Downloaded from http://jramc.bmj.com/ on August 28, 2016 - Published by group.bmj.com

Footnote and endpiece

countryside refugees coupled with comba- The medical aspects of the 1565 Great tants arriving from overseas to assist the Order in the defence of the island.310 Siege of The housing problem was made worse by the necessary defence strategy of pulling Charles Savona-Ventura down houses deemed as interfering with an adequate defence process, and the destruction of houses resulting from con- ABSTRACT battle on a small island in the Central tinuous bombardment by the enemy The 1565 Siege of Malta served as a turning Mediterranean was viewed as the turning troops.3 While many of those without point in the westward Ottoman advance. The point in stopping the expansionist designs available housing were taken in by other fi 4-month long siege was resisted by the of the ; a number of rst- families, the housing problem was par- indomitable belief of the defenders that their hand and secondhand accounts were tially solved by the erection of tents and cause was just and holy. It also required prior written contemporaneously or in the temporary huts.11 fi 3–6 detailed organisation to ensure suf cient war immediate aftermath, while the subse- Malta had long been dependent on a materials and that the overall health of the quent historians of the Order of St. John 7–9 steady importation of grain from Sicily combatants and non-combatants was main- ensured detailed coverage of the events. and the fortified towns held numerous fl tained throughout the months of the siege. The expectation of a military con ict vaults for the safe storage of large This article reviews the contemporary and his- requires commanders to draw up a mili- fi fl amounts of grain suf cient to last several torical sources relating to the con ict to iden- tary operational plan which varies accord- months. The rumours of Turkish invasion tify the medical operational plans used by the ing to their respective objectives: the had prompted an increased effort to military during this historic siege. attacking forces desiring dominion over augment stores.12 A good store of wheat the defenders and the defenders wishing was purchased and sent to Malta by the to hold out until the attackers withdraw Prior of Messina, Signorino Gattinara. or are defeated. The operational plan Also ‘any ships they met with in the requires the incorporation of medical channel, which had cargoes of wheat, INTRODUCTION facets to maintain the health of the troops – wine, or other foodstuffs, they brought The 14 16th centuries saw a progressive and non-combatants, to care for the extension of Ottoman rule over the back with them to Malta where they were injured and to make the best use of bio- well paid for their provisions’.3 On the 9 Eastern Mediterranean and the Balkans logical and psychological aspects of starting with the fall of Constantinople in May 1565, when news of the departure warfare. fl 1453 and Western Europe found itself dir- of the Ottoman eet was received, all ectly threatened by the apparently irrevers- wheat, oats and other agricultural pro- ible Turkish encroachment.1 The Order of PUBLIC HEALTH MEASURES ducts were collected and put into storage 213 St. John, stationed in Europe’s underbelly In siege warfare, an important consider- at Birgu. on the Island of Malta after their expulsion ation for the defending commander is the Efforts were also made to reduce the from Rhodes, had proved unable to care of the combatants and non- number of unnecessary mouths to feed. fi ‘ protect the sister island of from combatants besieged within the forti ca- Between April and May 1565, a great ’ 8 Turgut Reis’s raid in 1551, while Tripoli tions; their numbers augmented by the number of people sailed to Sicily. A was lost to the Order in 1552. The Order populations seeking safety within the for- further batch of refugees had embarked fi ’ of St. John was a hospital and military reli- ti ed towns and fortresses: Birgu (Fort on the Order s ships to leave for Sicily, gious order set up originally in Jerusalem St. Angelo), (Fort St. Michael), but hostilities commenced before they 9 after the First Crusade. It was slowly Fort St. Elmo and Citadel . The could travel. In spite of this drive to pushed back westwards over the centuries siege conditions and the population over- wean out gente inhabile alla Guerra, the by the Ottoman incursions until it was crowding posed particular public health remaining population would have still ceded the Maltese Islands in 1530. By the issues that needed to be addressed to topped 22 000 with about a third being spring of 1563, news had begun to filter ensure sanitation and well-being. foreign or local combatants. Before the into the West of the arming of a new Plans were needed to house the sudden arrival of the Ottoman forces in Malta on Turkish armada at Constantinople. On 18 augmentation in the population within 18 May, the country inhabitants were fi May 1565, the Siege of Malta by the the forti ed towns resulting from the encouraged to go to the nearest forts with Turkish forces commenced (Table 1). The siege was finally lifted on 12 September ( Julian calendar). The defenders were led Table 1 Timeline of the 1565 Siege of Malta by the religious leader of the Order Fra Jean Parisot de la Valette; the besiegers by 18 May Arrival of the Turkish Armada Piyale Pasha and Kizilahmedi Mustapha 25 May Siege of fort St. Elmo starts Pasa, eventually joined by Turgut Reis.2 In 23 June Fall of Fort St. Elmo Piccolo Soccorso the 18th century, the French writer 2 July Arrival of a contingent of Christian re-enforcements ( ) Voltaire wrote that ‘nothing is so well 15 July Assault of Senglea using sea and land troops known as the Siege of Malta’. This heroic 28 July Assaults on Senglea and Birgu 7 August Christian cavalry mounts attack of Turkish base camp at Marsa 7 September Arrival of significant Christian re-enforcements (Gran Soccorso) Correspondence to Prof Charles Savona-Ventura, 8 September Siege lifted Humanities, Medicine & Science Foundation, University of Malta, Tal-Qroqq, MSD 2090, Malta;charles. 12 September Turkish Armada leaves [email protected]

Savona-Ventura C. J R Army Med Corps March 2014 Vol 160 No 1 1of6 Downloaded from http://jramc.bmj.com/ on August 28, 2016 - Published by group.bmj.com

Footnote and endpiece all their livestock, thus ensuring an aug- country. … There are 500 salme of wheat Birgu, but Senglea boasted only one.17 mentation of food supply within the forti- in the stores, and other 600 with private These were insufficient to cater for the fications but also depriving the attacking individuals, between grain and barley. We increased mortality brought on by the forces from supplies. The knights Luigi have 70 cantari of biscuit, but no wine, conflict. The knights and victims of the Balbiano and Adrian Maimon were vinegar, or oil or any other provisions left Great Siege were buried in the cemetery entrusted to bring the inhabitants and … advising you that the provisions which opposite the San Lorenzo-a-mare Church their livestock into the fortified towns. To are to be brought over should be biscuit, at Birgu. Their remains were later reduce disturbance and pressure on the as here no facilities for baking bread exist, exhumed and reburied in the grounds of food stores, all unnecessary animals were except for our consumption’.4 The pro- the St. John Conventual Church in slaughtered. La Valette had his own dogs blems of provisions were also a concern . Some remains from the siege put down.3 for the relieving forces since ‘no way was were reburied in 1787 in a common crypt Some inhabitants sought the protection found how to feed that army on an island sited in the grounds of Fort St. Angelo. of Fort St. Elmo taking shelter in the so poor in victuals … He ordered that on Ensuring a regular Christian burial for all ditch around the fort. Because of the embarking and landing each person should the dead who gave their life in this con- fort’s small size and expecting heavy carry so much biscuit as would last at flict was important to maintain religious repeated assaults, ‘the Grand Master … least 30 days at the rate of 24 ounces per and psychological morale. Many of the gave orders that all the women, children, man per day … Each one who landed combatants were volunteers whose only and old people who had taken shelter in received a sack with 75 libbre of biscuit’.6 presumed reward was a heavenly one. The the ditch around St. Elmo, should be sent The other essential commodity was combatants had received from Pope Pius over to Birgu. Only men who were fitto adequate reserves of water. In January IV a plenary indulgence and a pardon for fight or work were to be kept there. The 1565, an inspection of all the public and all their sins. Thus ‘if they fell in the siege, result was that, when the Turks attacked private wells and cisterns in Birgu and they would find a place in heaven’.3 the fort, there were eight hundred fighting Senglea was made while arrangements The measures taken to dispose of the men defending it. He provisioned the gar- were made to enable the storage facilities dead by the besieged were however not rison with biscuit, wine, cheese, salt pork, of 40 000 barrels of water at Birgu to completely sufficient for public health vegetables, oil, and vinegar. As for fresh anticipate for the needs of the besieged control during and after the lifting of the meat they had the island cattle which had there.11 Geronimo de Huete, Balthasar siege. The great number of corpses and been kept in the ditch around the fort’.310 Empador and Antoine de Bourne were mangled human remains buried under the The fort continued to be regularly sup- made ‘responsible for seeing that water rubble attracted huge swarms of flies; an plied with provisions throughout the con- was continuously drawn from the Marsa epidemic of high fever that occurred flict until its fall. to keep the cisterns of Birgu, St. Michael, within the Birgu fortifications was attribu- In Birgu, the grain supply was generally and St. Angelo always full.’ The water ted to the presence of these flies.3 sufficient and ‘it was always allowed to rationing was entrusted to the knights Archaeological excavations have suggested sell grain by those who had it, and there Antonio Pacheero Caraveo and Marco that the Ottoman casualties were also was always enough to sell’.6 By 23 June, it Antonio Altavilla. The Grand Master also buried, possibly at Marsa and became important to initiate a system of ‘apportioned the wells and water cistern, .18 19 Wild dogs roaming the food distribution within Birgu when all so that everyone knew where to draw his countryside disinterred the superficially inhabitants received three one-pound own ration’.3 In spite of these precautions, buried corpses to feast on their flesh.8 loaves daily. In addition, the Grand acute water shortage was felt by the first Master ‘ordered all the corn and wine that week of July 1565. This was met with by FIRST-AID FACILITIES was in private hands to be brought into rebellious actions by the Birgu populace On the battlefield, the most important the public magazines, paying the price sufficient to cause the Grand Master to factor that determines whether an injured thereof to the proprietors’.10 On 6 consider expelling the civilians from the individual survives or not is the front-line September, the bread ration of the sol- town.8 This was only circumvented by the first-aid management. This is where in the diers and knights was reduced in some of discovery on 21 July of a water spring at heat of the battle or the interim, tourni- the Auberges.311The cereal grain was Birgu while digging to extract stone for quets are applied to stop bleeding and baked into bread and hard tack after repairing the fortification walls.6 burns are suitably managed. During the being ground by the hand and animal Public health under siege conditions Great Siege, first-aid stations were set up operated mills in Birgu and the wind- also requires careful attention to environ- on top of the battlements with barrels of driven mills in Senglea. Some bartering mental hygiene. Previous public health salt water to manage and reduce the for food also took place between the regulations had been placed in force effects of burns.3 The defending comba- besiegers and the besieged. ‘The Turks addressing the abuse of public water sup- tants were particularly at risk of burns opposite St Michael gave Martello some plies, the washing of hemp, the control of when handling some of the defence local fruit, such as melons and oranges. In pigs in streets and the controlled slaughter mechanisms. Burns could easily be caused exchange for these he gave them some of animals.14 The public health concerns by the flash of the firing musket and white bread and cheese. When the Turks became even more essential under siege could also be experienced when handling saw this, they were dumb-founded, for conditions. A quick burial after a battle the burning hoops and pitch/oil being they had been convinced that we were was essential, though notable knights or thrown down on the attackers. Recorded extremely short of food’.3 noblemen were laid out awaiting formal examples of burn injuries on the defen- At Mdina, on 11 August, the remaining burial presumably after being embalmed.3 ders’ side include Don Jaime de provisions included ‘200 oxen for food Burial during the Mediaeval period was Sanoguera who had his face burnt by gun- and an equal number of other bovines for generally carried out within the grounds powder but valiantly continued to fight, our sustenance, and 1000 between sheep of churches and chapels.15 16 In 1574, Commander Buoninsegna who was and goats, besides pigs which roam the there were 17 chapels and churches in wounded by an incendiary and the

2of6 Savona-Ventura C. J R Army Med Corps March 2014 Vol 160 No 1 Downloaded from http://jramc.bmj.com/ on August 28, 2016 - Published by group.bmj.com

Footnote and endpiece

Maltese tailor-soldier Marco who was wounded again by a musket shot, rather day of conflict at Senglea. With this rate burned to death by incendiaries.3 than risk being re-branded a coward, he of casualties, the hospital quickly filled up Fighting went on for hours on end opted to receive medical attention on site to 200 inmates by 11 June.3 often in the summer heat—in July and and returned to the battle. La Creda was On 6 June, emergency medical facilities August the average temperature in Malta eventually killed during the fighting in were organised in the various Auberges of is 32°C with a maximum often above 36°C. Birgu on 19 August.10 Once the blockade the Order and in suitable private houses It was therefore necessary to ensure that was effectively enforced by the besiegers, which were evacuated and converted into nourishment in the form of food and the guardroom was used to house the casualty hospitals.3 Each emergency facil- fluids was at hand for the use of the com- non-walking injured. Thirty knights ity was assigned surgeons and chaplains, batants. ‘The attacks lasted for nine hours, sought refuge there and surrendered to and provided with necessary medications. from daybreak until just after noon. The the janissaries when the fort fell on 23 There was also a smaller supplementary Turks were relieved more than a dozen June. Very little quarter was given and hospital consisting of a large hall sited times by fresh troops, while we refreshed only seven knights were captured and next to the Auberge d’Italie close to Fort ourselves with well-watered wine and a kept alive to be eventually transferred to St. Angelo. This had been set up about a few mouthfuls of bread…. made available Ragusa pending their exchange with 30 decade earlier (around 1554) and was to all the posts which were engaged’.3 Turkish prisoners.620 maintained by the Italian Knights.22 Wine and vinegar were essential additives In the same courageous spirit, on 6 When the Admiral Pedro de Monte fell ill to help ‘purify’ the water which could June, Captain Miranda stationed at Fort owing to his ceaseless exertions and his easily become stale and contaminated St. Elmo, after being badly wounded, advanced age, he retired to this facility to leading to gastrointestinal disturbances. refused to be evacuated and sat in a chair recuperate.3 The effort needed to persist with fighting near the guns where he stayed to the end Care was taken ‘to get in a great stock wearing bulky armour for hours on end of the action. Similarly, Bailiff Negroponte of wine, of provisions, and remedies for led to ‘many dying and falling exhausted was injured with an arrow in the leg but the sick and wounded’10 and a large by fatigue and by combat’. Even the fresh continued fighting.3 In the last stand of supply of medicaments had been stored troops relieving the besieged in September Fort St. Elmo, those knights who ‘were not before the onset of the hostilities. By succumbed to the temperature and as they able to walk by reason of their wounds, August, the medicinal supply was running advanced in the heat, many fainted and had themselves carried in chairs to the side low. New supplies were shipped from dropped dead.56 of the breach, where, armed with swords Sicily, but the supply ship was captured by Provisions were also needed to trans- which they held in both hands, they waited the besiegers.821Medications were dis- port the severely wounded to the hospital. with heroic resolution’.10 tributed freely as necessary. In a post-siege It is very likely that this would have been Senglea probably had a similar first-aid petition dated February 1566 made by carried out by one’s own comrades- management station. Facilities for the Antonio de Lauda, the apothecary sought in-arms, though it may also have been a transport of the injured depended on the compensation from the Order for medica- task assigned to the non-combatants. wooden pontoon constructed between tion distributed freely to the population When the knight Abel de Bridiers de la Senglea and Birgu, clearly visible in the during the siege months.2 Gardampe was shot during a battle at Fort d’Aleccio frescos (Figure 1).7 On July 13, The Sacra Infermeria was also badly St. Elmo, his comrades-at-arms went to before the expected assault on Fort sited during the conflict since it was near his assistance to carry him to the Fort’s St. Michael, ‘La Valette had a floating the Post of Castille. The access to the chapel. He however refused their help bridge, which had been constructed of infirmary was protected by the demolition and crawled to the chapel on his own ini- barrels and planks, towed into position of houses leading to it, while the gates tiative where he was later found dead.10 between Birgu and St. Michael, so that the leading to the foreshore were blocked and More organised transport was needed to latter could be quickly reinforced if the parapets were constructed. These were transport the injured from the peripheral occasion arose’.3 manned by soldiers under the command fronts at Fort St. Elmo and Senglea which of lay officers of the Infirmary. A line of did not have formal hospital services on HOSPITAL SERVICES chain entanglements and underwater site and the injured were regularly trans- The expected casualties necessitated an obstacles was created from Fort St. Angelo ferred to Birgu for treatment. A great augmentation in hospital services. After to the Post of Castille. The Post was stock of remedies for the sick and making the maritime town of Birgu their repeatedly attacked, and on two occa- wounded was however kept in each of the administrative centre, the Order quickly sions, 7 and 20 August, the Turkish forces fortifications.10 set out to build a Sacra Infermeria in that penetrated a breach in the bastions in the At Fort St. Elmo, the guardroom served town, managed during the siege by Fra area. On both occasions the defenders as a first-aid station. The transport of the Gabriel Ceralta.321However, this facility managed to repulse the Turks, on the wounded from Fort St. Elmo to the Sacra was inadequate to cope with the continu- latter occasion with the help of the Infermeria at Birgu was undertaken by ous inflow of injured on a daily basis for a ‘walking injured’.10 The sick and injured boats clandestinely at night, until a total 4-month period. The first big clash of the continuously contributed to the war effort blockade of the fort was enforced by the Great Siege took place on the 21 May by replenishing the fighting supplies such besiegers.310Only the very severely when 150 people were wounded. Two as making fuses for the arquebuses.3 wounded were transported to Birgu; the days later the siege of Fort St. Elmo The fortified citadel Mdina was gener- rest were treated on site and continued to began. The injured were regularly trans- ally serviced by the eight-bedded Santo fight on. The knight, Juan de la Creda, ferred to Birgu, sometimes amounting up Spirito Hospital housed outside the walls was branded a coward and jailed after he to 60 casualties per day. Throughout the and hence useless during the siege.23 With got himself evacuated from Fort St. Elmo conflict, the overall casualties averaged the onset of hostilities, the facilities at the for a minor injury.10 He was subsequently 100–400 per day,11 though on 15 July, as hospital together with the facilities in the released and sent back to the fort. When many as 600 men were wounded in one adjoining Franciscan monastery were

Savona-Ventura C. J R Army Med Corps March 2014 Vol 160 No 1 3of6 Downloaded from http://jramc.bmj.com/ on August 28, 2016 - Published by group.bmj.com

Footnote and endpiece

Figure 1 Detail from one of Matteo Perez d’Aleccio’s frescoes at the Grand Master’s in Malta showing the various fortifications (arrow indicates locality of the Sacra Infermeria).

transferred to an edifice within the citadel comfort of the lodgings and of the few cis- galleys at anchor in Marsamxett were walls for use of the sick and injured. This terns that are on the island, by nature very adapted as hospitals.25 is evidenced by the post-siege request parched’.6 The besiegers experienced diffi- dated 1566 by the Franciscan Friars who culties in assisting the wounded on the USE OF BIOLOGICAL WARFARE requested the return of the beds that had front line since any attempt to help the Another important aspect of the strategies been lent to the Mdina Universitá for the wounded exposed the assistants making used during the Great Siege was biological use of the wounded during the siege.24 them easy targets for the defenders. Many warfare. Prior to the siege, la Valette While hostilities around Mdina were of the wounded were therefore aban- ordered that all wells and cisterns in the limited to skirmishes by the cavalry sta- doned to die in the trenches dying ‘like countryside were to be contaminated. The tioned there, these services were definitely dogs in tens a day’.811 copious water spring at Marsa was also used to treat the wounded such as the 29 When the Ottoman fleet had set sail for poisoned under the supervision of the gravely wounded horseman injured during Malta, it carried provisions sufficient for Protomedicus Camillo Rossa using hemp, a skirmish on 7 August.11 6 months, but this had been greatly wheat, arsenic and other ingredients.9 reduced by the loss of a large merchant- Unsuspecting, the Ottomans continued to THE OTTOMAN MEDICAL SERVICES ship in the Nauplia Channel. Further pro- obtain their water supply from the Marsa The Ottomans also set up a number of visions consisting of raisins, dates, honey, spring right through the siege.3 The poi- medical stations in their various camps oil and other things were furnished by the soning of the water sources had its effects around the region. Their Bey of Tunis. By 12 June, however, the on the Ottoman troops for ‘besides sus- main camp seems to have been that set up ‘provisions (of the Ottoman forces) were taining many wounded, they had started at Marsa where they knew that copious very scarce in the army ... the labourers suffering from a fever in their belly, caused freshwater was available—being unaware were rationed to ten ounces of biscuit a by the discomforts, the lack of essentials that the source had been poisoned by the day, and … many were dying from disease and the almost insufferable heat of the knights. The Marsa camp was attacked by … A vessel was dispatched by the pashas season. Whereby many were dying all the the Mdina Cavalry on 28 July who sys- to Tripoli, together with a barge and four time fading out of life and without any tematically slaughtered the sick, wounded galleys. These … were full of sick and solace’.6 The Turkish ships obtained their and other non-combatants they found wounded. It was planned that they should water from a pool sited near the strait there.3 Since Marsa was close to a marsh- return with provisions for the army, since between Malta and Gozo, probably at land region, the wounded soon fell ill they were short of honey, oil, raisin, St. Paul’s Bay. At Fort St. Elmo, ‘there was with ‘the blood flux (dysentery)’ and butter, and other delicacies which the a freshwater pool nearby but, since they ‘other contagious distempers’ such as Muslims relish’.3 By the end of August, would not be able to use it, the defenders ‘putrid fevers’ and ‘tifo’.810The Turks the Turkish base hospital camp could not threw salt into it’. There was apparently a ‘had occupied some villages for the accommodate more casualties/sick and the source of freshwater within the fort since

4of6 Savona-Ventura C. J R Army Med Corps March 2014 Vol 160 No 1 Downloaded from http://jramc.bmj.com/ on August 28, 2016 - Published by group.bmj.com

Footnote and endpiece the knights stationed in Fort St. Elmo pro- should dispatch some money to pay the significantly from those years before the posed to ‘ensure that the water in the fort troops—for nothing makes soldiers siege suggesting that the structure of the was poisoned’ if they were given permis- happier than money … He had gaming local population was not significantly sion to sally out of the fort and fight in tables set up, as well as bars, and the altered by the fighting.26 27 The death toll the open.3 troops were naturally delighted’.3 of the Ottoman force was heavier esti- On their part, the Ottomans attempted mated at 35 000 men3 or 40% of the PSYCHOLOGICAL WARFARE to instil a sense of fear and foreboding in fighting force.2 Both sides also used psychological warfare the defenders. During the assault of The medical consequences of the siege to boost their troop’s morale and scare off St. Elmo, ‘so great was the noise, the continued—in those who had suffered the enemy. La Valette continually relied shouting, the beating of drums, and the direct war injuries, and from deaths result- on the sense of honour and shame to clamour of innumerable Turkish musical ing from the adverse post-siege condi- maintain order and encourage his knights instrument, that it seemed like the end of tions. After the lifting of the siege, to die for the Order. Mercenary soldiers the world’.3 They also tried to demoralise conditions did not immediately improve were encouraged to volunteer for danger- the defenders after the fall of Fort and the adverse health conditions per- ous duties at Fort St. Elmo with promises St. Elmo by beheading the fort’s defen- sisted. About half of the Florentine troops of higher pay and rewards.3 Religious sen- ders and mounting these on stakes on the left in Malta after the siege ‘never saw timents were also encouraged among the walls. In addition, the beheaded bodies their homes again for they died from the troops and even more importantly among were floated off on wooden boards hard conditions and from disease’.3 On a the non-combatant population. During towards Birgu. In retaliation, La Valette personal level, individuals were left the siege of Fort St. Elmo, a devout ordered the beheading of captured maimed for life claiming financial assist- Capuchin friar of the Order of St Francis Turkish soldiers and the firing off of the ance for their sacrifice during the battle. went to the fort and ‘preached a sermon, heads towards the besiegers.310This Individuals who received such aid from encouraging the garrison and putting new event is clearly depicted on one of Matteo the Order years after the event included: heart into them for the fight. After hearing Perez d’Aleccio’s frescoes.7 He also gave Didaco di Aranda and Ludovico Rocca his words the men felt strengthened and instructions that all Turkish prisoners who each lost an arm while Nicolo de consoled, and ready for whatever might were to be killed. The motive for this was Alvarano, Sigismund Talhamar and befall.’ Important Christian feast days to ‘put his soldiers and the inhabitants, Benedict Sanguineo sustained a leg injury such as Corpus Christi on 21 June were whatever extremes they might be reduced that left them crippled. Pedro di Escovedo also celebrated with great pomp.3 to, out of all hopes of capitulating, and to was severely wounded by a bullet in the Religious sentiment was also encour- make them sensible, that their own preser- throat and lost his speech.2 Fra Geronimo aged among the Ottoman troops. During vation and that of the place were Zaportella suffered from mente captus the night prior to an assault, ‘the Turks inseparable’.10 requiring curators to be appointed to care had been assembled on the high ground Both sides had to ensure discipline for his needs.28 29 near the fort, shouting at the top of their among the troops and anyone suspected voices, as is their custom when praying. of or caught deserting was punished Two hours before dawn their priests severely. On the Turkish side, ‘any man Funding None. absolved them of their sins, exhorting who was absent from his post would Competing interests None. them to fight well and to die for their false receive one hundred strokes on the belly’.3 3 faith’. The Ottomans ‘attacked with such On the defenders’ side, traitors who were Provenance and peer review Not commissioned; wild courage that they were like caught were quartered or hanged. ‘… A externally peer reviewed. afion-eaters—afion is a kind of drug which Greek, … was tempted by the devil to go To cite Savona-Ventura C. J R Army Med Corps has such violent effects that, after eating a and tell the enemy that the relief force had 2014;160:1–6. little of it, men lose their reason and arrived, as well as how to prevent them Received 29 June 2013 become quite without fear.’ The use of getting down to Birgu. … He paid for his Revised 15 July 2013 hashish by the Turks during the conflict treachery by being quartered’. Dissent was Accepted 16 July 2013 was confirmed when this was found in the also severely punished. An Italian from Published Online First 18 September 2013 purses of dead soldiers.3 Genoa was hanged within sight of the J R Army Med Corps 2014;160:1–6. The continual psychological stress and enemy ‘for saying publicly that we had no doi:10.1136/jramc-2013-000137 pressure experienced by the Grand chance at all, and that it would be better Master seem to have taken their toll and for us to accept the money and the free REFERENCES ‘Grand Master La Valette, indomitable passage that the Turks were offering’.3 1 Gibbon E. The history of the decline and fall of the though his spirit was, was sorely tired (not . London: Murray, 1862; Chapter 68. 2 Spiteri SC. The Great Siege. Knights vs Turks MDLXV. without good reason), yet he concealed his THE AFTERMATH Anatomy of a Hospitaller victory. Malta: Gutenberg, feelings with his usual wisdom’. The The 1565 was a 2005. efforts of a ‘jester who had come to the battle where no mercy was offered or 3 Balbi di Correggio F. La verdadera relacion de todo island with Marshal Robles… kept La requested. On the Christian side, ‘over lo que el Anno de M.D.LXV ha succedido en la Isla Valette informed of what was happening two thousand five hundred soldiers of all de Malte. Barcelona 1568; English translation: Bradford E. The siege of Malta 1565. England: at the various posts; as well as trying to nationalities died in the siege. Seven thou- Penguin Books, 2003. amuse him with his quips—although there sand Maltese men, women, girls and boys 4 Letter dated 11th August 1565 from Fra Vincenzo was little enough to laugh about’.3 The were also killed, as well as five hundred Anastagi to Ascanio della Corgna. In Pellini P. Dell morale of the combatants had to be main- slaves belonging to the Order’. The siege historia di Perugia, Venice: Gio Giacomo Hertz, vol. 1: 1066–1073; English translation in Bonello tained while measures were necessary to had a minimal effect on population G. Histories of Malta—versions and diversions. amuse the soldiers. La Valette was advised growth and in 1567, the number of bap- vol. 3. Malta: Fondazzjoni Patrimonju Malti, that ‘from a morale point of view, he tisms in most villages did not differ 2002:123–34.

Savona-Ventura C. J R Army Med Corps March 2014 Vol 160 No 1 5of6 Downloaded from http://jramc.bmj.com/ on August 28, 2016 - Published by group.bmj.com

Footnote and endpiece

5 Bonello G. ed. Pallavicino Rangone—inordinate critic struggle for the Mediterranean. Mid-Med Bank 20 Letter in Ragusa Archives, n.d. (post-September of de Valette. Histories of Malta—confessions and Report, 1985:22–59. 1565). In: Bonello G. Histories of Malta—mysteries transgressions. vol. 9. Malta: Fondazzjoni Patrimonju 13 National Malta Library. Archives of the Order of and myths. vol. 8. Malta: Fondazzjoni Patrimonju Malti, 2008:58–66 (based on document housed in Malta 90, fol.152. Malti, 2007:27–53. the Vatican Archives, Miscellanea, Armadio II, 14, 14 National Malta Library. Universitá Ms 13 (23. 21 Cassar P. Medical . London: f.38). vii.1538), fol.162–163v. Wellcome Historical Medical Library, 1965:37–44. 6 Adriani GB. Istoria de suoi tempi, Florence, 1583, 15 Ramaswamy S, Pace JL. The Medieval skeleton 22 Darmanin Demajo G. Storia dell’albergia della lingua 727–45. English translation in Bonello G. Histories of remains from St. Gregory’s Church at Zejtun (Malta): d’Italia. Archivio Storico di Malta 1929;1:261. Malta—confessions and transgressions. vol. 9. Part I. Paleopathological studies. Arch Ital Anat 23 Fiorini S. Santo Spirito Hospital at Rabat, Malta—the Malta: Fondazzjoni Patrimonju Malti, 2008:39–56. Embriol 1979;84:43–53. early years to 1575. Malta: Department of 7 Lochhead IC. The Siege of Malta 1565—Matteo 16 Blagg TFG, Bonanno A, Lutrell AT. eds. Excavations Information, 1989. Perez d’Aleccio’s frescoes in the Grand Masters’ at Hal Millieri, Malta: a report of the 1977 campaign 24 Mifsud A. Un cenno al 1565 nel 1915. Archivum Palace, Valletta. Malta: Heritage Malta, 2009. conducted on behalf of the National Museum of Melitense 1917 July, 231. 8 Bosio G. Dell’Istoria della Sacra Religione et Ill.ma Malta and the University of Malta. Malta: University 25 Curione CS, Mizzi EF. Nuova storia della Guerra di Militia di San Giovanni Gerosolimitano. Rome: Press, 1990:84–95. Malta 1565. Roma: Tipografia Leonina, 1927. Facciotto, 1602; Parte III: 280, 307, 325, 502, 503, 17 Aquilina G, Fiorini S. eds. Documentary sources of 26 Archivum Paroeciae. As reported in: Ciappara 511. Maltese History. Part IV Documents at the Vatican. F. Marriage in Malta in the late eighteenth century. 9 Baudoin J. Histoire des Chevaliers de l’Ordre de No.1 Archivio Segreto Vaticano Congregazione Malta: Associated News Ltd, 1988:126. S. Iean de Hierusalem. Paris: Jacques d’Allin, Vesdcovi e Regolari Malta: Visita Apostolica no.51 27 Savona-Ventura C. War and population change in 1643:484–6. Mgr. Petrus Dusina, 1575. Malta: University Press, the Maltese context. Malta Med J 2006;18:35–40. 10 Vertot R. The history of the Knights of Malta. 2011. 28 National Malta Library. Archives of the Order of London: G. Strahan, 1728; volume 2. 18 Borg B. Workmen discover a Muslim cemetery. Times Malta 91, f.185v. 11 Zabarella CS. Lo assedio di Malta—Maggio of Malta 11 February 2012. 29 Bonello G. ed. In and out of the Knights’ prisons. In: Settembre 1565. Torino: Tip. Salesiana, 1902. 19 Buhagiar CM. National Museum of Archaeology Histories of Malta—convictions and conjectures. 12 National Malta Library. Universitá Ms 13, fol.338. In: News: 1998 & 1999. Malta Archaeol Rev vol. 4. Malta: Fondazzjoni Patrimonju Malti, Cassar C, Cutajar D. Malta and the 16th century 2000;4:45. 2003:9–43.

6of6 Savona-Ventura C. J R Army Med Corps March 2014 Vol 160 No 1