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 [{260}] 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. The attitude which the religious attendants at the hospitals were to assume toward the patients upon whom they wait is clearly stated. In nearly all of the French hospitals of the thirteenth century, at least, the statutes in this matter do not differ much from this specimen:
"When the patient arrives he shall be received thus: First, having confessed his sins to the priest, he shall be communicated religiously and afterward be carried to bed and treated there as our Lord, according to the resources of the house; each day, before the repast of the brethren, he shall be given food with charity, and each Sunday the epistle and gospel shall be read and aspersion with holy water made with procession."
As is noted by Miss Speakman, all through the hospital statutes of these times the name of Masters or Lords is applied to the patients. The expression in Old French is Les Seignors Malades. The ordinary name for hospital was Maison Dieu, which has been well translated "God's Hostelry." It is evident, then, though the origin of the phrase "Our Lords the Poor," as applied to hospital patients, has been said to be obscure, that it is only a re-echo of the scriptural expression, "Whatsoever ye shall do, even to the least of these, behold ye do it unto Me." A quotation which was emphasized in the old rule of St. Benedict, promulgated for the treatment of those received into the hospitality of the Benedictine monasteries, "All guests shall be received as Christ, who Himself has said, 'I was a stranger and ye took Me in.'"
In modern times, the necessity for providing for patients whatever within reason they may long for has often been insisted on. It is curiously interesting to find a striking anticipation of this very modern rule in the customs of these old-time hospitals. As a result of the attitude of supreme good will toward patients, there is an injunction in many hospital statutes, that whatever the patient may desire, if it can be obtained and is not bad for him, shall be given to him until he is restored to health. The Knights Hospitalers of St. John of Jerusalem followed the injunction so carefully and endeavored to satisfy even whims of their patients that might seem unreasonable to such an extent, that their conduct in the matter became proverbial and gave rise to at least one pretty legend, the hero of which is no less a personage than the famous Eastern Sultan of the later Crusade period.
"Saladin desiring to prove for himself this reputed indulgence of the knights to their patients, disguised himself as a pilgrim and was received among the sick in the hospital in Jerusalem. He refused all food, declaring that there was only one thing that he fancied, and that he knew they would not give him. On being pressed, he confessed that it was one of the feet of the horse of the Grand Master. The latter, on being acquainted with this fact, ordered that the noble animal should be killed and the sick stranger's desire satisfied. Saladin at this point, thinking the experiment had gone far enough, declared himself taken with a repugnance to it, so the animal was spared."
Virchow studied very faithfully the management of these medieval hospitals, and was evidently quite impressed with the success with which difficulties had been [{262}] met and overcome. None knew better than he all the difficulties there were in hospital management, for during nearly fifty years he had been identified with many hospitals, from city charity institutions to the various kinds needed for war and those erected in connection with universities for teaching purposes. He had very little patience with religious formulas, and was indeed a typical agnostic. Notwithstanding this, he has been perfectly frank in confessing how much is accomplished by the religious management of the hospitals, and even did not hesitate to declare that if hospitals for the poor particularly, are to be successfully managed, there must be a change in the view-point of those who take up the work of hospital nursing, and the attendants must come from better social classes than is at present the custom. (This is of course for Germany.)
The question as to whether secular or religious management of hospitals shall prevail has not been as yet absolutely decided, and this adds to the value of Virchow's opinion. No one knew better than he of the many sacrifices required if the patients are to be properly cared for. Himself, as I have said, utterly without religion, it is curious to see how he recognizes the benefit that religious motives confer upon the management of a hospital, and how much better the work is likely to be done by those who give themselves up to the care of the sick as a Christian duty. He says:
"The general hospital is the real purpose of our time, and anyone who takes up service in it must give himself up to it from the purest of humanitarian motives. The hospital attendant must, at least morally and spiritually, see in the patient only the helpless and suffering man, his brother and his neighbor; and in order to be able to [{263}] do this he must have a warm heart, an earnest devotion, and a true sense of duty. There is in reality scarcely any human occupation that brings so immediately with it its own reward, or in which the feeling of personal contentment comes from thorough accomplishment of purpose.
"But so far as the accomplishment of the task set one is concerned, the attendant in the hospital has ever and anon new demands made upon him and a new task imposed. One patient lies next the other, and when one departs another comes in his place.
"From day to day, from week to week, from year to year, always the same work, over and over again, only forever for new patients. This tires out the hospital attendant. Then the custom of seeing suffering weakens the enthusiasm and lessens the sense of duty. There is need of a special stimulus in order to reawaken the old sympathy. Whence shall this be obtained--from religion or from some temporal reward? In trying to solve this problem we are standing before the most difficult problem of modern hospital management. Before us lie the paths of religious and simple care for the sick. We may say at once that the proper solution has not yet been found.
"It may be easy, from an impartial but one-sided view of the subject, to say that the feeling of duty, of devotion, even of sacrifice, is by no means necessarily dependent on the hope of religious reward, nor the expectation of material remuneration. Such a point of view, however, I may say at once, such a freedom of good will, such a warmth of sympathy from purely human motives as would be expected in these conditions, are only to be found in very unaccustomed goodness of [{264}] disposition, or an extent of ethical education such as cannot be found in most of those who give themselves at the present time to the services of the sick in the hospitals. If pure humanity is to be a motive, then other circles of society must be induced to take part in the care of the sick. Our training schools for nurses must teach very differently to what they do at present, if the care of the sick in municipal hospitals shall compare favorably with that given them in religious institutions. Our hospitals must become transformed into true humanitarian institutions."