There had been an organized system of poor-relief in every parish at least since the eleventh century…St Riquier, for example, served more than five hundred meals each day; Corbie distributed fifty loaves; while Cluny kept an annual reserve of five hundred sides of salt pork for the use of the poor. […]

Thus, by the conjoint efforts of the hierarchy, the new [religious] Orders, and private generosity, there came into being a host of charitable institutions…[T]heir character was always markedly religious; the staff consisted of men or women dedicated to God and styled ‘brothers’ or ‘sisters,’ who, even if they belonged to no recognized congregation, followed a Rule inspired in most cases by that of the Hospital of St John of Jerusalem, and were almost always governed by a cleric, priest or monk. The majority of hospitals were vast buildings – that of Milan was renowned for its beauty – where the sick, the infirm, and the aged alike were received and cared for. […]

Abandoned children, according to ecclesiastical law, were to be laid at the door of a sanctuary or religious house as a precaution against their being killed. They had their own hospital, run by the Order of the Holy Ghost, or were sheltered by Hospitallers of Jerusalem who had left their normal duties in Palestine so as to carry on this holy work in Europe. Some of these children’s hospices were enormous, and the inmates were looked after until they reached adult age, when work was found for the boys and a dowry provided for those girls who did not wish to take the veil.

Henri Daniel-Rops, Cathedral and Crusade: Studies of the Medieval Church (1050-1350) 


A hospital movement, quite distinct from that of Innocent III., which attracted so much attention shortly after the general hospital became common as to deserve particular consideration, was the erection of the leproseries or special institutions for the care of lepers. Leprosy had become quite common in Europe during the Middle Ages, and the continued contact of the West with the East during the crusades had brought about a notable increase of the disease. It is not definitely known how much of what was called leprosy at that time, really belonged to the specific disease now known as lepra. There is no doubt that many affections, which have since come to be considered as quite harmless and non-contagious, were included under the designation leprosy by the populace and even physicians incapable as yet of making a proper differential diagnosis. Probably severe cases of eczema and other chronic skin diseases, especially when complicated by the results of wrongly directed treatment or of lack of cleansing, were not infrequently pronounced to be true leprosy.

There is no doubt at all, however, of the occurrence of real leprosy in many of the towns of the West from the twelfth to the fifteenth centuries, and the erection of these hospitals proved the best possible prophylactic against the further spread of the disease. Leprosy is contagious, but only mildly so. Years of intimate association with a leper may, and usually do, bring about the communication of the disease to those around them, especially if they do not exercise rather carefully, certain precise precautions as to cleanliness after personal contact or after the handling of things which have previously been in the leper’s possession. As the result of the existence of these houses of segregation, leprosy disappeared during the course of the next three centuries, and thus a great hygienic triumph was obtained by sanitary regulation.

This successful sanitary and hygienic work, which brought about practically the complete obliteration of leprosy in the Middle Ages, furnished the first example of the possibility of eradicating a disease that has once become a serious scourge to mankind. That this should have been accomplished by a movement that had its greatest source in the thirteenth century is all the more surprising, since we are usually accustomed to think of the people of the times as sadly lacking in any interest in sanitary matters. The role of the Popes in the matter is another striking feature well worthy of note. The significance of the success of this segregation method was lost upon men down almost to our own time. This was unfortunately because it was considered that most of the epidemic diseases were conveyed by the air. They were thought infectious and due to a climatic condition rather than contagious, that is, conveyed by actual contact with the person having the disease or something that had touched him, which is the view now held. With the beginning of the crusade against tuberculosis in the later nineteenth century, however, the most encouraging factor for those engaged in it was the history of the success of segregation methods and careful prevention of the spread of the disease, which had been pursued against leprosy. In a word, the lessons in sanitation and prophylaxis of the thirteenth century are only now bearing fruit because the intervening centuries did not have sufficient knowledge to realize their import and take advantage of them.

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

During the Civil War, hospitals required a large number of laundresses. The surgeon in charge decided whether the laundresses worked on hospital grounds or if they took the hospital laundry back to their tents. If the laundresses worked on the grounds, shelter might consist of buildings, tents, sheds, or trees. A Confederate surgeon in Kingston, Georgia, did not provide his laundresses with any facilities at all. Because his grandmother and mother always washed outside with no shelter, he expected his laundresses to do the same and gave them no protection from the weather. […]

Laundresses were often pressed into service to nurse the sick and wounded. This was particularly true during the Civil War. Laundresses from both the North and the South assumed nursing duties in the field and in hospitals. After a battle, when a large number of wounded suddenly needed care, laundresses were pressed into duty as nurses. Few laundresses received recognition for nursing, but they did what needed to be done.

Jennifer J. Lawrence, Soap Suds Row: The Bold Lives of Army Laundresses, 1802-1876 (2016)

It is of curious interest, though not surprising, to find that in the midst of the organization of new hospitals and reorganization of old hospital foundations in the thirteenth century, attempts were made to correct abuses which still continue to be some of the thorny problems of hospital management. For instance, the danger was recognized of having the expenses of administration outrun those of the hospital proper, and of having the number of attendants, or at least of persons living upon the hospital revenues, greater than was absolutely needed for the care of patients. There are various Papal decrees and decisions of diocesan synods in this matter. Pope Honorius III., who occupied the Papal See from 1216 to 1227, and must be considered as a very worthy successor of the first great Pope of the century, Innocent III., in approving the union of two hospital foundations at Ghent, required that only a certain limited number of Brothers and Sisters for nursing purposes should be received, in order that the community expenses proper might not impair to too great a degree the resources of the hospital for its real purpose of taking care of patients. Previously, he had insisted by a decree that the number of Brothers and Sisters in the hospital community at Louvain should not exceed the proportion of more than one to nine of the patients. Synodal decrees in various bishoprics allowed only board and clothing, but nothing more, to attendants in hospitals. In the thirteenth century the personal satisfaction of accomplishing a charitable work in attendance upon the sick was expected to make up for any further remuneration.

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

Probably the most interesting feature of the early history of the hospital movement is the spirit of evolution to meet growing needs and developing ideals which it manifested. In spite of the judicious consideration devoted to the establishment of the original hospital of the Holy Ghost at Rome, it was not long before it proved inadequate for its purpose. One of the eminently noteworthy things that constantly repeat themselves in history is that where a social need is discovered and a remedy found for it, it is not long before the need increases to such a degree as to outstrip the original remedy. Before half a century had passed Innocent’s successors declared in unmistakable terms that the original hospital was entirely too cramped and crowded.

Accordingly, a much larger and handsomer building was erected. Visitors to Rome admired the new building, and it proved an incentive for larger plans for hospitals in other important cities. At the end of the thirteenth and the beginning of the fourteenth centuries some really imposing edifices were erected as hospitals, especially in towns of Italy. It was at this time that the artistic Italian mind seems to have realized the truth, which has only come to be recognized again in quite recent times, that a hospital building should be as fine a structure as the finances of a city will permit. It was felt that nothing was too good for the ailing citizens and that the city honored itself by making its public buildings a monument of artistic purpose. The earliest example of how well this was accomplished is to be found at Siena, whose hospital continues to be down to the present time one of the most interesting objects of admiration for the visitor…The hospital movement of the thirteenth century, however, culminated in monuments as famous and as architecturally beautiful as any that have been built in recent years.

…It is typical of the times in many ways. We have only just begun again in very modern times, as we have already said, to consider that some of the best of our buildings in any large city should be those intended for the sick and the poor of the community. The city must respond nobly to its civic duties. The idea, however, came so naturally to the medieval mind that apparently there was no question about it. Only in very recent years has come the additional thought that these buildings must be appropriately decorated, and that the work of the greatest artists of the time can have no better place for its display than the walls of a hospital or a great charitable institution. Bartolo’s frescoes, on the walls of the hospital at Siena, tell the story of the work that was done for foundlings and pilgrims as well as for the sick in the early days of its establishment. The first picture of the series represents the baptism of the children that had been picked up and brought to the hospital.

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

It might perhaps be thought that these hospitals of the Middle Ages would be of very little interest to the modern student of things social and medical except for the fact, surprising enough in itself at this time of supposed neglect of social duties, when the paternal spirit of the municipality is presumed scarcely to have developed as yet, that such institutions were provided. It would ordinarily be assumed that they were, in accordance with the lack of knowledge of the time as regards the influence of light and air on the ailing, dingy and unventilated, lacking most of the qualities that distinguish our modern hospital.

As a matter of fact, however, just as our architects go back to the Middle Ages to get models for our churches and municipal buildings, and even our millionaires’ palaces and public institutions, they also find that in the matter of hospitals much valuable guidance is to be obtained from what was accomplished by these people of the Middle Ages, of whom we ordinarily think so little. Mr. Arthur Dillon, an architect, writing in the “Mail and Express” for May 7th, 1904, described the hospital founded by Marguerite of Bourgogne, the sister of St. Louis, at Tanierre in France in 1293. It consisted of a ward, a building attached to it by a covered passage in which Marguerite herself lived for many years, and separate buildings for kitchens, for storage of provisions and for the lodging of the twenty monks and nuns who had charge of the sick. A feature that perhaps we would not admire very much, was that adjacent to the buildings there was a cemetery. They were not so fearful about death in the Middle Ages, however, as we are apt to be; and who shall say that the contemplation of it did not often give that restful sense of submission to whatever would come, that sometimes means so much in serious illness, and keeps the patient from still further exhausting vitality by worrying as to the outcome? The medicine was stronger than our degenerate generation might be able to bear, but then all their medicines were apt to be stronger in that time.

The situation of the hospital might well be thought ideal. The princess had gardens about her lodging, and the whole property was surrounded by a high wall, along which flowed the branches of a small stream, which doubtless tempered the atmosphere and served as a carrier off of much undesirable material. The hospital ward itself was 55 feet wide and 270 feet long and had a high arched ceiling of wood. It was lighted by large pointed windows high up in the walls. At the level of the window-sills, some twelve feet from the floor, a narrow gallery ran along the wall, from which the ventilation through the windows might be readily regulated and on which convalescent patients might walk or be seated in the sunshine. The beds were placed each in a little room formed by low partitions. Privacy was thus secured much better than in the modern hospital wards, and as there were only forty beds, the ventilation was abundant.

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

The regulations for the admission and care of patients are interesting as showing how much these medieval institutions tried to fulfill the ideal of hospital work. The people of the Middle Ages had not as yet suffered all the disillusionments that come from the abuse of charity at the hands of those who least deserve help, and besides, the attendants at the hospitals were expected to do their work for its own sake and from the highest motives of Christian benevolence rather than for any lesser reward. At the beginning, at least, there seems to be no doubt that this lofty purpose was accomplished very satisfactorily; but men and women are only human, and after a time there was deterioration. Even Virchow, however, was so struck by the ideal conditions that existed in these early hospitals that he discussed the necessity for having in modern times hospital attendants with as unselfish motives as those of the medieval period. It seems worth while then to give some of the details of this supremely Christian management of hospital work.

In an article on the medieval hospitals in the Dublin Review for October, 1903, Elizabeth Speakman quotes from the statutes of various hospitals sufficient to show how the internal government of these charitable institutions was regulated. There was always a porter at the main door, usually one of the Brothers or Sisters, who had the power to receive patients applying for admission. At certain places, however, it seems to have been necessary to inform the superior; and the statutes of the French Hospital at Angers say, that the prioress is to go herself without delay to receive patients or to send one of the Sisters for that purpose, “not severe or hard, but kind of countenance.” At the same place the statutes say, “the number of the sick is not to be defined, for the house is theirs, and so all indifferently shall be received as far as the resources of the house allow.”

From many of the hospitals members of the community were sent out from day to day to find out if there were any lying sick who needed care and who should be sent to the hospital. They were expected also to pick up any of the infirm whom they might find along the streets and bring them to the hospital.

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

Indeed, Virchow’s tribute to Pope Innocent III. as the initiator of all this humanitarian work is so frank and outspoken that, coming as it does from a man whose sympathies with the Papacy were well known to be the slightest, it deserves to be recalled in its completeness, in order that another factor for the vindication of Innocent’s character may be better known. The great pathologist said:

“The beginning of the history of all of these German hospitals is connected with the name of that Pope who made the boldest and farthest-reaching attempt to gather the sum of human interests into the organization of the Catholic Church. The hospitals of the Holy Ghost were one of the many means by which Innocent III. thought to hold humanity to the Holy See. And surely it was one of the most effective. Was it not calculated to create the most profound impression to see how the mighty Pope, who humbled emperors and deposed kings, who was the unrelenting adversary of the Albigenses, turned his eyes sympathetically upon the poor and sick, sought the helpless and the neglected upon the streets, and saved the illegitimate children from death in the waters! There is something at once conciliating and fascinating in the fact, that at the very time when the fourth crusade was inaugurated through his influence, the thought of founding a great organization of an essentially humane character, which was eventually to extend throughout all Christendom, was also taking form in his soul; and that in the same year (1204) in which the new Latin Empire was founded in Constantinople, the newly erected hospital of the Holy Spirit, by the old bridge on the other side of the Tiber, was blessed and dedicated as the future centre of this organization.”

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

It is no wonder, with all this activity of the hospital foundation movement, that Virchow should have been unstinted in his praise of the Pontiff and of the Church responsible for the great charity. He said: “It may be recognized and admitted that it was reserved for the Roman Catholic Church, and above all for Innocent III., not only to open the bourse of Christian charity and mercy in all its fulness, but also to guide the life-giving stream into every branch of human life in an ordered manner. For this reason alone the interest in this man and in this time will never die out.”

Even this was not all that he felt bound to say, and in his admiration he quite forgot the constant opposition he manifested toward the Papacy on all other occasions. This happened to be the one feature of Papal influence and endeavor that he had investigated most thoroughly, and one is tempted to wonder if like investigation in other directions would not have shown him the error of prejudiced views he harbored with regard to other phases of the beneficent influence of the Popes in history. More knowledge is all that is needed, as a rule, to overcome all the anti-Papal prejudices founded on supposed historical grounds.

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

Accordingly, the Pope extended an invitation which, under the circumstances, 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.

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