The cost of providing hospital care in Malta : 1733-1798

Abstract

In a sense, of the two roles of the Order of St John of Jerusalem, the military one is the junior role because it evolved later to support the first vocation to provide a refuge and nursing for pilgrims and the sick poor in the Holy Land. But the persistence and intensity of its participation in the military struggle against the Muslim in the eastern Mediterranean inevitably left deeper marks on the early modern world's perception of the Order. The successes in the siege of Malta and the sea battle near Lepanto a few years later further underscored its military prowess and image. The Knights themselves, however, still clung true to their original Hospitaller calling. Even during their near nomadic existence in 1522-30, when they were forced to move their base on several occasions, they started a hospital for the benefit of their Lords, the poor sick, wherever they could. These were all rather modest manifestations of their benevolence, reflecting the transience of their intended presence in that particular place. But once they felt firmly established on Malta, their new hospital was to be the emblem of the Order's renewal of its ancient Hospitaller traditions, showering munificence on the poor sick. The Sacra lnfermeria was modelled on the leading Italian Renaissance hospitals of the time, providing the best medical care science could provide to cure the body, and a pious environment that also brought comfort and salvation to the patients' soul. Despite the vast sums of money invested in developing fortifications and operating a navy, there was always enough left to operate the hospital and the other healthcare institutions. But around the middle of the eighteenth century, the word 'deficit' started to feature progressively more frequently in the Treasury's vocabulary. After the severe blow of the Loi Spoliateur in 1792 it became the salient subject. The Order was now in deep financial crisis and needed to find new ways to increase income and reduce expenditure. The Sacra lnfermeria cost much less than the navy or the fortifications to operate and maintain, but was arguably the least important in terms of the Order's own short term survival. How would this impact the Order's strategy on hospital care? What decisions were taken in relation to the Infirmary? Was any of the staff discharged to reduce costs? Where patients turned away, or worse turned out? Where any services discontinued? Where patients made to contribute to the cost of their treatment? Where the standards of care lowered in any way? The usual way to answer such questions would be to examine contemporary books, reports, and official and unofficial correspondence in which so-called independent sources would have expressed an opinion on the relevant points. Unfortunately, very few such testimonies exist, and those that do, apart from the usual concerns of competence, independence, prejudices, personal perceptions, hidden agenda, etc., only provide a single opinion at a specific point in time. No single source provides multiple opinions at different points in time to facilitate a before-and-after comparison where personal bias, etc., would at least be a constant. In this study I have tried to arrive at these answers through a different route.