There is no evidence that the Maltese islands suffered from outbreaks of cholera before the 19th century. It is true that, in 1745, in his manuscript treatise titled De Morbidus Abdominis, Giuseppe Demarco (1712-89) seems to refer to Cholera Morbo but he gave no information regarding its epidemiology, though his later writings refer to “choleraic symptoms” observed in 1767, 1770 and 1783.

It was in 1816 that, in India, cholera assumed epidemic proportions. It reached China in 1819 and Persia in 1821. The cholera epidemic reached Europe soon afterwards and went on to devastate many countries across the continent: Russia in 1830, Vienna and Berlin in 1831, Britain (London) in 1832, Spain in 1833, Gibraltar in 1834, France (Marseilles) in 1835, and The Kingdom of the Two Sicilies in 1837.

Plan of the Floriana Ospizio.

All told, there were 62 million victims worldwide. It reached Malta in June 1837 where it first attacked the old and weak inmates of the Ospizio at Floriana and went on to spread to every corner of the Maltese islands before it died out in October.

Robert Heinrich Koch (1843-1910), the discoverer of the cholera bacterium in 1883. Photo: Avast HTML document

Before the discovery of the cholera bacterium by Robert Heinrich Koch (1843-1910) in 1883, the mode of transmission of cholera was the subject of arguments and debates because the medical profession was divided: some believed it was infectious and contracted from the environment, while others held that it was contagious and the disease passed on from one person to another.

By 1837, Maltese doctors were expecting the arrival of cholera in Malta from mainland Europe, very probably with trepidation, since the memory of the 1813 plague outbreak was still fresh in many Maltese minds.

One has also to keep in mind that cholera was a relatively new epidemic and there was no real experience on how the victims were to be medically treated. In his 1848 publication titled The Cholera in Malta in 1837, Dr Giuseppe Maria Stilon wrote that “it was scarcely possible to obtain medical assistance to the sufferers”.

People did their best to avoid contact even with their loved ones

June 9, 1837, was the date when the first two cases of certified cholera appeared at the Ospizio; within four days, there were another 25 fatalities. Based on the assumption that the origin of the malady was due to environmental causes, on June 13 and 14, the governor ordered that 645 out of the 750 inmates were to be transported to and isolated at Fort Ricasoli.

Minute by Governor Bouverie, dated July 19, 1837, confirming the outbreak of cholera in Malta. Photo: Malta National Library

But the epidemic continued unabated even at this new location and, within 10 days, 200 inmates died from the disease. The medical staff became incapable of dealing with the increasing number of new cases.

Two doctors – Gavino Portelli and Giuseppe di Salvo – contracted the disease and had to leave while some nurses simply abandoned their patients. Insubordination followed, and 45 corpses were even left unburied. Freeing prisoners to take care of the sick proved to be a non-starter, and chaos reigned.

The appointment of another doctor, Anthony Speranza, on June 21, brought order to the hospital with burials, proper treatment and spiritual assistance becoming the order of the day. Eighty-three of the healthy inmates were allowed to return to their families after a total of 257 had succumbed to the disease.

This depopulation of Ricasoli helped to diminish the incidence of new cases. Still, out of the 537 inmates who had contracted cholera, 442 died. They were buried not far from Fort Ricasoli in a plot of land where Wied Għammieq Cemetery now stands.

Sir Henry Frederick Bouverie (1783-1852), Governor of Malta during the 1837 cholera outbreak. Photo: National Archives of Malta

The ordinance issued by Governor Bouverie on July 29, 1837, regarding the cholera outbreak. Photo: Malta National Library

On June 19, somewhat belatedly, Governor Lieutenant-General Sir Henry Frederick Bouverie (1783-1852) had appointed a Central Health Committee comprising nine members (Maltese and British) to supervise the reported cases and deal with the epidemic. It met on June 22 and made the following proposals:

A hospital was to be provided for each of the country districts situated in the highest and airiest location of the village;

Each village/town would have its own local committee comprising of the deputy luogotenente, the parish priest, the principal medical practitioner and other respectable local inhabitants.

The duties of these committees included: the removal of filth from streets, courts and cellars; visiting houses in narrow lanes, damp and low-lying places; overseeing public cleanliness; discovering concealed diseases; encouraging the heads of families to apply for medical assistance as quickly as possible; presenting early assistance to the poor and destitute by either sending them to hospital if they so wished or by supplying them with medicines at home if they opted to remain there; supplying the deputy luogotenente with printed instructions for the treatment of the disease; and animating medical men to be zealous in their duties.

The cholera hospital at Mqabba, one of a number set up throughout the Maltese islands to cater for the patients who contracted cholera.

On June 21, a similar committee, Comitato di Salute, was formed in Gozo and formulated rules similar to those of Malta, to which one has to add that the dead were to be interred in cemeteries in the presence of a police sergeant, under sette palmi di terra and the necessary quantity of lime mortar, and not in churches. If a burial was permitted in a church, the grave was to be well sealed.

The epidemic reached out to various districts, including Floriana, Senglea, Birkirkara, and the military and naval hospitals. The people were terrified and did their best to avoid contact even with their loved ones as graphically recounted by the eyewitness Sarah Austin (the wife of one of the Royal Commissioners of 1836, in Malta till 1838). She wrote: “I have seen mothers refuse to go near their children, husbands their wives. I have seen one of eight brothers (in the upper classes) not one of whom would approach their father’s death-bed. In short, every variety of atrocious selfishness… as to cure, it is anything, everything, nothing. Nobody knows. Everything succeeds – everything fails.”

The terror-stricken populace alleged that the medical profession refused to tend to cholera-stricken patients, an unfounded perception because almost all the members of the medical profession – including the naval and military doctors – offered their services when called to do so on June 20. In fact, Lorenzo Guillet and Cleardo Naudi both died during the execution of their medical duties on July 13 and 30 respectively.

The obituaries of two doctors, Drs Lorenzo Grillet and Cleardo Naudi, who died of cholera during July 1837. They contracted the disease when carrying out their medical duties. Photo: Malta National Library

Temporary hospitals were established in Valletta, Floriana, Senglea, Mdina, Żejtun, Żebbuġ, Ħamrun, Qormi, and Żurrieq. People were encouraged to resort to hospitalisation as soon as the illness was in its initial stages but, unfortunately, many patients went to hospital in a moribund state. Those who remained at home were supplied with free medications and services.

The epidemic reached its peak in July with 6,286 known new cases causing 2,743 deaths. In Gozo, on June 29, it was decided that the Conservatorio delle Zitelle would be used as a cholera hospital in the event that the disease reached Gozo. The inmates were to be transferred to Casa San Calcedonio in Rabat (Victoria).

The former Casa di San Calcedonio in Rabat, Gozo, now Manresa Retreat House.

As expected, on July 6, the disease reached Gozo, and by the end of the month, it had 510 cases and suffered 183 fatalities, especially in the poorer districts where housing conditions and sanitation were very bad. By August 31, 743 cases of cholera had been recorded.

A very graphic description of the last moments of his Gozitan patients is given by Dr Thomas Chetcuti in his 1838 publication titled Notizie storiche e patologiche-cliniche sul cholera che divampò in Malta e Gozo nell’estate del 1837.

The 1848 English translation, by S. D. Watson, of Dr Giuseppe Stilon’s book about the 1837 cholera outbreak in Malta.

In spite of the precautions taken, cholera continued to wreak havoc for over three months. The civilian population of Malta – 103,344 persons – suffered 7,672 cholera cases (7.4% of the populace), of whom 3,784 died, a mortality rate of 49.3% of those infected. In Gozo – population 16,534 – there were 818 cholera cases (4.9% of the populace), of whom 368 died, a mortality rate of 45% of the infected persons. To these figures, one has also to consider the military population, including dependents. Out of 3,214 persons, there were 313 (9.7%) cases of cholera, of whom 71 died, a mortality rate of 22.7% of those infected.

The epidemic also caused economic hardship because many businesses had to close shop. This caused an economic stagnation, hitting mostly the poor. In fact, both the governor and the bishop set up funds to provide some relief to the poor and destitute.

In August, and more so in September, the number of new cases declined significantly and the epidemic started to wane. On October 11, 1837, it had ceased completely and the Quarantine Office issued a clean bill of health. However, cholera was to rear its ugly head on other occasions in Malta: in 1848, 1850, two small outbreaks in 1854 and 1856, 1865, 1867, 1887 and 1911.