Hospitaller: An overview of the Hospital

Slide 1
Dear Colleagues and Supporters,
Thank you for visiting the St John Ophthalmic Association’s website.
My name is David Verity. I am an ophthalmic surgeon based in London, and a supporter of the Order of St John and the Eye Hospital group. In this talk I shall summarize the early history of the ancient Order, explore the medical origins of the new Order of St John which was reestablished by Queen Victoria in the 1880’s, and talk about the current work of the Eye Hospital Group.

Finally, I shall describe the work of the Ophthalmic Association and its mission to drive forwards the postgraduate strategy of the Hospital Board, and represent and promote the postgraduate and academic interests of our staff and the wider Order.

I hope you find this informative, and thank you for your support for St John.

Slide 2
In the medieval Islamic world the word “Bimaristan” referred to a hospital where the sick were cared for by qualified staff.
The word is derived from ‘Bimaristan, a Persian word (بیمارستان bīmārestān) meaning “hospital”, with Bimar- from Middle Persian (Pahlavi) of vīmār or vemār, meaning “sick”, and Stan, meaning a location, or place. The Hospice in Jerusalem, which subsequently became the Hospital of the Knights of the Order of St John, was originally built in the Muristan sector of the Old City of Jerusalem in about 700 AD, the word Muristan reflecting its ancient origins.

Slide 3
However, the precise history of the ancient Order of St John and the first hospital in Jerusalem are uncertain. Historical records identify a hospice within the city walls in the 7th century. The injunction to treat all patients irrespective of race, religion and creed can be traced back to the time of the ancient Persian Bimeristans. By 1023 the traders from the north Italian Amalfi coast had assumed ownership and responsibility, led by Gerard Tum, the first Provost. By 1113 Pope Pascal II had issued a Papal Charter, and the Order was born

Slide 4
In the Knight’s hospital complex, seen here at the bottom of the archeological plan of the Muristan, a hospice existed which was large enough to house over 1000 in patients, with separate male and female wards. In times of emergency, which frequently beleaguered the Knights, the hospital could accommodate as many as 2000 patients.
Although we may think of them as old fashioned, they employed surprisingly modern techniques for their times, such as the use of honey to encourage wound healing, leaches to remove peripheral oedema, and silver platters upon which to serve food. We know now that silver has antibacterial properties, but the Knights’ Jewish and arabic physicians had known this for years.

Slide 5
After the fall of the Latin Kingdom in the East, the Knights, and their trading, healthcare and whole infrastructure moved ever westwards across the Mediterranean basin, first to Acre, and from there to Cyprus, where their logistics and supply base was situated, and thence to Rhodes, Crete, and finally Malta.

Slide 6
Built in 1574, the Sacra Infermeria in Malta was the most revolutionary hospital Europe. Here the Knights of St John continued to provide health-care until the arrival of Napoleon in 1798, and so successful were they that their hospital earned the name ‘the Nurse of the Mediterranean’ , where they employed Arabic and Jewish physicians, attracting patients from the entire medieval world.

The Sacra Infermeria’s 155 metre (508 feet) main ward was the longest in Europe, housing knights and aristocrats while the poor were squeezed onto shared beds in the ward below.

From the era of the Knights through to the arrival of Napoleon and Nelson and up to the First World War, the hospital would continue to care for the sick and wounded, leading to Malta’s nickname as the ‘Nurse of the Mediterranean’.

Slide 7
Thus, The ancient Order of St John had provided uninterrupted medical care of the highest standard for 775 years, from 1023 until the capture of Malta in 1798.
The Catholic Priories and Knights had survived, the English Order was dissolved during the Dissolution of the Monasteries by King Henry VIII in 1564, but was reinstated by Queen Victoria over 300 years later.

Slide 8
The history of the modern Order of St John is intricatedly linked to a blinding condition which had long been prevalent in Eurasia. This disease was trachoma, also known as the Egyptian Ophthalmia, or Mesopotamian Scourge.
Artefacts from Ur, in modern Iraq, and dated 2700 BC, include a pair of epilation forceps almost certain to have been used for removing aberrant eyelashes due to trachoma.
The urgent need for research into the causes of this condition, and prevention of its devastating complications, played a pivotal role in the foundation of two great institutions – The Order of St John, and Moorfields Eye Hospital in London

Slide 9
Trachoma was first seen in early settlements in Mesopotamia, the so-called “Fertile Crescent”, the geography defined by the Tigris and Euphrates rivers
It is an infectious disease that causes the eyelids to turn inwards, resulting in the eyelashes rubbing the surface of the eye, leading to corneal scarring and blindness

Slide 10
In fact references to trachoma go back even further, to China as long ago as the 27th century BC.
We know that the Emperor Huang Ti Nei Ching had surgery for trichiasis, almost certainly due to trachoma, and descriptions of the disease and its management have been found inscribed animal bones and tortoise shells dating from the 16th to 11th Centuries BC.

Slide 11
Thus, Trachoma, meaning ‘roughness in Greek, and referring to the effect of the inturning eyelashes on the eyeball, is one of the oldest afflictions of the human race. In more modern times, it came to be known as the Mesopotamian Scourge in 2000 BC, and as the ‘Egyptian Ophthalmia’ which debilitated Napoleon’s troops during the Egyptian campaigns between 1789 and 1799.
With the return of afflicted troops in the 19th century, and with trachoma also rampant throughout the army barracks of Europe, hospitals were established to deal with this threat, the most well known of which is Moorfields Eye Hospital. Dr John Vetch gave a compelling account of trachoma’s threat at the time, and was the first to enforce strict hand-hygiene measures which resulted in reduced transmission.

Slide 12
In the early 20th century, with the threat extending as far as the Americas, trachoma was the main reason for an immigrant arriving to New York to be deported. Indeed, in 1913 President Woodrow Wilson signed an act designating funds for the eradication of the disease, and over 1000 Immigrants who attempted to enter the U.S. through Ellis Island, New York were quarantined there until it was certain they were disease free.

Slide 13
With the resurgence of support for the Order of St John in England, some three hundred years after its dissolution in the 16th century, Queen Victoria founded an ophthalmic hospital in Palestine in 1882, and subsequently granted a Royal Charter, establishing a Modern Order of St John which subsequently spread across the Commonwealth and to North America.

The eye hospital was built as a humanitarian exercise to serve the poor indigenous population in which disease was rife.
The UK was reasonably well off, thanks to the industrial revolution, and could afford this gesture.
This slide shows the first hospital, built on the road to Bethlehem, with the First Annual Report.

Slide 14
In 1960, after a series of moves, and a brief closure during the First World War, the Hospital relocated to its current position in Sheik Jarrah. Now, some 60 years later, the Hospital Group operates facilities throughout the West Bank, and in Gaza, one of the most geopolitically challenging places in the world.

Slide 15
The population St John serves is very poor. Over 4 and a half million Palestinains now live in the West Bank and Gaza, almost a third are under the age of 10, and a similar proportion lack food security, that is, they are not certain where their next meal is coming from.
Adding hardship to misfortune, blindness in this population is 10 times higher than in the West, with no universal public healthcare system. A staggering 15-20% of patients are diabetic, with high rates of congenital ophthalmic diseases in addition.

Slide 16
St John’s eye units are located across the Palestinian Territories, with the main hospital in East Jerusalem.
• In Anabta in the north, we treat over 20,500 outpatients each year.
• In Jerusalem, about 50,000 outpatients, and 3500 surgical patients, are managed each year.
• In Hebron in the south we see over 13000 outpatient and surgical patients yearly, and through our mobile outreach services across the territories we see a similar number of patients.
• In 2016 we opened a flagship hospital in Gaza itself, against considerable logistical odds, with over 30,000 patients managed there each year, where the need in a population of 3 million is severe.

Slide 17
Ophthalmic services in this population are in constant demand. The graphs on this slide demonstrate a year-on-year rise in surgical and outpatient demand, by about 61 and 67% respectively over the past 10 years. Our surgical services are particular need, with a growing need for cataract operations, squint surgery, glaucoma procedures, injury repair, correction of periocular deformities, and so on.

Slide 18
The Eye Hospital Group trains and employees ophthalmic nurses, doctors and allied heath professionals. In 2015 the St John Ophthalmic Association was formed by the Hospitallers of the Order both to support and represent the postgraduate interests of our staff, as well as the academic profile of the wider Order.

Slide 19
The SOA is now a formal entity within the Eye Hospital group, and is formed of 5 ‘hubs’ across the world. This structure largely reflects the distribution of the St John Priories across the Commonwealth, North America, and the European St John Orders, particularly in Sweden.
In addition, the Association is developing its on-line teaching capabilities, with the current MasterClass series, evolving Cutting Edge series, and on-line Lexicon being three such examples.
It also supports younger people interested in the work of St John, with leading young professionals forming a group called ‘iYouth, ensuring continued interest and involvement from the next generation.

Slide 20
Broadly, there are two arms to the SOA’s mission. These are to drive forwards the Board’s strategy for postgraduate development, and to support and promote the academic profile of the Group as a whole.
In doing so, the Association aims to improve opportunities for our staff, to keep the Priories across the world regularly informed of our medical and nursing activities, and to engage professionals across the Priories who would like to contribute more to the work of St John, be it through supporting our Fellowship programs, offering clinical expertise, or helping the SOA develop its online learning platform.
Over the past 5 years, thanks to our supporters, we have been able to promote Clinical Fellowships, observerships in Moorfields, and regional teaching events. We have also published as a group, and been able to support medical visitors from abroad see first-hand our work.

Slide 21
I hope you have found this talk informative. I would like to thank the Board of Trustees of the Eye Hospital Group, our Patron, and our many colleagues around the world for supporting the Association over the years. I believe that a formal professional network for St John will benefit our staff, enhance our regional and international profile, support the Board, and attract interest and expertise from colleagues around the world.

In all this work we are motivated by the 2-part motto of the Order: ‘Pro Fide, Pro Utilitate Hominum’: ‘For the faith, and in the service of humanity’.

Thank you.