10 - Medieval Hospitals
Medieval times (500 A.D.) are noted, insofar as science and medicine are concerned, as a period of sterility, of inertia. Yet out of this troubled millennium came a significant contribution to the welfare of mankind; the hospital.
In the Western World were largely the creations of Christianity. However, institutions of a similar nature had existed in other parts of the world long before the birth of Christ. Records tell of hospitals in Ceylon as early as the fifth century B.C., and in India as early as 260 B.C. Arabian hospitals, with large and liberal endowments, came long after the beginning of the Christian era. Whether the Mohammedans got the idea from Buddhists or from Christians is subject to conjecture.
Romans created hospital-like institutions when they established large buildings for treatment of troops stationed on distant frontiers, and when they opened valetudinarian for care of civilians who were sick.
Early European hospitals were more like homes for the aged, or hospices. The sick found their place in these hospitals only insofar as they were a part of the group of helpless individuals, including paupers, pilgrims, travelers, aged persons, orphans, and others destitute. For such as these, Christian charity provided “hospitality,” especially food and shelter. Early medieval hospitals rarely specialized in treatment of the sick. Usually the sick were received for the purpose of supplying their bodily wants and of ministering to their spiritual needs until they were well enough to return to work.
The oldest actual hospital in France seems to have been the Hotel-Dieu, founded in Lyons about 542 by Childebert 1, king of the Franks. The famous Hotel-Dieu of Paris was founded about 652 by St.Landry, the 28th Bishop of Paris. The oldest hospital in Italy is believed to be Santa Maria Della Scala in Siena, established in 898.
Impetus was given to development of hospitals in the twelfth century by the Crusades; and further stimulation during the fourteenth century by the spread of the plagues. Large groups of people were moving by various routes to the Holy land, and stragglers, sick, and wounded were returning. This movement of thousands of individuals under almost primitive circumstances provided most favorable conditions for spread of disease and for epidemics.
Foundation of the Order of Hospitals of the Holy Ghost in 1180 stimulated a new wave of founding of hospitals. In a short time, Holy Ghost hospitals were opened within cities all over Europe. Pope Innocent 111 (1198-1216) sponsored the founding of such a hospital in Rome, in 1198, at the old Tiber Bridge. Innocent summoned Guy of Montpellier and put him at the head of the Order and of the Roman hospital. This institution, the Ospedale di Santo Spirito, continues in operation today. In Florence, the Ospedale di Santa Maria degli Innocenti, established as a founding’s hospital, has operated continuously since 1421.
The first hospital of record in England was built in York, in Saxon times, 937 A.D. After the Conquest, many more were founded. Others of early days include: St. Gregory’s dating from 1084; St. Cross,’ at Winchester, from 1123; and St.Thomas,’ from 1215. One of the most important of English medieval hospitals, and still a distinguished institution, is St.Bartholomew’s of London, founded in 1123.
In Spain, Madrid’s General Hospital traces its foundation to three Moorish hospitals, combined by Philip 11 in 1566.
Moslems were no less zealous than Christians in promoting works of charity. In fact, Arabians were far ahead of their European contemporaries in adopting kindly treatment toward mentally ill persons. Numerous hospitals were erected in Mohammedan cities in Asia Minor. As early as 707 A.D., the Caliph El We lid is reported to have founded a hospital in Damascus; another was established at Cairo in 874; two at bag dad in 918; and three more in Egypt, between 925 and 977. One of the greatest of Moslem hospitals was Al-Mansur, founded in 1283, in Cairo. The Saracen cities in Spain also had large well- managed hospitals.
In addition to the Hotels- Dieu of Lyons and Paris, several other old French hospitals still operate. In 1260, Louis 1X founded the Hospital des quinze Vingts as a home for the blind. It is now a general hospital, but specializes in ophthalmology. Louis X111 founded La Salpetriere as an asylum for indigent women; it later became a hospital for patients with mental and nervous diseases, and today is an immense, rambling institution providing general hospital services.
One of the most charming old hospitals in France, and one quite typical of hospitals established in medieval times, is the Hotel-Dieu of Beaune. It is reputed to be the oldest existing hospital which has continuously occupied its original building. Set in the midst of the ancient walled city of Beaune, in the heart of Burgundy’s Cote d’Or, some 250 miles southeast of Paris, this hospital has a history as colorful as its steep, gabled roofs.
Severe times preceded its establishment: the Hundred Years’ War was just drawing to a close; and the French kingdom of Charles V11, and the Duchy of Burgundy, under Philip the Good, had just become reconciled by the treaty of Arras (1435). When soldiers were not plundering the countryside, professional robbers were. Terrified country people fled for refuge to castles and to walled cities. Famine and pestilence further compounded their miseries. The pitiful needs of the poor, the destitute, and the wick were too much for small cities to cope with.
This situation stirred charitable emotions in the chancellor to the Duke of Burgundy, Nicholas Rolin. Wealthy in his own right, high in diplomatic circles, Rolin and his wife, Guigone De Saslins, agreed to devote their fortune to building a “hostel of God” for the poor and the sick. The chancellor had approval for his project from Pope Eugene 1V and from Duke Philip, Beaune, because of its fortifications and its situation at the crossroads of fifteenth- century travel routes, was the site chosen. Land was acquired adjoining the market place. On August 4, 1443, under the portal of Beaune’s Church of the Notre Dame, in the presence of eminent churchmen, civic leaders, and citizens, the charter was drawn for the Hotel-Dieu de Beaune.
The Hospital followed the Flemish style of architecture. The first structure was completed and dedicated in December, 1451, and the first patient was admitted January 1, 1452. Six sisters were assigned to care for the poor and the sick who sought shelter in “la Grand’ Chambre des Povres” –the Great Hall of the poor.
The great, or main, ward indeed is an edifice of magnificence and beauty: it is 236 feet (72 meters) from the entrance to the stained glass windows at the far end: 46 feet (14 meters) from wall to wall; and 52 feet (16 meters) from the beautifully flagstone floor to the tip of the soaring roof. This roof is shaped like the hull of a ship, turned upside down (symbolizing charity going about the world as a ship sails on the sea). Eleven six-sided wood beams span the structure from eave to eave, with king posts ascending from their centers to peak of the roof. The beams are exquitely carved with gargoyles and symbolic figures, brightly painted; and escutcheons of the founders decorate the central joints. Along the sides, each bed is enclosed in a separate cubicle, with draw curtains for privacy. The motif of dark red and gold is carried throughout- curtains, drapes, and bed covers, each adorned with initials and symbols of the founder and his wife who made possible this project. Outside each bed-cubicle there is a small table and chair, each with its individual pewter goblet, bowl, and copper basin- to this day preserving style and grace of the fifteenth century.
Across one end, and a part of a las grand’ chamber des Povres, is a small but beautifully appointed chapel. It is so arranged that, when the dividing curtains are drawn, patients may attend Mass and follow the service without moving from their beds. This arrangement is similar to that to be found in many fifteenths- century French hospitals.
Since its building, begun in 1443, many additions have been made to this hospital. Among these are: several wards, a great kitchen, a pharmacy, a museum; also added were gardens, courts, and precious pieces of art. Innovations of yesteryear are museum pieces today, supplanted for practical purposes by new and modern equipment; but these are preserved for their nostalgic and historic significance.
Like its contemporary institutions, the Hotel-Dieu de Beaune gradually changed from a hostel for the poor and the aged to proffer services of a modern hospital. Despite vicissitudes of time, economic changes, and numerous wars, this hospital has continued to serve the poor, the sick, and the needy, day in and day out, for over 500 years. The ancient buildings with gay, varicolored tiled roofs that belie the grief and the pain they shelter, have been supplanted those of old, the air of fifteenth- century France has been preserved. Even the costume of the good sisters of the Congregation of Sainte Marthe (known in the old days as the “Dames hospitalieres de I Hotel-Dieu de Beaune”), who have given devoted and loving attention to those entrusted to their care, has remained virtually unchanged since the day the first great ward opened, January 1, 1452.
Even at best, medieval hospitals left much to be desired. The Hotel-Dieu in Paris in the fourteenth century had grown to a capacity of 800 to 900 patients; and it probably doubled in size within another century. However, the number of beds actually was much less, for it was the practice of those days to use enormous beds holding four to six patients. Included in this hospital’s equipment in the fifteenth century were two portable bathtubs mounted on wheels.
Crude and medically deficient though they must have been, and without sanitary facilities, medieval hospitals shaped a solid foundation of compassion upon which today’s modern hospitals are built. From wards, operating rooms, and laboratories of hospitals of the nineteenth and twentieth centuries has come a stream of decisive clinical discoveries. Viewed in perspective, the conclusion is inescapable that modern medical practice owes much indeed to charitable and humanitarian principles laid down in the hospitals of medieval times.
“La Grand Chambre des Povres” – The Great Room of the Poor – is believed to be the world’s oldest edifice to have been in continuous use as a hospital. Representative of medieval hospitals, it is a part of the Hotel-Dieu de Beaune, France, founded in 1443. Combined with modern professional hospital service it carefully preserves the atmosphere of the fifteenth century. Sisters of the Congregation of Sainte Marthe, garbed in habits traditional to their ancient order, have cared for the sick, the aged and the indigent in this hospital for more than 500 years, uninterrupted by wars, or by economic or political changes.