J R Army Med Corps: first published as 10.1136/jramc-144-01-10 on 1 February 1998. Downloaded from J R Army Med Corps 1998; 144: 40-45 Inspector of Hospitals Ralph Green and the Plague in Malta of 1813 Lt Col W Bonnici MRCGP,DCH,RAMC* 24 Armoured Field Ambulance, Gaza Barracks, Catterick Garrison, DL9 4AU SUMMARY: Bubonic plague reached Malta from Alexandria on 29 March 1813. The British garrison of about 3700 men escaped lightly, with only twenty deaths. However, the epidemic brought the Army medical officers in conflict with the Colonial Governor. This article looks at the turbulence generated by the plague among the medical staff officers, and at the role they played in the Public Health Services of the island. Introduction lazaretto. Green informed his regimental surgeons that he Malta became a British possession in September 1800. had that morning inspected the cadaver of a female who It was administered by the garrison commander who acted had died of plague. He urged them to be vigilant and to as His Majesty's Civil Commissioner. However, in 1813 inspect the troops frequently, as "it was very probable from the Islands were formally annexed to the Crown, and a the incautious life of a soldier, someone might receive the Governor was appointed to run the colony. Lieutenant­ infection and communicate it to the rest of the garrison" General Sir Thomas Maitland was the first and most (3). Green assembled a medical board with Brooke autocratic of the thirty-four British Governors. He arrived Faulkner as president, and instructed him "to draw up a in Malta on 3 October 1813, and took command of the few medical rules for the guidance of the Maltese" (3). garrison from the ailing Civil Commissioner, Lieutenant­ However, the regimental surgeons found to their "mutualguest. Protected by copyright. • General Sir Hildebrand Oakes. Maitland was soon in astonishment and distress", that none of them had ever conflict with his medical officers. He rebuked Deputy seen the plague. "From the state of our knowledge of thf Inspector of Hospitals Ralph Green and Garrison Surgeon disease," observed Surgeon William Stafford, 3rd Garrisc Joseph Thomas for presuming to take upon themselves the Battalion, "we could have but little to recommend, and th: functions of the Executive Government. Eventually, was chiefly to keep the bowels open by mild laxatives, Maitland insisted that both be "expurgated" from Malta drink plenty of lemonade ..... to pay strict attention , (1). cleanliness, frugality in diet, and temperance in conjugu There was a schism in the medical department. Arthur pleasures" (3). Brooke Faulkner, Physician to the Forces in Malta from Up to 13 May, the Committee of Health deluded itself ' December 1811 to May 1814, was highly critical of the that the disease was completely under its control, and that - Garrison Surgeon for failing to rigidly enforce the the only seeds that had taken root were securely shut up quarantine regulations. Brooke Faulkner was a vigorous within the lazaretto. The plague, however, marched on advocate of the doctrine of contagion. His belief that the relentlessly. "It seemed to laugh at their exertions" said plague was only transmitted by contact differed from that Calvert, and "jumped from house to house and from street held by Robert Calvert, an anticontagionist and Physician to street. Those who had no communication together, as to the Forces in Sicily who, in August 1813, volunteered well as those who had, fell alike victim to its fury" (4).http://militaryhealth.bmj.com/ for plague service in Malta. Nevertheless, the people were still very sceptical that the Maitland had no confidence in his medical staff, and plague was amongst them. To dispel the general disbelief maintained it absurd to suppose "that any medical man is a in its existence, Green, Thomas and the Apothecary to the _ bit better judge than any other member of the community Forces William T Iliff published a proclamation affirming as how the plague is to be stopped and what are the that "we who have seen and assisted in the examination of measures to be adopted on the occasion" (2). He therefore the bodies of several individuals who have died in the kept his private counsel, and implemented his own lazaret and in the city of Valletta, do certify that these measures to eradicate the plague. individuals, did die of real and malignant plague" (5). In order to check the spread of the pestilence, the Committee Green and the plague of Health urged the government to suspend all commercial On 19 April 1813 the daughter of a shoemaker from the activities. They also recommended halting all movement on September 28, 2021 by city of Valletta died of a very malignant fever. Several within the city, severing contact with the countryside and . days later her mother became febrile, developed buboes in shutting up the people within their own dwellings for a . the groin and axilla and died on 3 May. Deputy Inspector period of forty days. These measures were only partly . of Hospitals Ralph Green was the Principal Medical implemented. The Committee of Health felt that the Officer of the Malta garrison, and a member of the failure of the government to heed all their advice was not . Committee of Health, presided over by Staff Surgeon only enabling the plague to spread unchecked, but was also . Joseph Thomas. On being notified of these suspicious directing the hostility of the people against them. On 22 deaths the Committee of Health removed the family to the June therefore they exhorted the Civil Commissioner to * now 23 Para Fd Amb RAMC, Montgomery Lines, Aldershot, Hants GUll 2AZ. J R Army Med Corps: first published as 10.1136/jramc-144-01-10 on 1 February 1998. Downloaded from W Bonnici 41 publish all the recommendations that they had given him. "inheritance of a sound constitution and difference in the .Oakes acknowledged that their suggestions had been mode of living" (8). : beneficial, but had felt it inappropriate to implement them According to a contemporary description, the · all, on the grounds of costs. He had always regarded the "pestilential fever makes its appearance with loss of · Committee of Health as a purely advisory body, and could appetite, violent headaches and from debility, excessive not conceive how they had dared to presume otherwise. irritability takes place. A tumour of the quality of a The health officials were unwilling to hold office without whitlow forms in the neck, or under the arm, or knee, that the powers to enforce their proclamations and resigned seldom ever fails to kill the patient in ten or twelve hours, their office on 28 June. Oakes replaced them with an who dies raving mad. It is very rare if ever one recovers, advisory Council of Health with himself as president, and unless the tumours ripen and burst" (9). About thirty to .. Green and Thomas among its ordinary members (6). On 3 forty soldiers of the 3rd Garrison Battalion contracted , July a medical police was raised to ensure compliance with plague, of whom eleven died. Surgeon W Stafford purged the quarantine regulations. The plague in Valletta started them all with Calomel. Calomel, mercurous chloride, was to abate by the end of August. However, it was still raging liberally prescribed to cleanse the bowels, as it was · fiercely in the countryside and on 11 September troops imperative to remove all residue of food lest it underwent surrounded the infected villages so as to segregate them putrid transformation and poisoned the body. Initially, the from the rest of the island. Oakes returned to England on patients were treated under canvas, but in July a military 11 October 18l3. pest hospital was set up in the convent of Saint His successor was not one to rule by committees. On 29 Calcedonius at Floriana. Green was superintendent of the November, Maitland abolished the Council of Health, and pest hospital. He appointed a steward, a cook, and two returned Green to his sole duties as Principal Medical orderly men to work in the hospital, but neither steward Officer. The Governor claimed that the doctors had nor cook were permitted to enter the sick room. Green attempted to usurp the power of the state. He alleged that directed the staff to pay the strictest attention to the guest. Protected by copyright. Green and Thomas had "taken it into their heads to enter personal cleanliness of the sick by frequently changing :uto a new kind of political speCUlation and to attempt to their bed and body linen. The rooms and corridors were to iN up what I never heard of before, a government purely be washed and sprinkled with vinegar. When ~iedical" (7). The Committee of Health, declared administering medicine or food to the sick, the attendants trJiaitland, has assumed "that because the plague existed, were advised to rinse their mouth with strong vinegar, and <:i\'e whole island was a lazaret, and that because it was a to suspend respiration for a while so as to avoid inhaling ilazaret they had the right to govern it, and went on to force the noxious exhalations of the patient. A hospital mate on government into measures of expense, holding out the the staff of the garrison hospital in Valletta was detached threat that if whatever they proposed was not executed, the for duty at the pest hospital. On 4 July, Mr Francis government would become totally answerable for the Dagenhart took up residence at the hospital. Dagenhart health of the island and for any loss of lives that might was relieved by hospital mate J Henry Milles on 30 July, ensue" (2).