Charity and Alms giving: the centuries old dilemma whether to help the poor and give charity or whether
charity encourages mendicancy and loitering from those able but lazy poor. Private and Church charities were founded to help alleviate the suffering of many poor families, yet some still believed that these only encouraged unemployment and vagrancy. The themes of deserving and undeserving poor runs throughout the study of charitable institutions during the 19th century.
Civil, private and church charities: In Malta, numerous private and church charities were developing during the reign of the Knights of the Order of St. John. Although not directly administered by the Knights, they were approved of and sheltered. In some cases private charities with financial difficulties were aided by the Order's coffers. In the 19th century, the British Colonial Government amalgamated all the private and church charities in existence at the time under the Civil Charitable Institutions of Malta. This remained in existence until the 20th century when the Maltese Government renamed it as the Medical Department which continued to incorporate in it the most important medical and sheltering institutions. Although these charities changed their administrative characteristics under British rule, the paternalistic attitude of the populace towards these services did not change. It was considered the right of the poor and the Maltese citizens (especially the taxpayer) to be given hospital care and shelter in asylums.
Hospitals and Asylums Architecture: Various buildings were adapted, and in rare occasions built, to serve the purpose of medical institutions or asylums in Malta. The main architectural hospital markers can be seen in these buildings. Until the 19th century, most buildings were of the mansion type or built around closed courtyards which serviced the needs of the whole buildings. During British rule, only two civil hospitals were built and both were differing forms of the pavilion systems so much propagated at the time by medical champions like Florence Nightingale and Joseph Lister. The need for better buildings to house these medical institutions was felt throughout the 19th century. Hospitals and asylums were often cramped and ill suited for patients due to raising damp, structural damages, lack or defective drainage systems and periodic infestations due to lack of cleanliness.
Institutionalization: It is often debated whether institutions were oppressive and markers of an inflexible
social structure. As common examples of such institutions, prisons, hospitals, asylums and mental institutions are mentioned. In this research, the Foucauldian views do not match the data and documentation found in archives. The negative views of such institutions and what they must have meant for the poor or the sick are only partially shown throughout this research. This study analyses the good and
bad reputations of Maltese civil charities and gives numerous examples where sick or poor patients refused to be admitted into these institutions. On the other hand the applications to be admitted into these institutions were rising year after year shedding some light on the economic and social situation of the lower strata of Maltese society in the 19th century.
District Medical Officers (or Parish Doctors): The charitable system under the Knights' rule during the 17th and 18th centuries also included regional alms giving around the various villages and parishes. Under the British rule, this system of poor relief was further evolved and greater care was given to who was eligible for relief or not. In Malta, the system of parish doctors was also introduced and District Medical Officers were posted in the 13 districts around Malta and the sister island Gozo. These medical doctors
filtered most of the medical cases and were obliged to send to the general hospital of Floriana only those in need of dire and immediate attention. Others who needed shelter and asylum were brought to the attention of Government's officials and put in the list under the respective institution as their needs entailed.
Island Colonies – most of my research was focused on the charities in the island of Malta during the 19th century. Malta was under the direct rule of Britain and formed part of the extensive British Empire. In Island colonies like Cyprus, Gibraltar and Malta under British rule, elderly, poor and those in need of care used a combination of resources, social networks and exploitation of government sponsored institutions in
order to survive. A strong factor amongst these societies is the great amount of negotiation done with various institutions varying on the patients' social background, health status, rural or urban location and household composition.