Psychological and Medical Aspects of the Siege of 1565
The historians that have occupied themselves with the story of the siege of 1565 have confined their attention almost exclusively to its religious, military and political implications. As far as can be ascertained no account has been written about its medical aspects and the psychological. reactions of the civilian population under the stress of war. The amount of information on these aspects of the siege is very scanty. No medical man of that period appears to have made any observations on the subject, or, if any did, they have either been destroyed or not yet brought to light. Hence only lay sources are available. These are fragmentary since contemporary and later historians recorded only the more dramatic manifestations of medical happennings. Besides, the descriptions that they give are more often picturesque than detailed and medically informative. However, in spite of these shortcomings it is possible, from the material gleaned from various sources, to form a general picture of medical events and to follow the civilian population through its varying reactions in response to the invasion alarm, hatred of the enemy, the self-preservative drives, the joy of victory and post-war fears.
The siege of 1565 lasted four months, from the 18th May to the 8th of September. The main fighting took pace in three areas — round the fort of St. Elmo (23rd May to 23rd June) at Senglea and at Birgu (6th July to 8th September). It has been estimated that the number of fighting men involved in the siege operations was 90,000 on the Turkish side  and 9,100 men under arms on the Order’s side  together with the civilian population which must have numbered well over 22,000 souls. 
A Turkish invasion had been anticipated since a long time, but according to the calculations made by the Knights, the Turks were not expected to attack Malta before the end of June. As things turned out, however, the invaders appeared off the Island on the morning of the 18th May. This sudden, unexpected arrival induced great fear in the population.  The first reaction, when the alarm was sounded, was one of bewilderment which soon gave place to turmoil and confusion.  A number of country folk set out to collect their cattle and save their crops and carry them inside the fortifications, but others, overcome by terror, ran hither and thither not knowing what they were doing.  Even those who in the past had earned a reputation for bravery and steadfastness in the face of danger could not hide, in the pallor of their faces, their uneasiness and fear. 
Viperano, writing a year after the siege, gives a very vivid picture of the initial reaction of the population. “The arrival of the enemy” he says “excited so much fear and apprehension in the hearts of the Maltese, who are naturally timid and hardly used to war, that many hid themselves in their houses or behind walls while others chose the caverns and the cliffs. One could not help feeling pity for them in seeing some of them in tears and trembling with terror taking refuge here and there with their wives and children in the absence of the necessaries of life and without any hope of obtaining food.” 
The Grandmaster had issued orders that in the event of an invasion all the heads of cattle and crops that could not be conveyed inside the fortifications were to be destroyed;  but because of the initial panic that seized the population, this order was incompletely carried out with the result that a great quantity of provisions fell into the hands of the Turks later on.  Another version has it that the loss of these provisions was due to the little care shown by the country people to save their animals because they were not anticipating that the Turks would remain in the Island for long. 
Very probably both factors — panic and over-optimism in the face of danger —were operative, for in spite of the apparent contrasting characters of these two states of mind, each of them may spring from the emotion of fear. Panic is a very common response to a fear stimulus, especially where masses of people are involved; but over-confidence and the belittling of danger in the face of a real peril may also be a defence mechanism against fear. Those who panicked were terrified of the Turks and made no attempt to hide their terror neither from themselves nor from others; while those who did not bother to destroy their flocks and crops because they appeared optimistic about the outcome of the Turkish invasion, may have been as afraid of the enemy as those who panicked, but with this difference — they substituted a psychological flight for a muscular one. Indeed one way of escaping from danger is to minimise the importance of its threat to the self-preservative urges of the personality, or else to deny its existence altogether. This form of escapism from a fear-stimulus and its attendant anxieties and obligations manifests itself in the over-compensatory attitude of an unjustified optimism. The consequences were as harmful to the war effort of the community as those of panic.
The presence of a civilian population in a sterile and defenceless Island constituted a major problem for the Order in time of war. The knights were well aware of it and since many years they had been trying, if not to solve it radically, at least.to mitigate it. In fact as early as 1551 they had contemplated, in the event of a Turkish invasion, the mass evacuation of what they called the “useless civilians” i.e. the women, children and the aged, from Malta and Gozo and their transfer to the southern coasts of Sicily.  Serious opposition had been encountered from the Gozitans against this scheme. They declared that they would only leave Gozo if induced to do so by active force and that they preferred to risk the hardships of a siege in their own castle of Rabat in the company of their wives and children rather than suffer separation from their families.  It was afterwards discovered, however, that their real intention was to abandon Gozo and make for Malta if and when an invasion materialised.  When, however, the Turks did come in 1551 the Gozitans had no opportunity of carrying out this manoeuvre. In fact they were overwhelmed by the Turks and after surrendering their castle, between 5,000 to 6,000 of them were taken slaves. 
The Maltese were so impressed by the fate of the Gozitans that many families volunteered to emigrate to Sicily in that year and not a few of them settled there for good.  In April 1552 one thousand persons — women, children and old people — left Malta for Sicily.  As rumours of a Turkish invasion subsequently became less persistent, this exodus dried up, but when in the early months of 1565 news of Turkish military preparations against Malta again started reaching the Island, the evacuation of civilians was resumed. Between the 16th April and the 13th May 1565, “a great number of people,” among whom there were many of the principal families of the island, sailed to Sicily to be out of reach of the dangers of war.  A further batch of refugees had already embarked on four galleys and were waiting for the opportune moment to sail when the Turkish fleet unexpectedly appeared off the Island and the voyage had to be put off. 
While every official encouragement — including free passages — had been afforded to the Maltese to leave the Island, no detailed scheme had been prepared for the internal evacuation of the remaining population from the countryside to within the fortifications. The consequence was that at the announcement of the enemy’s landing, the country folk found themselves without guidance. A number of old people, women and children hid themselves in the caves or Rdum where they were afterwards discovered by the Turks,  but the majority of the villagers tried to seek refuge within the defences of Birgu. They argued that once the Grandmaster had fixed his residence in Birgu, this town must have been the strongest fortress in the Island, as indeed it was.
This mass movement towards Birgu in time of war was not the first of its kind. A similar rush of the people on this town had occurred in 1551 when, during a widespread Turkish raid on Malta, some 12,000 persons had sought protection within its walls.  In this month of May 1565, however, the Grandmaster viewed this second influx of so many people into such a restricted area with very grave concern. It had not yet been forgotten how in 1551 the refugees had to lie about in the streets of Birgu day and night because there was not sufficient room for them in the houses; how they suffered from thirst owing to scarcity of water and how its conformity with the then current miasmatic theory of infection, fears of an outbreak of pestilence had tortured their minds owing to the “very foul odours derived from the breath, the sweat and the other exhalations of so many human bodies and animals crowded together.”  He feared that the same scenes would repeat themselves and that some contagion might arise during the forthcoming siege with disastrous results. He, therefore, gave orders that the gates of Birgu that led to the countryside were to be shut to prevent further congestion inside the town. He also appointed a Knight, Fra Gabriel Gort, a Catalan, to take charge of the distribution inside the other fortifications of the Island of those civilians that had been left outside the gates of Birgu. Most of these refugees were eventually conducted within the walls of Senglea where they were “very charitably accommodated.” 
A request to transfer themselves to Birgu came also from the inhabitants of Mdina. Finding themselves without adequate means of defence, they sent a delegate to the Grandmaster to ask for the supply of the necessary arms and of a sufficient number of soldiers to defend the city, or else to request that the inhabitants of Mdina be allowed to abandon their city and repair with their possessions within Birgu. This new threat to the internal security of Birgu was averted in time by the Grandmaster, who, choosing the first alternative, sent the required arms and men to Mdina. This move so satisfied the citizens of that citadel and raised their morale to such a pitch that, in the words of one of the Knights, “they performed their duty faithfully and bore themselves with valour during the whole siege.”  Thanks to the measures thus taken, the initial panic of the masses was promptly and effectively dealt with.
The Influence of Religion
The feeling of relief experienced by the civilian population when it found itself posted securely inside the bastions of Birgu, Senglea and Mdina was further strengthened as a result of the religious ceremonies held during the succeeding days of the war. On the first day of the Turkish landing, La Valette ordered the public exposition of the Holy Sacrament in the churches and appealed to the people to offer prayers for their deliverance. Further religious ceremonies and processions were held periodically during the siege. 
To appreciate the psychological effects of these religious activities on the people, we must bear in mind that more than a national motive was involved in the conflict: for apart from being their foes from the national viewpoint, the Turks were also the enemies of the Maltese in so far as they were the enemies of all Christians. A historian designates the Maltese of the sixteenth century as having been “very devout and good Catholics” while the Turks were labelled “the infidel dogs.” Patriotic resistance in those days thus became identified with the religious motive and the struggles against the Moslems inevitably assumed the nature of a Holy War. Under such conditions, La Valette’s public enlistment of religion could not but result in bolstering up the morale of the population. First of all the reliance on supernatural help infused hope and courage in an anxious population. The Maltese were convinced that in the past they had received supernatural assistance in times of national emergencies. Thus they firmly believed that during the Moorish siege of Mdina in 1428-29, St. Paul had been seen clad in armour and mounted on a steed attacking the enemy,  while they still remembered how in 1551 Mdina had been besieged by the Turks and how the siege was lifted a day or two after the effigy of St. Agatha had been carried in procession to the walls of the city.  They now saw no reason why supernatural forces should not intervene on their behalf as in the past. This expectation of divine help dispelled to a great extent what remained of the emotional tension that had been engendered by the invasion alarm. In the second place, it united the Maltese to their rulers. It must be remembered that the Knights, with their encroachments on the political rights and privileges of the Maltese in previous years, had provoked in the people an undercurrent of resentment and hostility against the Order.  The treatment of the Maltese by the Order has been described as having been that of “a crowd of Christian slaves bound to obey all the whimsical laws of the Knights under the usual penalties of the birch, the oar and the gallows.”  The Maltese and the Knights thus formed two separate communities with little or no cohesive bonds between them. It is remarkable that even during the siege the Knights maintained their aristocratic outlook — they and their soldiers were “i nostri” while the Maltese civilians were “la bassa plebe” or “il popolo minuto.” Religion formed the only ground on which the people and their rulers could meet on an equal footing. The Turks by threatening this common faith of the Maltese and the Knights strengthened the religious bond between the two communities and thus caused the people to forget their grievances for the time being and to rally unhesitatingly around the Grandmaster and his Knights.
Adaptation to War Conditions
Though the initial excitement had been brought under control, the civilian population had yet to learn to adjust itself to exposure to actual warfare. Until this adjustment took place there were transitory moments of fear and discouragement. Thus the official historian of the Order reports that a group of Maltese workers, who were engaged in repairing the bastions of Senglea, showed such fear of the enemy fire when first exposed to it, that fleeing from their place of work they sought shelter “sotto le falde delle donne loro.”  However, these men soon adapted themselves to the new war conditions and later on they not only lost their fear but became very daring. Those civilians, too, numbering some 5,300 men, who were conscripted into the army, proved to be worthy comrades of the Knights and of the regular soldiers by their valour and endurance though they received little training and had no special knowledge of the arts of war.  The same adjustment was shown by the women, children and old people who, finding themselves in the battle areas, joined fearlessly in the fight.  Thus it has been recorded that “wives and children fought with an intrepidity that equalled in some measure the resolute bravery of the Knights; and if paternal and conjugal love inspired their men with a courage and force to which they had been hitherto insensible, there were not wanting heroic women who ran to the assistance of their fathers, their brothers, and their husbands and who generously exposed themselves to the greatest dangers.” 
Reactions to the Loss of St. Elmo
The first serious psychological crisis of the war came after the loss of St. Elmo on the 23rd June. Apart from its military consequences this event was especially demoralising because it occurred on the eve of the feast of St. John Baptist, the patron saint of the Order. Mustafa did not fail to exploit the situation. In addition to grief and discouragement, he managed to inculcate terror in an already anxious population by a very effective form of propaganda. He caused all the dead Knights found in St. Elmo to be beheaded, and after tying their mutilated bodies to planks, he sent them floating in the Grand Harbour so that they could be seen by all the inhabitants and defenders on the bastions of Senglea and Birgu.  This sight produced the desired effect on the besieged. Anticipatory fears of a major disaster gripped the hearts of the civilian population who understood that a like fate awaited them. The men of Birgu and Senglea met in subdued groups to vent their preoccupations, but the women showed their fear and grief in a more demonstrative manner by their loud lamentations in the streets of the towns. 
La Valette realised the dangers of this state of affairs. He was aware that Mustafa’s fear-propaganda aimed at alienating the people from their loyalty to the Knights and at stirring in them the desire for the suspension of hostilities.  The way to ward off the immediate consequences of such a crisis was to restrain the too demonstrative show of grief and anxiety of the people; secondly, to divert their attention from their reverses; and, finally, to replace the fear-stimulus by another one of an opposite kind capable of arousing buoyant emotions and of elevating their damaged morale. Accordingly, he commanded the women to stop their moanings and lamentations, and gave orders that the feast of St. John was to be celebrated on the morrow with the usual festivities and fireworks.  Then in a speech to the people at the piazza of Birgu, he warned them not to pay heed to any promises of leniency that the Turks might make to them as it was not the first time that the enemy had made similar promises in the past and then failed to keep them. Those persons, therefore, who might have thought it expedient to come to terms with the enemy erred gravely. It was wiser not to expect any quarter from the Turks and to wage a pitiless war to the end. 
On that same day he issued a “bando” ordering that all Turkish prisoners of war were to be put to the sword and cut to pieces without being allowed the least quarter.  He commanded, moreover, that this slaughter was to be carried out by the people “perché (il popolo) a suo talento ne facesse giustizia.” 
Cruelty of the Crowd
The “bando,” which, we are told, pleased everybody,  was scrupulously carried out as soon as the occasion arose and the outbreak of hatred and violence that it unleashed reached histrionic heights. The behaviour of the Maltese crowds becomes frankly repulsive to watch but in judging the crowd of 1565 it is relevant to view it against its special historical background.
They lived in an aggressive age. Their lives and their property were continually exposed to the rapacity of the pirates that infested the Mediterranean. Threats of destruction and death impinged upon them at every hour of their lives. It is no wonder, therefore, that their hostile impulses were stirred to such a degree as to earn them the reputation of being very reluctant to forget the offences received.  Apart from this external pressure, a good deal of aggression was interwoven in their social fabric. Through the institution of slavery they had developed a certain callousness to human suffering and a blurring for the values of human life. They lived in times when even the maintenance of public order and the administration of the law were based on extreme measures of violence. The infliction of torture, for instance, was taken as a matter-of-fact procedure in the extraction of truth from an accused person in a court of law. The execution of criminals was made an occasion for a public diversion so that the people became quite immune to the sight of men being marched and birched through the streets and then quartered or beheaded and their corpses thrown into the gutter; and also to the spectacle of gibbets with corpses dangling from them in the most prominent spots of the Island.  We must, therefore, think of the Maltese crowd of the 16th century as being formed of a mass of unrefined folk in whose pattern of life violence, in one form or another, played an integral part and in whom it was not difficult to stir the desire for retaliation and vengeance especially when the invitation for violence came from the leader himself in times of stress.
The first slaughter took place on the 8th July. A number of Moslem galley slaves, chained in pairs, were made to repair a breach in the fortifications at Birgu. In this position they were exposed to the artillery fire of their co-religionists. Two of the slaves called out to the Turkish artillery men to warn them of their presence and to ask them to desist from firing to spare their lives. Not understanding what the slaves were saying, the Christian soldiers suspected that the slaves were inciting the Turks to assault the post. Thereupon, the slaves were seized upon by the people, and mobbed and stoned to death by a crowd of boys who afterwards trailed their corpses along the streets of Birgu. 
Another scene of popular violence occurred, also at Birgu, on the 15th July when four captured Turkish prisoners of war were handed over to the people who after horribly mutilating them continued, for some time, to drag their lurid remains along the streets of Birgu and Senglea. 
A similar scene was enacted at Birgu on the 23rd August when Turkish prisoners, after being tortured to extract military information from them, were handed over to the people “so that in its fury it will put them to death.” 
At Mdina the execution of prisoners was an almost daily occurrence.  The historian of the Order complacently remarks that these executions gave great satisfaction to the people who had become very avid for revenge.  Even official justice utilised this lust for blood of the population for the execution of its death sentences. Thus the sentence of death decreed against a Calabrese renegade was ordered to be carried out by the children of Mdina who killed him by prodding him with pointed canes and then stoning and burning him. 
A psychological analysis of these mass phenomena leads up to several points of interest. First, they afford an instance of how a people under stress accepts the directives of the leader uncritically, and how promptly the crowd regresses to a primitive level of behaviour once its collective aggressive emotions are aroused.
Secondly, though the leader must ultimately bear the moral responsibilty for the excesses of brutality committed by the crowd, it is doubtful whether the people would have responded so enthusiastically to La Valette’s call for revenge if identical desires for retribution had not already been simmering in themselves. In fact it appears that what the leader does in such circumstances is not to create a thirst for blood “de novo” but only to harness the aggression that is already smouldering in the people and to provide them with the victim or scapegoat on whom to vent their passion for revenge. 
Thirdly, when ordered by the leader, violence is liable to be more brutal and fanatical than when it springs from the crowd spontaneously, because the leader’s sanction removes all inhibitory moral influences and feelings of guilt that would normally tend to restrain the individual when acting on his own responsibility.
Fourthly, La Valette, in spite of his superior intellectual and cultural background, seems to have, himself, remained free from feelings of regret and remorse for the consequences of the outburst of violence which he provoked by his “bando.” This is the more remarkable when we consider that his move served no useful purpose from the purely military point of view; in fact he was only avenging himself on an already vanquished and defenceless enemy. Besides, he was not forced to resort to it under the force of popular pressure; on the other hand it was he who spurred the people to violence. Moreover, he was the leader of a Christian community ostensibly engaged in a war in defence of all that Christianity stood for — charity, mercy, brotherly love and forgiveness — against an enemy that personified all that was evil and brutal. La Valette had called the Turks “atroci, bestiali e sceleratissimi barbari”  but he seems to have remained unaware that by his “bando” he had approached their pattern of behaviour very closely. Indeed the contradiction between the professed war aims of La Valette and the mass violence that he unleashed makes one wonder how such intense hatred could thrive side by side with religious fervour. Of course such instances of psychological dissociation are not uncommon, but one cannot help thinking that in those days the appeal of religion was more of an emotional than a spiritual one, and that in spite of their adherence to formal religion, the ethical standards of the Knights were not above the medieval atmosphere, still steeped in barbarity, in which they lived.
It required a very serious threat to their self-preservative instincts to induce the people to turn their thoughts and energies in a fresh direction towards the end of July.
The food situation never gave the knights any great worry for they had amassed enough biscuits, flour, salted meat, wine and vinegar to last them for many months. Some measure of control over bread consumption had been rendered necessary when the provisions brought by the refugees from the countryside became exhausted in the first week of June. Two commissioners were appointed to ascertain the number and condition of the people that had taken refuge in Senglea and Birgu. It was found that 17,000 persons had the means to buy bread, while 7,000 were so poor that they could not afford to do so. These were liberally supplied with bread free of charge during the whole period of the siege.  Stricter measures of control were adopted on the 23rd June  when all the stores of food-stuffs and wine that had been laid up in private houses were taken over by the Government to establish a more orderly and a fairer distribution of provisions.  Moreover, La Valette ordered the killing of all the dogs in Senglea and Birgu, as besides disturbing the garrison at night, they were daily consuming their provisions.  Thanks to these measures the food situation was saved for the duration of the siege, so that even at its worst period, apart from other items of food, every one among the besieged received three one-pound loaves a day. The blackmarket in foodstuffs did not seem to have existed for besides being abundant, the main items of food were sold at prices that were within the means of the most modest pocket of both civilian and soldier.  The citizens of Mdina, who numbered 4,000 souls, fared better still. In fact at the end of the siege they still had 1,000 head of cattle and 250 horses and mules, apart from fowls, bread and biscuits. 
The question of the provision of water, however, presented a different aspect. In spite of the storage of 40,000 barrels of water in the various fortifications,  the situation of the water supply became critical at Birgu in the first week of July. Writing to the Viceroy of Sicily on the 8th of this month, La Valette recorded his anxiety at the sight of the great multitude of useless civilians within Birgu, who on account of the scarcity of water had already started to voice their discontent. He was also worried at the thought that, in spite of all efforts to limit water consumation, it appeared certain that they were going to be reduced to a grave extremity.  In fact the water shortage increased as the days passed. The people of Birgu started reacting violently. There were great disorders; some hideous crimes were committed and were severely punished. The historian of the Order does not state what the disorders and crimes were but that the situation was desperate is shown by La Valette’s admission that the supply of water could only last for a few days more, and that he was faced by one of two alternatives — either send out of Birgu the civilian population, a step that was deemed to be brutal and also dangerous as it could have given rise to open rebellion; or else to perish with the people.  Fortunately, La Valette was spared the choice, for on the 21st July a spring of water was discovered in a house in Birgu and a very serious threat to the safety of the island was averted in time. 
A less serious difficulty in the form of a housing problem had to be faced a few days later. A number of houses had to be pulled down at the beginning of the siege of Birgu extending from the post of Castille to the Infirmary for purposes of defence.  More houses were destroyed by the defenders, later on in the siege, to obtain stones to hurl them against the enemy.  The housing shortage became acute when the enemy artillery added its quota of destruction. Between the 22nd and the 28th July a heavy artillery barrage was opened against Senglea and Birgu from Mount Sceberras and Mount Salvatore.  It has been estimated that there were 77 pieces of artillery on Mount Sceberras alone directed almost entirely on Birgu. Entire houses were destroyed and a great number of women and children perished in this bombardment.  The homeless survivors could not be accommodated in the remaining houses as these were already overcrowded. The need for shelter was therefore met by the provision of tents and huts that were erected under the protection of the ramparts.  Strong defences of very solid contruction were also put up to prevent the destruction of more houses. As the building of these defences involved great danger to those working on them, La Valette compelled the slaves to do the work. Hundreds of them were killed and those of them that attempted to retreat to safety were forced to turn back by the severe punishments inflicted on them by the besieged who cut the ears of the more obstinate slaves and even put some of them to death. 
Reaction to Death of Melchior de Robles
A severe damaging blow to civilian morale was occasioned by the death, through enemy action, of the “Maestro di campo,” Melchior de Robles. To realise the magnitude of the effect of his death on civilian morale it is sufficient to mention that his reputation with the people was such that they “placed in him their main hope for deliverance” after God and the Grandmaster. Since such was his prestige, it is no marvel that the people felt terrified and lost at his disappearance from the defences.  La Valette soon intervened to heal this new breach in the people’s morale. In a public declaration he feigned that the loss of Robles was not so great as it appeared because the Knights and soldiers had been so well instructed by him in the arts of war that each one of them was capable of carrying out the work that had, up to then, been performed by Robles.  Calm was again restored among the people and when on the 27th August La Valette ordered the women, children and the aged to work in the arsenal, to help in the repair of the fortifications and to clear the debris from the ruined bastions, the people bent to this new task without complaint. After all, before the issue of this official order, the women and children had on many occasions, quite spontaneously, joined the soldiers in the fight, so much so that La Valette did not hestitate to declare that without their help the fortress might, perhaps, have been lost.  Although an imposed labour is always irksome, it is probable that La Valette’s order, in spite of its apparent hardship, helped in an indirect way to raise the morale of the population. Indeed experience has shown that the active occupation of civilians in time of war diminishes anxiety and neutralises the feeling of helplessness that often overcomes non-combatants.
The Holy Infirmary
While these psychological trials were being endured by the besieged, adequate means for dealing with surgical and medical casualties had to be provided. At the time of the siege there were three hospitals in the Island. One of them was Santo Spirito Hospital of Rabat. This, however, hardly deserved to be called a hospital in those days, since it consisted only of a small church adapted as a hospital and containing only four beds. Apart from its inadequacy, it was situated outside the walls of Mdina and therefore out of reach of the defenders of that citadel.
Another hospital was maintained by the Italian Knights at Birgu. It occupied a large hall of their auberge situated near the Fort of St. Angelo on the foreshore of what is now called Dockyard Creek. We do not know what its compliment of beds was but it could not have been very large.71
The third hospital was the Holy Infirmary, also at Birgu, erected by the Order in 1532, on that part of the foreshore of the town looking across Kalkara Creek towards Salvatore Hill. Its professional. staff consisted of physicians, surgeons and an apothecary. Only “learned and experienced” doctors were engaged by the Order. Besides taking an oath that they would do their best for the welfare of the patient, the physicians undertook to abide, in their clinical work, by the writings of the most accepted medical authorities. The surgeons were not taken on the staff until they had been examined and approved by the physicians. The apothecary was in charge of the dispensary, but he too was under the immediate supervision of the physicians.
From the strategic point of view, the Infirmary presented a very grave problem because, owing to its exposed position, it was very vulnerable to Enemy attacks.
As long as the Turks were occupied in reducing the Fort of St. Elmo, the Infirmary received no attention from them and it carried on its work without hindrance. Having captured the Fort of St. Elmo, the Turks opened their attack on Birgu and thus the infirmary found itself in the midst of one of the fiercest and most dangerous battle areas of the war. Owing to its position it came in the line of firing of the gun batteries mounted by the Turks on the Hill of San Salvatore on the other side of Kalkara Creek facing the hospital.
The Infirmary relied for its defence from infantry attacks on those sections of the bastions of Birgu that were entrusted to the men of the langues of Castille, Germany and England ― the last one being represented by only one knight, Sir Oliver Starkey, the secretary of the Grandmaster, who had under him the sailors and soldiers of the galleys.72 A few gates that led from the site of the Infirmary to the foreshore were blocked and parapets were constructed. These were entrusted to a group of soldiers under the command of the lay officers of the Infirmary.73 As the Grand Hospitaller was away from Malta at the time74 and as his lieutenant was in charge of the post of the French langue,75 the officers in charge of these parapets must have been the two “prodomi”76 and the Head Infirmarian.77 Moreover, a line of chain entanglements and underwater obstacles was stretched along the coast from Fort St. Angelo to the post of Castille to prevent the Turks from making a landing on the foreshore of the Infirmary.78
From the beginning of the siege of Birgu, the bastions defending the Infirmary came within range of the enemy artillery.79 The battering that they received was so severe and incessant that a dangerous breach was made in them by the end of July and from this day onwards the fate of the Infirmary hung precariously in the balance. By the 1st of August the enemy was only 20 or 30 paces distant from the breach in the fortifications. The situation became increasingly critical and grave. By the 7th August the first Turkish soldiers had penetrated the breach,80 but they were repulsed after heavy fighting during which La Valette himself took part and was wounded. Another onslaught on the approaches of the Infirmary was opened on the 20th August. The Turks caused further damage to the bastions at the post of Castille and nearly advanced into Birgu.81 The ranks of the defenders had been seriously depleted and La Valette did not dispose of enough men to replace his losses at this post. So he thought of the men that were lying wounded at the nearby Infirmary and resolved to induce as many of them as possible to return to the fight in spite of their injuries. He proceeded to the Infirmary and ordered all the walking patients to assemble in the Great Ward; then after showing them the wound that he had sustained in his leg, he told them that he, too, needed rest in bed for his injury, but realising the extreme gravity of the situation he preferred to die fighting rather than wait to be slaughtered in the Infirmary by a relentless enemy. His words produced the desired effect for all those who could carry themselves went to the parapets to join the defenders, and only the dying and those who could not support themselves on their legs remained behind in the Infirmary.82 After a fight lasting a whole day the Turks were again thrown back. Other attacks were launched against the approaches of the Infirmary but none of them succeeded in causing any serious damage to the hospital.
Reception of Casualties
It was under these disadvantageous conditions that the Infirmary had to carry on its work during the siege. Immediately the operations of war were started, the Infirmary, besides discharging all the functions of a general hospital, was called upon to assume the additional and more onerous role of a casualty hospital.
The first major encounter with the enemy took place on the 21st May outside the gates of Birgu. On that day the first batch of wounded men entered the infirmary. There were 150 of them.83 Two days later the Turks started their attack on Fort St. Elmo and more wounded men poured in to the infirmary from this fort. Sometimes as many as 60 casualties were admitted in one day.84 The wounded were conveyed from St. Elmo in boats that plied under cover of darkness between the fort and Birgu85 across the harbour. By the 5th June, however, the Turks begun attacking these boats by firing at them from the shore, hitting some of them and wounding the oarsmen.86 On one occasion a wounded knight was killed during transit by an arquebus bullet.87
Soon the infirmary was unable to cope with the numerous casualties and sick brought to it, so that by the 6th of June the hospital had become full with 200 patients and the patients were being distributed among the various auberges and also in private houses.88 At this stage two circumstances intervened which slowed somewhat the rapid rate of admission of casualties into the hospital. First, owing to increased enemy activity, boat transport across the harbour between the fort and Birgu became extremely risky and, therefore, less frequent after the 16th June. Secondly, because of these transport difficulties, the losses of the garrison of the fort could not be replaced. It was, therefore, resolved that those soldiers who were not seriously wounded but who could no longer continue the fight should still remain in the fort and do all the work that was needed behind the fighting lines. The men were persuaded not to abandon the fight except when they sustained fractures or were feeling exhausted from excessive blood loss.89 These arrangements had the effect of diminishing somewhat the volume of the stream of casualties from the fort. Besides, it was ordered that only those who were very severely wounded were to be transported to the Infirmary.90 La Valette attached the greatest importance to this provision and he was not prepared to tolerate any departure from it as shown by the following incident. One day he saw among the wounded men from St Elmo, Captain Della Cerda, who had just reached the Infirmary from the fort to be treated for his wounds. The Grandmaster, however, was not satisfied that Della Cerda’s wounds were of so grievous a nature as to justify his leaving the fort. He, therefore, sent the captain to prison to show his displeasure and to set an example to others.91
During the siege of St. Elmo, the number of casualties that were taken to the Infirmary from the fort was 300.92 Those who could not be conveyed to the Infirmary owing to transport difficulties were placed in the chapel of St. Elmo but when this fell into the hands of the enemy the casualties collected in the chapel were killed by the Turks.93
The Grandmaster was well aware that the Infirmary had become too small to accommodate all the medical and surgical patients that needed hospital treatment. Following the loss of St. Elmo therefore, and in anticipation of the siege of Senglea and Birgu, he issued a “bando” in the last week of June to remedy this state of affairs. Among the steps taken was the evacuation of a number of houses in Birgu that were well protected from enemy missiles. They were turned into emergency hospitals for the sick and wounded among the soldiers and civilians of the two towns. He also assigned to each hospital the number of chaplains and surgeons which he deemed necessary and the drugs with which they were to be provided.94 Subsequent experience fully justified these measures. In fact the number of casualties during the following two months was far greater than that during the siege of St. Elmo. There were instances when the number of wounded men that had to be treated was 100, and even 350 and 400 in a single day, while on one occasion, on the 15th July, as many as 600 men were wounded in one day at Senglea.95
Before the beginning of the siege, stores of medicinal drugs had been laid aside,96 but if we are to believe the Spanish renegade, Francesco de Aquilar, these were no longer obtainable at the Infirmary and at the pharmacies by the beginning of August, so that the wounded men were dying as the result of the scarcity of medicaments that were deemed necessary for the treatment of wounds.97 The historian of the Order does not contradict de Aquilar; on the other hand he states that the renegade’s statements “were founded on a basis of truth.”98 Besides we know that a boat loaded with medicinal preparations which was sent to Malta towards the end of July by the Viceroy of Sicily never reached the Island as it was captured by the Turks.99 We are, therefore, justified in believing that if drugs and medicines were not altogether unobtainable, they must have started to become scarce though not to such an extent as to preclude the embalming of the body of the “mastro di campo,” Melchior de Robles, whose death occurred in those days.100 It is not known what hospital arrangements were made at Mdina. That some kind of hospital service was organised is proved by the request of the Friars Minor Observants, dated 21st August 1566, addressed to the Jurats of Mdina, in which the friars asked to have back the beds which they had lent for the use of the wounded to the Mdina University during the siege.101 Owing to the fact that the country side was in the hands of the Turks only an occasional wounded. man could reach Birgu from Mdina safely to receive treatment at the Infirmary,102 so that when casualties were numerous they had to be treated at Mdina as must have happened on the 7th August, when following an encounter with the enemy twenty-nine horsemen were conveyed to the citadel more or less gravely wounded.103
It is difficult to know the number of casualties suffered by the Order and the Maltese during the siege, but according to one estimate about 6,000 men under arms died from wounds and disease, while 2,000 civilians and slaves also perished from the same causes.104
Types of Wounds Sustained
The various types of wounds sustained by the belligerents may be classified under the following headings:—
1. Bullet wounds caused by projectiles fired from the arquebus which was the firearm most in vogue at the time. When the bullets entered a cavity such as the head and chest, they were attended by a fatal issue.105
2. Incised, punctured and penetrating wounds were produced by blows from swords (single or double handed ones), scimitars or sabres, halberds, pikes and arrows.
3. Lacero-contused wounds were numerous. They were caused mostly by stones which were either thrown at the adversary by the defenders from the bastions, or else were scattered in the form of splinters by the impact of the cannon balls that smashed the rocks or the stone work of the fortifications.106 Fractures of the limbs were also produced by this means. Disfiguring wounds of the face, and head injuries resulted from the hurling of iron balls studded with pointed nails into the face of the adversary.107
4. Eye injuries were caused by arquebus bullets and by arrows.
5. Burns were suffered almost exclusively by the Turks and resulted from the following weapons devised by the Order’s troops:—
(a) Fire-hoops (“cerchi di fuoco”). These were large wooden hoops covered with flax and coated with an inflammable substance. After the hoops were set on fire, they were hurled horizontally at the enemy from the height of the bastions. These hoops were so wide that they could encircle two or even three men. This kind of weapon was especially vulnerable for the Turks who went into battle clad in voluminous and light clothing that very easily caught fire. Once they found themselves trapped inside these fire-hoops, the Turks had no way of escape from the fire except by throwing themselves into the sea to extinguish it.108
(b) Fire-pipkins (“pignatte di fuoco”). These were half-baked earthenware pots containing an incendiary mixture made of gunpowder, camphor, saltpetre and pitch. They were provided with a wick and, after this was lighted, the pipkins were thrown among the attackers. On hitting a hard object, the vessel broke and the mixture caught fire.109 More than 30,000 of these pipkins were used during the siege. The “trombe di fuoco” and the “picche di fuoco” were similar contraptions, consisting of hollow cylinders of wood filled with inflammable material.
(c) Another invention was the smearing of arquebus bullets with lard before they were fired. By this means the bullets retained so much heat when fired that when they hit the adversary, besides producing the usual gunshot wound, they also burned his clothing and set him on fire.
6. A few casualties, all of them fatal, are worth recording because they happened in a rather unusual way. A cannon ball fired from the Turkish batteries on Corradino Hill, smashed its way through some houses of Senglea and then passed over to Birgu. Here it ended its course by crushing into the house of Frà Luis Cortit, a Catalan knight. The knight, who happened to be at home at the time, was hit by the ball which amputated away both lower limbs. He died soon after.110
Acute heart failure from excessive exertion was responsible for the death of a few Christian soldiers while they were pursuing, in hot sunshine, a number of Turks, some of whom also fell dead from the same cause.
A few cases of heat stroke with psychotic manifestations occurred at the beginning of September, which was exceptionally hot that year.
Treatment of Wounds
Whether some form of anaesthesia was employed during operative procedures in Malta at the time of the siege of 1565 is not known. A few primitive methods of anaesthesia had, however, been devised in Europe since the early middle ages. These ways of producing anaesthesia remained the only ones in the field of surgery until the beginning of the nineteenth century. There was the narcotic sponge (“spongia somnifera”), which after immersion in a solution of mandrake, belladonna and other drugs, was pressed over the mouth of the patient, who as a result of sucking in the solution, lost consciousness and fell into a deep sleep. The so called “hammer-stroke” was also practised. The patient’s head was encased in a sort of helmet on which the surgeon delivered a good blow with a wooden hammer in such a way as to knock the patient unconscious and thus enable him to go through the operation without feeling pain.111 Insensibility to pain was also produced by compression of the carotid arteries — a measure that results in syncope.112 It is not improbable that the surgeons working in Malta in 1565 were familiar with these methods of anaesthesia and that they made use of all or some of them.
The surgical management of injuries at this time had just started to be conducted on rational lines. Wounds were washed with salted water as a first aid measure.113 Splinting and traction, in the case of fractures, were used; depressed fractures of the skull were treated by elevation of the detached fragment of bone and trepanning was resorted to when necessary.
Wounds involving the soft tissues were sutured and the ligature of vessels had begun to replace the cautery as a haemostatic. After suturing, the wound was dressed with tow or with wool, soaked in a medicament. When a patient sustained a wound of the mouth which rendered the oral intake of food impossible, the necessary nourishment was administered by means of nutrient enemas.
The pharmacological treatment of wounds, on the other hand, was not so advanced. Like his modern colleague, the sixteenth century surgeon aimed at the prevention of pus formation and at the promotion of the closure of the wound without scarring; but the means he employed to obtain these results were still based on the misconceptions of Hippocrates, Galen and Avicenna. His physiology was still of a primitive kind and he acted on such notions as that the liver distributed the blood to the limbs, that the lungs gave origin to the veins and the heart to the nerves.113a
It was thought that the healing of a wound was due to the “natural heat” of the body, and the degree of “humidity” and “softness” of the part offended. The sex and age of the patient, as well as the season of the year, were also believed to influence the union of wounds in so far as they determined the amount of “humidity” and “softness” of the patient’s tissues. Thus the bodies of children and women were retained to be humid and soft, while those of old people, travellers and labourers were hard and dry. As a consequence of this way of thinking various pharmacological agents, to which were attributed different degrees of humidity and astringency, were employed to aid the healing of wounds. When treating injuries of the soft tissues desiccating or astringent drugs were to be used but only in “moderate strengths” because it was held that very strong concentrations of these agents would produce too much dryness and this in turn would lead to much scarring. High concentrations of these substances, however, were not contra-indicated in old standing and indolent wounds.
The medicaments in common use were:
1. White of egg. This was regarded as being the most beneficial of the “simple medicaments,” because it promoted union by its bland drying action.
2. Black wine was also a favourite. It was applied to all types of wounds but being “cold and earthy” it was especially indicated for fractures. When taken internally wine creates “good blood” and when applied externally it dries, strengthens the injured part and prevents inflammation.
3. Other “simple medicaments” were oil of roses, honey of roses, digestive of turpentine and yellow of egg. The wounds were dressed with these substances in the form of ointments, cataplasms and emplastra; or else the wound cavity itself was filled with one of them.
4. Oil by itself was contra-indicated as it was observed that it prevented union and produced putrefaction and foul smells. When mixed with wine, however, it was alleged to exercise a beneficial effect because in combination with wine it lost its harmful properties while it neutralised the astringency of wine and relieved pain. Such mixture of two or more “simple medicaments” were called “composite or compound” medicaments.
5. Other compound medicaments in use were:— (a) Mixture of oil, wax and rust; (b) emplastra of oil, wax and litharge — especially recommended for fistulae, and indolent ulcers; (c) mixture of yellow of egg with oil of roses and digestive of turpentine.
6. Ointments containing ingredients derived from such plants as “ocymum basilicum,” honeysuckle, “betonica officinalis” and various species of “centaurea” also formed part of the surgeon’s pharmacological armamentarium.
With our present knowledge of asepsis it is natural to expect that such forms of treatment led to fatal results, but it is recorded that there were patients who did survive despite of treatment. Indeed “many” of those who sustained wounds during the defence of St. Elmo and who were thus treated at the Infirmary recovered from their injuries. Moreover, they seem to have suffered from no serious residual disabilities because following their discharge from hospital they were able to take an active part in the fighting during the siege of Birgu and Senglea.114
One outstanding feature of the siege was the infliction of injuries on all the chief commanders in the field. The first to be wounded, and the only one to die from his injuries, was Dragut, the renowned military engineer. On the 18th June he was hit on the head near his right ear115 by a piece of stone. This had been splintered off from the stone-work of the Turkish batteries on Mount Sceberras by the impact of a cannon ball fired from Fort St. Angelo.116 Dragut fell to the ground unconscious. There were no external signs of fracture of the skull but he lost blood from his nose and mouth. His breathing became difficult and stertorous. He was conveyed to his tent at the Marsa where he was treated by a Christian slave who had some knowledge of medicine.117 In spite of the care with which he was surrounded he died five days later without regaining consciousness. On the 24th June his body was taken to Tripoli for burial.118
Pialì Pasha, who was in charge of the naval operations, was struck on the head on the 25th May by a fragment of stone detached from a rock that had been shattered to pieces after it was hit by a projectile during the siege of St. Elmo. His turban, however, diminished the impact of the blow and he escaped with a light injury. In fact he only remained dazed for about an hour.119 The historian Bosio gives a different account of this incident. He states that Pialì was thrown to the ground from his horse by the air currents generated by the passage of a cannon ball that went past him. He also states that he remained dazed for some days.120
Mustafà Pasha, a veteran of 70 years who commanded the land forces, was injured on the 20th August while he was leading the assault on Senglea. He was struck in the head by a spent bullet which made him reel into a trench and rendered him unconscious for some hours. However, he suffered no serious ill-effects.121 According to another version he was wounded in the face by a stone but the injury was so slight in nature that he was not obliged to retire from the fight.122
La Valette was wounded on the shin by an arquebus bullet on the 7th August. The jambes that he was wearing warded off the missile that otherwise would “certainly have fractured the bone.”123 Bosio writes that the injury was caused by a piece of stone and not by a bullet. He adds that La Valette went about wearing a black taffeta stocking over his bandage and that he limped for many days and had to use a walking stick for support.124
The Turkish Medical Services in the Field
Of the Turkish medical organisation during the siege we know very much less than we do about the Order’s services. The Turks set up their main camp at Marsa.125 This site had the advantage of being supplied with a spring of water which, however, proved to be inadequate for the requirements of the Turkish army so that the soldiers had to convey water from St. Paul’s Bay and even from Gozo.126 At the Marsa they also established their hospital and their cemetery in the vicinity of the Villa and garden of the Grandmaster where Mustafà had his headquarters.127 The wounded and the sick were accommodated in huts set up among the trees.
A map published in Venice in 1565 by Domenico Zenoi, shows another “tent hospital” for the reception of dysentery patients on the shore of Marsamxeft Harbour roughly midway between Pietà and Manoel Island.
It is very difficult to estimate the number of wounded men that passed through these field hospitals as only approximate figures are available. Generally the historians of the time satisfied themselves with such generic expressions as “an extraordinary number of wounded”128 or “there was an immense number of wounded”;129 but sometimes definite figures are given. Thus we are told that after heavy assaults 1,200 or 2,000 and even 4,000 casualties were suffered by the Turks in one single day.130 The siege of St. Elmo alone cost them some 7,000 wounded.131 By the 24th June about one fourth of the Turkish army was lying ill or wounded.132
From the Marsa hospital, those patients who had no prospects of returning to combat duties were evacuated by sea to Tripoli. On one occasion (13th June) four galley loads of sick and wounded soldiers were removed to North Africa.133 The transport of casualties to this base, however, does not appear to have been effected without a hitch. In fact the speed of their evacuation did not keep pace with the rate of incidence of sickness and wounding. To make matters worse for the Turks, the Marsa hospital was attacked by the cavalry of Mdina on the 28th July. The Turkish guards were taken by surprise and the Mdina cavalry invaded the hospital encampment causing havoc and death among the patients. The self-preservative reactions of the sick and wounded aroused by the threat of destruction have been vividly described. “Those who were lying almost dead in their beds, and who a little while previously were feeling so weak that they could hardly support themselves on their legs, fled from the scene with such speed as if they had never been ill and ran away, as swiftly as healthy men.” In their flight they created such a confusion and made so much noise that their panic reached that section of the army that was, at the time, hotly engaged in attacking Senglea and Birgu.134
These events remind us that in the sixteenth century belligerents recognised no claims of common humanity and that the fallen soldier had as yet not been granted the privilege of immunity from further enemy attacks. Recriminations were savage and mutual. In 1560, for instance, during the battle for the Island of Gerbe, it was the misfortune of the Christian sick and wounded to be cut to pieces by the victorious Turk,135 while we have already seen how the wounded found in the chapel of St Elmo were put to the sword when the Turks invaded that fort. In those days the soldier showed no respect for his adversary, not even when the latter was engaged in a mission of mercy. Thus after one encounter during the siege, those Turks who after the battle went about picking their dead, were not spared by our snipers who shot as many of them as they could in what the Order’s historian complacently calls a “piacevole e sicura caccia.”136
By the end of August the Marsa hospital had become too small to house all the sick and wounded; for this reason the galleys at anchor in Marsamxett harbour were adapted as hospitals. The poops of the galleys were reserved for the Turkish soldiers, while the Christian slaves who were taken ill were accommodated among the benches of the oarsmen.137 But this measure afforded only a short respite, as the galleys soon became filled with patients. Not only the hospital organisation but also the transport of the wounded from the scene of battle to the field hospital seem to have broken down at this period. In fact, casualties were conveyed only as far as the ordinary camps while many others were not even picked up but were left in the trenches which, owing to the rain that had fallen on the previous day, were soon turned into muddy hollows. Here the Turkish wounded were abandoned dying “like dogs in tens a day” and forming a horrible spectacle for their comrades.138
Apart from the usual surgical cases, the Turks had to contend with the widespread occurrence of infectious illness among their troops. The Marsa enjoyed the reputation of being a very unhealthy area notorious for its “pestiferous atmosphere.”139 Moreover, the water springs and cisterns of the Marsa and other parts of the Island that had been abandoned by the defenders were previously poisoned by the Order’s chief physician, Camillo Rosso, on instructions received from the Grandmaster. The poisonous concoction was made up of hemp, wheat, arsenic and other ingredients which had been kept ready for the purpose.140 It is alleged that this water poisoning produced serious illnesses among the Turks and caused the death of many of them until they detected its nature and resorted to its decontamination.141 One estimate puts the number of deaths from this cause at about 800 Turks.142
In an age when no one knew how infectious diseases were propagated and how their spread could be prevented, it is not surprising to find that in an army of 90,000 men illness should take a heavy toll. The occurrence of disease was ascribed to atmospheric changes, such as the excessive diurnal heat followed by the nocturnal humidity of the Maltese summer, to the poisoning of the air by the odours of excreta and the emanations from the many unburied or badly interred corpses, and to the scarcity of water.143
Illness appeared among the Turkish troops soon after their landing in the Island. On the 27th May a Spanish renegade from the Turkish side “informed the Grandmaster that, apart from shortage of water, the Turks were suffering from dysentery which was causing havoc among them.144 It was later learned that “putrid fevers” and “tifo” were also claiming their victims.145 It is impossible to determine whether “tifo” was typhoid or typhus as no distinction had yet been drawn between these two diseases146 and no description of the clinical features of the diseases that afflicted the Turks has come down to us; but it would not be surprising if we were to discover that both these diseases were prevalent among them.
These illnesses first appeared in the Marsa hospital among the wounded themselves and, then spread to attack the healthy troops. They prevailed throughout the duration of the siege147 and their incidence and severity were so high that they threatened to decimate the Turkish soldiers more than the operations of war; but the end had come.
The long awaited relief force from Sicily that had been promised to the Grandmaster was on its way to Malta. The news of its safe arrival in the Island on the 8th of September was received with great rejoicings by the defenders. The siege was raised and men and women thronged the streets. “Some of them wept for joy and raising their hands to heaven thanked God for their deliverance; others ran about shouting ‘Help is at hand! Victory! Victory!’ while others still, embraced and kissed all those whom they happened to meet.”148 In their jubilant excitement neither the Knights nor the people thought of falling upon the retreating enemy so that the Turks had the time, between the 7th and the 13th September, to embark both men and material, and sail out in good order from Marsamxett Harbour and St. Paul’s Bay.149
In spite of the several Turkish attempts to alienate the Maltese from the Knights, the inhabitants of this Island remained steadfast in their loyalty towards the Older. To their great credit it has been recorded that while men of nearly every nationality had deserted to the Turks not one single Maltese had ever done so.150
But though the Islanders and the Knights succeeded in repelling the Turks, they did so at very great cost. When the people became sober after the exultation of victory they realised what an immense price they had paid for their deliverance — the countryside impoverished and pillaged, the villages destroyed, the water supply of the two towns reduced to disgusting muddy fluid and the population reduced to nearly 20,000 souls.151
For many months following the end of the siege, the Infirmary remained full of war casualties, to which were added those men of the relief force that had fallen ill. They were so numerous that they had to be accommodated in private houses.152 These men had fallen ill in spite of the precautions taken to prevent the outbreak of serious illnesses. The Knights had been so much impressed by the havoc wrought by disease in the Turkish army that when the relief force from Sicily landed in Malta, the Grandmaster refused to allow the troops to encamp anywhere in the districts round Santa Margherita, St. Salvatore Hill, Corradino and Marsa where the Turks had settled. He was afraid that, owing to the large number of Moslems that had fallen ill and had died in these areas, these localities would become the foci of some vast epidemic if they were to be occupied again by a large body of troops.153 Moreover, signs were not wanting to arouse fears and suspicions of an impending outbreak of pestilence as the causes of disease were then understood. In fact the dogs of the countryside had run wild and not finding enough to eat in the deserted villages and farms, started disinterring the superficially buried corpses and eating their flesh. Besides, the Birgu had become invaded by such large numbers of flies that the inhabitants could not defend themselves from these insects, so much so that in the end it was found necessary to destroy them with gunpowder fire.154
In view of the unsanitary conditions that prevailed during the siege, the possibility of the existence of scabies, vermin infestation and tuberculosis naturally arises. One finds no reference to these diseases in the writings of the period, but it is not inconceivable that they may have occurred since we know that the factors fostering their development and spread were all present such as the massing of large number of people under unhygienic conditions, neglect of personal cleanliness due to shortage of water and ignorance of the risks of dirty surroundings.
The discomforts endured during the siege and the devastation that spread around them, made an impression in the minds of the people that was not readily forgotten; so that when, in the spring of the following year, rumours of another Turkish invasion were again current, the population was not in a fit psychological state to face another war. They were still war-weary and sick of the hardships and sights of war. Their immediate reaction was to abandon the Island. Nearly all the families who had the necessary means left the Island in the months of [p.206] March and April and repaired to Sicily. They had declared, according to the Order’s historian, that they preferred to go begging round the world than have to go through the sufferings of the previous year. Many of the descendants of the Greeks and Rhodians that had followed the Order to Malta in 1530 and settled here also left the Island together with the Maltese families. They went to Saragossa, Modica, Alicata and Girgenti. Their number must have been considerable for it has been said that these places had all the appearance of being colonies of the inhabitants of Malta.155
Fear is highly infectious and from the people this escapism spread to the highest ranks of the Order itself. In fact it was seriously debated among the Knights whether the Grandmaster and his Council should remain in Malta in the event of another Turkish invasion.156 It was only when the Turks opened their attack against Hungary that calm returned to the Island for every one felt that the Turkish preparations were not directed against Malta.
To us who view the happenings of 1565 at a distance of four centuries, the siege has an air of finality. To the people of those days, however, there was nothing to assure them that it was going to be the last of its kind. Perhaps none better than us of to-day can understand their post-war predicament for their experiences were not dissimilar to our present situation. Like them we have lived very close to death through a long siege; like them we had the better of our adversaries; and like them no sooner than the war was over, we were and still are assailed by fears of another war. But here the similarity ends, for while we can look back at their anxieties and see how they triumphed over them, we of to-day can only very dimly visualise our future trials but can get no glimpse of the manner of their ending.
 SANMINIATELLI ZABARELLA, Carlo, Lo assedio di Malta. Torino, 1902. p. 612.
 ZAMMIT, Them., Malta, the Islands and their History. Malta, 1926. p. 131.
 PRESCOTT, G. L’assedio di Malta. Malta, 1861. p. 27 (footnote).
 Bosio, Iacomo, Dell’Istoria della Sacra Religione et Ill.ma Militia di San Giovanni Gerosolimitano — Parte Terza, 1602. p. 513.
 SANMINIATELLI ZABARELLA, op. cit. p. 170.
 Bosio, I., op. cit., p. 513; GAUCI, Gaetano, Il Grande Assedio di Malta nel 1565, Malta, 1891. p. 11.
 Bosio, I., op. cit., p. 513.
 VIPERANO, G.A., La guerra di Malta (Translation by E.F. Mizzi), Malta 1931, p. 15.
 SANMINIATELLI ZABARELLA, op. cit., p. 128.
 Ibidem, p. 170.
 BOSIO, I., op. cit. p. 525.
 Bosio, I., op. cit. p. 280.
 Ibidem, p. 292.
 Ibidem, p. 292.
 Ibidem, p. 305.
 Ibidem, p. 307.
 Ibidem, p. 325.
 Ibidem, p. 502, 503, 511.
 Ibidem, p. 513.
 SANMINIATELLI ZABARELLA, op. cit. p. 204.
 Bosio, I., op. cit. p. 297.
 Ibidem, p. 297.
 Ibidem, p. 515.
 Ibidem, p. 516.
 SANMINIATELLI ZABARELLA, op. cit. p. 171 & 181.
 A painting by Mattia Preti recording this tradition exists in the Cathedral Church at Mdina.
 CASSAR PULLICINO, J., Pirates and Turks in Maltese Tradition, in “Scientia” Vol. XIV, No. 4 of 1948, p. 164.
 “Ma l’ordine degli Ospitalieri invece di cattivarsi l’affezione dei sudditi coll’equità e la mitezza, inaugurò un governo despotico ed arbitrario.” CARUANA, A.E., Sull’origine della lingua maltese. Malta, 1896. p. 323-24.
 ZAMMIT, Them., The Inhabitants of the Maltese Islands, in “Archivum Melitense,” July 1913, p. 243.
 BOSIO, I., op. cit. p. 602.
 BEDFORD, W.K.R., The Order of the Hospital of St. John of Jerusalem, London, 1902, p. 70.
 GAUCI, G., op. cit. p. 181.
 VERTOT, The History of the Knights of Malta, London, 1728, Vol. II, Book VIII, p. 18.
 ZAMMIT, Them., Malta, the Islands and their History. p. 135.
 BOSIO, I., op. cit. p. 579.
 SANMINIATELLI ZABARELLA, op. cit., p. 340-41.
 Bosio, I., op. cit. p. 579.
 SANMINIATELLI ZABARELLA, op. cit. p. 341.
 VERTOT, op. cit. p. 2. BOSIO, I., op. cit. p. 580.
 SANMINIATELLI ZABARELLA, op. cit. p. 341.
 Bosio, I., op. cit. p. 580.
 Ibidem, p. 95.
 MIFSUD, A., Knights Hospitallers of the Venerable Tongue of England, Malta, 1914, p. 174. Similar scenes were still to be seen in the eighteenth century in Malta. Thus a number of slaves who plotted to overthrow the Order and kill the Grandmaster and the Knights were sentenced to death as follows in 1748:— two of them “tanagliati e divisi in quarti”; another two were “strozzati e decapitati”; and twenty-one were “scannati.” See Raccolta di varie cose, Malta, 1843, p. 182.
 Bosio, I., op. cit. p. 592.
 SANMINIATELLI ZABARELLI, op. cit. p. 426.
 Ibidem, p. 426.
 Bosio, I., op. cit. p. 580.
 GIGLIO, Ferdinando, Il memorabile assedio di Malta del 1565, Malta, 1853, p. 103.
 Bosio, I., op. cit. p. 627.
 This hatred persisted for hundreds of years. So much so that the Government had to issue a Public Notice in 1802 by which it was made an offence to insult or molest in any way Turkish visitors to Malta. See Collezione Bandi, Malta, 1840.
 Bosio, I., op. cit. p. 580.
 Bosio, I., op. cit. p. 546.
 SANMINIATELLI ZABARELLA, op. cit. p. 342.
 BOSIO, I., op. cit. p. 579.
 PRESCOTT, G., op. cit. p. 93.
 SANMINIATELLI ZABARELLA, op. cit. p. 529.
 Bosio, I., op. cit. p. 698.
 SANMINIATELLI ZABARELLA, op. cit. p. 128 & 161.
 Bosio, I., op. cit. p. 594.
 Bosio, I., op. cit. p. 609.
 Ibidem, p. 613.
 GIGLIO, F., op. cit. p. 107.
 Ibidem, p. 161.
 SANMINIATELLI ZABARELLA, op. cit. p. 446.
 Ibidem, p. 459.
 Ibidem, p. 451.
 PRESCOTT, G., op. cit. p. 119.
 Bosio, I., op. cit. p. 633.
 GIGLIO, F., op. cit. p. 172.
 Bosio, I., op. cit. p. 609.
71 DARMANIN DEMAJO, G., Storia dell’albergia della lingua d’Italia, in “Archivio Storico di Malta,” Vol. I, Fasc. IV, p. 261.
72 SANMINIATELLI ZABARELLA, op. cit. p. 166.
73 BOSIO, I., op. cit. p. 518.
74 BOSIO, I., op. cit. p. 650.
75 BOSIO, I., op. cit. p. 517.
76 BOSIO, I., op. cit. p.608; SANMINIATELLI ZABARELLA, op. cit. p. 160.
77 SANMINIATELLI ZABARELLA, op. cit. p. 160.
78 SANMINIATELLI ZABARELLA, op. cit. p. 372.
79 VERTOT, op. cit. p. 17.
80 SANMINIATELLI ZABARELLA, op. cit. p. 487.
81 SANMINIATELLI ZABARELLA, op. cit. p. 520.
82 GIGLIO, F., op. cit. p. 197.
83 SANMINIATELLI ZABARELLA, op. cit. p. 185.
84 SANMINIATELLI ZABARELLA, op. cit. p. 298.
85 BOSIO, I., op. cit. p. 539.
86 SANMINIATELLI ZABARELLA, op. cit. p. 239.
87 BOSIO, I., op. cit. p. 564.
88 BALBI, F., A true account of all that took place in the Island of Malta in the year 1565, Published in 1568. Translated by H.A. Balbi and published in the “Sunday Times of Malta” of 2nd May 1937 to 25th July 1937.
89 SANMINIATELLI ZABARELLA, op. cit. p. 250.
90 SANMINIATELLI ZABARELLA, op. cit. p. 290.
91 SANMINIATELLI ZABARELLA, op. cit. p. 240.
92 SANMINIATELLI ZABARELLA, op. cit. p. 333.
93 BOSIO, I., op. cit. p. 574.
94 SANMINIATELLI ZABARELLA, op. cit. p. 343.
95 SANMINIATELLI ZABARELLA, op. cit. p. 425.
96 BOSIO, I., op. cit. p. 499.
97 BOSIO, I, op. cit. p. 626.
98 BOSIO, I, op. cit. p. 627.
99 CURIONE, C.S., Nuova storia della guerra di Malta (1565). Translated by E.F. Mizzi. Rome, 1927, p. 111.
100 BOSIO, I., op. cit. p. 633.
101 MIFSUD, A., Un cenno al 1565 nel 1915, in “Archivum Melitense,” July 1917, p. 231.
102 BOSIO, I., op. cit. p. 547.
103 SANMINIATELLI ZABARELLA, op. cit. p. 495.
104 SANMINIATELLI ZABARELLA, op. cit. p. 603.
105 Bosio, I., op. cit. p. 540.
106 Bosio, I., op. cit. p. 637.
107 GAUCI, G., op. cit. p. 180.
108 BOSIO, I., op. cit. p. 555.
109 BOSIO, I, op. cit. p. 562.
110 BOSIO, I., op. cit. p. 612.
111 PARENTI, G.C., Leggende e nozioni sull’evoluzione dell’anestesia, in “Gazzetta Sanitaria,” February 1951, p. 72.
112 GUTHRIE, D., A History of Medicine, London, 1947, pp. 108, 116, 302.
113 PRESCOTT, G., op. cit. p. 129.
113a FIORAVANTI, M.L., La chirurgia, 1582, Venetia, p. 16.
114 BOSIO, I., op. cit. p. 575 & 680.
115 BOSIO, I., op. cit. p 566.
116 GIGLIO, F., op. cit. p. 84.
117 SANMINIATELLI ZABARELLA, op. cit. p. 313.
118 BOSIO, I., op. cit. p. 576.
119 SANMINIATELLI ZABARELLA, op. cit. p. 211.
120 BOSIO, I., op. cit. p. 605.
121 SANMINIATELLI ZABARELLA, op. cit. p. 522.
122 BOSIO, I., op. cit. p. 679.
123 SANMINIATELLI ZABARELLA, op. cit. p. 488.
124 BOSIO, I., op. cit. p. 644.
125 SANMINIATELLI ZABARELLA, op. cit. p. 185.
126 SANMINIATELLI ZABARELLA, op. cit. p. 201.
127 BOSIO, I., op. cit. p. 698.
128 SANMINIATELLI ZABARELLA, op. cit. p. 236.
129 SANMINIATELLI ZABARELLA, op. cit. p. 425.
130 SANMINIATELLI ZABARELLA, op. cit. p. 290, 471, 491.
131 SANMINIATELLI ZABARELLA, op. cit. p. 333.
132 SANMINIATELLI ZABARELLA, op. cit. p. 351.
133 SANMINIATELLI ZABARELLA, op. cit. p. 283; BOSIO, I., op. cit. p. 557.
134 BOSIO, I., op. cit. p. 629.
135 BOSIO, I., op. cit. p. 439.
136 BOSIO, I., op. cit. p. 645.
137 CURIONE, C.S., op. cit. p. 102-103.
138 SANMINIATELLI ZABARELLA, op. cit. p. 552.
139 BOSIO, I., op. cit. p. 698.
140 A similar stratagem had been employed by the Moslems against the Christian army that had landed on the Island of Gerbe in 1560 when the water in the wells was rendered bitter and undrinkable by the immersion into it of aloe plants. BOSIO, I., op. cit. p. 423 & 426.
141 GIGLIO, F., op. cit. p. 10; BOSIO, I., op. cit. p. 514.
142 VIPERANO, G.A., op. cit. p. 17.
143 SANMINIATELLI ZABARELLA, op. cit. p. 278.
144 SANMINIATELLI ZABARELLA, op. cit. p. 207.
145 BOSIO, I., op. cit. p. 612.
146 The clinical differentiation between these diseases was established by Sir William Jenner, (1815-1898) of the London Fever Hospital in the 19th century. “British Medical Journal” of 23rd May 1938 p. 192.
147 SANMINIATELLI ZABARELLA, op. cit. p. 440 & 513.
148 BOSIO, I., op. cit. p. 694.
149 ZAMMIT, Them. Malta, the Islands and their History, Malta, 1926.
150 BOSIO, I., op. cit. p. 546. Other historians, however, disagree with Bosio. Indeed BALBI, “Sunday Times of Malta” of 20th June 1937 p. 15, and GAUCI, op. cit. p. 90, state that there was a Maltese renegade.
151 BOSIO, I., op. cit. p. 776.
152 BOSIO, I., op. cit. p. 710.
153 SANMINIATELLI ZABARELLA, op. cit. p. 585.
154 BOSIO, I., op. cit. p. 710.
155 BOSIO, I., op. cit. p. 737.
156 BOSIO, I., op. cit. p. 738.