By 1815 the buildings and grounds were amplified to three wings - all built on the foundations of Juan Mateos's original house. The new hospital accommodated 500 men and known as the Cob (dollar) Hospital because of its costliness.12 Meanwhile the civilian population had no proper hospital facilities - Catholics kept their sick in some small rooms in the Spanish church (St. Mary the Crowned), the Jews had a wretched ward of 6 to 8 beds and the leases of some houses were assigned to the support of the British poor. The lack of proper medical facilities meant that during the 1804 Yellow Fever epidemic around 5,000 civilians succumbed to the disease compared to 894 soldiers. Only 28 out of a then civilian population of 14,000 escaped the infection.13
In 1804 a committee for the public health was set up with subscriptions of leading citizens including Aaron Cardozo, of the Jewish community, many of the leading Catholic and Protestant merchants as well as the Moroccan consul Hammet Beggia and the Methodist Society. Lt. Governor Sir Thomas Tigge also contributed generously but the biggest donor was the Milanese born architect and builder, Guiseppe Maria Boschetti. The money raised was used to erect a temporary Isolation Hospital to the north of Landport Gates on the site of the present Laguna Estate.14
In 1815 the newly arrived governor, George Don, reconstructed the old Blue Barracks into a Civil Hospital. Don had intended the construction of the building would be borne by civilian contributions but this proved insufficient and most of it was financed by the Crown. To raise the required funds Don imposed special taxes on ships anchoring in the bay as well as on bread and all flour imported. Court fines were also used for this purpose as well as legacies such as John Gavino's in 1820 which was devoted to the Catholic section of the hospital. A fee of 2/2d daily (half a Spanish 'hard' dollar) what's to be paid by those patients who could afford it. Further savings were made when Boschetti agreed to manage the construction of the works without charge.15
In March 1815, an officer, a sergeant, and thirty men began construction of the new building with Boschetti supplying Joseph lemoise as the civilian Superintendent of Works. The first two wards were opened in August 1815 and the completed hospital was formally opened by Don on the 17th of July 1816. Two identical marble plaques were erected to commemorate the new hospital. It was named the Civil Hospital and comprised of three separate departments, for Catholics, protestants and Jewish patients - each managed by a committee who provided a Deputy Governor to run the administration of the hospital under the direction of governor Don himself. Later governors retained the position of Governor of the Civil Hospital. The Civil Hospital also became known as the Triple Hospital due to the shape and function of each Wing. The Civil Hospital was certainly functional and was described as "useful but not ornamental". In appreciation for his work, the Catholic Community commissioned a portrait of Don which hung in their section of the hospital and is now kept at the Gibraltar Museum.16
In 1818, the hospital established a maternity service to assist with "home deliveries." A maternity Ward would only be opened 100 years later. In 1821 two rooms were allocated for insane patients and in 1823 further improvements were initiated by Boschetti.
In 1828 Gibraltar was struck by a terrible Yellow Fever epidemic. In only 4 months, 5,442 civilians and military patients were affected of which 1,605 died. 585 such patients were treated at the civil Hospital with 185 deaths, just above the average mortality for the whole epidemic but a very creditable effort considering that only the severest cases would have been admitted to hospital. Only 90 beds were available at the time and Don himself footed the £100 drugs bill resulting from the epidemic.
Hugh Frazer, Surgeon and Secretary of the Civil Hospital wrote to sir George Don on the 5th of October 1829:
“... I therefore find it amply sufficient to observe that the building so appropriated [for the Civil Hospital], was formerly a Barrack, called the 'Blue Barrack' that for many years, when under this appellation, it was an old ruinous, confused Mass of Buildings, that under the sanction of His Majesty's Government it was given up in this state in the year 1815 for the purposes of an hospital; upon this tottering Mass, have the present splendid, airy and comfortable Apartments arisen.
... it may be likewise well to observe that very little of the old Building now remains, the repairs having been of so extensive a nature as to render in reality, a recent erection. There are 93 Bedsteads always ready for the reception of Patients, and that is about as many as the Building can well contain, that is of acute cases of disease - during the Epidemic of 1828, this number was proved rather too great, but merely because each Case was a serious one."
No modification was carried out to the Civil Hospital over the next 50 years but the 1875 Report on the Civil Hospital recommended extensive reconstruction work and the enlargement of the hospitals capacity from 90 to 120 beds. A third floor was suggested for the Protestant Block, and also for the Administration Block, to home an infectious diseases ward.
Captain Samuel Buckle, the Colonial Engineer, produced a plan for the new hospital and Albert Imossi was the Contractor of Works.17 On the 28th of June 1880 (Anniversary of Queen Victoria's coronation) the Governor, Lord Napier of Magdala, laid the foundation stone for a new South Wing. On the 31st of December 1882, Lord Napier opened the two new wards named Don and Napier Wards - intended for male medical and surgical patients respectively. Also unveiled was the new emblem for the new Hospital which consisted of a Castle and Key to which was added the Serpent of Aesculapius with the words CALPE above the castle. This plaque was removed when the new renovations started in 2014 and is currently at the Heritage Trust.