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 HOSPITALS

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HOSPITALS

as oil, wheat, and salt; by regular contributions from charitable associations; and by the income from churches under its control. In many instances the diocesan laws obliged each of the clergy, especially the canons, to contribute to the support of the hos- pital. The laity also gave liberally either to the general purposes of the hospital or to supply some .special need, such as heating, lighting, or providing for the table. It was not uncommon for a benefactor to donate one or more beds or to establish a life- annuity which secured him care and treatment. The generosity of the hospital and its patrons was frequently abused, e. g. by malingerers or tramps {validi vagranles), and stricter rules concerning ad- mission became necessary. In some cases the num- ber of attendants was excessive, in others the hospital was unable to provide a separate bed for each patient. In spite of these drawbacks, " we have much to learn from the calumniated Middle Ages — much that we, with far more abundant means, can emulate for the sake of God and of man as well' ' (Virchow, " Abhandl.", II, 16).

Post-Reformation Period. — The injury inflicted upon the whole system of Catholic charities by the upheaval of the sixteenth century, was disastrous in many ways to the work of the hospitals. The dis- solution of the monasteries, especially in England, deprived the Church in large measure of the means to support the sick and of the organization through which those means had been employed. Similar spoliations in Germany followed so rapidly on the introduction of the new religion that the Reformers themselves found it difficult to provide anything like a substitute for the old Catholic foundations. Even Luther confessed more than once that under the papacy generous provision had been made for all classes of suffering, while among his own followers no one contributed to the maintenance of the sick and the poor (.Sammtl. Werke, XIV, 389-390; XIH, 224- 225). As a result, the hospitals in Protestant coun- tries were rapidly secularized, though efforts were not wanting, on the part of parish and municipality, to provide funds for charitalile purpo.ses (Uhlhorn, III).

The Church meanwhile, though deprived of its necessary revenues, took energetic measures to re- store and develop the hospital system. The human- ist J. L. Vives (De subventione pauperum, Bruges, 1526) declared that by Divine ordinance each must eat his bread after earning it by the sweat of his brow, that the magistrates should ascertain by census who among the citizens are able to work and who are really helpless. For the hospitals in particular, Vives urges strict economy in their administration, better pro- vision for medical attendance and a fairer apportion- ment of available funds whereby the surplus of the wealthier institutions should be assigned to the poorer. Vives's plan was first put into execution at Ypres in Belgium and then extended by Charles V to his entire empire (1531).

Still more decisive was the action taken by the Council of Trent which renewed the decrees of Vienne and furthermore ordained that every person charged with the administration of a hospital should be held to a strict account and, in case of inefficiency or irregularity in the use of funds, should not only be subject to ecclesiastical censure but should also be removed from office and obliged to make restitirtion (Session XXV, c. viii, De Reform.). The most im- portant, however, of the Tridentine decrees was that which placed the hospital under episcopal control and proclaimed the right of the bishop to visit each institution in order to see that it is properly managed and that every one connected with it discharges his duties faithfully (Session XXII, c. viii, De Reform.; Session VII, c. xv, De Reform.). These wise enact- ments were repeated by provincial and diocesan synods throughout Europe. In giving them practical

effect St. Charles Borromeo set the example by found- ing and endowing a hospital at Milan and by obliging hospital directors to submit reports of their adminis- tration. He also determined the conditions for the admission of patients in such wise as to exclude unde- serving applicants (First Council of Milan, part III, c. i, in Harduin, X, 704). At Rome, the principal foundations during this period were: the hospital established by the IBenfratelli in 1.5S1 on the island in the Tiber where the ^Esculapium of pagan Rome had stood; the hospital for poor priests founded by a charitable layman, Giovanni Vestri (d. 1650); that of Lorenzo in Fonte (1624) for persons who had spent at least fourteen years in the service of the popes, cardinals, or bishops; that of San Gallicano for skin diseases, erected by Benedict XIII in 1726.

In France the control of the hospitals had already passed into the hands of the sovereign. Louis XIV established in Paris a special hospital for almost every need — invalids, convalescents, incurables etc., besides the vast " hospital general" for the poor. But he withstood the efforts of the episcopate to put in force the Tridentine decrees regarding the superin- tendence and visitation of the hospitals. On the other hand, this period is remarkable for the results accom- plished by St. Vincent de Paul, and especially by the community which he founded to care for the poor sick, the Sisters of Charity (q. v.). Since the Refor- mation, indeed, women have taken a more prominent part than ever in the care of the sick; over a hundred female orders or congregations have been established for this purpose (see list in Andr6- Wagner, " Diet, de droit canonique", Paris, 1901, II, s. v. Hospitaliers; also articles on the different orders in The Catholic Encyclopedia).

A noteworthy attempt at reform during the eigh- teenth century was that of the Hotel-Dieu at Paris under Louis XVI. This hospital, which usually had 2400 patients and at times 5000, had long suffered from overcrowding, poor ventilation, and neglect of the patients. To remedy these defects, a commission was appointed including Tenon, Lavoisier, and Laplace. The principal recommendation contained in their report (1788) was the adoption of the pavilion sys- tem modelled on that of the hospital at Pljinouth, England (1764). The French Revolution, however, intervened and it was only during the nineteenth century that the needed improvements were intro- duced. In the other European countries, meanwhile, there had been many new foundations: in England, Westminster (1719), Guy's (1722), St. George's (1733) ; in Germany, the Charit6 at Berlin established by Frederick I (1710) and the hospital at Bamberg, by Bishop Franz Ludwig von Erthal (1789); in Austria the General Hospital at Vienna, promoted by Joseph II, 1784.

America. — The first hospital was erected befcre 1524 in the City of Mexico by Cortes, in gratitude, as he declared in his will, "for the graces and mercies God had bestowed on liim in permitting him to dis- cover and conquer New Spain and in expiation or satisfaction for any sins he had committed, especially those that he had forgotten, or any burden these might be on his conscience for which he could not make special atonement". It was called the Hospital de la Purlsima Concepcion, later of Jesus Nazareno, after a neighbouring shrine. It is still in existence and its superintendents are appointed by the descen- dants of Cortes, the Dukes of Terranova y Mon- teleon. Clement VII by Bull of 16 April, 1529, conferred on Cortes the perpetual patronage of this and other similar institutions to be founded by him. Within the first decade after the Conquest, the Hos- pital of San Lazaro was founded with accommodation for 400 patients, and the Royal Hospital, also in the city of Mexico, was established by a decree of 1540. The law of 1541 ordered hospitals to be erected in all