Humans have populated the Malta archipelago since at least 2400 BC, leaving behind temples that appear to have served as centers of religion and healing. The Phoenicians colonized the archipelago around 700 BC and ruled it until they were conquered in 218 BC by the Romans. In AD 60, according to the Acts of the Apostles, St. Paul was shipwrecked there and cured the father of the Roman governor Publius of dysentery. Roman rule brought tangible medical developments, such as clay feeding bottles, running water systems, heated rooms, and public baths, with early versions of U‑shaped toilet seats.

After the division of the Roman Empire, Malta became part of its eastern or Byzantine part. In 870 AD, the Aghlabids—an Arab dynasty—took control of the region, followed by a succession of rulers: the Normans of Sicily in 1091, then the Swabians, the Aragonese, and finally the Spanish. The islands were given to the Order of St. John in 1530 to rule them as a vassal state of the Kingdom of Sicily.

In 1565, the Ottoman Empire under Suleyman the Magnificent attempted to take the islands, in what is remembered as the Great Siege of Malta. The defenders, under Grand Master Jean Parisot de La Valette, numbered around 7,000 while the attackers boasted approximately 30,000 troops and a formidable naval fleet. The Turks attempted to take Fort Saint-Ange in Birgu, Fort Saint-Michel in Senglea in the eastern part of the Valletta Harbor, and Saint Elmo in the western part, but were eventually forced to withdraw by a large force of the Habsburg Empire.

The Order of St. John continued to rule Malta for over two centuries, a period characterized by the flourishing of the arts and architecture and by an overall improvement in the social order. In 1574, they erected the Sacra Infermeria (Holy Infirmary) Hospital in Valletta, the capital city of Malta, near the fortress of St. Elmo. It became one of Europe’s leading hospitals. It could shelter nine hundred patients and charitably admit everyone, from beggars and slaves to the aristocracy.¹ They introduced strict hygiene protocols, separate wards for medical and surgical cases, a renowned pharmacy with majolica jars, naval medical services for sailors, a women’s hospital, and community nursing services. Their quarantine system, developed to combat plague, was among the most advanced in the Mediterranean.

Ships entering Malta were isolated at the Lazzaretto on Manoel Island beginning in 1634, protecting both local and regional populations. In 1676, Grand Master Nicolas Cotoner founded the School of Anatomy and Surgery, the precursor to the modern University of Malta’s medical school. Dissection and post‑mortem examinations were emphasized, attracting students from across Europe. It was there that in 1886, Surgeon Major David Bruce discovered the microbe causing the Malta Fever or Brucellosis.

In 1798, the Order was expelled after the French First Republic invaded the islands. After a few months of French rule, the Maltese rebelled and expelled the French. Malta became a British protectorate in 1800 and a British colony in 1813.

Under British rule (1800–1964), Malta became a major hub for military medicine. During World War I, it earned the title “Nurse of the Mediterranean” for the treatment of over 135,000 wounded soldiers at Gallipoli and Salonika. In World War II, despite heavy bombardment, it continued to provide essential medical services while enduring siege conditions. It gained its independence in 1964, became a republic in 1974 while remaining in the Commonwealth, and has been a member state of the European Union since 2004.

Since its independence, Malta has developed a modern, universal healthcare system. The opening of Mater Dei Hospital in 2007 marked a major milestone, and Malta now participates actively in EU health initiatives. Its centuries-old medical tradition continues to shape its national identity.

End note

1. For more on the Infirmary, see Sally Metzler, “The Holy Infirmary of the Knights of St. John in Malta,” Hektoen International 2016, https://hekint.org/2017/02/24/the-holy-infirmary-of-the-knights-of-st-john-in-malta/; for more on illness in Malta, see Victor Grech, “COVID-19 and Malta’s Black Plague epidemic of 1813,” Hektoen International 2020, https://hekint.org/2020/04/14/covid-19-and-maltas-black-plague-epidemic-of-1813/.