The Army Medical Department
And the Malta Garrison
1859

On 1 Jan 1859, the effective strength of the infantry was 3,692 rank and file. There were 680 men in the Royal Artillery and 165 troops in the Royal Engineers giving a total effective strength for the garrison of 4537 rank and file. By the 1 Dec 1859, the total effective strength of the garrison was 7,044 rank and file with the infantry increasing to 5,964 men, and the Royal Engineers to 300 men.

The average strength of the garrison was 5,310 men, exclusive of colonial troops. Early in the year, it consisted of parts of 6th Bde RA, two Coys of RE, the 2nd/3rd Foot, 2nd/15th Foot, 1st/21st Foot, 4th/Rifle Bde, and the RMF. In the end of February the 2nd/23rd Foot joined direct from England and the 2nd/22nd Foot arrived in the end of May. Garrison HQ moved from the palace to the Auberge de Castille, which had hitherto been used as the officers' mess of the Royal Artillery and Royal Engineers.

There were 6,446 admissions (1214/1000 mean strength) into hospital, with 101 deaths (19.02/1000 mean strength), including 5 invalids awaiting their passage to England. There were 59 deaths from miasmatic diseases or diseases caused by infections. Admissions were for:

• 12 deaths from tuberculosis
• 7 from accidents
• 9 from respiratory illness
• 7 from nervous causes
• 5 from circulatory diseases
• 1 from digestive diseases
• 1 from urinary diseases.
• 59 admissions for paroxysmal fevers (11.1/1000)
• 1431 for continued fevers (269.5/1000) with 47 deaths (8.85/1000)
• 803 for dysentery and diarrhoea (151.2/1000) with 10 deaths (1.88/1000)
• 286 for ophthalmia (53.9/1000)
• 288 for Rheumatism (54.2/1000) with 2 deaths (0.38/1000)

Admissions were considerable in the 22nd and 23rd Foot and Rifle Bde, but the mortality was greatest in the 23rd, Rifle Bde, 15th Foot and RA. Only the 1st/21st seemed to have escaped. Medical officers attributed the prevalence of fever to the large number of young soldiers who were for the first time exposed to the heat of a Malta summer. It is now thought likely that sandfly fever or phlebotomus fever in non immune soldiers was to blame.

From 1837 to 1846, paroxysmal fevers had accounted for 2.8 admissions/1000 of mean strength with 0.28 deaths/1000 mean strength; continued fevers for 207.3 admissions/1000 strength with 1.46 deaths/1000 strength, dysentery and diarrhoea for 150.5 admissions/1000 strength with 2.41 deaths/1000 strength, rheumatism for 42.7 admissions/1000 strength with 0.09 deaths/1000 strength. Thus although there had been a slight increase in paroxysmal fevers and rheumatism, the great difference both in number of cases and deaths was due to fevers of the continued type. The excess in 1859 over the previous average amounting to 62 per 1000 in the admissions and 7.4/1000 in the deaths.

In Oct 1859, the average number of troops quartered at St George's Bay during the whole season of musketry was 800 to 1000 men. Tents were pitched on bare rock. The whole place was exposed to strong winds which often blew their tents away.

Government supported the following Charitable Institutions:

1. The Hospital for Incurables at Valletta with 294 inmates. This was the former female hospital which had opened in 1849 for those with incurable diseases.

2. The Orphan Asylum at Valletta for male and female orphans, aged between 6 and 16 years. The asylum had place for 118 inmates and had opened in 1852. It had been the former Male Civil Hospital. Most of the children were orphaned by both parents.

3. The Central Hospital at Floriana with 1,420 inmates. This opened in 1850 and had beds for 350 patients.

4. The Lunatic Asylum with 329 inmates. This opened in 1837, at Ta' Franconi Floriana, but was replaced by a new asylum at Attard in 1861.

5. The Ospizio at Floriana which had room for 884 aged and impotent poor over 60 years. In 1859, the average age of the inmates was over 75 years.

6. The Penitentiary at the Ospizio which could accommodate 15 inmates. Females who had been dissolute and who provided a certificate from their spiritual advisor that they were anxious to repent, were allowed an asylum in the penitentiary, but had to work for their maintenance.

7. The Foundling Asylum founded during the time of the Order of St John, had 44 foundlings in 1859. This institution was attached to the Ospizio in Floriana, and received all abandoned infants, until nurses could be found for them in the country.

8. The Santo Spirito Hospital at Rabat was enlarged in 1850. It was able to care for 100 patients.

9. The Ospizio at Rabat Gozo had beds for 185 patients. It opened in 1850 and offered asylum to 180 aged and poor over 60 years.

10. The Hospital at Rabat Gozo had 339 sick in 1859, but was built to house only 120 patients.

Inspector General John Forrest thought that lack of adequate ventilation was the cause of the increase in the prevalence of fever in Lower St Elmo Barracks:

The RA occupy the barracks situated on the upper part of Fort St Elmo, on an elevated position, freely exposed in all directions. The Rifle Bde were quartered in the lower part of the same fort; but the barracks occupied by them, and subsequently by the 2nd/23rd Foot, is almost at sea level, and is completely enclosed on all sides, so that free access of air is impossible. It is fully exposed to the sun and is badly ventilated and liable to dampness. A small parade ground lies in front of the barrack, dividing it from the lofty wall which encloses the upper part of the fort, and across this courtyard various sewers from privies in the military prison and from Upper St Elmo pass. The contents accumulate in the sewers and the earth becomes infiltrated with decaying matter and most offensive gases are produced. In the middle of Sept, trenches were dug in the parade ground for fitting gas pipes in the barracks. By the earth being turned over in this way, free escape was afforded to the effluvia from the decomposing matter, the well known exciting cause of typhoid type of fever, which first infected the Rifle Bde and subsequently the 2nd/23rd Foot when this regiment replaced the Rifle Bde.

In 1859, Simple Continued Fever reached a maximum of 269.5 per 1000 strength. The term continued fever embraced all the varieties of fever while typhoid fever included any diseases in which great prostration of the nervous and vascular system existed. There were six forms of continued fever: (i) Febricula or Ephemeral Fevers, (ii) Relapsing, (iii) Typhus, (iv) Typhoid/Enteric/Pythogenic Fevers (v) Gastric Remittent Fever of the Mediterranean, (vi) Bilious Fevers. Typhoid type fever prevailed during the latter part of the summer and autumn. Typhoid fever patients looked feverish with flushed faces and often developed an eruption of rose papular spots in the second week of their illness. The rash was distinguished from the typhus rash which was initially of the petechial type but afterwards coalesced to form larger blotches. All fever was held to arise from a poison in the air, the product of decomposition of organic matter, secondary to poor drainage and sewage contamination of the soil. Soldiers and orderlies became infected through their exposure to the emanations from the bodies of patients and the emissions from their stools and secretions. Soldiers often visited the latrines to smoke and imbibed the poison propagated by the effluvia and contagion of the sewers.

In his report on Fever in Malta, Assistant Surgeon Marston Jeffery Allen RA, stated that during 1859, the garrison suffered severely from the epidemic prevalence of typhoid or enteric fever. Sometime between 1855–56, a typhus fever patient was admitted into one of the hospitals from a transport vessel from the Crimea. The patient, and one of the two attendants who contracted the fever, died.

On 17 Dec 1858, Mr Ferdinando Vincenzo Inglott was appointed Comptroller of the Charitable Institutions and a member of the Council of Government, in place of Sir William Henry Thornton who had resigned. The Offices of Comptroller of Contracts and of Inspector of Charities were amalgamated under Ferdinand Inglott.

In July 1859, Inglott was granted leave to visit several lunatic asylums and other public charitable institutions in England and France. He was to make himself master of their working, so that he may be better enabled with such practical experience, to complete the reform now being carried out in the institutions of Malta.

On 27 Sep 1888, his salary of £400 was increased to £500 a year, but he never obtained his increase. Inglott reformed the Charitable Institutions and abolished the system of restraining lunatics in irons.

On 14 Oct 1858, the plans and estimates for a new military Hospital on St Francis Ravelin Floriana were submitted for approval. The estimated costs for the new hospital of 300 beds was £44,201 8s 5d. The hospital was not built as the site was found to be too small.

• 27 Feb Martha Mary Jane Dalton born 7 Sep 1858, daughter of Mary and 1st Class Military Clerk John Henry Dalton.
• 13 Nov Arthur Robert Munro born 14 Oct 1859, son of Susannah and Hugh Munro Clerk of Works War Department.