princess had gardens about her lodging, and the whole property was
surrounded by a high wall, along which flowed the branches of a small
stream, which doubtless tempered the atmosphere and served as a
carrier off of much undesirable material. The hospital ward itself was
55 feet wide and 270 feet long and had a high arched ceiling of wood.
It was lighted by large pointed windows high up in the walls. At the
level of the window-sills, some twelve feet from the floor, a narrow
gallery ran along the wall, from which the ventilation through the
windows might be readily regulated and on which convalescent patients
might walk or be seated in the sunshine. The beds were placed each in
a little room formed by low partitions. Privacy was thus secured much
better than in the modern hospital wards, and as there were only forty
beds, the ventilation was abundant.
Mr. Dillon, from the standpoint of the architect, says
of it:
{268}
"It was an admirable hospital in every way, and it is doubtful if we
to-day surpass it. It was isolated, the ward was separated from the
other buildings, it had the advantage we so often lose of being but
one story high, and more space was given to each patient than we can
now afford.
"The ventilation by the great windows and ventilators in the ceiling
was excellent; is was cheerfully lighted, and the arrangement of the
gallery shielded the patients from dazzling light and from draughts
from the windows and afforded an easy means of supervision, while
the division by the roofless, low partitions isolated the sick and
obviated the depression that comes from the sight of others in pain.
"It was, moreover, in great contrast to the cheerless white wards of
to-day. The vaulted ceiling was very beautiful; the woodwork was
richly carved, and the great windows over the altars were filled
with colored glass. Altogether, it was one of the best examples of
the best period of Gothic architecture."
Probably the most interesting feature of the early history of the
hospital movement is the spirit of evolution to meet growing needs and
developing ideals which it manifested. In spite of the judicious
consideration devoted to the establishment of the original hospital of
the Holy Ghost at Rome, it was not long before it proved inadequate
for its purpose. One of the eminently noteworthy things that
constantly repeat themselves in history is that where a social need is
discovered and a remedy found for it, it is not long before the need
increases to such a degree as to outstrip the original remedy. Before
half a century had passed Innocent's successors declared in
unmistakable terms that the original hospital was entirely too cramped
and crowded.
[Illustration: Hospital Ward of Tonnerre, France (_Viollet-le-Duc,
Dictionnaire de l' Architecture Francaise, XI au XVI Siecle_). This
was built by the sister of Louis IX of France, Marguerite of
Bourgogne, who retired to it herself to spend her life caring for the
ailing poor.]
{269}
Accordingly, a much larger and handsomer building was erected.
Visitors to Rome admired the new building, and it proved an incentive
for larger plans for hospitals in other important cities. At the end
of the thirteenth and the beginning of the fourteenth centuries some
really imposing edifices were erected as hospitals, especially in
towns of Italy. It was at this time that the artistic Italian mind
seems to have realized the truth, which has only come to be recognized
again in quite recent times, that a hospital building should be as
fine a structure as the finances of a city will permit. It was felt
that nothing was too good for the ailing citizens and that the city
honored itself by making its public buildings a monument of artistic
purpose. The earliest example of how well this was accomplished is to
be found at Siena, whose hospital continues to be down to the present
time one of the most interesting objects of admiration for the
visitor. Portions of this Siena hospital as it now exists were built
as early as the last decade of the thirteenth and the first decade of
the fourteenth century. It was during the first half of the fourteenth
century that it was resolved to make the building as beautiful in the
interior by means of great artistic decoration and frescoes as it was
imposing on the exterior. It was not for a century and a half later
that Milan's magnificent hospital took on its modern shape, though the
city had been always famous for its care of the sick. The hospital
movement of the thirteenth century, however, culminated in monuments
as famous and as architecturally beautiful as any that have been built
in recent years.
To take, for example, that of Siena, a good {270} description of which
may be found in The Story of Siena, by G. Gardner. (Dent, London,
1902.) The buildings occupy the whole side of the Piazzo del Duomo,
directly opposite the facade. They constitute almost as striking a bit
of architecture as any edifice of the period, and contain a
magnificent set of frescoes, some of them of the fourteenth century,
many others of later centuries. The Siena school of painting in the
fourteenth century was doing some of the best art work of the time,
and as a consequence the hospital has been of perennial interest.
Artists and amateurs and dilettante visitors have gladly spent time in
studying and admiring its artistic treasures at nearly all times, but
more especially in recent years. The sympathetic admiration for its
art has led to a better appreciation of the motives of the generation
that built it, than even the sublime humanitarian purpose which
dictated it or the work for suffering humanity which it accomplished.
It is typical of the times in many ways. We have only just begun again
in very modern times, as we have already said, to consider that some
of the best of our buildings in any large city should be those
intended for the sick and the poor of the community. The city must
respond nobly to its civic duties. The idea, however, came so
naturally to the medieval mind that apparently there was no question
about it. Only in very recent years has come the additional thought
that these buildings must be appropriately decorated, and that the
work of the greatest artists of the time can have no better place for
its display than the walls of a hospital or a great charitable
institution. Bartolo's frescoes, on the walls of the hospital at
Siena, tell the story of the work that was done for foundlings and
pilgrims as well as for {271} the sick in the early days of its
establishment. The first picture of the series represents the baptism
of the children that had been picked up and brought to the hospital.
It is characteristic of the times, too, that one of the greatest
pictures on the hospital walls is not something that makes for the
glory of the trustees or the founders, nor that is some fancy of the
painter, some study of myth or landscape, in which he might have been
especially interested. Probably the masterpiece of the old painters is
the Scala del Paradiso (the stairs to heaven), by Vecchietta. The
picture was evidently painted for the department of the foundlings,
and its subject is the ascent of these little children to heaven and
their welcome by the angels and saints and by the Heavenly Father. A
more inspiring vision to be impressed upon the minds of these growing
children who had been abandoned by their own, and who must have felt
all of their loneliness in spite of their favorable surroundings,
could scarcely have been imagined.
The dedication of the hospital is expressed in terms very typical of
the Middle Ages, or as they might better be called, "The Ages of
Faith." It reminds one of the formal terms of wills, as they used to
be worded in olden times: "In the Name of God, Amen. To the honor,
praise and reverence of God and of His Mother, Madonna, Holy Mary
Virgin, and of all the saints of God, and to the honor and exaltation
of Holy Mother Church and of the Commune and of the people of the city
of Siena, and to its good and pacific state, and to the increase of
the Hospital of Madonna, Holy Mary Virgin, of Siena, which is placed
in front of the chief church of the city, and to the recreation of the
sick and {272} the foundlings of the said hospital." This dedication
is to be found at the beginning of the statutes of the hospital as
they were formulated in 1305.
The hospital did excellent service, and most of the original building
has remained down to our own day. It has seen many times of trial for
the citizens of Siena, and has proved its usefulness. Twice during the
fourteenth century it saw the coming of the Black Death, and its wards
and corridors and every room were filled with the dead and the dying.
During the fourteenth century St. Catherine of Siena spent much of her
time in the hospital, and it was her work here that gave her the
glorious prestige that came so unlooked for. The special confraternity
with which she was associated met in one of the smaller rooms of the
hospital. Attached to the hospital there was a special house for
lepers, and this was one of the favorite places for St. Catherine's
visitations. It is not surprising to find that she was, at the
beginning at least, very much opposed by her family in her choice of
such an occupation as this personal devotion to the poor and the sick.
In reading the story, one is reminded of the opposition that is
sometimes evoked at the present time when young women feel the
necessity for some occupation other than so-called social duties, and
take to slum visiting, or the care of the cancer poor, or some other
form of practical aid for the needy, apart from the giving of money,
or of doing a little sewing in a Lenten class, supposed to be the
limit of their charitable work in their special social circle.
[Illustration: HOSPITAL, MEXICO (FOUNDED BEFORE 1524) This hospital
was founded by Cortez prior to 1524 "in recognition of the graces and
mercies that God had bestowed upon him by the discovery and conquest
of New Spain and as an exoneration or satisfaction for any forgotten
fault or load which might weigh on his conscience and for which he
could not make special or particular atonement." After his death the
endowment was administered by a superintendent and has continued to be
under private management. It now belongs to the Dukes of Terranova y
Montaleone, Cortez' Italian descendants, who nominate and maintain an
agent to supervise the hospital (_A History of Nursing, Nutting and
Dock_).]
It is of curious interest, though not surprising, to find that in the
midst of the organization of new hospitals and reorganization of old
hospital foundations in the thirteenth century, attempts were made to
correct {273} abuses which still continue to be some of the thorny
problems of hospital management. For instance, the danger was
recognized of having the expenses of administration outrun those of
the hospital proper, and of having the number of attendants, or at
least of persons living upon the hospital revenues, greater than was
absolutely needed for the care of patients. There are various Papal
decrees and decisions of diocesan synods in this matter. Pope Honorius
III., who occupied the Papal See from 1216 to 1227, and must be
considered as a very worthy successor of the first great Pope of the
century, Innocent III., in approving the union of two hospital
foundations at Ghent, required that only a certain limited number of
Brothers and Sisters for nursing purposes should be received, in order
that the community expenses proper might not impair to too great a
degree the resources of the hospital for its real purpose of taking
care of patients. Previously, he had insisted by a decree that the
number of Brothers and Sisters in the hospital community at Louvain
should not exceed the proportion of more than one to nine of the
patients. Synodal decrees in various bishoprics allowed only board and
clothing, but nothing more, to attendants in hospitals. In the
thirteenth century the personal satisfaction of accomplishing a
charitable work in attendance upon the sick was expected to make up
for any further remuneration.
The other serious problem of hospital management was to keep those not
really suffering from serious disease, malingerers of various kinds,
from occupying beds and claiming attention, to the deprivation of
those who were genuinely ill. Various regulations were made looking to
the careful examinations of such persons, {274} though in most places
with the affirmation of a standing rule, that all those complaining of
illness were to be received into the hospital for at least one day,
until their cases could be examined with sufficient care to decide how
much of reality and how much of simulation there might be in their
pretended symptoms. The tramp, of course, has always been in the
world, and probably always will be, and so what are called the sturdy
vagrants (validi vagrantes) received the special attention of those
wishing to eliminate hospital abuses, and various decrees were made in
order to prevent them from receiving sustenance from the hospitals, or
in any other way abusing the privileges of these charitable
institutions.
A hospital movement, quite distinct from that of Innocent III., which
attracted so much attention shortly after the general hospital became
common as to deserve particular consideration, was the erection of the
leproseries or special institutions for the care of lepers. Leprosy
had become quite common in Europe during the Middle Ages, and the
continued contact of the West with the East during the crusades had
brought about a notable increase of the disease. It is not definitely
known how much of what was called leprosy at that time, really
belonged to the specific disease now known as lepra. There is no doubt
that many affections, which have since come to be considered as quite
harmless and non-contagious, were included under the designation
leprosy by the populace and even physicians incapable as yet of making
a proper differential diagnosis. Probably severe cases of eczema and
other chronic skin diseases, especially when complicated by the
results of wrongly directed treatment or of lack of cleansing, were
not infrequently pronounced to be true leprosy.
{275}
There is no doubt at all, however, of the occurrence of real leprosy
in many of the towns of the West from the twelfth to the fifteenth
centuries, and the erection of these hospitals proved the best
possible prophylactic against the further spread of the disease.
Leprosy is contagious, but only mildly so. Years of intimate
association with a leper may, and usually do, bring about the
communication of the disease to those around them, especially if they
do not exercise rather carefully, certain precise precautions as to
cleanliness after personal contact or after the handling of things
which have previously been in the leper's possession. As the result of
the existence of these houses of segregation, leprosy disappeared
during the course of the next three centuries, and thus a great
hygienic triumph was obtained by sanitary regulation.
This successful sanitary and hygienic work, which brought about
practically the complete obliteration of leprosy in the Middle Ages,
furnished the first example of the possibility of eradicating a
disease that has once become a serious scourge to mankind. That this
should have been accomplished by a movement that had its greatest
source in the thirteenth century is all the more surprising, since we
are usually accustomed to think of the people of the times as sadly
lacking in any interest in sanitary matters. The role of the Popes in
the matter is another striking feature well worthy of note. The
significance of the success of this segregation method was lost upon
men down almost to our own time. This was unfortunately because it was
considered that most of the epidemic diseases were conveyed by the
air. They were thought infectious and due to a climatic condition
rather than contagious, that is, conveyed by actual {276} contact with
the person having the disease or something that had touched him, which
is the view now held. With the beginning of the crusade against
tuberculosis in the later nineteenth century, however, the most
encouraging factor for those engaged in it was the history of the
success of segregation methods and careful prevention of the spread of
the disease, which had been pursued against leprosy. In a word, the
lessons in sanitation and prophylaxis of the thirteenth century are
only now bearing fruit because the intervening centuries did not have
sufficient knowledge to realize their import and take advantage of
them.
Pope Innocent III. was not the only occupant of the Papal throne whose
name deserves to be remembered with benedictions in connection with
the hospital movement of the thirteenth century. His successor took up
the work of encouragement where Innocent had left it at his death, and
did much to bring about the successful accomplishment of his
intentions in the ever wider spheres. Honorius III. is distinguished
by having made into an order the Antonine Congregation of Vienna,
which was especially devoted to the care of patients suffering from
the "holy fire" and from various mutilations. The disease known as the
holy fire seems to have been what is called in modern times
erysipelas. During the Middle Ages it received various titles, such as
St. Anthony's fire, St. Francis's fire, and the like, the latter part
of the designation evidently being due to the striking redness which
characterizes the disease, and which can be compared to nothing better
than the intense erythema consequent upon a rather severe burn. This
affection was much more common in the Middle Ages than in later times,
though it must not be forgotten that its {277} disappearance has come
mainly in the last twenty-five years. It is now known to be a
contagious disease, and indeed, as Oliver Wendell Holmes pointed out
over half a century ago, may readily be carried from place to place by
the physician in attendance. It does not always manifest itself as
erysipelas when thus carried, however, and the merit of Dr. Holmes's
work was in pointing out the fact that physicians who attended
patients suffering from erysipelas and then waited on obstetrical
cases, were especially likely to carry the affection, which manifested
itself as puerperal fever. A number of cases of this kind were
reported and discussed by him, and there is no doubt that his warning
served to save many precious lives.
Of course nothing of this was known in the thirteenth century; yet the
encouragement given to this religious order which devoted itself
practically exclusively to the care in special hospitals of
erysipelas, must have had no little effect in bringing about a
limitation of the spread of the disease. In such hospitals patients
were not likely to come in contact with many persons, and consequently
the contagion-radius of the disease was limited. In our own time,
immediate segregation of cases when discovered has practically
eradicated it, so that many a young physician, even though ten years
in practice, has never seen a case of it. It was so common during the
Civil War and for half a century before that here in America, that
there were frequent epidemics of it in hospitals, and it was generally
recognized that the disease was so contagious, that when it once
gained a foothold in a hospital ward nearly every patient suffering
from an open wound was likely to be affected by it.
It is interesting then to learn that these people of the {278} Middle
Ages attempted to control the disease by erecting special hospitals
for it, though unfortunately we are not in a position to know just how
much was accomplished by these means. A congregation devoted to the
special care of the disease had been organized, as we have said, early
in the thirteenth century. At the end of this century this was given
the full weight of his amplest approval by Pope Boniface VIII., who
conferred on it the privilege of having priests among its members It
will be remembered that Pope Boniface VIII. is said to have issued the
bull which forbade the practice of dissection. That bull only
regulated, as I have shown, the abuse which had sprung up of
dismembering bodies and boiling them in order to be able to carry them
to a distance for burial, which was in itself an excellent hygienic
measure. His encouragement of the special religious order for the care
of erysipelas must be set down to his credit as another sanitary
benefit conferred on his generation.
Many orders for the care of special needs of humanity were established
during the thirteenth century. It is from this period that most of the
religious habits worn by women originate. They used to be considered
rather cumbersome for such a serious work as the nursing and care of
the sick, but in recent years quite a different view has been taken.
The covering of the head, for instance, and the shearing of the hair
must have been of distinct value in preventing the communication of
contagious diseases. There has been a curious assimilation in the last
few years of the dress required to be worn by nurses in operating
rooms to that worn by most of the religious communities. The head must
be completely covered and the garments worn are of material that can
be washed. {279} It will be recalled that the head-dress of religious
being, as a rule, of white, on which the slightest speck shows, must
be renewed frequently, and therefore must be kept in a condition of
what is practically surgical cleanliness. While this was not at all
the intention of those who adopted the particular style of head-dress
worn by religious, yet their choice has proved, in what may well be
considered a Providential way, an excellent protective for the
patients on whom they waited, against certain dangers that would
inevitably have been present, if their dress had been the ordinary one
of the women of their class, during these many centuries of hospital
nursing by religious women.
In a word, then, all the features which characterize our modern
hospitals, found a place in the old-time institutions for the care of
the ailing, which we owe to the initiative of the Church and religious
orders, and above all, the Popes. While we are accustomed to hear
these old-time institutions spoken of slightingly, that is because our
knowledge of them was not as detailed as it should be, until the
recent interest in things medieval revealed many details previously
misunderstood. The hospitals of the thirteenth, fourteenth and
fifteenth centuries were much better than those of subsequent
centuries down practically to our own time. The reason for this
decadence is rather complex, but it evidently occurred in spite of the
Church and the Popes. Much of it was due to the fact that,
particularly in the sixteenth and seventeenth centuries, the political
governments interfered in the work of charity and hospital management,
and always to the detriment of it. The greatest triumph of the Church
during the earlier centuries is to be found in the magnificent
organization of the {280} hospital system and the anticipation of so
many things in the organization of hospital work, the care of patients
and even the prevention of contagious disease, that we are apt to
think of as essentially modern.
{281}
THE CHURCH AND THE EXPERIMENTAL METHOD.
There is a very generally accepted false impression with regard to the
attitude maintained by the Church during the Middle Ages, especially
toward what is known as the experimental method in the gaining of
knowledge, or as we would now say, in the study of science. It is
commonly supposed that at least before the sixteenth century, though
of course in modern times it has had to change its attitude to accord
with the advances of modern science, the Church was decidedly opposed
to the experimental method, and that the great ecclesiastical scholars
of the wonderful period of the rise of the universities were all
absolute in their confidence in authority and their dependence on the
deductive method as the only means of arriving at truth. This
widespread false impression owes its existence and persistence to many
causes.