The earliest city hospitals that we know of were due to the fatherly care and providence of that great Pope, Innocent III., whose pontificate (1198-1213) has been more misunderstood than perhaps any corresponding period of time in history…It was in connection with these hospitals founded by Pope Innocent III., or the result of the movement initiated by him, that the insane were cared for at first. This may seem to have been an undesirable method, but at the present time there is an almost universal demand on the part of experts in mental diseases for wards for the mentally diseased in connection with city hospitals, because admission is thus facilitated, treatment is begun earlier, the patient is not left in unsuitable conditions so long, friends are readier to take measures to bring the patient under proper treatment and surveillance, and, as a consequence, more of the acutely insane have the course of their disease modified at once, and more cures take place than would otherwise be possible. Of course, this was not the idea of the original founder of the medieval hospitals, or even the conscious plan of those who were in charge. They had to take the mentally infirm because there was nowhere else for them to go at that time. As a matter of fact, however, their simple method of procedure was better in the end for the patient than is our more complex method of admission to insane asylums, with its disturbing necessity for formal examination of the patient under circumstances that are likely to increase any excitement that he may be laboring under. And the transfer to an institution bearing the dreaded name of asylum, or even sanitarium (for that term has taken quite as ominous a meaning in recent years) is sure to aggravate the patient’s irritated state, and to exaggerate symptoms which might otherwise be relieved by prompt, soothing care, and by the consciousness that his ailment is being treated rather than that he himself is being placed in durance.

An examination of the methods for the care of the insane in the Middle Ages brings out clearly the fact, that the modern generation may learn from those old Catholic humanitarians, whose hearts and whose charity served so well to make up for any deficiencies of intellect or of science the moderns would presume them to have labored under. There are said to be three great desiderata for the intelligent care for the insane:

First: The open door system, permitting patients who are not violent, and who can be trusted even though they have many queer notions, to come and go at will.

Second: The after care treatment of those who have been insane, to the end that they may not be compelled to go back to strenuous lives of toil; and above all, that they may not be forced into the too harrassing conditions of which their mental breakdown originally was born.

Third: A colony system by which patients of lowered intelligence may be cared for in the country, far away from the stress of city life, and where, without the cares of existence pressing upon them, they may be surrounded by gentle, patient, kindly friends who will make every allowance for their peculiarities and strive to help them in their up-hill struggles.

These desiderata are so absolutely modern that they have only been formulated definitely with the beginning of the twentieth century.

James J. Walsh, The Popes and Science (1908)

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