The Popes and Science

To take, for example, that of Siena, a good 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 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 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.

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 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, 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.

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 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 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 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. 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 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.