Following on from our look at Vesalius and the science of Anatomy, I got the idea for this article from the rulebook of the order known as Camillans, who by the time of its publication had been in service for a little over twenty years in Milan. It is offered as regulation so we can surmise that the contents were rigidly adhered to, by the nursing assistants. The Maggiore hospital in Milan was run by an order of brothers, the Camillans, who offered basic healthcare, interspersed with a substantial amount of religious guidance to the poor. Hospitals such as the Maggiore were designated mainly for the treatment of the poor. As religion played a key role in medicine during this period, and the Church blamed sin for the diseases in existence, those in charge felt it their duty to redirect the sufferers to God. Throughout the rules listed there are continued references to Religion, and this goes as far as to provide separate nursing assistants for the physical and the spiritual wellbeing.
The main task of the spiritual assistants was to teach the poor prayers and so on, in order that they would be able to make their confessions and either be healed or be at peace with God before they died. It was interesting to see that if a patient took a turn for the worse, confession should be encouraged, and the Father notified, rather than medical help being summoned for the patient. Also if a patient were asleep when it came time for Mass, they were to be awoken. The spiritual assistant was to count the spoons given out during meals.
‘….give spoons to everybody, counting them when….’
This implies that the patients were sinners and would steal the spoons. As much attention to details of clean uniform, sweeping rooms and laying of tables for dinner has been given as there are instructions for the medical treatment of the patient. Meals were basic and followed a set time, as did toilet requirements and visits by the doctor. Daily purging was instructed and the assistant brothers were to follow only the instructions of the Corporals.
The overall impression we get from documents of this type was that the physical suffering of a patient was attributed to their spiritual wellbeing, and because of this, the real cause would be overlooked and to a large degree untreated. It begs the question as to how many people were cured in this particular Hospital, or whether it was set up in an effort to ‘heal’ people spiritually when they were at their most vulnerable as we see Catholicism was the driving influence with no allowance being made for alternative, or lack of, faith amongst the patients.
So how, if at all, did hospital care for the sick poor change in the early modern period? Well, there were differences in treatment of the poor already in existence dependant on a number of factors. And gradual but noticeable changes in the treatment of the poor sick have taken place over the early modern period based on social, religious and medical advancement. I previously believed that hospitals were formed to treat only the poorest members of society, who could not afford the private care of a Physician, and that hospitals were a last resort, where the poor sick went to die. But with further research, this does not appear to be the case. The first thing I noticed is the variation of institutions operating as hospitals. Some were simply a kind of sanctuary where the poor and destitute could go and receive food, shelter and possibly religious rehabilitation in order to become a functioning member of society. Sickness in some of these cases was not a factor in admission.
As we have seen, religion played a large part in the administration of early hospitals, both before and after the Reformation, with the overall cause of illness amongst the poor being attributed to lack of moral fibre, in other words, sin. The general theme of the period being was that if you confessed your sins before God, your physical ailments would then be healed as He saw fit. This also tied in with early belief in the medical profession of creation over evolution and the continuance of the soul after death.
Another example of this was the French Daughters of Charity in the seventeenth and eighteenth centuries, who were successful in carrying out a range of medical duties from ‘preparing drugs to performing minor surgery’, yet still attempted to avoid treating those patients ‘tainted by sin’ and with conditions such as syphilis. Italy had a number of established Hospitals for the poor sick established from as early as the fourteenth century where treatment was dramatically different to those of England. In Florence, there were four substantial institutes recorded, and although run on a religious footing, did have a low mortality rate successfully treating many acute illnesses, based on certain medical knowledge and the most basic needs of the poor. In many cases this involved a simple nutritious diet, clean conditions, lots of quiet and rest and minimal intervention. One in particular, Santa Maria Nuova, started out ‘to serve the poor… but by the sixteenth century it was serving the sick with emphasis on the poor’ This hospital was credited with a substantial clinical staff, a teaching facility, a well-stocked pharmacy, and paid nursing staff.
Methods of financial support for medical facilities varied across Europe both before and after the reformation. In many countries for example, Hospitals were provided, and continually subsidised, by charitable donations from wealthy patrons, with differing reasons. In some countries, such support was religiously motivated, buying your way into Heaven as it were. In others, it was more a networking issue. Having become a benefactor of such an institute, you would be accorded membership onto the Board of Governors and were able to mix with other benefactors and increase trading opportunities, for example. In others you were able to sponsor poor people that you knew of to be admitted for treatment.
In sixteenth century Protestant Germany, Bugenhagen attempted reform whereby women in particular after receiving treatment from the community health chest, had to return the favour by performing nursing duties of their own unless excluded by pre-designated circumstance. This ensured ongoing care was available to the community. Refusal to comply was met with the withdrawal of future care for these women.
In Scotland it was harder to gain admission to Hospital. A patient would have to prove illness, and have a sponsor, before being able to obtain treatment. In some areas it was practice to provide the patients with the money to go out daily and buy their own food. This practice was eventually rejected when it was realised that the poor would often either keep the money and reside in the Hospital for longer than necessary as they did not get well, or were using the money to go to the alehouses and drink instead.
The role of the Hospital eventually developed into the Medical institutes that we recognise today. New approaches including specialist hospitals for treating contagious diseases such as the Plague appeared across Europe. Advances in medicine, particularly in the eighteenth century, meant emphasis was placed on medical treatment rather than faith and government acts for the relief of the poor and properly funded hospitals, were eventually introduced.
In the next part we will look at how various other areas of medicine were born and encouraged, and hopefully later show the link between the reformation, medicine and the development of the modern Workhouse