 31 July, Oakes reported to Bathurst that on 27 July there had been two instances of the contagion among the men of the 3rd Garrison Battalion, of which one terminated fatally on 28 July. The 3rd Garrison Battalion lost eleven men. Plague appeared in every company of the battalion. Stafford says that during the time the battalion was infected with plague they had between 30 and 40 cases of tumour in the axilla attended with slight fever. They were all treated with calomel purges (mercurous chloride) and the ungt. hydr. rub. They all survived, which made Stafford doubt whether they had been really plague cases. When Stafford enquired as to how Maltese practitioners treated their patients, he was told that out of the first 60 patients who were bled, 59 had died. "From which," deduced Stafford, "it was evident I had nothing to expect from the lancet". Stafford believed in the use of the oily friction as a preventive for plague. He found it very useful and attributed the decline of infected cases to its use.
Surgeon William Stafford records his first case in the 3rd Garrison Battalion as having broken out on 14 June. Jerry Wiseman, aged 32 years, spare habit of body, complained of a headache with slight rigors. Stafford found a tumour in the inferior gland of his groin, about the size of a walnut. He treated him with calomel until his gums became sore, Jalap, Cons. bolus and Ungt hydr rubs on the tumour. Wiseman recovered and returned to duty on 2 July.
His second case occurred on 10 July. Robert Clark, aged 24 years, spare habit, lively disposition, was on sentry duty above the gate through which the pest cart passed heavily laden with bodies. Clark suddenly became lame from a pain in his foot akin to the burning of coal. Stafford found a pimple between the big toe and second toe of the right foot. There was a red streak rising from it. This speedily ascended up the inside of the leg and very soon after a swelling occurred in the inferior inguinal gland. Stafford thought that his plague lesion was the result of some pest-dust that had entered through a defect of his shoe the moment the pest cart passed through the gate. The clinical picture that Stafford describes, however, fits in more with a simple infected ulcer of the foot with lymphangitis and lymphadenitis. It was unlikely to have been a case of plague. Clarke had mounted guard at seven in the morning after marching half a mile from the barracks to his post. As expected, he recovered and was back on duty on 25 August.
Stafford's first reported fatal case was that of John Evans. He fell ill on 22 July and died three days later. Evans was aged 30 yrs, of spare habit of body but much addicted to liquor and always dirty and slovenly. He was thus one of those so called "predisposed individuals" on whom a pestilential atmosphere was more likely to take root and generate disease. However, his symptoms might be explained by other conditions than plague. Evans had walked seven miles from the Boschetto outside Rabat, where French Prisoners of War were kept, and had returned to his barracks very drunk. He had been involved in a fight as he had two black eyes and several bruises about his arms and shoulders. On 25 July, Evans had complete suppression of urine. The hospital steward noticed a small tumour on the lumbar region which increased rapidly in size before his very eyes before Evans expired. Stafford attributed this lumbar swelling to a carbuncle of the most malignant kind brought on by the extreme debility and fatigue of the long journey under a summer sun. The clinical picture however, could be explained by internal bleeding following an assault with suppression of urine from haemorrhagic shock and a rapidly increasing muscular haematoma.
The 3rd Garrison Battalion was quartered not more than a hundred paces from the military pest hospital and not more than 500 paces from the place where suspected articles were brought to be burnt. In October, the regiment became infected again after remaining free during the whole month of September. At the beginning of October, a woman of that corps was attacked with what was considered to be a simple fever. She was permitted, in consequence of this opinion, to remain in the barracks during the first week of the illness. She became worse at the end of this period and was removed to the regimental hospital. She died on 22 October, without exhibiting any symptom of plague.
Further cases broke out at the Floriana Barracks "when four or five men were seized in the course of a day or two". On 24 October, Maitland removed the whole regiment to Fort Ricasoli where they were kept under the strictest quarantine in their own Lazaretto. He alleged that the plague had been introduced into the regiment by an NCO of that regiment who had been caught trafficking in goods taken out of infected houses. Both the buyer and the seller died of plague. The NCO infected some of the soldiers but as soon as they got rid of the infected articles the disease at once stopped.16
On 17 October, Albert Rostoski, a Pole aged 35, of spare habit, developed a fever, headache and a small tumour in the lower gland of the left thigh. He was seen by Robert Calvert on 21 October when he deteriorated. Calvert ordered him to be taken by boat from Fort Ricasoli to the Military Pest Hospital, where he was examined by Assistant Surgeon Nicholas Cloak. Cloak opened the bubo, which had by then suppurated, and the man recovered. On 8 November, Thomas Shell, a regimental tailor was attacked with a bubo in the groin and died after 3 days. His wife was affected with a carbuncle on her leg but survived. Another tailor who had no connection with the former was attacked with a fever and bubo and died on 13 November 1813.
The case reports written by Stafford on those who died of supposed plague, place undue emphasis on individual lack of morality as a cause of disease. Edward Traynor, aged 27 years, became ill on 20 October and died on 22 October at the military pest hospital. He was stout and well made, but had slept on the battery with a common woman for two nights, exposed to the night dews. Stafford observed that Traynor was "not supposed to be a case of plague, as the imprudence of his conduct was sufficient to account for all his symptoms".
A man servant of Captain Chilcott RN, passed a night in a house of ill fame and in a very short time afterwards, developed a bubo in the inferior gland of his groin. He died in the military pest hospital. Another case was that of a Sergeant of the 14th Regiment who acted as a blacksmith to the officers of the garrison and worked his forge in Floriana. The Sergeant being a very useful man was excused all other duty. He was allowed to live as he pleased and to go when and where he pleased. He was very fond of liquor and women. He frequently went to Valletta on pretence of business but probably went into improper houses. Following on such a visit he developed a bubo which was at first thought to be venereal but later diagnosed as plague. He too died at the military pest hospital.
The Military Plague Hospital at Saint Calcedonius Floriana
On 4 July 1813, a military pest hospital was opened in the House of Our Lady of Manresa, popularly known as St Calcedonius. Green was superintendent of the hospital. He visited it daily during the three months it received patients. His last case of plague was on 25 September. Brooke Faulkner gives a total of 20 to 30 cases of plague treated at the House of Manresa. Before visiting the sick, Green rubbed himself all over with oil, and also covered himself entirely with a dress of oiled silk. This ensured that infected matter did not make contact with his skin. It also prevented the absorption of the contagion, by promoting free and copious perspiration. He was lucky not to have had patients with pneumonic plague as his defences would have not have withstood the airborne bacilli. Four hospital mates were on duty at the pest hospital. They slept within the hospital or near it during the month they were on duty. On completion of their shift, they underwent quarantine at the lazaretto.
The hospital mates, apart from Nicholas Cloak, came from Sicily for pest duty. Those serving at the Military Pest Hospital Floriana were: Mr Francis Dagenhart was the first residential medical officer. He commenced his duties on 4 July. On 30 July, Dagenhart was relieved by Hospital Mate Jeremiah Henry Miles. Dagenhart had to pass a month in quarantine before he could resume his duties at the garrison hospital. Miles was in turn relieved by Hospital Mate Edward Hollier. Nicholas Cloak, assistant surgeon 3rd Garrison Battalion, was the last medical officer at the pest hospital.
The hospital attendants consisted of a steward, a cook, and two orderlies. Neither steward nor cook were allowed to enter the sick rooms. Green ordered his staff to pay the strictest attention to the personal cleanliness of the sick, by frequent changes of their bed and body linen. The rooms and corridors were to be washed regularly. The floor was to be sprinkled with vinegar. A fumigating lamp, filled with half an ounce of sulphuric acid and the same quantity of powdered nitre, was placed at each patient's bedside. The lamp produced sufficient nitric gas for six hours. The attendants were obliged to keep the lamps filled up as required by day or by night. The hospital mates had their own fumigating lamp which was kept in constant activity in their own rooms.
Green gave his medical gentlemen the following orders. "Previous to visiting the sick the entire body was at an early hour to be well rubbed with oil. A dress covering the whole body, made of painted canvas, was to be put over the usual clothes consisting of a shirt, long trousers, buskins and gloves made of the same material, with cap. Any uncovered part of the face or neck was to be rubbed with oil".
Brooke Faulkner was physician to the pest hospital. He bled his patients by use of the lancet or by the application of leeches. He also administered mercury or quicksilver preparations, and camphor. Mercury increased the flow of saliva, and acted as a universal stimulant which induced vomiting, diarrhoea, sweating and diuresis. Camphor was a powerful sudorific. It served as a general purpose body cleanser, which washed out the morbid matter through its production of copious sweating. Brooke Faulkner considered the use of cold affusion and turpentine as highly beneficial. He did not prescribe calomel, although he was aware that its use had produced good results in the hands of William Stafford.
The Naval Hospital in Saint Christopher Street Valletta, had forty or fifty in-patients at the time. Only only patient became infected. A male nurse who used to go to market, accompanied by an officer, picked up the infection when he strayed away to see an infected family. He was immediately removed to the pest hospital. Everything touched by him was burned to destroy the contagion. Such prompt measures were said to have prevented the pestilence from spreading beyond that individual.22
Plague in the Casals
On 3 July 1813, the Extraordinary Council of Health raised an executive police force. Lieut. Colonel Francis Rivarola Sicilian Regiment, was appointed Inspector General of Police. Baron Benedict Muller de Friedberg acted as his deputy. Colonel Rivarola was invested with the power of a magistrate independent of all others. The corps of civil guards was placed under his command. He was also given the authority to call to his aid any other military force he deemed necessary.
While the number of plague victims in Valletta and Floriana decreased, those infected in the casals increased. On 10 September 1813, Oakes ordered a cordon of armed troops to surround the infected casals of Zebbug, Birkirkara and Qormi. No one was allowed to pass through the cordon, under pain of death . Plague also reappeared at Rabat. It too was surrounded by a cordon while every person attacked was immediately transported to the lazaretto.
Zebbug had taken preventive measures to ward off the plague. On the outbreak of the epidemic in Valletta, the authorities of Zebbug divided the town into three districts. Each district was assigned three deputies who attended the internment of the first victims preceded by beating of drums and armed men. The first victim in the casal was recorded on 25 May. By 25 June eight had died. About the middle of June a civic guard was formed to avoid contact with Qormi. Subscriptions were raised for the support of the poor.
On 25 June, Zebbug raised a Committee of Health. This visited suspected houses daily, called in medical aid, distributed food and charity to the infected, and placed suspected cases under observation. Until 25 August, the sick and their families were without hospitals, other than their own houses in which they were strictly segregated. From this date onwards, the sick of the poorer classes of Zebbug were removed to 104 barrache erected in a field on the outskirts of the casal. They had no shelter from the sun. Within fifteen days of being transported there, 189 people died.
On 29 August, Rivarola and 30 troops were sent to form a cordon around the village. The men were accommodated in a very well ventilated corner magazine with doors opening into the street. More troops followed in September, but these were placed under canvas. The strict isolation of the casal installed by the troops was said by Maitland to have brought the plague to its knees in less than a month from their arrival. Similar cordons were thrown around Birkirkara and Qormi.
The plague at Qormi yielded to neither executive authority nor church rule. Maitland alleged that the plague was stoked in the village through the shameful practice of the theft of susceptible articles out of infected houses, and through individuals hiding these infected goods in places that had escaped the vigilance of the police. On 4 December 1813, he placed Qormi under martial law, and appointed a military commission composed of Deputy Adjutant General Col Anderson, Capt Andora and Capt Muller de Freidberg of the Sicilian Regiment, to enforce it. Qormi, with its population of about 3000, was entombed within three security cordons.
On 9 January 1814, the newly appointed Superintendent of Quarantine, Deputy Inspector of Hospitals Robert Grieves, together with the Protomedico, Luigi Caruana, inspected the Lazaretto of Qormi. They found the village surrounded by two walls, the inner wall of ten feet in height and ten paces away from an outer wall, which was six feet in height. A single, well guarded gate with a triple barricade and high works was the only access to the village. The walls were further guarded by a cordon of troops. Qormi was kept in strict isolation for three months. It reported its last case of plague on 7 March 1814.
The Plague in Gozo – the death of George Craig McAdam
On 29 January 1814, Malta was declared free of plague and all restrictions were lifted. Robert Calvert and Brooke Faulkner left Malta to join Lord William Bentinck's expedition to Genoa. The Board of Health in Sicily, however, would not allow them to land, and they had to return to Malta. They arrived back on 11 March, to find that plague had broken out in the neighbouring island of Gozo. This small outbreak resulted in the loss of 104 lives, including that of the Physician to the Forces George Craig McAdam.
On 2 March 1814, Maitland was informed of an outbreak of fever in the village of Xaghra, which was confirmed as plague on 7 March. The outbreak was confined to six houses in the north west part of Xaghra. No houses facing the north west part of the village towards Marsalforn, were affected. Maitland was determined to stamp out any new focus as quickly as possible. On 8 March a detachment of the Sicilian Regiment under the command of Captain Carter, the eldest captain of the Sicilian Regiment, was sent to cordon off the village. Carter had strict orders to maintain a sanitary cordon around the infected village. The outer cordon consisted of 100 men of the Sicilian Regiment who were accommodated in seven tents and six houses. Physician to the Forces George Craig McAdam, who had arrived in Malta in January 1814, accompanied the troops to Gozo. Assistant surgeon Giovanni Montanaro Maltese Provincial Battalion, also accompanied the detachment.
Unfortunately, Carter, from necessity but in contravention to his orders, employed a Maritime Maltese guard of seven men of the island militia, instead of calling for more experienced troops from the mainland. Maitland alleged that one of these men had a relative at Xaghra. "He communicated with the infected house, caught the plague himself and communicated it to the rest of the party. These, in turn communicated it to their families, who were immediately confined to the Lazaret. Thus its further progress was effectually stopped."
On 31 March, all the inhabitants of four fifths of the village were placed in tents on the neighbouring ridge of Ghajn Luqin. The remaining fifth of the casal, facing the north west was never infected. This removal seemed to have acted beneficially for, in the succeeding two months to the last death on 28 May, only 49 died. Up to 31 March there had been 51 deaths. Those suspected or contacts were quarantined in barrache erected near the hospital.
On 19 March, a farm house on Ghajn Luqin ridge, sited at the southern extremity of the village, was appropriated as a pest hospital. This consisted of a large ox stable and four rooms, two of which were used as living quarters. The other two rooms served as a mill and a storeroom for keeping straw. The rooms were badly lit and poorly ventilated. A field below the ridge served as a burial ground. McAdam visited this hospital on several occasions and, in breach of the quarantine regulations, returned to his lodgings at the Franciscan convent, Rabat. Nearly every case of plague subsequent to 19 March was treated here.
On 20 March, Maitland reported to Bunbury his confidence in being able to master the plague in a very short time. "The plague though it has not broken out here again has made its appearance at Gozo. It has a carried off 10 or 12 people, it seeming to be of a most virulent description. It has already been confined to the spot where it broke out and I have little doubt we shall be able to master it in a very short time".28
Maitland believed that the plague had been carried to Gozo by a man liberated from quarantine who, previous to his leaving the island, had dug up and carried off a small box containing wearing apparel which he had buried before being sent to the lazaretto and which he did not re-open until he got to Gozo. By 27 March 1814, Maitland told Lord Bunbury that the plague in Gozo "is diminishing daily but we have lost about 30 men by it and its distance and the difficulty of getting at it extremely embarrassing."
By 3 April, he had "encamped the whole village infected without any accident occurring and I have sanguine expectations that it is now in decline though it has carried off between 30 and 40 people. This is a burden on the public purse more than on the breath of individuals when I consider the mass of infected goods of all kinds that have been expurgated and sent abroad and the number of suspected men that have been sent out of the lazaretto, I am only astonished we have got off so well".28
In the first week of May, George Craig McAdam, who had been much too apt to mix with the infected, contracted the plague. He died on 6 May 1814. As to how he might have picked up the contagion, McAdam had stated that he had been in the habit of exposing daily to the air the jacket he wore on his visits to the lazaretto the moment he returned from his visits. However, thinking that all danger was at an end he had left off that precaution and thrown his jacket into a heap of dirty linen in the corner of his room, where it had laid for 10 days, and that coming in from riding two days before he was seized with the plague, he had taken off his coat and put on this jacket.
Surgeon to the Forces James Dillon Tully attributed the death of McAdam, whose exertions were unceasing in the cause he had undertaken, to his want of belief in the contagion of the plague. Maitland was most displeased with his death. "After he had it on him, he had styled it the rheumatism which has led to a most unpleasant uncertainty relatively to most of the officers there, who it appeared had communicated with him. The conduct of this gentlemen was most reprehensible and if had been a common man he would have been liable to suffer death for it"30.
One other death followed that of McAdam, but by 28 May, the plague in Gozo had fizzled out. On 13 June the remaining families that had been infected were moved to Ramla Bay. There, they were guarded by a cordon and made to bath three times a day under the superintendence of police. The villagers were allowed to return to their homes on 28 June. The military cordon under Captain Carter was removed on 26 July, and full pratique with Malta was granted on 8 September 181427.
In October 1814, Maitland gave Carter the local provincial rank of major in recognition for his "most dangerous and most unpleasant three month service" at Xaghra. He suppressed the governorship of Gozo and appointed Carter in command of that island29. In 99 days, from 1 March 1814 to the last death, 104 died, yielding a proportion of 7.2% out of the four-fifths of the population which had been afflicted.5
Deaths from Plague in Civilian Population: April–October 1813
Deaths from Plague in Civilian Population: March - December 1813 (Calvert R Plague in Malta in 1813)
Out of a population of 96,000 in Malta and Gozo, about 4,486 people perished from plague. The garrison of around 3,700, escaped lightly with no more than twenty deaths. The plague drained the Treasury of Malta, costing 2,583,685 Maltese scudi. At the exchange rate of 1s 9d per scudo this was the equivalent to £232,531 sterling. The revenues for the year 1812 amounted to only 130,000 to 140,000 pounds. The deficiency of 172,750 pounds was supplied by a subsidy from the military chest whereof 16,875 pounds was repaid in 1816, leaving 155,875 pounds as the expense which the epidemic cost to Great Britain in aid of the civil government of Malta.5
Maitland and his doctors
Maitland was not inclined to place in any other hands than his own the heavy responsibility of the Public Health of the islands. His response to a petition by the merchants, for the re-establishment of the Committee of Health, was characteristic of the man. "There must either be in my mind a power or no power, and as to any set of persons directing or advising or interfering with the most essential point of all government, when the lives and property of every men in the island are concerned, or of their pretending to state what their individual opinion may be with regard to great public interests as applicable to foreign nations, I fairly own I cannot make out the benefit of any such interference".18
Maitland set out his strategy for tackling the plague the very minute he set foot on Malta. In his scheme, doctors were destined to play a minor role. "When the plague originally broke out and at which time Oakes was extremely unwell, it appears that every thing that was done was in truth executed under the control of the medical people, who assumed to themselves that because the plague existed the whole island was a lazaretto, and that because it was a lazaretto they had a right to govern it. They then went on forcing government into measures of expense, in some instances totally unnecessary and into any other measures they chose, holding out the threat that if whatever they proposed was not executed, the government would become totally answerable for the health of the island and for any loss of lives that might ensue".12
"The truth is however that nothing can be so absurd as the supposition that any medical men is a bit better judge then any other member of the community, how the plague is to be stopped and what are the measures to be adopted on the occasion. It is for them to decide whether the general disease is plague or not, and upon them to decide on the merits of each individual case, and to cure those who are indisposed if they can, but the means of eradicating the evil are a very different nature. They have nothing to do with medicine or its professors and rest solely upon the energy, activity and diligence of the police in hindering communication and in keeping every person out of contact with his neighbour".12
"In short, the lines were clearly drawn that it was the duty of the medical men to act merely as executive medical officers under the sovereign power but that all measures necessary for eradicating the evil generally in the island rested solely and alone with that power. Here, however, at first the case was exactly reversed. The public purse and the only executive function of government, to wit, those of stopping the disorder, were usurped by them till at length they went so far, because Oakes did not choose to give way to them in every thing and to surrender the government into their hands, to resign their offices as members of the Board of Health - the most fortunate event that could have taken place".12
Maitland believed that "medical advice respecting the preventive treatment of plague so far from being useful is almost invariably attended with evil consequences, for I have rarely met with any medical practitioner who has not some favourite theory to which he was attached and by which he was so biased that he always endeavoured to bend the facts connected with the causes and appearances of the plague to this theory".
Maitland scorned those who attributed the plague to a deleterious change in the atmosphere acting on a weak and predisposed constitution. "There is a doctrine entertained particular by the medical men that the air has a considerable influence and that the atmosphere at times is of a character to assist the prevalence of the plague and at others to lead towards its decrease. These gentlemen must therefore suppose that until the end of July the atmosphere was of a nature to encourage the plague and from that time forward of a character to defeat it. It is however in this view of the subject a most extraordinary consideration that the visible power of an efficient and rigorous police and a change in the whole nature of the atmosphere should take place at once and the same moment. At Zebbug whenever the police was established that moment the disease disappeared, whenever it was not established it continued to grow strength. It is ironic that a favourable change of atmosphere accompanied the police where ever it was established," remarked Maitland.24
Staff Surgeon James Dillon Tully supported Mainland's methods in as much as they concurred with the theory of contagion. "It is the extraordinary nature of this malady", said Tully, "that none may be more easily avoided, may be approached with more perfect impunity, and that, simply by shunning contact. It has therefore been found that the soldier is the best physician and the sword and bayonet enforcing segregation of the diseased from the sound to be the surest treatment.20
Maitland thought that he had triumphed over the doctors. To Torrens he wrote on 28 October 1813, "The great trouble in this island at present is to keep the doctors in their proper places. Mr Deputy Inspector Green and Mr Acting Superintendent Thomas having taken it into their hands to enter into a new kind of political speculation and to attempt to set up what I have never heard of before a government purely medical. I have, however, administered them such a dose that I presume they will go quietly in future without attempting to interfere with what does not belong to them, though I have no doubt, they will be abusing me on all hands. There is however a schism among themselves and I understand Dr Brooke Faulkner will be amusing you with complaints of all kinds against them and probably against Oakes. I say this gentleman has the character of being extremely troublesome and I believe from what I have heard that he has been turned out of every situation in which he has been placed".17
It is difficult to pass judgement on the alleged misconduct of the army medical staff officers in Malta during the plague. Green and Thomas who bore the brunt of Maitland's criticism were praised by others for their work during the plague. Oakes regarded Green as a most worthy man and a very zealous and meritorious officer. Likewise, he said of Thomas that: from the period of the first appearance of the plague, Mr Thomas has devoted himself without consideration of personal risk to the service of the public and amidst circumstances of unprecedented embarrassment and peril. It is therefore with a sense of his merits that I recommended him to the post of superintendent of the Quarantine Department.
The Board of Commerce was equally magnanimous in their praise of Thomas who "by his activity and zeal in the discharge of his duties had justly acquired our confidence and esteem, and by his unremitting attention to the arduous and perilous duties which had devolved on him since the appearance of the plague has given us the most satisfactory proofs of his ability to fill so important a post".
None of these recommendations, however, cut any ice with Maitland who was averse to having either Green or Thomas in charge of the quarantine department. On 16 November 1813, he told Lord Bathurst, "I understand upon this head that the merchants here presume to address your lordship in favour of Mr Thomas and requesting that he might be considered from the great service he has rendered upon the late occasion. My opinion however upon that subject is widely different and I certainly cannot recommend that either that gentlemen or Mr Green be applauded for their conduct, as they have seemed to me, to have done much to confuse and embarrass but little ended to systematise or regulate".23
On 8 July 1813, Deputy Inspector of Hospitals Robert Grieves was nominated Superintendent of the Lazaretto. He reached Malta in November but was instructed by the Army Medical Board to report to Green who had been promoted Inspector of Hospitals on 26 August. Maitland would have none of this, and was determined to remove his senior medical staff officers, who had been on the island for over 12 years. "I have had more trouble with the medical people here than with any other set but have got them now into pretty good order - but the thing will not go on well till we expurgate them out of the island, Green of the nature of whose conduct to Oakes you can have no idea".25
In November 1813, he wrote to Lord Bathurst, Grieves is arrived but from some circumstances or other I take it some private transaction in the Army Medical Board, Mr Green has got a letter from that Board stating he is to remain here as inspector - after his conduct in this island it will be impossible to rest the thing on its right legs while he has any thing to say - besides the idea of having an inspector here is perfectly absurd and useless. May I therefore entreat that he may be moved, and that Mr Staff Surgeon Thomas be sent to some other quarter for as long as we have our medical men interfering with government and dabbling with our merchants it is impossible we can ever get our health placed on the footing and basis it should be.26
Staff Surgeon Joseph Thomas failed to gain the permanent post of Superintendent of Quarantine in Malta or to be promoted Inspector of Hospitals. He left Malta in June 1815 when he joined the army destined to act against Naples. He then moved to the Ionian Islands, where Maitland, who was also Lord High Commissioner of the Ionian Islands, appointed him Head of the Quarantine Department at Zante. There he was credited with having prevented the introduction of the plague amongst the troops and inhabitants of Zante.
In January 1814, Ralph Green left Malta for the Eastern Coast of Spain. He was relegated to half pay on 25 February 1815. However, he was recalled to the service on 10 April 1817 and served as the PMO to the West Indies. After four years in post, he returned to England in extreme ill health and was granted a military allowance of 30 shillings a day. He was then fifty years old and still a bachelor. He died on 17 June 1837, aged seventy years.
His obituary said of him: "The talents and merits of this old and most respectable officer were conspicuous, and noticed with applause in several Gazettes, where he had served, more particularly in Egypt, where he had the appointment of Assistant Inspector of Hospitals, and in the West Indies where he had the medical superintendence during several years of unusual sickness and mortality".21
It would have been inconceivable for Ralph Green and Joseph Thomas to have been trusted with higher office, had they really been as incompetent as Arthur Brooke Faulkner and Thomas Maitland made them out to be. Admittedly, the medical staff officers failed to act in unison, as they held different beliefs. At a time when promotion to the next rank depended very much on patronage, all advanced themselves at the expense of their colleagues.
The source of the conflict between Maitland and his doctors had more to do with the nature of Maitland's autocratic personality. Sir George Cornwall Lewis said of him: "There are a certain number of English here in Malta who admire what they call Maitland's vigour and energy; but the more rational among them are now aware that his system of driving and kicking mankind into obedience is, in the long run, mischievous and absurd"31. It was inevitable that Maitland would clash with whatever section of society challenged his authority, regardless of their greater expertise in the area, and this could not have been conductive to harmonious co-operation in time of crisis.
1TNA:CO 158/23, Fryers to Bunbury 11 May 1813.
2Calvert Robert. An account of the origin and progress of the plague of Malta in 1813 pp 55-56. In the Medico-Chirurgical transactions Royal Medical and Chirurgical Society of London 1815.
3Frewen Walter. Sir Thomas Maitland the mastery of the Mediterranean. Chap 10, p 130. Quarrel with the doctors.
4First report from the Select Committee appointed to consider of the means of improving and maintaining the foreign trade of the country 1824. Minutes of evidence of Ralph Green before the Select Committee.
5Burrell William Henry. Report on the plague of Malta in 1813 General Board of Health Appendix V to the second report on quarantine London 1854.
6Arrival of plague ships in Malta since 1813 in Cholera some spots visited by cholera in 1837 (also deals with the plague in Gozo of 1813).
7Brooke Faulkner Arthur. Observations of the plague as it lately occurred in Malta.
Edinburgh Medical and Surgical Journal 1 April 1814.
8TNA:CO 158/22, f 110, 12 May 1813 Oakes to Bunbury (report of start of plague).
9Stafford William. Observations on the plague in Malta. Edinburgh Medical and Surgical Journal 1816; XLV:13-21.
10 McArthur John, Stanier Clarke James. The Naval Chronicle. Vol 30, July-December 1813. Nautical Anecdotes Account of the late plague at Malta its symptoms, treatment and cure p 43. Cambridge University Press 2010.
11TNA:CO 158/22, F 157, Notice of Government dated 24 May 1813.
12TNA:CO 158/39, Maitland to Bathurst dated 27 October 1813.
13Report from the Select Committee of the House of Commons on the doctrine of the contagion of the plague, in 1819. Evidence of Brooke Faulkner Page 467, 14 June 1819.
Brooke Faulkner A. Treatise on the plague designed to prove its contagiousness from facts gathered during the author's residence in Malta in 1813. Medico chirurgical review. 1820; 1; 586.
14TNA:CO 158/23, Green to the editor of the Giornale di Malta dated 4 September 1813.
15TNA:CO 158/22, 20 July 1813 Oakes to Bathurst (Green's proclamation to civilians re fumigation).
16TNA:CO 158/39, Maitland to Sidmouth dated 5 Dec 1813.
17TNA:CO 158/40, Maitland to Torrens dated 28 Oct 1813.
18TNA:CO 158/31, Maitland to Grant dated Corfu 1 May 1822.
19TNA:CO 158/31, Maitland to Sidmouth dated 5 Dec 1813.
20Tully J D. A history of the plague as it lately appeared in the islands of Malta, Gozo and Corfu and Cephalonia. London 1821.
21Obituary Ralph Green in The United Service Magazine and Naval and Military Magazine London 1837.
22Malta Mail and United Service Journal No 35 dated 3 March 1843 - Contagiousness of the plague.
23TNA:CO 158/39, Maitland to Bathurst dated 16 November 1813.
24TNA:CO 158/39, Maitland to Sidmouth dated 56 December 1813.
25TNA:CO 158/24, Maitland to Bunbury dated 16 November 1813.
26TNA:CO 158/25, Maitland to Bunbury dated 21 November 1813.
27TNA:CO 158/25, Maitland to Bathurst dated 3 June 1814.
28TNA:CO 158/25, Maitland to Bunbury dated 20 March 1814.
29TNA:CO 158/25, Maitland to Bunbury dated October 1814.
30TNA:CO 158/24, Maitland to Bunbury dated 15 May 1814.
31Dixon C Willis. The Colonial administration of Sir Thomas Maitland. London 1969.
Schembri Giovanni Battista. An essay practical and sanitary on various observations regarding the plague, the manner in which it is encountered and the method of checking, attacking and extirpating it as practiced in the Lazaretto of Malta. Malta 1843.
Collection of printed notices of different authorities during the plague of 1813 in Malta Vol 1 May to July 1813, Vol II July to Oct 1813 Malta Lib Fr 6 17 or BO 1 56.
Scicluna George J. Sunday Times Of Malta 10 Jan 1965. A hundred days of plague in Gozo part one.
Scicluna George J. Sunday Times Of Malta 17 Jan 1965. A hundred days of plague in Gozo part two.