The century of Columbus

by James J. Walsh

Many of the habits worn by the religious who were devoted to nursing had certain features that made them much more hygienic for patients than ordinary feminine dress. As a rule, they were very simple, often made of washable materials, the head was always covered and spotless white was worn around the shoulders and at the wrist. This was sufficient of itself to keep constantly in mind the necessity for scrupulous cleanliness. Dirt showed very readily. When the nurses, or at least those who had the main duties to perform, came of refined families and wore these habits there could have been no neglect of cleanliness.

The best possible evidence for the proper appreciation of the place of hospitals in life at this time is to be found in Sir Thomas More's account of the hospitals in Utopia. It must not be forgotten that he was travelling in Flanders when he wrote it. He pictures the people of his ideal republic as possessed of fine large hospital buildings, providing ample accommodations so that even in times of epidemic there need be no danger of contagion and abundantly supplied with all that is necessary for the care of the ailing. The standard was not what was good enough for the ailing poor, but what was worthy of the dignity of the city caring for its citizens. The proof of the completeness of their arrangements for the care of patients is to be found in the added declaration that practically everyone who was sick preferred to go to the hospital rather than to be cared for at home. This is the condition of affairs which is now developing among us again, [{201}] after a long interval, during which hospitals were the dread of the poor and the detestation of those who had to go to them. The whole passage is extremely interesting for this reason:

"But they take more care of their sick than of any others; these are lodged and provided for in public hospitals. They have belonging to every town four hospitals, that are built without their walls and are so large that they may pass for little towns; by this means, if they had ever such a number of sick persons, they could lodge them conveniently, and at such a distance that such of them as are sick from infectious diseases may be kept so far from the rest that there can be no danger of contagion. The hospitals are furnished and stored with all things that are convenient for the ease and recovery of the sick; and those that are put in them are looked after with such tender and watchful care, and are so constantly attended by their skilful physicians, that as none is sent to them against their will, so there is scarce one in a whole town that, if he should fall ill, would not choose rather to go thither than lie sick at home."

The spirit of the century and its power of organization of charity and good works is well expressed by the foundation of the Brothers of Mercy in Spain, in 1538, by a Portuguese soldier who had been wounded in battle, as was not infrequent in those days, and vowed to devote his life to God if he recovered. He rented a small house in Granada, where he gathered together a number of sick people and nursed them with the greatest care. In order to support them he went through the streets in the evening with a basket begging for his patients. After a time others came and joined him in his good work. Alms boxes were placed here and there through the city to remind people of the help that was needed. Gradually the scope of their work increased, they were given charge of hospitals, they visited the sick at their homes and the order spread not only over Europe but throughout the Spanish-American countries on this continent. Within a hundred years after the foundation the annual number of patients under their care was said to have been some two hundred thousand. A number of houses of the order was [{202}] founded in Italy, and over their alms boxes down there the sign was, Fate bene, fratelli, (Do good, little brothers). From this sign they came to be known as the Fate Bene Fratelli, the Do Good Little Brothers.

The proper care of the insane is usually looked upon as a very modern phase of humanitarian evolution. Most people think that until the last hundred years the insane have been hideously neglected, when not treated with absolute barbarity, and that the rule has been simply to put them away so that they could not injure themselves or others, confining, manacling, and otherwise hampering their activities, regardless of their health or the mental effect on them. In this once more, as in most of the historical ideas with regard to humanitarian development, the erroneous notions are due to the fact that the care for the insane was at its lowest point during the eighteenth and the early part of the nineteenth century, and that there has been a magnificent improvement since, though it must not be forgotten that there has not been a single generation since when there have not been very serious complaints deservedly uttered of awful neglect of the insane in some part of the civilized world. We have had revelations with regard to the care of the insane in the country districts of even our Eastern States which have been almost incredible. The conditions that we have come to learn as existing in the South in the care of the insane, which have been brought to light by the recent investigation of pellagra, have been of a similar character. The epithet mediaeval which is applied so often to these conditions is absolutely unwarranted by our present knowledge of old-time care of the insane.

It has been concluded that, since care for the insane was so neglected in the eighteenth century, it must have been almost infinitely worse in preceding centuries. The same fallacy lies at the root of a great many false impressions with regard to mediaeval and Renaissance history. The eighteenth was the lowest of centuries in art, literature, education, and humanitarian purpose. The preceding centuries exhibit some very interesting developments of care for the insane, some of which anticipate our most modern ideas. At Gheel in [{203}] Belgium, from the earlier Middle Ages, they cared for defectives on the village plan. Similar institutions were not infrequent. They developed the "open door" system of caring for the insane and insane institutions were mainly in connection with monasteries, well out in the country, and under good conditions, since they were never crowded. It is always crowding that brings serious abuses with it and leads to what seems to be barbarity, but is really an inability to cope with the large problem with inadequate means.

It so happened that just before the beginning of Columbus' Century there was a special development of care for the insane and the opening of a series of hospitals that represent an epoch in the history of care for these poor people. The most important part of this development of the fifteenth century occurred in Spain. Asylums were founded at Valencia, Saragossa, Seville, Valladolid and Toledo. This movement has sometimes been attributed to Moorish or Mohammedan influence, but even Lecky, in his "History of European Morals," has rejected these assertions which are absolutely without proof. Spain continued to be the country in which lunatics were best cared for in Europe down to the beginning of the nineteenth century. Pinel, the great French psychiatrist who struck the manacles from the insane of France, declared Spain to be the country in which lunatics were treated with most wisdom and most humanity. In his book on "Mental Alienation" he gives some details of the treatment which show a very modern recognition of the need to be gentle and careful of the insane rather than harsh and forceful.

In England a rather important development of care for the insane occurred during this century in connection with Bedlam Hospital, London. This, originally founded as a home for the suffering poor, as its name Bethlehem (house of bread) implies, whether they had any specific ailment or not, came after a time to be a hospital, and then as a further development confined its care to the insane. Tyndale is the first to use the word Bedlam as meaning a madhouse or a madman, so that the conversion had evidently taken place in his time. One very interesting custom developed which serves to show the mode of treatment practised. A "bedlam" came to [{204}] signify one who had been discharged from this hospital with the license to beg. After recovery from their acute conditions the insane were allowed to go out on condition, if there was no one to care for them, that they wore a tin plate on their arms as a badge to indicate that they had been for a time in the asylum. This tin plate aroused the sympathy of those they met and they were helped in various ways by the people of the time. Besides, it served as a warning that, since such people had been for a time in the asylum, they were not to be irritated nor treated quite as other folk, but on the contrary to be cared for. They were known as bedlamers, bedlamites or bedlam beggars. They were treated so well that tramps and other beggars of various descriptions obtained possession of badges and abused the confidence of the public.

After Henry VIII's time Bedlam, which had been a religious institution, passed under the care of the state, and from this time on the story of abuses of all kinds is repeated at successive investigations in every other generation. Evelyn, in his "Diary of 1656," notes that he saw several poor creatures in Bedlam in chains. In the eighteenth century it became the custom for those seeking diversion and entertainment to visit Bedlam and observe the antics of the insane patients as a mode of amusement. This was done particularly by the nobility and their friends. A penny was charged for admission into the hospital, and there is a tradition that at one time an annual income of £400 accrued from this source. This would mean that one hundred thousand people had visited the hospital in the course of a year. Some of Hogarth's pictures show the hospital being visited in this way by fashionable ladies.

In Rome the Popes, recognizing the superiority of the care for the insane as practised in Spain and in Navarre, opened a Pazzarella at Rome in the sixteenth century under the care of three Navarrese. This hospital for the insane "received crazed persons of whatever nation they be and care is taken to restore them to their right mind; but if the madness prove incurable they are kept during life and have food and raiment necessary to the condition they are in." Evidently they [{205}] looked for improvement in many cases and expected to allow the patients to leave the asylum at least for a time, though if their alienation continued they were kept. Just about the end of Columbus' Century a Venetian lady of wealth, evidently attracted by the kind of care given the insane, "was moved to such great pity of these poor creatures upon sight of them that she left them heirs to her whole estate. This enabled the management with the approbation of Pope Pius IV to open a new house."