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 Malta 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 Ottoman Empire; 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 Gozo 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), Senglea (Fort St. Michael), but hostilities commenced before they 9 after the First Crusade. It was slowly Fort St. Elmo and Citadel Mdina. 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, Msida 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 Valletta. 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.