On 1 Sep 1808, the Malta garrison consisted of a total of 4,948 officers and men. There were: 217 Commissioned and Warrant Officers, 374 Non Commissioned Officers, 4,026 Rank and File fit for duty. 32 Commissioned and Warrant Officers were absent and 296 Rank and File were sick.
The Fifth Report of the Commissioners of Military Enquiry recommended that General hospitals abroad be managed on the hospital plan, that is, on a reduced scale of officers and servants, and on the principle of providing all the articles of subsistence on the spot.
It further recommended the abolition of the rank of Purveyor, as the Commissary General provided the hospitals abroad with almost all the articles of subsistence. It noted that if the Purveyor was now a mere steward or storekeeper, a person with that rank and pay of such description of officer should be appointed to the situation.
From 1808, Purveyors were selected from those versed in accounts and were not necessary medical officers. Purveyors, Deputy Purveyors and Purveyor's Clerks were all commissioned officers, the last ranking as ensign.
An institution for the education of medical cadets under the superintendence of the Inspector General had already existed. The Secretary-at-War stated that in addition to the knowledge that an attendance on the London Hospitals could give, and which at the time of the appointment of the mates, they were certified to possess, they could not be made acquainted with army medical practice, economy and discipline, previous to their actual employment. At York Hospital, Chelsea there would necessary be such an attendance of experienced Army Medical Officers so that this previous knowledge might be communicated with very little expense, perhaps with the addition of only one professional person.
At the start of the Peninsular War all available staff medical officers were withdrawn from overseas stations and diverted to Spain.
Medical officers discharged from the service on half-pay were liable to be recalled at any time. Article 6 of The Fifth Report of the Commissioners of Military Enquiry reaffirmed that HM Warrant of 12 Mar 1798 in respect to half-pay was to be strictly adhered to.
It stated that the half-pay list was to be first resorted to for the supply of all officers to the hospital staff. The half-pay list was to be examined to ascertain whether any efficient officer can be obtained from it, and whether all who may decline to go on active list are justly entitled to retain their half-pay as a reward for past service.
Article 22 of the Fifth Report of the Commissioners of Military Enquiry recommended that the rank of Deputy Inspector should be a promotion from that of Staff Surgeon. No Surgeon who had not been on full-pay as Regimental or Staff Surgeon for a minimum of seven years, was to be raised to the rank of Deputy Inspector.
The Secretary-at-War disagreed with this recommendation. He felt that eligibility for promotion would be an incentive for Regimental and Staff Surgeons to qualify as Physicians, so that in future the rank of Physician would be filled as far as possible from Regimental and Staff Surgeons, and the rank of Deputy Inspector and Inspector chosen from the Physicians.