characterized the situation in Germany. In the south, the closeness of
Montpelier made the example of the hospital of the Holy Ghost of that
city especially forceful. In other portions of France it is well known
that the Sisters of the Holy Ghost very early established separate
hospitals from those founded by the Brothers of the Holy Ghost. There
are records of such separate hospitals entirely under the control of
Sisters in Bar-Sur-Aube, in Neuf-Chateau, and, according to Virchow,
at many other places. At the same time, however, there still continued
to be hospitals of the Holy Ghost as at Besancon, where the Brothers
and Sisters of the Holy Ghost had their institutions in common, though
there was a distinct separation of the communities and allotment of
tasks. The Brothers cared rather for the surgical cases, while the
care of the children and the pregnant women was confided to the
Sisters. This of itself was rather an advantage, since the separation
of the women and the children from the ordinary hospital patients,
must have proved an important preventive of infection and an
ameliorating factor as regards that hospital atmosphere especially
likely to be unfavorable to these delicate, sensitive cases. We know
now what hospitalism means for them.
That the influence of the movement initiated by Innocent III. was felt
even in distant England is very clear, from the fact that practically
all of the famous old {255} British hospitals date their existence as
institutions for the care of the ailing from the thirteenth century.
The famous St. Bartholomew's Hospital in London had been a priory
founded at the beginning of the twelfth century, which took care of
the poor and the destitute sick, but at the beginning of the
thirteenth century it became, in imitation of the Hospital of the Holy
Spirit at Rome, frankly a hospital in the modern sense of the word.
St. Thomas's Hospital, which continues to be down to the present time
one of the great medical institutions of London, was founded by
Richard, Prior of Bermondsey, in 1213. Bethlehem, or as the name was
softened in the English speech of the people, Bedlam, was founded
about the middle of the thirteenth century. Originally it was a
general hospital for the care of the sick of all kinds, though in
later times it became, as its name has come to signify in modern
English, a place exclusively for the care of the insane. Bedlam, in
the fourteenth century, and probably also in the later years of the
thirteenth, made provision for a certain number of the insane in
addition to other patients, so that it presented the accomplishment of
that desideratum for which we are striving in the twentieth century--a
city general hospital with psychopathic wards. This arrangement, as we
have said in the chapter on the Church and the Mentally Afflicted, has
many advantages over the special hospital for the insane, entrance to
which, as a rule, requires tedious formalities.
Bridewell and Christ's Hospital, the other two of the institutions
long known as the five royal hospitals of London, were either actually
founded or received a great stimulus and a thorough reorganization
during the thirteenth century. In the succeeding centuries Bridewell
{256} ceased to be a hospital and became a prison, while Christ's
Hospital, though retaining its name, became a school. With some of
these institutions the name of Edward VI. has become associated, but,
as pointed out by Gairdner, the English historical writer, without any
due warrant. Gairdner says in his History of the English Church in the
Sixteenth Century, "Edward has left a name in connection with
charities and education which critical scholars find to be little
justified by fact." The supposed foundation of St. Thomas's Hospital,
as he points out, was only the re-establishment of this institution,
"and even when it was granted by Edward to the citizens of London, it
was not without their paying for it." Many institutions, charitable
and educational, had been destroyed by Henry VIII., and the crying
need for them became so great under Edward's reign that the government
was compelled to provide for their re-establishment.
It is no wonder, with all this activity of the hospital foundation
movement, that Virchow should have been unstinted in his praise of the
Pontiff and of the Church responsible for the great charity. He said:
"It may be recognized and admitted that it was reserved for the Roman
Catholic Church, and above all for Innocent III., not only to open the
bourse of Christian charity and mercy in all its fulness, but also to
guide the life-giving stream into every branch of human life in an
ordered manner. For this reason alone the interest in this man and in
this time will never die out."
Even this was not all that he felt bound to say, and in his admiration
he quite forgot the constant opposition he manifested toward the
Papacy on all other occasions. This happened to be the one feature of
Papal influence {257} and endeavor that he had investigated most
thoroughly, and one is tempted to wonder if like investigation in
other directions would not have shown him the error of prejudiced
views he harbored with regard to other phases of the beneficent
influence of the Popes in history. More knowledge is all that is
needed, as a rule, to overcome all the anti-Papal prejudices founded
on supposed historical grounds.
Indeed, Virchow's tribute to Pope Innocent III. as the initiator of
all this humanitarian work is so frank and outspoken that, coming as
it does from a man whose sympathies with the Papacy were well known to
be the slightest, it deserves to be recalled in its completeness, in
order that another factor for the vindication of Innocent's character
may be better known. The great pathologist said: "The beginning of the
history of all of these German hospitals is connected with the name of
that Pope who made the boldest and farthest-reaching attempt to gather
the sum of human interests into the organization of the Catholic
Church. The hospitals of the Holy Ghost were one of the many means by
which Innocent III. thought to hold humanity to the Holy See. And
surely it was one of the most effective. Was it not calculated to
create the most profound impression to see how the mighty Pope, who
humbled emperors and deposed kings, who was the unrelenting adversary
of the Albigenses, turned his eyes sympathetically upon the poor and
sick, sought the helpless and the neglected upon the streets, and
saved the illegitimate children from death in the waters! There is
something at once conciliating and fascinating in the fact, that at
the very time when the fourth crusade was inaugurated through his
influence, the thought of founding a great {258} organization of an
essentially humane character, which was eventually to extend
throughout all Christendom, was also taking form in his soul; and that
in the same year (1204) in which the new Latin Empire was founded in
Constantinople, the newly erected hospital of the Holy Spirit, by the
old bridge on the other side of the Tiber, was blessed and dedicated
as the future centre of this organization." [Footnote 31]
[Footnote 31: Virchow's article on the German hospitals is to be found
in the second volume of his collection of essays on Public Medicine
and the History of Epidemics, which is, unfortunately, not translated
into English, so far as I know, but will have to be consulted in the
original Gesammelte Abhandlungen aus dem Gebiete der Oeffentlichen
Medicin und der Seuchenlehre von Rudolf Virchow, Berlin, 1879. August
Hirschwald.]
The quotation from Virchow gives a good and quite comprehensive idea
of the scope of these institutions. The ailing of all kinds were
received beneath their hospitable roof. In many cases the regulations
for the reception of pregnant women and for the care of the foundlings
are still extant, besides the hospital rules for the care of the
various kinds of patients. The department set aside for the foundlings
was in most places rather an allied institution than an integral part
of the hospital itself. While these were called findel or foundling
houses in Germany, in Italy this harsh name was not used, but the
institutions were termed hospitals for the innocents, thus emphasizing
the most pitiable feature of the cases of the little patients, and not
branding them for life with a name that suggested their having been
abandoned by those who should have cared for them.
The regulations for the admission and care of patients are interesting
as showing how much these medieval institutions tried to fulfill the
ideal of hospital work. The people of the Middle Ages had not as yet
suffered all {259} the disillusionments that come from the abuse of
charity at the hands of those who least deserve help, and besides, the
attendants at the hospitals were expected to do their work for its own
sake and from the highest motives of Christian benevolence rather than
for any lesser reward. At the beginning, at least, there seems to be
no doubt that this lofty purpose was accomplished very satisfactorily;
but men and women are only human, and after a time there was
deterioration. Even Virchow, however, was so struck by the ideal
conditions that existed in these early hospitals that he discussed the
necessity for having in modern times hospital attendants with as
unselfish motives as those of the medieval period. It seems worth
while then to give some of the details of this supremely Christian
management of hospital work.
In an article on the medieval hospitals in the Dublin Review for
October, 1903, Elizabeth Speakman quotes from the statutes of various
hospitals sufficient to show how the internal government of these
charitable institutions was regulated. There was always a porter at
the main door, usually one of the Brothers or Sisters, who had the
power to receive patients applying for admission. At certain places,
however, it seems to have been necessary to inform the superior; and
the statutes of the French Hospital at Angers say, that the prioress
is to go herself without delay to receive patients or to send one of
the Sisters for that purpose, "not severe or hard, but kind of
countenance." At the same place the statutes say, "the number of the
sick is not to be defined, for the house is theirs, and so all
indifferently shall be received as far as the resources of the house
allow."
From many of the hospitals members of the community were sent out from
day to day to find out if there {260} were any lying sick who needed
care and who should be sent to the hospital. They were expected also
to pick up any of the infirm whom they might find along the streets
and bring them to the hospital. The attitude which the religious
attendants at the hospitals were to assume toward the patients upon
whom they wait is clearly stated. In nearly all of the French
hospitals of the thirteenth century, at least, the statutes in this
matter do not differ much from this specimen:
"When the patient arrives he shall be received thus: First, having
confessed his sins to the priest, he shall be communicated religiously
and afterward be carried to bed and treated there as our Lord,
according to the resources of the house; each day, before the repast
of the brethren, he shall be given food with charity, and each Sunday
the epistle and gospel shall be read and aspersion with holy water
made with procession."
As is noted by Miss Speakman, all through the hospital statutes of
these times the name of Masters or Lords is applied to the patients.
The expression in Old French is Les Seignors Malades. The ordinary
name for hospital was Maison Dieu, which has been well translated
"God's Hostelry." It is evident, then, though the origin of the phrase
"Our Lords the Poor," as applied to hospital patients, has been said
to be obscure, that it is only a re-echo of the scriptural expression,
"Whatsoever ye shall do, even to the least of these, behold ye do it
unto Me." A quotation which was emphasized in the old rule of St.
Benedict, promulgated for the treatment of those received into the
hospitality of the Benedictine monasteries, "All guests shall be
received as Christ, who Himself has said, 'I was a stranger and ye
took Me in.'"
{261}
In modern times, the necessity for providing for patients whatever
within reason they may long for has often been insisted on. It is
curiously interesting to find a striking anticipation of this very
modern rule in the customs of these old-time hospitals. As a result of
the attitude of supreme good will toward patients, there is an
injunction in many hospital statutes, that whatever the patient may
desire, if it can be obtained and is not bad for him, shall be given
to him until he is restored to health. The Knights Hospitalers of St.
John of Jerusalem followed the injunction so carefully and endeavored
to satisfy even whims of their patients that might seem unreasonable
to such an extent, that their conduct in the matter became proverbial
and gave rise to at least one pretty legend, the hero of which is no
less a personage than the famous Eastern Sultan of the later Crusade
period.
"Saladin desiring to prove for himself this reputed indulgence of
the knights to their patients, disguised himself as a pilgrim and
was received among the sick in the hospital in Jerusalem. He refused
all food, declaring that there was only one thing that he fancied,
and that he knew they would not give him. On being pressed, he
confessed that it was one of the feet of the horse of the Grand
Master. The latter, on being acquainted with this fact, ordered that
the noble animal should be killed and the sick stranger's desire
satisfied. Saladin at this point, thinking the experiment had gone
far enough, declared himself taken with a repugnance to it, so the
animal was spared."
Virchow studied very faithfully the management of these medieval
hospitals, and was evidently quite impressed with the success with
which difficulties had been {262} met and overcome. None knew better
than he all the difficulties there were in hospital management, for
during nearly fifty years he had been identified with many hospitals,
from city charity institutions to the various kinds needed for war and
those erected in connection with universities for teaching purposes.
He had very little patience with religious formulas, and was indeed a
typical agnostic. Notwithstanding this, he has been perfectly frank in
confessing how much is accomplished by the religious management of the
hospitals, and even did not hesitate to declare that if hospitals for
the poor particularly, are to be successfully managed, there must be a
change in the view-point of those who take up the work of hospital
nursing, and the attendants must come from better social classes than
is at present the custom. (This is of course for Germany.)
The question as to whether secular or religious management of
hospitals shall prevail has not been as yet absolutely decided, and
this adds to the value of Virchow's opinion. No one knew better than
he of the many sacrifices required if the patients are to be properly
cared for. Himself, as I have said, utterly without religion, it is
curious to see how he recognizes the benefit that religious motives
confer upon the management of a hospital, and how much better the work
is likely to be done by those who give themselves up to the care of
the sick as a Christian duty. He says:
"The general hospital is the real purpose of our time, and anyone
who takes up service in it must give himself up to it from the
purest of humanitarian motives. The hospital attendant must, at
least morally and spiritually, see in the patient only the helpless
and suffering man, his brother and his neighbor; and in order to be
able to {263} do this he must have a warm heart, an earnest
devotion, and a true sense of duty. There is in reality scarcely any
human occupation that brings so immediately with it its own reward,
or in which the feeling of personal contentment comes from thorough
accomplishment of purpose.
"But so far as the accomplishment of the task set one is concerned,
the attendant in the hospital has ever and anon new demands made
upon him and a new task imposed. One patient lies next the other,
and when one departs another comes in his place.
"From day to day, from week to week, from year to year, always the
same work, over and over again, only forever for new patients. This
tires out the hospital attendant. Then the custom of seeing
suffering weakens the enthusiasm and lessens the sense of duty.
There is need of a special stimulus in order to reawaken the old
sympathy. Whence shall this be obtained--from religion or from some
temporal reward? In trying to solve this problem we are standing
before the most difficult problem of modern hospital management.
Before us lie the paths of religious and simple care for the sick.
We may say at once that the proper solution has not yet been found.
"It may be easy, from an impartial but one-sided view of the
subject, to say that the feeling of duty, of devotion, even of
sacrifice, is by no means necessarily dependent on the hope of
religious reward, nor the expectation of material remuneration. Such
a point of view, however, I may say at once, such a freedom of good
will, such a warmth of sympathy from purely human motives as would
be expected in these conditions, are only to be found in very
unaccustomed goodness of {264} disposition, or an extent of ethical
education such as cannot be found in most of those who give
themselves at the present time to the services of the sick in the
hospitals. If pure humanity is to be a motive, then other circles of
society must be induced to take part in the care of the sick. Our
training schools for nurses must teach very differently to what they
do at present, if the care of the sick in municipal hospitals shall
compare favorably with that given them in religious institutions.
Our hospitals must become transformed into true humanitarian
institutions."
While some of this striking opinion of Virchow's was derived from
personal experience with hospitals managed by religious, it must not
be forgotten that such hospitals are rarer in Germany, at least in the
north, than almost anywhere else in the world. His opportunities then
were limited, and undoubtedly much of his favorable persuasions in
this regard was founded on his investigation of conditions as he had
learned to know them in the old-time hospitals of the later Middle
Ages. The traditions as to the treatment of patients in these early
times are such as to make us believe that hospital attendants did take
their work seriously from a very lofty motive, and that while medicine
and surgery were much less effective than in more modern times, the
tender care of patients did as much as was possible to make inevitable
suffering more bearable, and to keep the sight of painfully
approaching death from being a source of discouragement and even of
despair.
We have the best evidence, that of a contemporary, as to the
conditions which obtained in these medieval hospitals, and the
dispositions of the attendants as regards their religious duties would
seem to be an unmistakable {265} index as to their willingness to
sacrifice their own comfort for the sake of the patients. The well
known Jacques de Vitry, who had been Bishop of Acre and afterwards
Cardinal, and whose wide travel had given him many opportunities to
judge for himself, said:
"There are innumerable congregations, both of men and women,
renouncing the world and living regularly in leper houses and
hospitals of the poor, humbly and devoutly ministering to the poor
and the infirm. They live according to the rule of St. Augustine,
without property and in community and under obedience to one above
them; and having assumed the regular habit, they promise to God
perpetual continence. The men and women, with all reverence and
chastity, eat and sleep apart. The canonical hours, as far as
hospitality and the care of the poor of Christ allow, by day and
night they attend. In houses where there is a large congregation of
brethren and sisters, they congregate frequently in chapter for the
correction of faults and other causes. Readings from Holy Scriptures
are frequently made during meals, and silence is maintained during
meals in the refectory and other fixed places and at certain times.
.... Their chaplains, ministering in spiritual matters with all
humility and devotion to the infirm, instruct the ignorant in the
word of divine preaching, console the faint-hearted and weak, and
exhort them to patience and to correspond to the action of grace.
They celebrate divine office in the common chapel assiduously by day
and night, so that the sick can hear from their beds. Confession and
extreme unction and the other sacraments they administer diligently
and solicitously to the sick, and to the dead they give due burial.
These ministers of Christ, sober and sparing to themselves and {266}
very strict and severe to their bodies, overflowing with charity to
the poor and infirm and ministering with tender heart to their
necessities according to their powers, are all the more lowly in the
House of God as they were of high rank in the world. They bear for
Christ's sake such unclean and almost intolerable things, that I do
not think any other can be compared to this martyrdom, holy and
precious in the sight of God."
It might perhaps be thought that these hospitals of the Middle Ages
would be of very little interest to the modern student of things
social and medical except for the fact, surprising enough in itself at
this time of supposed neglect of social duties, when the paternal
spirit of the municipality is presumed scarcely to have developed as
yet, that such institutions were provided. It would ordinarily be
assumed that they were, in accordance with the lack of knowledge of
the time as regards the influence of light and air on the ailing,
dingy and unventilated, lacking most of the qualities that distinguish
our modern hospital. As a matter of fact, however, just as our
architects go back to the Middle Ages to get models for our churches
and municipal buildings, and even our millionaires' palaces and public
institutions, they also find that in the matter of hospitals much
valuable guidance is to be obtained from what was accomplished by
these people of the Middle Ages, of whom we ordinarily think so
little. Mr. Arthur Dillon, an architect, writing in the "Mail and
Express" for May 7th, 1904, described the hospital founded by
Marguerite of Bourgogne, the sister of St. Louis, at Tanierre in
France in 1293. It consisted of a ward, a building attached to it by a
covered passage in which Marguerite herself lived for many years, and
_separate buildings_ for {267} kitchens, for storage of provisions and
for the lodging of the twenty monks and nuns who had charge of the
sick. A feature that perhaps we would not admire very much, was that
adjacent to the buildings there was a cemetery. They were not so
fearful about death in the Middle Ages, however, as we are apt to be;
and who shall say that the contemplation of it did not often give that
restful sense of submission to whatever would come, that sometimes
means so much in serious illness, and keeps the patient from still
further exhausting vitality by worrying as to the outcome? The
medicine was stronger than our degenerate generation might be able to
bear, but then all their medicines were apt to be stronger in that
time.