While some of this striking opinion of Virchow's was derived from personal experience with hospitals managed by religious, it must not be forgotten that such hospitals are rarer in Germany, at least in the north, than almost anywhere else in the world. His opportunities then were limited, and undoubtedly much of his favorable persuasions in this regard was founded on his investigation of conditions as he had learned to know them in the old-time hospitals of the later Middle Ages. The traditions as to the treatment of patients in these early times are such as to make us believe that hospital attendants did take their work seriously from a very lofty motive, and that while medicine and surgery were much less effective than in more modern times, the tender care of patients did as much as was possible to make inevitable suffering more bearable, and to keep the sight of painfully approaching death from being a source of discouragement and even of despair.
We have the best evidence, that of a contemporary, as to the conditions which obtained in these medieval hospitals, and the dispositions of the attendants as regards their religious duties would seem to be an unmistakable [{265}] index as to their willingness to sacrifice their own comfort for the sake of the patients. The well known Jacques de Vitry, who had been Bishop of Acre and afterwards Cardinal, and whose wide travel had given him many opportunities to judge for himself, said:
"There are innumerable congregations, both of men and women, renouncing the world and living regularly in leper houses and hospitals of the poor, humbly and devoutly ministering to the poor and the infirm. They live according to the rule of St. Augustine, without property and in community and under obedience to one above them; and having assumed the regular habit, they promise to God perpetual continence. The men and women, with all reverence and chastity, eat and sleep apart. The canonical hours, as far as hospitality and the care of the poor of Christ allow, by day and night they attend. In houses where there is a large congregation of brethren and sisters, they congregate frequently in chapter for the correction of faults and other causes. Readings from Holy Scriptures are frequently made during meals, and silence is maintained during meals in the refectory and other fixed places and at certain times. .... Their chaplains, ministering in spiritual matters with all humility and devotion to the infirm, instruct the ignorant in the word of divine preaching, console the faint-hearted and weak, and exhort them to patience and to correspond to the action of grace. They celebrate divine office in the common chapel assiduously by day and night, so that the sick can hear from their beds. Confession and extreme unction and the other sacraments they administer diligently and solicitously to the sick, and to the dead they give due burial. These ministers of Christ, sober and sparing to themselves and [{266}] very strict and severe to their bodies, overflowing with charity to the poor and infirm and ministering with tender heart to their necessities according to their powers, are all the more lowly in the House of God as they were of high rank in the world. They bear for Christ's sake such unclean and almost intolerable things, that I do not think any other can be compared to this martyrdom, holy and precious in the sight of God."
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 [{267}] 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.
Mr. Dillon, from the standpoint of the architect, says of it:
"It was an admirable hospital in every way, and it is doubtful if we to-day surpass it. It was isolated, the ward was separated from the other buildings, it had the advantage we so often lose of being but one story high, and more space was given to each patient than we can now afford.
"The ventilation by the great windows and ventilators in the ceiling was excellent; is was cheerfully lighted, and the arrangement of the gallery shielded the patients from dazzling light and from draughts from the windows and afforded an easy means of supervision, while the division by the roofless, low partitions isolated the sick and obviated the depression that comes from the sight of others in pain.
"It was, moreover, in great contrast to the cheerless white wards of to-day. The vaulted ceiling was very beautiful; the woodwork was richly carved, and the great windows over the altars were filled with colored glass. Altogether, it was one of the best examples of the best period of Gothic architecture."
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.
