The Popes and Science

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 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 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 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 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 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.'"

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 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 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 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 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 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 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.

The situation of the hospital might well be thought ideal. The 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:

"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.

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.