The Army Medical Department
And the Malta Garrison
1873

In 1873, the average strength of the garrison was 4,627 men, exclusive of colonial troops. There were 3,735 admissions into hospital (807.2 admissions/1000 mean strength), with 37 deaths (7.99 deaths/1000 mean strength), of which 6 occurred out of hospital and 4 among the invalids on their passage home and at the Invalid Depôt at Netley.

The 12th Brigade of the Royal Artillery which had arrived in October from England, had by far the highest ratio of admissions. The 1st/18th Regiment had the largest number of deaths.

158 invalids returned to England; 72 were discharged from the services at the Royal Victoria Hospital, Netley. Diseases of the circulatory (21), nervous (11) and respiratory systems (9), tubercular and rheumatism were the principal causes of invaliding from Malta.

The average number constantly non-effective through sickness (mean daily sick), excluding the Royal Malta Fencible Artillery, was 180 men. The ratio per 1000 mean strength constantly sick was 39.0; the average sick time to each soldier was 14.23 days; the average duration of each case was 17.63 days.

Febrile diseases accounted for 887 admissions into hospital (191.7/1000 mean strength) with 8 deaths (1.73/1000 mean strength). Admissions were for:

• 57 for nervous system diseases with 1 death
• 35 for circulatory diseases with 4 deaths
• 177 for respiratory conditions with 2 deaths
• 676 for digestive diseases with 2 deaths
• 241 for urinary problems with 2 deaths
• 243 for cutaneous diseases
• 241 for rheumatism
• 124 for syphilis
• 52 for phthisis with 9 deaths
• 449 for accidents with 4 deaths

One died from self inflicted wounds. Of the accidental deaths, two, one in the 28th the other in the 71st Regiments, were from drowning; two, one in the Royal Engineers the other in the 18th, were caused by falls resulting in skull fractures.

There were 72 admissions for paroxysmal fevers (15.6/1000) with 2 deaths (0.43/1000), 789 for continued fevers (170.5/1000) with 6 deaths (1.30/1000) and 1 for eruptive fevers (0.2/1000). Fourteen cases of continued fevers, two of which proved fatal, were of enteric fever, five occurred in the 12th Brigade Royal Artillery, three in the 1st/13th Regiment, three with one death in the 1st/18th Regiment, one which proved fatal in the 71st and two in the 74th Regiment. The 28th Foot had a fatal case of enteric fever.

A number of syphilis cases were traced to women, nominally the wives of soldiers, who had escaped registration under the Contagious Diseases Act 1861; a good number of admissions usually followed the arrival of the fleet in harbour and in 1873 many were imported by the 12th Brigade Royal Artillery.

On 28 Aug 1873, the almost completed hospital near Zabbar Gate, replaced the hired buildings in Vittoriosa, where the sick of the three infantry regiments, quartered on the western side of the Grand Harbour had been treated. In Sept, the hospital was handed over to the 1st/13th (Somersetshire Light Infantry) Regiment. The sick and the hospital establishment of the 1st/13th were transported from the Lower Vittoriosa Hospital to the Cottonera hospital.

The hospital had cost £21,000 to build. It was 355 feet long, 51 feet wide, and 47 feet high. It had four wards each 128 feet long and 26 feet wide containing 32 beds with a cubical space of 1,500 feet per patient. A verandah 9 feet wide ran on each side of these wards each of which had its separate bath and ablution rooms. In addition there were four wards with two beds each.

The basement had a prisoners' ward, and a contagious diseases ward for six patients, which was quite cut off from the rest of the hospital. The top floor had a day room for convalescent patients. The hospital had no quarters for medical officers, who had to live at a great distance from the sick under their charge.

On 29 June 1920, Cottonera Hospital was replaced by the Mtarfa Military Hospital. It was then offered on lease by the War Office and from 1929 became St Edward's College.

From 1 Apr 1873 military hospitals were organised as either General, Station, or Field Hospitals. A soldier when in hospital for other causes than wounds received in action, was subject to stoppages from pay of 7d when supplied with hospital diet and 6d when receiving medical comforts but not supplied with hospital diet.

Hospital stoppages for the Royal Malta Fencible Artillery were at the daily rate of 5d for men and boys. When a soldier was in hospital on account of sickness which was certified as the result of his own misconduct, he was liable to a stoppage of the whole of his pay. Sick soldiers on hospital ships conveying invalids were also subject to a stoppage of 6d a day.

The ranks of Inspector General of Hospitals and Deputy Inspector General of Hospitals were abolished. They were replaced with Surgeon General (ranking as Brigadier-General and Major-General after 3 yrs fulls service in rank) and Deputy Surgeon General (ranking as Lieutenant Colonel and Colonel after 5 years service).

Surgeons became Surgeon Majors, ranking as major and as a junior Lieutenant Colonel after 20 years full service as surgeon and surgeon-major. Surgeon serving in India were promoted to the rank of Surgeon-Major after only 12 years service.

The rank of Assistant Surgeon was abolished and replaced with that of Surgeon (ranking as Lieutenant and Captain after six years full service).

The Medical Department was given control of military hospitals. Officers and NCOs of the Army Hospital Corps had the authority to command the men of their own corps, patients in military hospitals and those below the rank of officers attached thereto for duty.

The regimental system of administration was terminated. Regimental Officers were withdrawn from regiments altogether and converted into staff officers. Medical officers attached to battalions were to serve with it for five years.

Every candidate for appointment to the Army Medical Department was to possess two diplomas, one to practice medicine and the other surgery in Great Britain and Ireland. He was to be registered under the Medical Act. Before receiving a commission, candidates had to pass an examination in military medicine, surgery, hygiene and pathology after attending the authorised probationary course at a general military hospital. On passing their examination at Netley they were commissioned as Surgeons (ranking as Lieutenants) on pay of 5s a day. Their commission was antedated to include their period of probation, but did not carry back pay.

Promotion form Surgeon-Major to Deputy Surgeon General and from Deputy Surgeon General to Surgeon General was on ability and merit. Medical officers retiring after 25 years full pay service could receive a step of the honorary rank but with no increase in their half pay.

Medical officer on half pay were eligible to be employed by the Secretary of State but had to vacate their appointments on attaining the age of 65 years.

Medical officers were allowed to retire after 20 years full pay service. Those of the rank of Surgeon or Surgeon Major were retired at the age of 55 years and all Surgeon Generals and Deputy Surgeon Generals had to retire at the age of 65 years.

Good service pensions were awarded and the six most meritorious officers of the AMD were named Honorary Physicians and six Honorary Surgeons to the Queen.

On Nov 1872, the Governor advised the Home Government, that with reference to that part of the Royal Warrant which directs that every candidate to be admitted to the competitive examination with the view of obtaining a commission as assistant surgeon in the army shall be unmarried, I am of the opinion that it would not be advisable to make this condition applicable to Malta, in as much as the most efficient medical men who have hitherto offered themselves as candidates for the vacancy of assistant surgeon RMFA are married men. If the condition of the warrant was to apply it would seriously limit choice.¹