The medical aspects of the 1565 Great Siege of Malta

The medical aspects of the 1565 GreatSiege of MaltaCharles Savona-Ventura

ABSTRACTThe 1565 Siege of Malta served as a turningpoint in the westward Ottoman advance. The4-month long siege was resisted by theindomitable belief of the defenders that theircause was just and holy. It also required priordetailed organisation to ensure sufficient warmaterials and that the overall health of thecombatants and non-combatants was main-tained throughout the months of the siege.This article reviews the contemporary and his-torical sources relating to the conflict to iden-tify the medical operational plans used by themilitary during this historic siege.

INTRODUCTIONThe 14–16th centuries saw a progressiveextension of Ottoman rule over theEastern Mediterranean and the Balkansstarting with the fall of Constantinople in1453 and Western Europe found itself dir-ectly threatened by the apparently irrevers-ible Turkish encroachment.1 The Order ofSt. John, stationed in Europe’s underbellyon the Island of Malta after their expulsionfrom Rhodes, had proved unable toprotect the sister island of Gozo fromTurgut Reis’s raid in 1551, while Tripoliwas lost to the Order in 1552. The Orderof St. John was a hospital and military reli-gious order set up originally in Jerusalemafter the First Crusade. It was slowlypushed back westwards over the centuriesby the Ottoman incursions until it wasceded the Maltese Islands in 1530. By thespring of 1563, news had begun to filterinto the West of the arming of a newTurkish armada at Constantinople. On 18May 1565, the Siege of Malta by theTurkish forces commenced (Table 1). Thesiege was finally lifted on 12 September( Julian calendar). The defenders were ledby the religious leader of the Order FraJean Parisot de la Valette; the besiegers byPiyale Pasha and Kizilahmedi MustaphaPasa, eventually joined by Turgut Reis.2 Inthe 18th century, the French writerVoltaire wrote that ‘nothing is so wellknown as the Siege of Malta’. This heroic

battle on a small island in the CentralMediterranean was viewed as the turningpoint in stopping the expansionist designsof the Ottoman Empire; a number of first-hand and secondhand accounts werewritten contemporaneously or in theimmediate aftermath,3–6 while the subse-quent historians of the Order of St. Johnensured detailed coverage of the events.7–9

The expectation of a military conflictrequires commanders to draw up a mili-tary operational plan which varies accord-ing to their respective objectives: theattacking forces desiring dominion overthe defenders and the defenders wishingto hold out until the attackers withdrawor are defeated. The operational planrequires the incorporation of medicalfacets to maintain the health of the troopsand non-combatants, to care for theinjured and to make the best use of bio-logical and psychological aspects ofwarfare.

PUBLIC HEALTH MEASURESIn siege warfare, an important consider-ation for the defending commander is thecare of the combatants and non-combatants besieged within the fortifica-tions; their numbers augmented by thepopulations seeking safety within the for-tified towns and fortresses: Birgu (FortSt. Angelo), Senglea (Fort St. Michael),Fort St. Elmo and Citadel Mdina. Thesiege conditions and the population over-crowding posed particular public healthissues that needed to be addressed toensure sanitation and well-being.Plans were needed to house the sudden

augmentation in the population withinthe fortified towns resulting from the

countryside refugees coupled with comba-tants arriving from overseas to assist theOrder in the defence of the island.3 10

The housing problem was made worse bythe necessary defence strategy of pullingdown houses deemed as interfering withan adequate defence process, and thedestruction of houses resulting from con-tinuous bombardment by the enemytroops.3 While many of those withoutavailable housing were taken in by otherfamilies, the housing problem was par-tially solved by the erection of tents andtemporary huts.11

Malta had long been dependent on asteady importation of grain from Sicilyand the fortified towns held numerousvaults for the safe storage of largeamounts of grain sufficient to last severalmonths. The rumours of Turkish invasionhad prompted an increased effort toaugment stores.12 A good store of wheatwas purchased and sent to Malta by thePrior of Messina, Signorino Gattinara.Also ‘any ships they met with in thechannel, which had cargoes of wheat,wine, or other foodstuffs, they broughtback with them to Malta where they werewell paid for their provisions’.3 On the 9May 1565, when news of the departureof the Ottoman fleet was received, allwheat, oats and other agricultural pro-ducts were collected and put into storageat Birgu.2 13

Efforts were also made to reduce thenumber of unnecessary mouths to feed.Between April and May 1565, a ‘greatnumber of people’ sailed to Sicily.8 Afurther batch of refugees had embarkedon the Order’s ships to leave for Sicily,but hostilities commenced before theycould travel.9 In spite of this drive towean out gente inhabile alla Guerra, theremaining population would have stilltopped 22 000 with about a third beingforeign or local combatants. Before thearrival of the Ottoman forces in Malta on18 May, the country inhabitants wereencouraged to go to the nearest forts with

Table 1 Timeline of the 1565 Siege of Malta

18 May Arrival of the Turkish Armada25 May Siege of fort St. Elmo starts23 June Fall of Fort St. Elmo2 July Arrival of a contingent of Christian re-enforcements (Piccolo Soccorso)15 July Assault of Senglea using sea and land troops28 July Assaults on Senglea and Birgu7 August Christian cavalry mounts attack of Turkish base camp at Marsa7 September Arrival of significant Christian re-enforcements (Gran Soccorso)8 September Siege lifted12 September Turkish Armada leaves

Correspondence to Prof Charles Savona-Ventura,Humanities, Medicine & Science Foundation, Universityof Malta, Tal-Qroqq, Msida MSD 2090, Malta;[email protected]

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all their livestock, thus ensuring an aug-mentation of food supply within the forti-fications but also depriving the attackingforces from supplies. The knights LuigiBalbiano and Adrian Maimon wereentrusted to bring the inhabitants andtheir livestock into the fortified towns. Toreduce disturbance and pressure on thefood stores, all unnecessary animals wereslaughtered. La Valette had his own dogsput down.3

Some inhabitants sought the protectionof Fort St. Elmo taking shelter in theditch around the fort. Because of thefort’s small size and expecting heavyrepeated assaults, ‘the Grand Master …

gave orders that all the women, children,and old people who had taken shelter inthe ditch around St. Elmo, should be sentover to Birgu. Only men who were fit tofight or work were to be kept there. Theresult was that, when the Turks attackedthe fort, there were eight hundred fightingmen defending it. He provisioned the gar-rison with biscuit, wine, cheese, salt pork,vegetables, oil, and vinegar. As for freshmeat they had the island cattle which hadbeen kept in the ditch around the fort’.3 10

The fort continued to be regularly sup-plied with provisions throughout the con-flict until its fall.

In Birgu, the grain supply was generallysufficient and ‘it was always allowed tosell grain by those who had it, and therewas always enough to sell’.6 By 23 June, itbecame important to initiate a system offood distribution within Birgu when allinhabitants received three one-poundloaves daily. In addition, the GrandMaster ‘ordered all the corn and wine thatwas in private hands to be brought intothe public magazines, paying the pricethereof to the proprietors’.10 On 6September, the bread ration of the sol-diers and knights was reduced in some ofthe Auberges.3 11 The cereal grain wasbaked into bread and hard tack afterbeing ground by the hand and animaloperated mills in Birgu and the wind-driven mills in Senglea. Some barteringfor food also took place between thebesiegers and the besieged. ‘The Turksopposite St Michael gave Martello somelocal fruit, such as melons and oranges. Inexchange for these he gave them somewhite bread and cheese. When the Turkssaw this, they were dumb-founded, forthey had been convinced that we wereextremely short of food’.3

At Mdina, on 11 August, the remainingprovisions included ‘200 oxen for foodand an equal number of other bovines forour sustenance, and 1000 between sheepand goats, besides pigs which roam the

country. … There are 500 salme of wheatin the stores, and other 600 with privateindividuals, between grain and barley. Wehave 70 cantari of biscuit, but no wine,vinegar, or oil or any other provisions left… advising you that the provisions whichare to be brought over should be biscuit,as here no facilities for baking bread exist,except for our consumption’.4 The pro-blems of provisions were also a concernfor the relieving forces since ‘no way wasfound how to feed that army on an islandso poor in victuals … He ordered that onembarking and landing each person shouldcarry so much biscuit as would last atleast 30 days at the rate of 24 ounces perman per day … Each one who landedreceived a sack with 75 libbre of biscuit’.6

The other essential commodity wasadequate reserves of water. In January1565, an inspection of all the public andprivate wells and cisterns in Birgu andSenglea was made while arrangementswere made to enable the storage facilitiesof 40 000 barrels of water at Birgu toanticipate for the needs of the besiegedthere.11 Geronimo de Huete, BalthasarEmpador and Antoine de Bourne weremade ‘responsible for seeing that waterwas continuously drawn from the Marsato keep the cisterns of Birgu, St. Michael,and St. Angelo always full.’ The waterrationing was entrusted to the knightsAntonio Pacheero Caraveo and MarcoAntonio Altavilla. The Grand Master also‘apportioned the wells and water cistern,so that everyone knew where to draw hisown ration’.3 In spite of these precautions,acute water shortage was felt by the firstweek of July 1565. This was met with byrebellious actions by the Birgu populacesufficient to cause the Grand Master toconsider expelling the civilians from thetown.8 This was only circumvented by thediscovery on 21 July of a water spring atBirgu while digging to extract stone forrepairing the fortification walls.6

Public health under siege conditionsalso requires careful attention to environ-mental hygiene. Previous public healthregulations had been placed in forceaddressing the abuse of public water sup-plies, the washing of hemp, the control ofpigs in streets and the controlled slaughterof animals.14 The public health concernsbecame even more essential under siegeconditions. A quick burial after a battlewas essential, though notable knights ornoblemen were laid out awaiting formalburial presumably after being embalmed.3

Burial during the Mediaeval period wasgenerally carried out within the groundsof churches and chapels.15 16 In 1574,there were 17 chapels and churches in

Birgu, but Senglea boasted only one.17

These were insufficient to cater for theincreased mortality brought on by theconflict. The knights and victims of theGreat Siege were buried in the cemeteryopposite the San Lorenzo-a-mare Churchat Birgu. Their remains were laterexhumed and reburied in the grounds ofthe St. John Conventual Church inValletta. Some remains from the siegewere reburied in 1787 in a common cryptsited in the grounds of Fort St. Angelo.Ensuring a regular Christian burial for allthe dead who gave their life in this con-flict was important to maintain religiousand psychological morale. Many of thecombatants were volunteers whose onlypresumed reward was a heavenly one. Thecombatants had received from Pope PiusIV a plenary indulgence and a pardon forall their sins. Thus ‘if they fell in the siege,they would find a place in heaven’.3

The measures taken to dispose of thedead by the besieged were however notcompletely sufficient for public healthcontrol during and after the lifting of thesiege. The great number of corpses andmangled human remains buried under therubble attracted huge swarms of flies; anepidemic of high fever that occurredwithin the Birgu fortifications was attribu-ted to the presence of these flies.3

Archaeological excavations have suggestedthat the Ottoman casualties were alsoburied, possibly at Marsa andMarsaxlokk.18 19 Wild dogs roaming thecountryside disinterred the superficiallyburied corpses to feast on their flesh.8

FIRST-AID FACILITIESOn the battlefield, the most importantfactor that determines whether an injuredindividual survives or not is the front-linefirst-aid management. This is where in theheat of the battle or the interim, tourni-quets are applied to stop bleeding andburns are suitably managed. During theGreat Siege, first-aid stations were set upon top of the battlements with barrels ofsalt water to manage and reduce theeffects of burns.3 The defending comba-tants were particularly at risk of burnswhen handling some of the defencemechanisms. Burns could easily be causedby the flash of the firing musket andcould also be experienced when handlingthe burning hoops and pitch/oil beingthrown down on the attackers. Recordedexamples of burn injuries on the defen-ders’ side include Don Jaime deSanoguera who had his face burnt by gun-powder but valiantly continued to fight,Commander Buoninsegna who waswounded by an incendiary and the

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Maltese tailor-soldier Marco who wasburned to death by incendiaries.3

Fighting went on for hours on endoften in the summer heat—in July andAugust the average temperature in Maltais 32°C with a maximum often above 36°C.It was therefore necessary to ensure thatnourishment in the form of food andfluids was at hand for the use of the com-batants. ‘The attacks lasted for nine hours,from daybreak until just after noon. TheTurks were relieved more than a dozentimes by fresh troops, while we refreshedourselves with well-watered wine and afew mouthfuls of bread…. made availableto all the posts which were engaged’.3

Wine and vinegar were essential additivesto help ‘purify’ the water which couldeasily become stale and contaminatedleading to gastrointestinal disturbances.The effort needed to persist with fightingwearing bulky armour for hours on endled to ‘many dying and falling exhaustedby fatigue and by combat’. Even the freshtroops relieving the besieged in Septembersuccumbed to the temperature and as theyadvanced in the heat, many fainted anddropped dead.5 6

Provisions were also needed to trans-port the severely wounded to the hospital.It is very likely that this would have beencarried out by one’s own comrades-in-arms, though it may also have been atask assigned to the non-combatants.When the knight Abel de Bridiers de laGardampe was shot during a battle at FortSt. Elmo, his comrades-at-arms went tohis assistance to carry him to the Fort’schapel. He however refused their helpand crawled to the chapel on his own ini-tiative where he was later found dead.10

More organised transport was needed totransport the injured from the peripheralfronts at Fort St. Elmo and Senglea whichdid not have formal hospital services onsite and the injured were regularly trans-ferred to Birgu for treatment. A greatstock of remedies for the sick andwounded was however kept in each of thefortifications.10

At Fort St. Elmo, the guardroom servedas a first-aid station. The transport of thewounded from Fort St. Elmo to the SacraInfermeria at Birgu was undertaken byboats clandestinely at night, until a totalblockade of the fort was enforced by thebesiegers.3 10 Only the very severelywounded were transported to Birgu; therest were treated on site and continued tofight on. The knight, Juan de la Creda,was branded a coward and jailed after hegot himself evacuated from Fort St. Elmofor a minor injury.10 He was subsequentlyreleased and sent back to the fort. When

wounded again by a musket shot, ratherthan risk being re-branded a coward, heopted to receive medical attention on siteand returned to the battle. La Creda waseventually killed during the fighting inBirgu on 19 August.10 Once the blockadewas effectively enforced by the besiegers,the guardroom was used to house thenon-walking injured. Thirty knightssought refuge there and surrendered tothe janissaries when the fort fell on 23June. Very little quarter was given andonly seven knights were captured andkept alive to be eventually transferred toRagusa pending their exchange with 30Turkish prisoners.6 20

In the same courageous spirit, on 6June, Captain Miranda stationed at FortSt. Elmo, after being badly wounded,refused to be evacuated and sat in a chairnear the guns where he stayed to the endof the action. Similarly, Bailiff Negropontewas injured with an arrow in the leg butcontinued fighting.3 In the last stand ofFort St. Elmo, those knights who ‘were notable to walk by reason of their wounds,had themselves carried in chairs to the sideof the breach, where, armed with swordswhich they held in both hands, they waitedwith heroic resolution’.10

Senglea probably had a similar first-aidmanagement station. Facilities for thetransport of the injured depended on thewooden pontoon constructed betweenSenglea and Birgu, clearly visible in thed’Aleccio frescos (Figure 1).7 On July 13,before the expected assault on FortSt. Michael, ‘La Valette had a floatingbridge, which had been constructed ofbarrels and planks, towed into positionbetween Birgu and St. Michael, so that thelatter could be quickly reinforced if theoccasion arose’.3

HOSPITAL SERVICESThe expected casualties necessitated anaugmentation in hospital services. Aftermaking the maritime town of Birgu theiradministrative centre, the Order quicklyset out to build a Sacra Infermeria in thattown, managed during the siege by FraGabriel Ceralta.3 21 However, this facilitywas inadequate to cope with the continu-ous inflow of injured on a daily basis for a4-month period. The first big clash of theGreat Siege took place on the 21 Maywhen 150 people were wounded. Twodays later the siege of Fort St. Elmobegan. The injured were regularly trans-ferred to Birgu, sometimes amounting upto 60 casualties per day. Throughout theconflict, the overall casualties averaged100–400 per day,11 though on 15 July, asmany as 600 men were wounded in one

day of conflict at Senglea. With this rateof casualties, the hospital quickly filled upto 200 inmates by 11 June.3

On 6 June, emergency medical facilitieswere organised in the various Auberges ofthe Order and in suitable private houseswhich were evacuated and converted intocasualty hospitals.3 Each emergency facil-ity was assigned surgeons and chaplains,and provided with necessary medications.There was also a smaller supplementaryhospital consisting of a large hall sitednext to the Auberge d’Italie close to FortSt. Angelo. This had been set up about adecade earlier (around 1554) and wasmaintained by the Italian Knights.22

When the Admiral Pedro de Monte fell illowing to his ceaseless exertions and hisadvanced age, he retired to this facility torecuperate.3

Care was taken ‘to get in a great stockof wine, of provisions, and remedies forthe sick and wounded’10 and a largesupply of medicaments had been storedbefore the onset of the hostilities. ByAugust, the medicinal supply was runninglow. New supplies were shipped fromSicily, but the supply ship was captured bythe besiegers.8 21 Medications were dis-tributed freely as necessary. In a post-siegepetition dated February 1566 made byAntonio de Lauda, the apothecary soughtcompensation from the Order for medica-tion distributed freely to the populationduring the siege months.2

The Sacra Infermeria was also badlysited during the conflict since it was nearthe Post of Castille. The access to theinfirmary was protected by the demolitionof houses leading to it, while the gatesleading to the foreshore were blocked andparapets were constructed. These weremanned by soldiers under the commandof lay officers of the Infirmary. A line ofchain entanglements and underwaterobstacles was created from Fort St. Angeloto the Post of Castille. The Post wasrepeatedly attacked, and on two occa-sions, 7 and 20 August, the Turkish forcespenetrated a breach in the bastions in thearea. On both occasions the defendersmanaged to repulse the Turks, on thelatter occasion with the help of the‘walking injured’.10 The sick and injuredcontinuously contributed to the war effortby replenishing the fighting supplies suchas making fuses for the arquebuses.3

The fortified citadel Mdina was gener-ally serviced by the eight-bedded SantoSpirito Hospital housed outside the wallsand hence useless during the siege.23 Withthe onset of hostilities, the facilities at thehospital together with the facilities in theadjoining Franciscan monastery were




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transferred to an edifice within the citadelwalls for use of the sick and injured. Thisis evidenced by the post-siege requestdated 1566 by the Franciscan Friars whorequested the return of the beds that hadbeen lent to the Mdina Universitá for theuse of the wounded during the siege.24

While hostilities around Mdina werelimited to skirmishes by the cavalry sta-tioned there, these services were definitelyused to treat the wounded such as the 29gravely wounded horseman injured duringa skirmish on 7 August.11

THE OTTOMAN MEDICAL SERVICESThe Ottomans also set up a number ofmedical stations in their various campsaround the Grand Harbour region. Theirmain camp seems to have been that set upat Marsa where they knew that copiousfreshwater was available—being unawarethat the source had been poisoned by theknights. The Marsa camp was attacked bythe Mdina Cavalry on 28 July who sys-tematically slaughtered the sick, woundedand other non-combatants they foundthere.3 Since Marsa was close to a marsh-land region, the wounded soon fell illwith ‘the blood flux (dysentery)’ and‘other contagious distempers’ such as‘putrid fevers’ and ‘tifo’.8 10 The Turks‘had occupied some villages for the

comfort of the lodgings and of the few cis-terns that are on the island, by nature veryparched’.6 The besiegers experienced diffi-culties in assisting the wounded on thefront line since any attempt to help thewounded exposed the assistants makingthem easy targets for the defenders. Manyof the wounded were therefore aban-doned to die in the trenches dying ‘likedogs in tens a day’.8 11

When the Ottoman fleet had set sail forMalta, it carried provisions sufficient for6 months, but this had been greatlyreduced by the loss of a large merchant-ship in the Nauplia Channel. Further pro-visions consisting of raisins, dates, honey,oil and other things were furnished by theBey of Tunis. By 12 June, however, the‘provisions (of the Ottoman forces) werevery scarce in the army ... the labourerswere rationed to ten ounces of biscuit aday, and … many were dying from disease… A vessel was dispatched by the pashasto Tripoli, together with a barge and fourgalleys. These … were full of sick andwounded. It was planned that they shouldreturn with provisions for the army, sincethey were short of honey, oil, raisin,butter, and other delicacies which theMuslims relish’.3 By the end of August,the Turkish base hospital camp could notaccommodate more casualties/sick and the

galleys at anchor in Marsamxett wereadapted as hospitals.25

USE OF BIOLOGICAL WARFAREAnother important aspect of the strategiesused during the Great Siege was biologicalwarfare. Prior to the siege, la Valetteordered that all wells and cisterns in thecountryside were to be contaminated. Thecopious water spring at Marsa was alsopoisoned under the supervision of theProtomedicus Camillo Rossa using hemp,wheat, arsenic and other ingredients.9

Unsuspecting, the Ottomans continued toobtain their water supply from the Marsaspring right through the siege.3 The poi-soning of the water sources had its effectson the Ottoman troops for ‘besides sus-taining many wounded, they had startedsuffering from a fever in their belly, causedby the discomforts, the lack of essentialsand the almost insufferable heat of theseason. Whereby many were dying all thetime fading out of life and without anysolace’.6 The Turkish ships obtained theirwater from a pool sited near the straitbetween Malta and Gozo, probably atSt. Paul’s Bay. At Fort St. Elmo, ‘there wasa freshwater pool nearby but, since theywould not be able to use it, the defendersthrew salt into it’. There was apparently asource of freshwater within the fort since

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




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the knights stationed in Fort St. Elmo pro-posed to ‘ensure that the water in the fortwas poisoned’ if they were given permis-sion to sally out of the fort and fight inthe open.3

PSYCHOLOGICAL WARFAREBoth sides also used psychological warfareto boost their troop’s morale and scare offthe enemy. La Valette continually reliedon the sense of honour and shame tomaintain order and encourage his knightsto die for the Order. Mercenary soldierswere encouraged to volunteer for danger-ous duties at Fort St. Elmo with promisesof higher pay and rewards.3 Religious sen-timents were also encouraged among thetroops and even more importantly amongthe non-combatant population. Duringthe siege of Fort St. Elmo, a devoutCapuchin friar of the Order of St Franciswent to the fort and ‘preached a sermon,encouraging the garrison and putting newheart into them for the fight. After hearinghis words the men felt strengthened andconsoled, and ready for whatever mightbefall.’ Important Christian feast dayssuch as Corpus Christi on 21 June werealso celebrated with great pomp.3

Religious sentiment was also encour-aged among the Ottoman troops. Duringthe night prior to an assault, ‘the Turkshad been assembled on the high groundnear the fort, shouting at the top of theirvoices, as is their custom when praying.Two hours before dawn their priestsabsolved them of their sins, exhortingthem to fight well and to die for their falsefaith’.3 The Ottomans ‘attacked with suchwild courage that they were likeafion-eaters—afion is a kind of drug whichhas such violent effects that, after eating alittle of it, men lose their reason andbecome quite without fear.’ The use ofhashish by the Turks during the conflictwas confirmed when this was found in thepurses of dead soldiers.3

The continual psychological stress andpressure experienced by the GrandMaster seem to have taken their toll and‘Grand Master La Valette, indomitablethough his spirit was, was sorely tired (notwithout good reason), yet he concealed hisfeelings with his usual wisdom’. Theefforts of a ‘jester who had come to theisland with Marshal Robles… kept LaValette informed of what was happeningat the various posts; as well as trying toamuse him with his quips—although therewas little enough to laugh about’.3 Themorale of the combatants had to be main-tained while measures were necessary toamuse the soldiers. La Valette was advisedthat ‘from a morale point of view, he

should dispatch some money to pay thetroops—for nothing makes soldiershappier than money … He had gamingtables set up, as well as bars, and thetroops were naturally delighted’.3

On their part, the Ottomans attemptedto instil a sense of fear and foreboding inthe defenders. During the assault ofSt. Elmo, ‘so great was the noise, theshouting, the beating of drums, and theclamour of innumerable Turkish musicalinstrument, that it seemed like the end ofthe world’.3 They also tried to demoralisethe defenders after the fall of FortSt. Elmo by beheading the fort’s defen-ders and mounting these on stakes on thewalls. In addition, the beheaded bodieswere floated off on wooden boardstowards Birgu. In retaliation, La Valetteordered the beheading of capturedTurkish soldiers and the firing off of theheads towards the besiegers.3 10 Thisevent is clearly depicted on one of MatteoPerez d’Aleccio’s frescoes.7 He also gaveinstructions that all Turkish prisonerswere to be killed. The motive for this wasto ‘put his soldiers and the inhabitants,whatever extremes they might be reducedto, out of all hopes of capitulating, and tomake them sensible, that their own preser-vation and that of the place wereinseparable’.10

Both sides had to ensure disciplineamong the troops and anyone suspectedof or caught deserting was punishedseverely. On the Turkish side, ‘any manwho was absent from his post wouldreceive one hundred strokes on the belly’.3

On the defenders’ side, traitors who werecaught were quartered or hanged. ‘… AGreek, … was tempted by the devil to goand tell the enemy that the relief force hadarrived, as well as how to prevent themgetting down to Birgu. … He paid for histreachery by being quartered’. Dissent wasalso severely punished. An Italian fromGenoa was hanged within sight of theenemy ‘for saying publicly that we had nochance at all, and that it would be betterfor us to accept the money and the freepassage that the Turks were offering’.3

THE AFTERMATHThe 1565 Great Siege of Malta was abattle where no mercy was offered orrequested. On the Christian side, ‘overtwo thousand five hundred soldiers of allnationalities died in the siege. Seven thou-sand Maltese men, women, girls and boyswere also killed, as well as five hundredslaves belonging to the Order’. The siegehad a minimal effect on populationgrowth and in 1567, the number of bap-tisms in most villages did not differ

significantly from those years before thesiege suggesting that the structure of thelocal population was not significantlyaltered by the fighting.26 27 The death tollof the Ottoman force was heavier esti-mated at 35 000 men3 or 40% of thefighting force.2

The medical consequences of the siegecontinued—in those who had suffereddirect war injuries, and from deaths result-ing from the adverse post-siege condi-tions. After the lifting of the siege,conditions did not immediately improveand the adverse health conditions per-sisted. About half of the Florentine troopsleft in Malta after the siege ‘never sawtheir homes again for they died from thehard conditions and from disease’.3 On apersonal level, individuals were leftmaimed for life claiming financial assist-ance for their sacrifice during the battle.Individuals who received such aid fromthe Order years after the event included:Didaco di Aranda and Ludovico Roccawho each lost an arm while Nicolo deAlvarano, Sigismund Talhamar andBenedict Sanguineo sustained a leg injurythat left them crippled. Pedro di Escovedowas severely wounded by a bullet in thethroat and lost his speech.2 Fra GeronimoZaportella suffered from mente captusrequiring curators to be appointed to carefor his needs.28 29

Funding None.

Competing interests None.

Provenance and peer review Not commissioned;externally peer reviewed.

To cite Savona-Ventura C. J R Army Med Corps2014;160:1–6.

Received 29 June 2013Revised 15 July 2013Accepted 16 July 2013Published Online First 18 September 2013

J R Army Med Corps 2014;160:1–6.doi:10.1136/jramc-2013-000137

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Roman Empire. London: Murray, 1862; Chapter 68.2 Spiteri SC. The Great Siege. Knights vs Turks MDLXV.

Anatomy of a Hospitaller victory. Malta: Gutenberg,2005.

3 Balbi di Correggio F. La verdadera relacion de todolo que el Anno de M.D.LXV ha succedido en la Islade Malte. Barcelona 1568; English translation:Bradford E. The siege of Malta 1565. England:Penguin Books, 2003.

4 Letter dated 11th August 1565 from Fra VincenzoAnastagi to Ascanio della Corgna. In Pellini P. Dellhistoria di Perugia, Venice: Gio Giacomo Hertz, vol.1: 1066–1073; English translation in BonelloG. Histories of Malta—versions and diversions.vol. 3. Malta: Fondazzjoni Patrimonju Malti,2002:123–34.




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5 Bonello G. ed. Pallavicino Rangone—inordinate criticof de Valette. Histories of Malta—confessions andtransgressions. vol. 9. Malta: Fondazzjoni PatrimonjuMalti, 2008:58–66 (based on document housed inthe Vatican Archives, Miscellanea, Armadio II, 14,f.38).

6 Adriani GB. Istoria de suoi tempi, Florence, 1583,727–45. English translation in Bonello G. Histories ofMalta—confessions and transgressions. vol. 9.Malta: Fondazzjoni Patrimonju Malti, 2008:39–56.

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