Part 21

The tradition of great teachers thus carried on during the first century after the absorption of Bologna into the Papal States, continued uninterruptedly in the next century, when we find on the list of professors at Bologna such names as those of Malpighi, the greatest mind in the medical sciences of the seventeenth century, and his colleague Fracassati, who, though over-shrouded by Malpighi, still claims a prominent place in the history of medicine. Bologna has a special feature of medical development to its credit which, because of its importance for science in general as well as for medicine, deserves to be mentioned here. During the century after the Popes became the rulers of the city scientific societies were founded here, and as the professors and {246} students of the medical school were also the most interested in science in general, the membership of these societies was largely made up of individuals connected with the medical school. A special society for the cultivation of anatomical knowledge, the first of its kind ever founded, was established in Bologna scarcely more than a century after the city came under the Papal dominion. It was called the Coro Anatomico, or anatomical choir, and had at first only nine members. Among these, however, were such distinguished men as Malpighi, Fracassati, Capponi, and Massari, to the last of whom the initiative of the foundation of the society is said to have been due. Bologna was noted during the sixteenth and seventeenth centuries for the number of foreign students of medicine who were attracted to its hospitable medical school and who carried the tradition of science for its own sake, so characteristic of this Papal Medical School, to all parts of the world.

After this consideration of the relation of the Popes to medical science during many centuries when medicine practically included all the physical sciences, it may seem utterly inexplicable to any fair-minded person that the tradition of the opposition of the Popes to science and scientific educational development should have apparently become a commonplace in history. This will not be a surprise, however, to those who know how perversive and influential has been the Protestant tradition which from the beginning of the sixteenth century has devoted itself to blackening the reputation of the Church, the Popes, and Catholic ecclesiastics generally. Nowhere is this more true than in history as written for English-speaking people. Those who left the old Church and their immediate descendants, justified their {247} withdrawal to themselves as well as others, by taking every possible excuse and inventing every possible pretext, to show how unworthy of their continued allegiance the old Church had been. The point of view thus assumed was taken quite seriously by succeeding generations, until at length a whole body of historical traditions, utterly unfounded in fact, accumulated, especially in England, where it must be remembered that for several centuries Catholics were not in a position to impugn and eradicate it. This unfortunate state of affairs, and not real opposition on the part of the Popes to science, is the source of the tradition with regard to the supposed opposition between the Church and science.

{248}

THE FOUNDATION OF CITY HOSPITALS.

Probably the most important work that the Popes did for medical science in the Middle Ages was their encouragement of the development of a hospital system throughout Christianity. The story of this movement is not only interesting because it represents a coordination of social effort for the relief of suffering humanity, but also because it represents the provision of opportunities for the study of disease and the skilled care of the ailing such as can come in no other way. Those who are familiar with the history of medicine, and especially of surgery, know that a great period of progress in these departments came during the thirteenth century. The next two centuries indeed represent an epoch of surgical advance such as was probably never surpassed and only equalled by the last century. This seems much to say of a medieval century 700 years ago, but our chapter on surgery will, I think, amply justify the assertion. The reasons for this great development in surgical knowledge are properly understood only when we come to realize that there was a corresponding development in hospital organization. These two features of medicine always go hand in hand. The hospitals, as might be expected, preceded the surgical development, and owed their great progress at this time mainly to the Popes.

The city hospital as we have it at the present time, that is, the public institution meant for the reception of those suffering from accidents, from acute diseases of various kinds, and also for providing shelter for those {249} who have become ill and have no friends to take care of them, is an establishment dating from the beginning of the thirteenth century. It will doubtless be a surprise to most people to be told that the modern world owes this beneficent institution to the fatherly watchfulness, the kindly foresight, and the very practical charity of one of the greatest of the Popes, whose name is usually associated with ambitious schemes for making the Papacy a great political power in Europe, rather than as the prime mover in what was probably the most far-reaching good work of supreme social significance that was ever accomplished.

At the beginning of the thirteenth century, mainly as the result of those much abused sources of many benefits to mankind in the Middle Ages, the Crusades, the people of Europe had begun to dwell together in towns much more than before. It is closeness of population that gives rise to the social needs. While people were scattered throughout the country diseases were not so prevalent, epidemics were not likely to spread, and the charitable spirit of the rural people themselves was quite sufficient to enable them to care for the few ailing persons to be found. With the advent of even small city life, however, came the demand for hospitals in the true sense of the word, and this need did not long escape the watchful eye of Innocent III. He recognized the necessity for a city hospital in Rome, and in accordance with his very practical character and wonderful activity, at once set about its foundation.

As was to be expected from his wise foresight, he did not do so without due consideration. He consulted many visitors to Rome and many distinguished medical authorities as to what they considered to be the best conducted {250} and most ably managed institution for the care of the sick in Europe at that time. Almost by common consent he was assured that the most successful hospital management was to be found at Montpelier. This French town near the shores of the Mediterranean had succeeded to the medical prestige formerly held by Salerno, and was now the favorite place of pilgrimage for the nobility and reigning sovereigns of Europe, whenever they became so ill that their ordinary medical attendants seemed to be able to do nothing for them. Pope Innocent was further told that the institution at Montpelier which was best conducted was undoubtedly the Hospital of the Fathers of the Holy Spirit.

Accordingly, the Pope extended an invitation which, under the circumstances, must have been practically a command, to Guy or Guido of Montpelier, the administrative head to whom the hospital there owed its successful organization, to come to Rome and establish a hospital of his order in the Papal capital. He provided the order with a sufficient foundation in what is now known as the Borgo, not far from the present Vatican. On this was erected, at the beginning of the thirteenth century, a hospital of the Holy Spirit, which still exists there, though, of course, the building has been many times renewed since the original foundation. This hospital of the Holy Spirit soon attained a world-wide reputation for careful nursing and medical attendance and for the discretion with which its surgical cases were treated. It was understood that all the ailing picked up on the streets should be brought to the hospital, and that all the wounded and injured would be welcomed there. Besides, certain of the attendants of the hospital went out every day to look for any patients who might {251} be neglected or be without sufficient care, especially in the poorer quarters of the city, and these were also transported to the hospital. This old Santo-Spirito hospital then was exactly the model of our modern city hospitals.

Pope Innocent's idea, however, was not to establish a hospital at Rome alone, but his fatherly solicitude went out to every city in Christendom. In accordance with this pre-determined plan, by personal persuasion, by the display of an interest in hospital work, and by official Papal encouragement he succeeded in having, during his own pontificate, a number of hospitals established in all parts of the then civilized world on the model of this hospital of the Holy Ghost at Rome. The initiative thus given proved lasting, and even after the Pontiff's death hospitals of the Holy Ghost continued to multiply in various parts of Europe, until scarcely a city of any importance was without one.

It is no less a person than Virchow, the greatest of modern medical scientists, who has traced the origins of the modern German city hospitals back to Innocent and given us a list of those which were established during the century following his pontificate. Here are the names of those towns from Virchow's list in which hospitals were founded during the thirteenth century in Germany alone, which will show very convincingly how widespread the hospital establishment movement was: Zurich, St. Gallen, Bern, Basel, Constanz, Villingen, Pfullendorf, Freiburg, Breisch, Stephansfelden, Oppenheim, Mainz, Speyer, Coblenz (an der Leer), Cologne, Crefeld, Ulm, Biberach, Rothenburg, Kirchheim, Mergentheim, Wimpfen, Reutlingen, Memmingen, Augsburg, Rothenburg a. Tauber, Muenchen, Frankfort a. M., {252} Hoxter, Dortmund, Brandenburg, Spandau, Salzwedel, Stendal, Berlin, Perleberg, Pritzwalk, Halberstadt, Halle, Quedlinburg, Helmstedt, Magdeburg, Sangerhauson, Eisenach, Naumburg, Hanover, Gottingen, Northeim, Bremen, Hamburg, Luebeck, Parchim, Wismar, Rostock, Schwerin, Mollen, Oldeslo, Ratzelburg, Ribnitz, Stettin, Stralsund, Greifswald, Demmin, Anclam, Breslau, Bunzlau, Gorlitz, Brieg, Glatz, Sagan, Steinau, Glogau, Inowraclaw, Wien, Meran, Brixen, Sterzing, Elbing, Thorn, Koenigsberg, Danzig, Marienburg, Riga.

Many of these towns were comparatively small. In fact, there were no cities that we moderns would call large in the thirteenth century. London had probably not more than some twenty thousand; Paris, even at the most flourishing period of the university, under fifty thousand. Most of the German towns had less than ten thousand, and of these which are the sites of hospital foundations mentioned by Virchow, probably not more than a dozen, if that many, had more than five thousand inhabitants. Since the movement spread even to such small towns, it can be readily understood how far-reaching in its effects was the policy initiated by Innocent III. and how thoroughly he laid the secure foundations of a great Christian hospital system.

[Illustration: Holy Ghost Hospital (Luebeck)]

Since the Papal example and recommendations produced so much effect upon Germany, which was not so closely united to the Holy See as were the Latin nations, it is easy to understand what an impetus to the hospital movement must have been given in the southern countries, even though we have not had the advantage of so patient a collector of information as Virchow to give us all the details. In the larger cities hospitals were already in existence, and these took on a new life because of the {253} hospital movement. In Paris, for instance, the Hotel Dieu, which had been in existence for some time, became so cramped for room in its original location, just beyond the Petit Pont, that at this time it had to be transferred to its present commodious quarters next to the Cathedral, on the square of Notre Dame. The hospital became a city hospital in the genuine sense of the word, and the citizens became interested in it to a noteworthy degree. It began to be the subject of bequests and benefactions of all kinds on the part of the clergy and laity, and many interesting details of these benefactions are still at hand in documents contained in the hospital archives of Paris. [Footnote 30]

[Footnote 30: Bordier, Archives Hospitalieres De Paris, Paris; Champion, Publications for the Society of the History of Paris, 1877.]

There are some curious historical details in these old documents, since they serve to show the method in use for designating houses at that time when, it must be recalled, street numbers had not as yet been invented. Most of the houses had on their facades some image or figure by which they were known. The Hotel Dieu, for instance, acquired during the thirteenth century the houses with the image of St. Louis, with the sign of the golden lion of Flanders, with the image of the butterfly with that of the wolf, with the images of the three monkeys, with the image of the iron lion, with the cross of gold, with the three chimneys, etc. A certain amount for the support of the hospital was allowed out of the city revenues, and a favorite method was to permit, in times of special stress upon the hospital, the collection of a tax on all of a certain commodity that came into the city. For a time, for instance, during an epidemic or other period of necessity, a hospital would obtain {254} permission to collect a tax on all the salt, or, occasionally, on all the wheat that entered Paris. This serves to show the renewed interest in city hospital affairs that had arisen mainly as the result of Papal initiative and encouragement.

In the smaller towns in France there was the same hospital movement as characterized the situation in Germany. In the south, the closeness of Montpelier made the example of the hospital of the Holy Ghost of that city especially forceful. In other portions of France it is well known that the Sisters of the Holy Ghost very early established separate hospitals from those founded by the Brothers of the Holy Ghost. There are records of such separate hospitals entirely under the control of Sisters in Bar-Sur-Aube, in Neuf-Chateau, and, according to Virchow, at many other places. At the same time, however, there still continued to be hospitals of the Holy Ghost as at Besancon, where the Brothers and Sisters of the Holy Ghost had their institutions in common, though there was a distinct separation of the communities and allotment of tasks. The Brothers cared rather for the surgical cases, while the care of the children and the pregnant women was confided to the Sisters. This of itself was rather an advantage, since the separation of the women and the children from the ordinary hospital patients, must have proved an important preventive of infection and an ameliorating factor as regards that hospital atmosphere especially likely to be unfavorable to these delicate, sensitive cases. We know now what hospitalism means for them.

That the influence of the movement initiated by Innocent III. was felt even in distant England is very clear, from the fact that practically all of the famous old {255} British hospitals date their existence as institutions for the care of the ailing from the thirteenth century. 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 destitute sick, but at the beginning of the thirteenth century it became, in imitation of the Hospital of the Holy Spirit at Rome, frankly a hospital in the modern sense of the word. St. Thomas's Hospital, which continues to be down to the present time one of the great medical institutions of London, was founded by Richard, Prior of Bermondsey, in 1213. Bethlehem, or as the name was softened in the English speech of the people, Bedlam, was founded about the middle of the thirteenth century. Originally it was a general hospital for the care of the sick of all kinds, though in later times it became, as its name has come to signify in modern English, a place exclusively for the care of the insane. Bedlam, in the fourteenth century, and probably also in the later years of the thirteenth, made provision for a certain number of the insane in addition to other patients, so that it presented the accomplishment of that desideratum for which we are striving in the twentieth century--a city general hospital with psychopathic wards. This arrangement, as we have said in the chapter on the Church and the Mentally Afflicted, has many advantages over the special hospital for the insane, entrance to which, as a rule, requires tedious formalities.

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 {256} 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 {257} 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 fact