XXI. CITY HOSPITALS. ORGANIZED CHARITY.

While the Thirteenth Century was engaged in solving the problems of the higher education and of technical education for the masses, and was occupied so successfully, as we have seen, with the questions of the rights of man and the development of law and of liberty, other and more directly social and humanitarian works were not neglected. There had been hospitals in existence from even before the Christian era, but they had been intended rather for the chronic ailments and as the name implies, for the furnishing of hospitality to strangers and others who had for the time no habitation, than for the care of the acutely ill. In the country places there was a larger Christian charity which led people to care even for the stranger, and there was a sense of human duty that was much more binding than in the modern world. The acutely ill were not infrequently taken into the houses of even those who did not know them, and cared for with a solicitude difficult to understand in this colder time. This was not so much typical of the times, however, as of the social conditions, since we have many stories of such events in our colonial days.

In the cities, however, which began more and more to be a feature of life in the Thirteenth Century, though they counted their inhabitants only by a few thousands where ours count them by hundreds of thousands, the need of some other method of caring for such cases made itself distinctly felt. At the end of the Twelfth and the beginning of the Thirteenth centuries this need became demandingly manifest, and the consequence was a movement that proved to be of great and far-reaching practical benevolence. It is to the first Pope of the Thirteenth Century, Innocent III., that we owe the modern city hospital as we have it at the present time, with its main purpose to care for the acutely ill who may have no one to take care of them properly, as well as for those who have been injured or who have been picked up on the Street and whose friends are not in a position to care for them.

The deliberateness with which Innocent III. set about the establishment of the mother city hospital of the world, is a striking characteristic of the genius of the man and an excellent illustration of the practical character of the century of which he is so thoroughly representative.

Pope Innocent recognized the necessity for the existence of a city hospital in Rome and by inquiry determined that the model hospital for this purpose existed down at Montpelier in connection with the famous medical school of the university there. Montpelier had succeeded to the heritage of the distinguished reputation in medical matters which had been enjoyed by Salernum, not far from Naples, during the Ninth, Tenth, and Eleventh centuries. The shores of the Mediterranean have always been recognized as possessing a climate especially suitable for invalids and with the diminution of the influence of the Salernitan school, a transfer of its prestige to Montpelier, where the close relationship with Spain had given the medical schools the advantage of intimate contact with the medicine of the Arabs, is not a matter of surprise. At Montpelier the hospital arrangements made by Guy de Montpelier were especially efficient. The hospital of which he had charge was under the care of the members of the order of the Holy Spirit.

Pope Innocent summoned Guy, or Guido as he was known after this, to Rome and founded for him the hospital of the Holy Spirit in the Borgo, not far from St. Peter's, where it still exists. This was the mother and model hospital for the world. Visitors to Rome saw it, and could not fail to admire its great humanitarian work. Bishops from all over the world on their official visits to the head of the Church, admired the policy under which the hospital was conducted, recognized the interest of the Pope in it, and went back to their homes to organize institutions of the same kind. How many of these were established in various parts of Europe is hard to determine. Virchow in his History of the Foundations of the German Hospitals, has a list of over one hundred towns in Germany in which hospitals of the Holy Spirit, or medical institutions modeled on this hospital at Rome were founded. Many of these towns were comparatively small. Most of them contained at the time less than five thousand inhabitants, so that it can be said without hesitation, that practically every town of any importance, at least in Germany, came under the influence of this great philanthropic hospital movement.

With regard to other countries, it is more difficult to determine the number of places in which such institutions were established. As both France and Italy were, however, much more closely in touch with the Holy See at this time, it would be surprising if they had not been affected as much as Germany by the Pope's enthusiasm in the matter. We do know that in various large cities, as in Florence, Siena, Paris and London, there was a development of existing hospitals and the establishment of new ones, that points to a distinct community of interest in the hospital movement. At Paris, the Hotel Dieu was moved from the Petit Pont, where it had been, to its present situation and received large extensions in size and in usefulness. It was at this time, particularly, that it received donations for endowment purposes that would enable it to be self-supporting. A number of bequests of property, the rent of which was to be paid to the hopsital, were made, and the details of some of these bequests have an interest of their own. Houses were not numbered at this time but were distinguished by various signs, usually figures of different kinds that formed part of their facade. The Hotel Dieu acquired the houses with the image of St. Louis, with the sign of the golden lion of Flanders, with the image of the butterfly, with the group of the three monkeys, with the image of the wolf, with the image of the iron lion, with the cross of gold, with the chimneys, etc. The Hotel Dieu, indeed, seems to have become practically a fully endowed institution during the course of the Thirteenth Century, for there are apparently no records of special revenues voted by the city or the king, though there are such records with regard to other places. For instance the Hospital of St. Louis received the right to collect a special tax on all the salt that came into the city. In England the hospital movement during the Thirteenth Century is evidently quite as active as in Germany, at least as far as the records go. These refer mainly to London and show that the influence of the work of Innocent III. and his enthusiasm was felt in the English capital. 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 ailing, but at the beginning of the Thirteenth Century it became more frankly a hospital in the modern sense of the word. St. Thomas' Hospital, which remains to the present day one of the great medical institutions of London, was founded by Richard, Prior of Bermondsey, in 1213. Bethlehem or Bedlam, which afterwards became a hospital for the insane, was founded about the middle of the Thirteenth Century. The name Bedlam is a corruption of Bethlehem, since adopted into the English language to express a place where fools do congregate. Bridewell and Christ's Hospital, which were the other two of the institutions long known as the five Royal Hospitals of London, also seem either to have been founded, or to have received a great stimulus and reorganization in the Thirteenth Century, but both ceased after some time to be places for the reception of the ailing and became, one of them a prison and the other a school.

The names of some of these institutions became associated with that of Edward VI. about the middle of the Sixteenth Century. For this, however, there was no proper justification, since, at most, all that was accomplished within the reign of the boy king, was the reestablishment of institutions formerly in existence which had been confiscated under the laws of Henry VIII., but the necessity for whose existence had been made very clear, because of the suffering entailed upon the many ailing poor by the fact, that in their absence there was nowhere for them to go to be cared for. As Gairdner points out 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' Hospital was only the reestablishment of this institution, and even when it was granted by him to the citizens of London, this was not, as Gairdner says, "without their paying for it."

How much all this hospital movement owes to Innocent III. will be best appreciated from Virchow's account of the German hospitals, the great German Scientist not being one of those at all likely to exaggerate, the beneficent influence of the Popes. He says:

"The main cause decisive in influencing and arousing interest of the people of the time in the hospitals of the Holy Ghost was the Papal enthusiasm in the matter. The beginning of their history is connected with the name of that Pope, who made the boldest and farthest-reaching attempt to gather the sum of human interest 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 bind 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 on the streets, and saved the illegitimate children from death in the waters. There is something conciliating and fascinating in the fact that at the very same time at which the Fourth Crusade was inaugurated through his influence, the thought of founding a great organization of an essentially humane character 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 Santo Spirito, by the Old Bridge across the Tiber, was blessed and dedicated as the future center of this universal humanitarian organization."

Virchow, of course, considers Innocent's action as due to the entirely interested motive of binding the Catholic world to the Holy See. Others, however, who have studied Innocent's life even more profoundly, have not considered his purpose as due to any such mean motive. Hurter who wrote a history of Pope Innocent III., the researches for which he began as a Protestant with the idea that in the life of this Pope better than anywhere else the pretensions of the papacy could be most effectively exposed, but who was so taken by the character of the man that before he completed his history he had become a Catholic, looks at it in a very different way. Even Virchow himself quotes Hurter's opinion, though not without taking some exceptions to it. Hurter said with regard to charitable foundations in his history of Pope Innocent III.: "All benevolent institutions which the human race still enjoys, all care for the deserted and needy through every stage of suffering from the first moment of birth to the return of the material part to earth, have had their origin in the church. Some of them directly, some of them indirectly through the sentiments and feelings which she aroused, strengthened and vivified into action. The church supplied for them the model and sometimes even the resources; that these great humanitarian needs were not neglected and their remedies not lacking in any respect is essentially due to her influence upon human character."

With regard to this Virchow says that hospitals had existed among the Arabs and among the Buddhists in the distant East, "nevertheless," he adds, "it may be recognized and admitted, that it was reserved for the Roman Catholic Church and above all for Innocent III., to establish institutions for the care of those suffering from diseases.

A corresponding hospital movement that received considerable attention within the Thirteenth Century was the erection of Leproseries or hospitals for the care of lepers. Leprosy had become quite common in Europe during the Middle Ages, and the 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 by 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 sometimes pronounced to be leprosy. Certain of the severer forms of what is now known as psoriasis -- a non-contagious skin disease -- running a very slow course and sometimes extremely obstinate to treatment, were almost surely included under the diagnosis of leprosy. Personally I have seen in the General Hospital in Vienna, a patient who had for many months been compelled by the villagers among whom he lived to confine himself to his dwelling, sustained by food that was thrown into him at the window by the neighbors who were fearful of the contagiousness of his skin disease, yet he was suffering from only a very neglected case of psoriasis.

There is no doubt, however, of the existence of actual leprosy in many of the towns of the West from the Twelfth to the Fifteenth centuries, and the erection of these special hospitals proved the best possible prophylactic against the further spread of the disease. Leprosy is contagious, but only mildly so. Years of association with lepers may and usually does 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.

The successful hygienic and sanitary 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 had become a 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 those times, as sadly lacking in any interest in sanitary matters. The significance of the success of the segregation movement was lost upon men down almost to our own time. This was, however, 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 to contagion, that is conveyed by actual 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 latter part of the 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 successors took up the work of encouragement where he had left it at his death and did much to bring about the successful accomplishment of his intentions in even 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 crysipelas. During the Middle Ages it received various titles such as St. Anthony's fire, St. Francis' fire, and the like, the latter part of the designation evidently being due to the intense redness which characterizes the disease, and which can be compared to nothing better than the erythema consequent upon a rather severe burn. This affection was a great deal commoner in the Middle Ages than in later times, though it must not be forgotten that its 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' 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 infection 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 was known of this 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 not a litte 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 practise, has never seen a case of it. It was so common in America during the Civil War and for half a century prior thereto, 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, 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 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 practise of dissection. The decretal in question, however, which was not a 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, and was in itself an excellent hygienic measure.

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. These 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 communication of certain 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. It will be recalled that the headdresses of religious, being as a rule of spotless white, 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 headdress worn by religious, yet their choice has proved, in what may well be considered a Providential way, to be an excellent protective for the patients 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.

The organization of charity is supposed to be a feature of social life that was reserved for these modern times. A subsequent chapter on Democracy, Christian Socialism and National Patriotism, shows how false this notion is from one standpoint; a little additional interpretation will show that the generations which organized the hospitals, took care of the lepers in such a way as to prevent their becoming sources of infection for others, and segregated such severe contagious diseases as erysipelas, not only knew how to organize charitable efforts, but were able to accomplish their purposes in this matter in such a way, that the friction of the charity organization itself absorbed as little as possible of the beneficent energy put into it, and much less than is the case in our own time. Besides the monasteries were really active centers of charity organization of the most practical character. They not only gave to the people when their necessities required it, but they were active employers of labor and in times of scarcity constantly made large sacrifices in order to keep their people employed, and even the community itself went on short rations in order that the suffering in the neighborhood might not be extreme. In times of prosperity there were, no doubt, abuses in monasteries, but no one ever accused them of neglecting the poor during times of famine.

While the Thirteenth Century was so intent upon the relief of the social needs consequent upon illness and injury, it did not neglect other forms of social endeavor. One of the crying evils of the Thirteenth Century was the fact that mariners and merchants, as well as pilgrims to the Holy Land, were not infrequently captured by corsairs from the northern coast of Africa, and sold into slavery. At times, if there was hope of a very large ransom, news of the condition of these poor victims might find its way to their homes. As a rule, however, they were as much lost to family and friends as if they had actually been swallowed up by the sea, which was usually concluded to have been their fate. The hardships thus endured and the utter helplessness of their conditions made them fitting subjects for special social effort. The institution which was to provide relief for this sad state of affairs had its rise in a typically Thirteenth Century way -- what, doubtless, the modern world would be apt to think of as characteristically medieval -- but the result achieved was as good an example of practical benevolence as has ever been effected in the most matter-of-fact of centuries.

Shortly after the beginning of the Thirteenth Century two very intelligent men, whose friends honored them very much for the saintliness of their lives -- meaning by saintliness not only their piety but their thoughtfulness for others before themselves -- had a dream in which they saw poor captives held in slavery and asking for some one out of Christian charity to come and ransom them. One of these men was John of Matha, a distinguished teacher of Theology at the University of Paris. The other was Felix of Valois, more distinguished for his piety than his learning, but by no means an ignorant man. On the same night, though living at a distance from one anofher, they had this identical dream. Having told it next day to some friends, it happened that after a time it came to their mutual knowledge that the other had had a similar vision. The circumstance seemed so striking to them that they applied to the Pope for an interpretation of it. The Pope, who was Innocent III., the founder of city hospitals, saw in it a magnificent opportunity for the foundation of another great Christian charity.

Accordingly in interpreting it, he directed their thoughts toward the redemption of Christian captives taken by the Saracens. He has as a consequence been regarded as the founder of the order of Trinitarians (A. D. 1198), and did, in fact, draft its Rule. It was called, from its object, Ordo de Redemptione Captivorum, (Order for the Redemption of Captives), but its members were more generally known as Trinitarians. They wore a white habit, having a red and blue cross on the breast. They were well received in France, where they had originated, were the recipients of large sums of money to be devoted to the objects of the order, and had large accessions to their number, among whom were many distinguished by ability and profound learning.

In the year 1200 the first company of ransomed captives arrived from Morocco, and one may easily imagine their joy on again regaining their freedom and beholding once more their friends and native land.

The members of this order were sometimes called Mathurins, from the title of the first church occupied by them in Paris. They spread rapidly in Southern France, through Spain, Italy, England, Saxony, and Hungary, and foundations of a similar kind were also opened for women. Cerfroid, in the diocese of Meaux, where the first house of the order was opened, became the residence of the General (minister generalis). There was a fine field for their labors in Spain, where the Moors were constantly at war with the Christians. The self-sacrificing spirit of these religious, which led them to incur almost any dangers in the accomplishment of their purpose, was only equaled by their zeal in arousing interest for the poor captives. They became the accredited agents for the ransoming of prisoners, and also for their exchange and even the Mahometans learned to trust and eventually to reverence them. When they could not ransom at once they thus succeeded in ameliorating the conditions in which slave prisoners were kept, and proved a great source of consolation to them.

Another order, having the same object in view but differing somewhat in its constitution, was founded in 1218, by Peter of Nolasco, a distinguished Frenchman, and Raymond of Pennafort the famous authority on canon law. In this, too, medieval supernaturalism evolved the usual practical results. In consequence of a vision, the order was placed under the special protection of the Blessed Virgin, and called the Order of the Blessed Virgin of Mercy (Ordo. B. Mariae de Mercede). Its members bound themselves by vow to give their fortunes and to serve as soldiers in the cause. Their devotion was so ardent, that for the accomplishment of their purpose they vowed if necessary to make a sacrifice of their very persons, as Peter actually did in Africa, for the redemption of Christian captives. Hence their members were divided into Knights who wore a white uniform, and Brothers, who took orders and provided for the spiritual wants of the community. Gregory IX., admiring the heroic devotion of these intrepid men, approved the order. Many thousands of captive Christians who would otherwise have dragged out a miserable existence as slaves among the Mahometans of North Africa, were thus rescued and restored to their families and a life of freedom and happiness in Europe. This was a fine practical example of Abolitionism worthy of study and admiration.