HOSPITALS
486
HOSPITALS
Hospital construction reached a high degree of
perfection about tlie middle of the fifteenth century.
Probably the best example of it is the famous hospital
at Milan, opened in 1445, though not completed
until the close of the fifteenth century. Dr. W.
Gill Wylie in his Boylston Prize Essay on Hospitals
says of it: "In 1456 the Grand Hospital of Milan
was opened. This remarkalile building is still in
use as a hospital and contains usually more than
2000 patients. The buildings stand around square
yards, the principal one being much larger than the
others, and separating the hospital into two parts.
The main wards on either side of this large court
form a cross, in the centre of which was a cupola,
with an altar beneath it, where divine service is
performed daily in sight of the patients. These wards
have corridors on both sides which are not so lofty
as the ceilings of the wards, and consequently there is
plenty of room for windows above these passages.
The ceilings are thirty or forty feet high, and the
floors covered with red bricks or flags. The outside
wards are nothing but spacious corridors. The wards
are first warmed by open charcoal brasiers. . . . This
Hospital built at the time when the Church of Rome
was at the height of her power, and but a short time
before the Reformation, is a good example of what
had been attained toward the development of hos-
pitals and it shows how much a part of the Church
the institution of hospitals was."
The administration of the hospital when this formed part of a monastery, was naturally in the hands of the abbot or prior and the details were pre- scribed in the monastic rule. The statutes also of the hospital orders (knights) regulated minutely the duties of the "Commander", who was at the head of each hospital. In other institutions, the official in charge was known as magister, provisor, or rector, this last title being given in Germany to the superior in case he was a priest, while in Italy he was called speda- lingo. These officials were appointed by the bishop, the chapter, or the municipaUty, sometimes by the founder or patron. Laymen as well as clerics were eligilile; in fact, legacies were sometimes made to a hospital on condition that only lay directors should have control, as, for instance, in the case of St. Matthew's at Pavia.
The regulations most generally adopted were those of the Order of St. John of Jerusalem; the Rule of St. Augustine and that of the Dominicans were also ob- served in many institutions. The first duty of the rector or magister was to take an inventory of the hospital holdings and appurtenances; he was obliged to begin this within a month after his appointment and to finish it within a year. Besides the general superintendence of the hospital, he was responsible for the accounts and for the whole financial adminis- tration, including the properties of the hospital itself and the deposits of money which are often entrusted to him for safekeeping. It was also his duty to receive each patient and assign him to his proper place in the hospital.
The brothers and sisters were bound by the vows of poverty, chastity, and obedience which they took at the hands of a priest, or, as at Coventry (England), at the hands of the prior and chapter. As in all re- hgious establishments, the schedule of duties was strictly prescribed, as were also the details of dress, food, and recreation. No one employed in the hos- pital was allowed to go out unaccompanied, to spend the night, or take any refreshment other than water outside the hospital. Penalties were inflicted for violation of these rules.
In the reception of patients, the broadest possible charity was shown. .4s Coyecque (op. cit., I, p. 6.3) says of the Hotel-Dieu at Paris: "soldiers and citi- zens, religious and laymen, Jews and Mohammedans, repaired in case of need to the Hotel-Dieu, and all
were admitted, for all bore the marks of poverty and
wretchedness; there was no other requirement."
Moreover, the hospital attendants were obliged at
stated times to go out into the streets and bring in
those who needed treatment. On entering the
hospital, the patient, if a Christian, went to confession
and received Holy Communion, in order that peace
of mind might benefit bodily health. Once admitted,
he was to be treated as the master of the house —
qiiasi dominus seciinditm posse domus, as the statutes
enact. According to their ability, the sick performed
the duties of prayer, attendance at Mass, and recep-
tion of the sacraments. They were especially recom-
mended to pray for their benefactors, for the au-
thorities, and for all who might be in distress. At
night-fall a sort of litany was recited in the wards,
each verse of which began: "Seignors malades, proies
por", etc. They were often cheered by the visits of
persons in high station or of noble rank and charitable
disposition, Mke Catherine of Sweden, Margaret, Queen
of Scotland, Margaret, Duchess of Lorraine, King
Louis IX of France.
The regulations concerning the physical well-being of the inmates prescribed that the sick should never be left without an attendant — infirmi aiitcm nun- quam sint sine vigili custodia (.\miens, XXXV) ; that nurses should be on duty at all hours of the day and night; that when the illness became serious the patient should be removed from the ward to a private room and receive special attention (Paris, XXII; Troyes, I, XXXIII; Vernon, XI). Santa Maria Xuova at Florence had a separate section (pazzeriu) for delirious patients. Similar provision was made for maternity cases, and the patients were kept in the hospital for three weeks after parturition. That due attention was paid to cleanliness and comfort is evident from what the recortls tell of baths, bed- linens, ventilation, and heating by means of fire- places or braziers.
The medical treatment was given by monks or other ecclesiastics — at least during the earlier period. From the twelfth century onward restrictions were placed on the practice of mcilicine by clerics, espe- cially in regard to surgical operations, and with still greater severity, in regard to the acceptance of fees for attendance on the sick; see the decrees of the councils: Clermont (1130), can. v; Reims (1181), can. vi; Second Lateran (1139), can. ix; Fourth Lateran (1215), can. xviii. At times a physician or surgeon was called in to render special assistance in certain cases; and this became more general as the medical schools in the universities developed, as at Salerno and Montpellier. An important document is the report sent in 1524 from Santa Maria Nuova in Florence to Henry VIII, who, with a view to reorgan- izing the London hospitals, had sought information regarding the famous Florentine institution. From this it appears that three young physicians were resident (adstantcs) in the hospital, in constant atten- dance on the sick and made a daily report on the condition of each patient to six visiting physicians from the city who gave prescriptions or ordered modifications in the treatment. Attached to the hospital was a dispensary {medicinarium) for the treatment of ulcers and other slight ailments. This was conducted by the foremost surgeon of the city and three assistants, who gave their services gratui- tously to the needy townsfolk and suppUed them with remedies from the hospital pharmacy. An interest- ing account of the apothecary's duties, with a list of the drugs at his disposal, is given by Lalleniand in his interesting work, "L'Histoire de la Charitd" (II, 225).
To meet its expenses, each hospital had its own endowment in the shape of lands, sometimes of whole villages, farms, vineyards, and forests. Its revenues were often increased by special taxes on such products
