In 1813 Malta suffered a serious outbreak of bubonic plague while under the rule of the British. It reached all parts of the island including Gozo and killed nearly 4500 people out of a population of 96,000. Its impact will have touched many families including my Callus ancestors, who were known victims. In this post I will tell the story of how it spread, what it was like for patients and their families and how the authorities tried to contain it and care for its sufferers.
Aetiology and Symptoms of Bubonic Plague
A number of detailed accounts of the plague’s progress were published in the years immediately following the disaster, including a Board of Health Report by the Chief Medical Officer William Burrell to a parliamentary select committee in 1854. An excellent and detailed summary of these can be found at Malta RAMC – Plague 1813.
In 1813 physicians did not know what caused the plague but there were two prevailing theories; contagion or miasmatist. The published reports were coloured by which of the theories the author subscribed to. Ralph Green was Inspector of Hospitals in 1813 and was responsible for managing the sick and containing the disease throughout Malta as a member of Malta’s Board of Health. He believed in the contagion theory which held that plague was spread by physical contact, be that with an infected person’s body, their effluents or anything that had been touched by them, e.g. their clothes or belongings. Quarantine was consequently considered the most effective course of action but little could be offered the patient either as a curative or by way of palliation.
Another account comes from Dr Robert Calvert, physician to the forces, who was a miasmatist. The miasma theory argued that plague was not dependent on contact but was spread through ‘foul air’ caused by atmospheric conditions prevailing according to climate, season and geography. Calvert observed how despite strict curfews and quarantines, the disease appeared to jump from street to street and village to village without any obvious contact but always abated or died out in the winter months.
In fact, we now know that the plague is spread by a flea carrying the organism Yersinia Pestis which it transmits to the black rat, Rattus rattus (WHO). When an infected flea tries to feed from an uninfected host, it regurgitates the offending organism into the wound created by its bite. Despite popular myth, bubonic plague rarely spreads from person to person. Infection from close contact was more likely caused when an untreated victim (and there was no treatment) went on to develop secondary pneumonic plague (i.e. of the lungs) which can spread the bacteria by coughs and sneezes. The main cause of the spread was living in close quarters to infected rats, which was why whole households succumbed.
Symptoms of plague appear about 3-7 days after exposure. The patient has flu-like symptoms including fever, headache, chills and weakness. The most telling symptom however is the appearance of buboes. These are painful swellings in the lymph glands located in the armpits, groin and neck, which turn black when they necrose (giving rise to the name ‘Black Death’).
Source: Centres for Disease Control and Prevention – Public health Image Library
Improvements in sanitation have massively reduced the risk of plague since the early part of the 20th century and early treatment with antibiotics means that the mortality rate has gone from 40 – 60% to around 1-15%.
The Maltese Epidemic in 1813 – First Contact and Spread
According to all the contemporary reports, the plague arrived in Malta on 29 March 1813 with the San Nicola, a brigantine vessel which had sailed from Alexandria in Egypt, where plague was raging. The master signaled that he had lost 2 men on the voyage to sickness, which he thought could be plague due to the black tumour on the neck of one of the men. The remainder of the crew appeared healthy, so they were allowed to disembark at the Lazaretto on Manoel Island which is on the other side of Valletta, after shaving their heads, washing in sea water followed by vinegar and then leaving their clothes behind on the ship. Nevertheless, on 1 April the captain and his servant, both of whom had attended the sick men on the voyage over, fell sick and died around 36 hours later. The ship was quarantined but after 2 weeks no further crew had succumbed and so a fresh crew was hired to sail the ship back to Alexandria, which was achieved without further event.
Then on 19 April, Dr Gravagna was called to the house of a shoemaker named Salvatore Borg who lived at 227 Strada San Paolo, a poor district of Valletta near the quayside of Grand Harbour, to attend his young daughter who was suspected of having typhus. The child had been ill for 5 or 6 days and later died. On 1 May, the mother who was 7 months pregnant, went into premature labour which ended in stillbirth and then she became ill with fever with signs of swelling in her superior inguinal glands (groin) which soon spread to the other side. She died later that night. Her husband developed fever a few days later with swellings in the groin and axilla. The doctor now suspected plague and notified the authorities.
Bubonic plague was a fairly regular and much feared visitor amongst the sea-faring nations of the Mediterranean, so although the last outbreak in Malta had been way back in 1675, there were strict quarantine protocols for such eventualities. The Board of Health swung into action. No ships were allowed to leave the port. All public meeting places, such as law courts and government offices, were shut and all the districts and suburbs of Valletta received a daily patrol by a medical team searching out new cases. Anyone who had come into contact with the Borg family were removed to the Lazaretto. The midwife who had attended the woman was found dead at her home a few days later.
More cases were soon found so the restrictions were increased. Crews had to stay on board their ships. Residents were instructed to stay indoors and not to congregate. The sale of any cloth or skins was banned. Any suspected cases were to be reported to the Board of Health and any attempt at concealment or failure to declare one’s self or others with symptoms was punishable by death!
The plague continued unabated. Everyone was understandably fearful. Many people secretly fled the city to stay with relatives or friends in the villages and countryside. The authorities suspected that people were not sticking to the regulations and were exacerbating the spread. However, years after the plague, Burrell’s report argues that there was no evidence of any contact between the San Nicola and the port residents and that the plague must have reached the population via any one of the many unsuspected ships from Alexandria entering Grand Harbour and mooring up at the quay near Strada San Paolo.
Reaction of the Casals including Żebbuġ
On news of the outbreak in Valletta, the casal (village) of Żebbuġ responded promptly by putting precautions in place. The casal was divided into 3 districts and residents were forbidden from moving outside their own cordon or outside the village walls. An official was assigned for each district to oversee the internment of any victims. Despite this, the first victim was recorded 25 May. Within a month, 8 people had died. A civic guard was then formed to prevent contact with the neighbouring village of Qormi (aka Curmi). On 29 August, troops placed a cordon around the casal to prevent all movements in and out. In neighbouring Qormi, martial law was imposed on the grounds that the population was worsening the spread by thieving from infected families (which was almost certainly untrue). In September, the military cordons were doubled in both villages. This was a bad policy that was to have catastrophic consequences for these 2 villages.
Plague map of 1813 showing casals (villages) where military cordons were in place. Source: Malta RAMC.
The population of Żebbuġ was around 4, 700 in 1813. Between May and October the village sustained 691 deaths due to plague, which represented about 14.5% of the total population, a staggering loss. Qormi’s population and death rates due to plague were very similar. Death rates amongst the military garrisoned there were, however, very low because they were patrolling the cordons outside the village walls and were in the fresh air, not cooped up in infested houses.
By contrast, the neighbouring villages of Siggiewi and Zurrieq, with populations of around 3,500 people, had 9 and 6 deaths respectively over the whole period, representing under 1% of their populations. Even Valletta fared better, losing 8% of its population.
The Plight of Victims
Quarantine harbour with Fort Manoel and Lazaretto, Valletta. Source: Malta RAMC with permission.
Patients who were transported to the Lazaretto near Valletta, suffered appalling conditions. When the hospital became full, the military erected barrache or pest houses in the ditches alongside the walls of the fort. These 12 foot square cabins were unfurnished, poorly ventilated and in the full force of the sun reflecting off the fortress walls so were unbearably hot for inmates (who were already suffering from fever). There were around 5 or 6 patients to a room and 2 attendants per 28 patients (and these were convicts drafted in from the prisons and who had therefore absolutely no wish to be there or much sympathy for the poor victims)! Patients had to lie on straw or bare floors. Sanitation was poor, there was no change of linen and the death rate was consequently extremely high. People who were symptom free but known contacts of victims were incarcerated with the sick in an attempt at containment at any cost and the cost was high, anywhere between 30-50 deaths per day at the peak!
In August, Joseph Callus, the cotton spinning mill owner of Żebbuġ, fell sick with plague. He was a young man who had been married about 3 years to Anna and had a 2 year old son, Andreas (my Gt Gt GF).
There was no hospital in Żebbuġ so patients were looked after in their own homes. While a diagnosis of plague in the household must have been a terrifying prospect for any family, being cared for at home was a much lesser evil for the patient. Like Valletta, a Committee of Health was formed to visit suspected households, dispense food, charity and medical aid and to keep suspected cases under observation. Public subscriptions were raised to help the poor.
People like Joseph, who were relatively well off, would have had better, less cramped housing and probably had servants. This may have lessened their own risk of contamination as it would be the servants who would come into contact with the food stores and animals in the lower part of the house where rats and fleas were more prevalent. The strict restrictions meant that no one was allowed to change their domicile during this period or enter other properties. Complete seclusion had to be maintained. The presence of servants would therefore have depended on whether they were living in.
Once an infection was notified, the house was marked up and guarded. During the height of the epidemic, houses in Żebbuġ and Qormi were actually locked up by the authorities. Only one person would be allowed out for a few hours every day for provisioning and the removal of bodies.
In late August, a field hospital was set up on the outskirts of Żebbuġ for the poorer sick but this was not much better for them as they also had no shelter from the sun. Within a couple of weeks 189 people had died there! Transferring patients away from dwellings into the fresh air did however stop further spread, probably because people were removed from the source of the contamination, namely the plague infested rat population.
As it was, Joseph Callus died 10 August 1813, aged 26. He was buried in a mass grave in the plague cemetery in Żebbuġ, the exact site of which is unknown.
Communion being given to a plague victim. Source: Public domain.
The number of new plague cases started to go down in Valletta from the end of August 1813 but continued to rise in Żebbuġ and Qormi until the end of September, probably due to the quarantine policy. During October plague fatalities reduced dramatically and by November no further deaths were recorded in Malta. The islands were officially declared plague free in September 1814.
We know of course that Joseph’s son Andreas Callus survived, but records for this period are sparse and I do not know at this stage whether Anna or any other members of his near or extended family did also. However, as our family tradition only mentions Joseph succumbing, I think we may deduce that Anna survived otherwise Andreas would surely have mentioned his being made an orphan.
One of the consequences of the plague must have been the collapse of the cotton industry and this would have had serious implications for the surviving Callus family. On 22 August 1813 an order was given to ban the gathering in of the cotton harvest as it was thought the crop might be a source of plague transmission. During this time however, people were banned from free movement around the casal or to places of congregation so the spinning mill could not have been operational. It was also impossible for people to trade or move anything down to the ports. Foreign ports also imposed quarantine restrictions on Maltese shipping and imports, some maintaining these until as late as 1826 (S. Sciberras)! The Callus income must have completely dried up during 1813 and may well have gone bust as a consequence of the trade embargo and the emergence of new, cheaper competitors in the cotton trade such as Egypt, Syria and India. Many local cotton farmers switched to growing grain instead.
In my next post I will describe what happened in Malta in the years following the plague to cause Andreas Callus and many of his Maltese compatriots to finally choose to leave their tiny island homeland for pastures new.
General Board of Health (1854), Appendix V on the Second Report on Quarantine: Report of Dr W.H. Burrell on the Plague of Malta 1813, HMSO: London.
Sciberras, S., Malta History: 3 – Economic and social issues of the last two hundred years. StBenedictCollege.org
Bonnici, W., Malta Royal Army Medical Corps: Inspector of Hospitals Ralph Green and the Plague of Malta 1813.