The first of the great professors who made the Papal Medical School famous was Realdo Colombo, often spoken of as Columbus simply, who was invited to teach in Rome by Pope Paul III., the same Pope who issued the bull founding the Jesuits. Some people might consider the two actions as representing contrary tendencies in education, but they are not such as know either the history of the Jesuits, or of the constant endeavor of the Popes to foster education. Columbus came to Rome, as we have said, with the prestige of having succeeded Vesalius at Padua, and later having been specially tempted by the reigning prince in Pisa, who wanted to create a great medical school in connection with his university in that city, which he was at that moment trying to raise to distinction, to accept the professorship of anatomy there.

Vesalius was still alive at this time, and the period when, if we would credit certain historians who emphasize the opposition between the Church and science, it was dangerous to dissect human bodies had not yet pa.s.sed. It is interesting to read the account of Columbus's reception in Rome, and the interest manifested in his work by all cla.s.ses in the Roman University at this time. His course in anatomy was so enthusiastically {233} attended that, as he himself tells in a letter to a friend, he often had several hundred persons in his audience when he gave his anatomical demonstrations on the cadaver.

These were not all medical students, but many of them were ecclesiastics, and some of them important members of the hierarchy.

Even cardinals manifested their interest in anatomy, and occasionally attended the public dissections--public, that is, as far as the University is concerned--which were made by Columbus.

Columbus's enthusiasm for anatomy was such that, as Dr. Fisher said of him in the Annals of Anatomy and Surgery, Brooklyn, 1878-1880, "he dissected an extraordinary number of human bodies, and so devoted himself to the solution of problems in anatomy and physiology that he has been most aptly styled the Claude Bernard of the sixteenth century." In one year, for instance, he is said to have dissected no less than fourteen bodies, demonstrating, as Dr. Fisher has said, that "it was an age of remarkable tolerance for scientific investigation."

Besides being an investigator, Columbus was a great teacher, and many of our modern methods of instruction in medical schools had their origin in the system of demonstrations introduced by him. His descriptions of the demonstrations for students upon living animals, show that some of the most recent ideas in medical teaching were antic.i.p.ated by this Roman professor of anatomy and medicine in the Renaissance period. His demonstrations of the heart and blood-vessels and of the actions of the lungs are particularly complete, and must have given his students a very practical working knowledge of these important physiological functions. In a word, the medical teaching of the Roman {234} University, under him at this time, far from being merely theoretic and distant from actual experience and demonstration, was thoroughly modern in its methods.

It is no wonder, then, that practically all the ecclesiastical visitors who came in such numbers to Rome, made it a custom at this time to attend one or more of Columbus's anatomical lectures. They were looked upon as one of the features of the Roman university life of the time. How much good was accomplished by this can scarcely be estimated. The example must have had great influence especially on members of faculties of various educational inst.i.tutions who came to the Papal See. To some degree at least these interesting teaching methods must have aroused in such men the desire to see them emulated in their own teaching inst.i.tutions, and therefore must have done much to advance medical education. The fact that these things were done in the Papal Medical School only emphasized the significance of them for ecclesiastics, and made them more ready to bring about their imitation in other teaching centers.

How well the Popes were justified in their estimation of Columbus's genius as an anatomical investigator will be best appreciated from his discovery of the pulmonary circulation, which formed, as Harvey confesses at the beginning of his work on the circulation, the foundation on which Harvey's great discovery naturally arose. It is probable that Columbus would not have come to Rome, in spite of the flattering offers held out to him, only that he was already the personal friend of a number of high ecclesiastics, and even of the Pope who extended the invitation. How well the Popes continued to think of Columbus after his years of work in the {235} Roman Medical School will be well understood from the fact that, when his great work _De Re Anatomica_ was published after his death by his sons, Pope Pius IV. accepted the dedication of it. This was of course not an unusual thing, for many books on other sciences were dedicated to the Popes, and the example thus set was subsequently imitated. Twenty-five years later, Professor Piccolomini dedicated his Anatomical Lectures to Pope Sixtus V. Subsequent anatomical publications of the Papal Medical School were issued under like patronage. The famous edition of Eustachius's anatomical sketches, published under the editorship of Lancisi, is a notable example of this, and went to press mainly at the expense of Pope Clement XI., who realized how valuable they were likely to be for the teaching of anatomy.

These two great discoverers in anatomy, Columbus and Eustachius, were succeeded, as is so often the case in the history of university faculties, by a man more capable of writing about great discoveries than of making them himself. This was Piccolomini, who devoted himself to showing how much the ancients had taught about anatomy, though at the same time he also made clear the place occupied by modern anatomical discoveries. While his name is not attached to any great discovery in the science of anatomy, he is generally acknowledged to have been one of the great teachers of his time and one who was needed just then in order to make people realize how the old and the new in anatomy must be coordinated. Piccolomini's successor in the chair of anatomy at Rome was another original genius and investigator whose name, however, and fame has never been as great among English-speaking people as in Italy, or among the Latin races generally. The fact that he was a rival {236} of Harvey's in the matter of the discovery of the circulation of the blood has always made the Italians exaggerate his position in medical history, while it has undoubtedly made English writers of medical history diminish the importance of his work.

Historians of science consider him worthy to be called the greatest living scientist of his time--the end of the sixteenth century. He was not only a scientific physician, but he was an authority in all the sciences related to medicine, and indeed had profound interests in every branch of physical science. His contemporaries looked up to him as a leader in scientific thought. To anyone who examines the question of the discovery of the circulation of the blood with freedom from bias, there can be no doubt but that the honor for this discovery has been unduly taken away from Caesalpinus in English-speaking countries, to be conferred solely on Harvey. Not that there is any wish to lessen the value of Harvey's magnificent original work, nor make little of his wonderful powers of observation, nor of the marvelous experimental and logical method by which he followed out his thoughts to their legitimate conclusion, but that I would insist on giving honor where honor is due, though most writers in English refuse to give Caesalpinus's claims a proper share of attention.

The Italians have always declared that Caesalpinus was the real discoverer of the circulation, and there is no doubt that his career occurs just at that point in the evolution of the medical sciences, and especially anatomy and physiology in Italy, where this discovery would naturally come. Lest it should be thought, however, that my interest in the Popes and the Papal Medical School has led me to exaggerate the claims of {237} Caesalpinus as a great naturalist and medical scientist, I prefer to quote the description of him given by Professor Michael Foster in his lectures on the History of Physiology, delivered in this country as the Lane Lectures, at the Cooper Medical College in San Francisco, and published by the Cambridge University Press, 1901. Professor Foster was not one to exaggerate the claims of any Italian, and least of all of any Italian who might be supposed to have a claim that would stand against Harvey's. The soupcon of Chauvinism in his treatment of Servetus and Columbus in this regard is indeed rather amusing. He said:--

"Of a very different stamp to Columbus was Andreas Caesalpinus. Born at Arezzo in 1519, he was for many years Professor of Medicine at Pisa, namely, from 1567 to 1592, when he pa.s.sed to Rome, where he became Professor at the Sapienza University and Physician to Pope Clement VIII., and where at a ripe old age he died in 1603.

"If Columbus lacked general culture, Caesalpinus was drowned in it.

Learned in all the learning of the ancients and an enthusiastic Aristotelian, he also early laid hold of all the new learning of the time. Naturalist as well as physician, he taught at Pisa botany as well as medicine, being from 1555 to 1575 Professor of Botany, with charge of the Botanic garden founded there in 1543, the first of its kind--one remaining until the present day."

Professor Foster admits that Caesalpinus had a wonderful power of synthetising knowledge already in hand and antic.i.p.ating conclusions in science that were to be confirmed subsequently. In his Medical Questions, though the work is written in rambling, discursive vein, he enunciated views which, however he arrived at them, certainly foreshadowed or even antic.i.p.ated those which {238} were later to be established on a sound basis. Foster quotes a pa.s.sage in which Caesalpinus made it very clear that he thoroughly understood the mechanism of the circulation and grasped every detail essential to it.

After quoting this pa.s.sage, which it must be confessed is rambling, Foster thus sums up what Caesalpinus has to say with regard to the circulation:--

"He thus appears to have grasped the important truth, hidden, it would seem, from all before him, that the heart, at its systole, discharges its contents into the aorta (and pulmonary artery), and at its diastole receives blood from the vena cava (and pulmonary vein)."

"Again, in his Medical Questions he seems to have grasped the facts of the flow from the arteries to the veins, and of the flow along the veins to the heart."

That there was no change of Papal policy in the next century can be gathered from an interesting phase of Papal interest in science which, though not directly concerned with medicine, eventually resulted in important theoretic advances in medical science. This was the encouragement of Father Kircher's work at Rome. Father Kircher was the Jesuit who made the first scientific museum. As the result of his general interest in things scientific he wrote a little book on the pest. In this book he stated in very clear terms the modern doctrine of the origin of disease from little living things, which he called corpuscles. Because of this Tyndall attributes to Father Kircher the first realization of the role that bacteria play in disease. Even more wonderful than this, however, was Father Kircher's antic.i.p.ation of modern ideas with regard to the conveyance of disease. He insisted that contagious diseases, as a rule, were not carried, as had been thought, by the air, but {239} were conveyed from one person to another, either directly, or by the intermediation of some living thing. He considered that cats and dogs were surely active in conveying diseases, and he even reached the conclusion that insects were also important in this matter. His expressions with regard to this are not of the indefinite character which one often encounters in the supposed antic.i.p.ation of important principles in medicine, but are very precise and definite. Father Kircher is quoted by Dr. Howard Kelly, of Baltimore, in his life of Major Walter Reed, whose work in showing that yellow fever is transmitted by mosquitoes is well known, as saying in one place, "Flies carry the plague," and in another place, "There can be no doubt that flies feed on the internal secretions of the diseased dying, then flying away they deposit their excretions on the food in neighboring dwellings, and persons who eat it are thus infected." It is interesting to find that the Professor of the Practice of Medicine in the Papal University at Rome when this book was published, far from resenting, as many professors of medicine might, the excursion of an outsider into his science, said Father Kircher's book "not only contains an excellent resume of all that is known about the pest or plague, but also many valuable hints and suggestions on the regional spread of the disease which had never before been made." He did not hesitate to add that it was marvelous for a man, not educated as a physician, to have reached such surprising conclusions, which seemed worthy of general acceptance. All this, it may be said in pa.s.sing, was within a few years after the trial of Galileo. In this next century the Popes continued their special efforts to secure the greatest teachers of anatomy and physiology for their Roman medical school. One of the {240} results was the appointment of Malpighi, whose name has deservedly become attached to more structures in the human body because of tissues which he first studied in detail, than any other man in the history of medicine. Malpighi represents the beginning of most of the comparative biological sciences, and his original observations upon plants, upon the lower animals, on fishes and then on the anatomical structure of man and the higher animals, stamp him as an investigating genius of the highest order. He was the personal friend of Innocent XI., who wished to have him near him at Rome as his own medical adviser, and besides desired the prestige of his fame and the stimulating example of his investigating spirit for the students of the medical school of the Sapienza. The closing years of Malpighi's life were rendered happier, and his wonderful researches were as well rewarded as such work can be, by the estimation in which he was held at Rome.

Malpighi was succeeded as Papal Physician and Professor in Rome by Tozzi, who is distinguished in the history of medicine for his commentaries on the ancients rather than for original observation, but who was looked upon in his time as one of the most prominent physicians in Italy. Tozzi had been the Professor of Medicine and Mathematics at the University of Naples, where he became famous. From here he received a flattering invitation to the chair of physic at Padua. In order that he might not desert Naples, his salary was raised and he was given the post of Protomedicus or Chief Physician to the Court. It was after this that the death of Malpighi left an important chair vacant in Rome, and there being no one apparently more worthy than this man for whom other important universities were contending, he {241} was offered the chair on such excellent conditions that he accepted it. It is another case of the Popes being not only willing and even anxious, but also able because of their position, to secure the best talent available for their medical school at the Roman University.

Undoubtedly one of the greatest members of the faculty that the Papal Medical School ever had is Lancisi, one of the supreme medical teachers of history, who is usually considered one of the founders of modern clinical medicine. When at the beginning of the eighteenth century Boerhaave attracted the attention of the world by his bedside teaching of medicine at Leyden, there were two occupants of thrones in Europe who proved to have particular interest in this new departure.

They were perhaps the last two who might ordinarily be expected to have much use for such improvements in medical education. One of them was the Empress Maria Theresa, of Austria, whose patronage of Boerhaave 's pupil, Van Swieten, secured the establishment of that system of clinical teaching which has since made the Vienna Medical School famous. The other was the Pope. With his approbation Lancisi established clinical teaching at Rome, and thus did much to maintain at Rome a great center of medical progress during the eighteenth century.

Lancisi was graduated at the Sapienza, the Roman University, at the early age of eighteen. When only twenty-two he became a.s.sistant physician at the Santo Spirito Hospital and began to show the first hint of the brilliant genius he was to display later in life.

Some ten years later, as the result of a compet.i.tive examination which still further demonstrated his talents, he was chosen Professor of Anatomy in his Alma Mater, {242} the Sapienza. He was only thirty-three at the time, and the fact that he should be chosen shows that the Papal University was ready to take advantage of talent wherever it found it and did not allow itself to be won only by notoriety at a distance. The excellence of the choice was demonstrated before long by Lancisi's brilliant career as a teacher and an original investigator. Some of the most distinguished medical men from all over the world came to listen to his lectures (according to Hirsch's Biographical Lexicon of the Most Prominent Physicians of All Times and Peoples), and even Malpighi and Tozzi, the Papal physicians during the time, were among his auditors. [Footnote 29]

[Footnote 29: Most of these details are taken from Hirsch's Biographisches Lexicon der hervorragenden Aertzte aller Zeiten und Volker. Wien und Leipzig, 1886.]

After the departure of Tozzi from Rome Lancisi became the Papal physician. He continued to be the medical adviser of Popes Innocent XI. and XII. and of Clement XI. until his death in 1720. It was under Clement that he had the new clinic built, in which teaching after the manner of Boerhaave was to be established. At his death Lancisi left his fortune and his library to Santo Spirito Hospital, on condition that a new portion of the hospital should be erected for women. There is no doubt that he belongs among the most distinguished of contributors to medical science, and Hirsch declares that anatomy, practical medicine, and hygiene are indebted to him for notable achievements. His books are still cla.s.sics. The one on Sudden Death worked a revolution in the medical diseases of the brain and heart.

His work _De Motu Cordis et Aneurysmatibus_ has been p.r.o.nounced epoch-making, and his suggestion of percussion over the sternum in order to {243} determine the presence of an aneurysm, made him almost an antic.i.p.ator of Auenbrugger and prompted Morgagni's famous book _De Sedibus et Causis Morborum_, which appeared after his death. Lancisi's work on Aneurysms was not published until after his death.

Two others of his books deserve mention because they show how broad were the interests of the man in many phases of progress in medicine.

Their t.i.tles are Diseases and Infections of Domestic Animals and The Climate of Rome.

The next great name in Italian medicine is that of Morgagni. He was not a regular Papal physician, nor a member of the faculty of the Papal Medical School, but he was often consulted, as we told in the chapter on Papal Physicians, both as to the health of the Popes and the methods of teaching at the Roman Medical School. His life brings us down almost to the nineteenth century, and the cordial relations of the Popes to him, far from being an exception in the history of medicine, are only typical of the att.i.tude of the Roman Pontiffs to medical and all other scientists from the dawn of the history of science in modern times.

While the Papal Medical School at Rome, attached to the university of the city and directly under the control of the Papal Curia, more especially deserves the name thus given it, it must not be forgotten that there was in the Papal States a series of medical schools in various cities. One of these, at Perugia, founded by a bull of Pope John XXII., has come under consideration in the chapter on A Papal Patron of Medical Education. Another medical school, that of Ferrara, which also was in the Papal States, had considerable prestige. Some distinguished professors taught there before going to {244} Padua or Bologna. At the beginning of the sixteenth century, Bologna, after having been during the preceding three centuries under the domination of one powerful family or another, from the Pepoli to the Bentivogli, and then to the Visconti and back again to the Bentivogli, was incorporated in the Papal States under Pope Julius II. At this time the Medical School of Bologna was at the height of its reputation and was one of the two greatest medical schools in Italy. Padua was its only rival. Shortly after this Rome became a serious compet.i.tor in medical education. Practically, then, this was a second Papal medical school, almost as directly under the control of the Popes as the Roman Medical School. Far from there being any diminution in the glory or the efficiency of the Bolognese Medical School, its reputation even became enhanced after the city came under the control of the Popes.

This is all the more surprising because, as we have shown, just about this time the Popes began the work of making their Medical School at Rome the most important center for medical education, especially in the scientific phases of medicine--anatomy, physiology, and comparative anatomy--that there was at that time in the world. In spite of this rivalry, however, nothing was done directly to hurt the prestige of the school of Bologna, and indeed the rivalry seems to have been more of an encouraging compet.i.tion than in any sense a destructive struggle for existence. When the Popes took possession of Bologna, Alexander Achillini was professor of anatomy and medicine in the Bolognese school, and his discoveries and methods of investigation attracted the attention of students from all over the world. His a.s.sistant for many years and his successor in the {245} post was Berengar of Carpi, of whom we have already said much in the chapter Anatomy Down to the Renaissance. For some time Vesalius lectured on medicine and anatomy at Bologna, and one of Berengar's most distinguished successors in the sixteenth century was Aranzi, who occupied the post of anatomical professor for thirty-two years and who corrected a number of errors in anatomical detail that had been made by Vesalius and others of the preceding generation. He confirmed Columbus's discoveries at Rome with regard to the course which the blood follows in pa.s.sing from the right to the left side of the heart, and made many important additions to the knowledge of the anatomical relations of the cavities of the heart, the valves, and the great blood vessels. There are a number of important structures in the brain which owe their names to him, and his descriptions of them are better, according to Prof. Turner, than those of other anatomists for a century after his time.

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 Fraca.s.sati, 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, Fraca.s.sati, Capponi, and Ma.s.sari, 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 a.s.sumed was taken quite seriously by succeeding generations, until at length a whole body of historical traditions, utterly unfounded in fact, acc.u.mulated, 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 surpa.s.sed 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 a.s.sertion. 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 inst.i.tution 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 inst.i.tution to the fatherly watchfulness, the kindly foresight, and the very practical charity of one of the greatest of the Popes, whose name is usually a.s.sociated 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 inst.i.tution for the care of the sick in Europe at that time. Almost by common consent he was a.s.sured that the most successful hospital management was to be found at Montpelier. This French town near the sh.o.r.es of the Mediterranean had succeeded to the medical prestige formerly held by Salerno, and was now the favorite place of pilgrimage for the n.o.bility 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 inst.i.tution 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 circ.u.mstances, 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, Munchen, 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, Lubeck, 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, Konigsberg, 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.

[Ill.u.s.tration: Holy Ghost Hospital (Lubeck)]

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 Pet.i.t 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 doc.u.ments 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 doc.u.ments, 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 b.u.t.terfly 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 inst.i.tutions 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 inst.i.tutions 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 dest.i.tute 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 inst.i.tutions 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.