Hospitaller Hospitals: Admission, Accommodation and Patient Care

Hospitaller hospitals grew from a Jerusalem institution for sick and poor pilgrims into a network that continued after the Order moved to Rhodes and, from 1530, Malta. Their work joined religious charity with the practical tasks of admitting patients, housing and feeding them, and arranging treatment. The evidence is especially detailed for the Jerusalem hospital’s early development and for the Sacra Infermeria in Malta, built in Valletta in the late sixteenth century. The Order also established a hospital on Rhodes in 1311, though less is known here about its daily operation.

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From a Jerusalem hospice to an Order institution

The Jerusalem hospital grew out of charitable provision for Christian pilgrims. Amalfi merchants had supported a Benedictine foundation in the city, and by around 1080 Gerard was responsible for its Hospital of St John. The brothers cared for sick, poor and injured pilgrims. After the First Crusade, the hospital developed as an institution in its own right; in 1113 Pope Paschal II formally recognized the community that served it as a religious order.

Although the Hospitallers later became a military order, care of the sick remained part of their identity. Their rule described sick people as those whom the brothers were bound to receive and serve. The phrase “our lords, the sick” expressed a religious ideal of serving vulnerable people as honoured guests. Hospitals also depended on practical organization: people had to be received, housed and supplied, and those providing medical treatment needed to work alongside the religious community.

After the Order established its headquarters on Rhodes, it founded a hospital there in 1311. The move to Malta in 1530 brought a new phase of hospital building. In Valletta, Grand Master Jean de la Cassière ordered the Sacra Infermeria, or Holy Infirmary, in 1574 to replace the hospital at Birgu. It was intended to receive Maltese and foreign patients and to provide lodging for pilgrims travelling to the Holy Land.

Who was admitted and who provided care?

Descriptions of the Jerusalem hospital from the later twelfth century say that it received sick people without distinction of nationality or religion. They also record that Jewish patients were given kosher food, prepared according to Jewish dietary rules. This evidence points to a hospital whose care extended beyond the Order’s own religious community, alongside the hospital’s Catholic religious life.

The Order’s own members had different responsibilities. Priest-brothers provided religious services, while serving brothers undertook practical duties; other brothers were associated with the Order’s military work. Doctors and surgeons are formally mentioned among the hospital personnel in the Order’s statutes of 1182. Their presence shows that medical care was not simply a matter of prayer or hospitality, alongside the attendants who maintained beds, meals and ward routines.

On Malta, hospital oversight also became an administrative concern. Between 1530 and 1532, Grand Master Philippe de Villiers de L’Isle-Adam established a Commission of Health made up of two knights and three lay notables. This brought members of the Order and other local figures into the supervision of health matters.

Wards and accommodation

In Jerusalem, the men’s hospital was described as having eleven wards. Medieval visitors’ accounts convey the scale of the institution but do not give a single dependable measure of its ordinary patient load: John of Würzburg reported that 2,000 sick people were being treated, while Theoderic described seeing 1,000 beds. These figures are different kinds of observation, not necessarily a fixed capacity or a count taken under the same conditions.

The Sacra Infermeria in Valletta began with two wards arranged around a central courtyard. As the hospital expanded, it came to include six large wards. The Great Ward, one of the building’s main spaces, was about 480 feet long. These large communal rooms allowed many patients to be housed within one institution, while additions changed the building’s capacity and layout over time. The reported capacity of the hospital varies widely, from 500 to 2,500 patients, and should be understood in light of those successive phases of expansion.

Not all patients were kept together. In 1596 the Valletta hospital added a separate ward for people with contagious and venereal diseases. Separating these patients from others was one practical way to organize accommodation around illness. The hospital also provided lodging for pilgrims, a function related to its older role in supporting travel to the Holy Land but distinct from admission as a patient.

Food, medicines and other provisions

Hospital care depended on resources beyond the labour of the people inside the building. In Jerusalem, gifts of property and money helped endow the institution, and the Order’s revenues and charitable collections supported its wider work. The Order’s central officers included a hospitaller responsible for the main hospital and a preceptor who managed administration and provisions. Such arrangements helped turn charitable gifts and institutional resources into continuing service.

Food was part of patient care. The Jerusalem evidence about kosher meals shows that feeding could take account of a patient’s religious practice. At Valletta, visitors described patients dining with silver plates and cutlery; preparing and serving food expressed the Order’s ideal of honouring the sick. On Malta, the hospital’s ability to provide food, water, clothing and medicines could be strained by political crisis. After the French occupation began in 1798 and the Maltese insurrection followed, reports describe shortages of fresh food, water, clothing and medication. These shortages belong to the hospital’s disrupted final period under French rule, not to ordinary Hospitaller administration.

Pharmacies were an important part of the Maltese institution. The Sacra Infermeria originally had two; one closed in 1636. A later enlargement, in 1712, included a pharmacy and a laboratory. These facilities show how the hospital’s provision of medicines became part of a larger institutional operation, alongside accommodation and medical treatment.

Treatment and changing medical facilities

The formal mention of physicians and surgeons in the Order’s statutes in 1182 indicates that medical practitioners had a recognized place in its hospital work. More detailed evidence for organized medical training comes from Malta. A School of Anatomy and Surgery was established within the Sacra Infermeria in 1676, and a dissection room was built for its work. The room was later moved to the site of the cemetery outside the hospital. These developments connected patient care with instruction and the study of the body.

Physicians and surgeons had different tasks in the later Maltese hospital. A historical account describes senior physicians and assistants serving rotating duties, alongside surgeons and their assistants. A barber-surgeon and helpers carried out bloodletting and cupping, procedures intended within contemporary medicine to draw blood or alter the body’s balance. Surgeons also treated cataracts, which cloud the eye’s lens, and urinary bladder stones. Pharmacy, bedside attendance and these procedures gave treatment a practical form alongside prayer and meals.

Across Jerusalem, Rhodes and Malta, the Hospitaller hospital combined religious duty with organized care. Its operation relied on accommodation, attendants, medical practitioners and provision of food and remedies, while its facilities changed with place and time. The Jerusalem hospital’s recorded admission of people from different religious communities, the foundation of a hospital on Rhodes, and the successive wards, pharmacies and teaching spaces in Malta show both continuity in the Order’s charitable purpose and variation in the means used to carry it out.