<h1>XXI <br/> CITY HOSPITALS—ORGANIZED CHARITY.</h1>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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 hospital, 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.</p>
<p>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.</p>
<p>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."</p>
<p>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:</p>
<p class="cite">
"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."</p>
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HOSPITAL OF THE HOLY GHOST (LÜBECK)</p>
<p>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."</p>
<p>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."</p>
<p>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.</p>
<p>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.</p>
<p>This 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.</p>
<p>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 erysipelas. 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.</p>
<p>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.</p>
<p>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 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 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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
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CHARITY (GIOTTO)<br/>
FORTITUDE (GIOTTO)<br/>
HOPE (GIOTTO)</p>
<p>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
another, 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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
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HOSPITAL INTERIOR</p>
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