This hospital was founded by Cortez prior to 1524 "in recognition of the graces and mercies that God had bestowed upon him by the discovery and conquest of New Spain and as an exoneration or satisfaction for any forgotten fault or load which might weigh on his conscience and for which he could not make special or particular atonement." After his death the endowment was administered by a superintendent and has continued to be under private management. It now belongs to the Dukes of Terranova y Montaleone, Cortez' Italian descendants, who nominate and maintain an agent to supervise the hospital (A History of Nursing, Nutting and Dock).
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 [{273}] 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.
The other serious problem of hospital management was to keep those not really suffering from serious disease, malingerers of various kinds, from occupying beds and claiming attention, to the deprivation of those who were genuinely ill. Various regulations were made looking to the careful examinations of such persons, [{274}] though in most places with the affirmation of a standing rule, that all those complaining of illness were to be received into the hospital for at least one day, until their cases could be examined with sufficient care to decide how much of reality and how much of simulation there might be in their pretended symptoms. The tramp, of course, has always been in the world, and probably always will be, and so what are called the sturdy vagrants (validi vagrantes) received the special attention of those wishing to eliminate hospital abuses, and various decrees were made in order to prevent them from receiving sustenance from the hospitals, or in any other way abusing the privileges of these charitable institutions.
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 [{276}] 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.
Pope Innocent III. was not the only occupant of the Papal throne whose name deserves to be remembered with benedictions in connection with the hospital movement of the thirteenth century. His successor took up the work of encouragement where Innocent had left it at his death, and did much to bring about the successful accomplishment of his intentions in the ever wider spheres. Honorius III. is distinguished by having made into an order the Antonine Congregation of Vienna, which was especially devoted to the care of patients suffering from the "holy fire" and from various mutilations. The disease known as the holy fire seems to have been what is called in modern times erysipelas. During the Middle Ages it received various titles, such as St. Anthony's fire, St. Francis's fire, and the like, the latter part of the designation evidently being due to the striking redness which characterizes the disease, and which can be compared to nothing better than the intense erythema consequent upon a rather severe burn. This affection was much more common in the Middle Ages than in later times, though it must not be forgotten that its [{277}] disappearance has come mainly in the last twenty-five years. It is now known to be a contagious disease, and indeed, as Oliver Wendell Holmes pointed out over half a century ago, may readily be carried from place to place by the physician in attendance. It does not always manifest itself as erysipelas when thus carried, however, and the merit of Dr. Holmes's work was in pointing out the fact that physicians who attended patients suffering from erysipelas and then waited on obstetrical cases, were especially likely to carry the affection, which manifested itself as puerperal fever. A number of cases of this kind were reported and discussed by him, and there is no doubt that his warning served to save many precious lives.
Of course nothing of this was known in the thirteenth century; yet the encouragement given to this religious order which devoted itself practically exclusively to the care in special hospitals of erysipelas, must have had no little effect in bringing about a limitation of the spread of the disease. In such hospitals patients were not likely to come in contact with many persons, and consequently the contagion-radius of the disease was limited. In our own time, immediate segregation of cases when discovered has practically eradicated it, so that many a young physician, even though ten years in practice, has never seen a case of it. It was so common during the Civil War and for half a century before that here in America, that there were frequent epidemics of it in hospitals, and it was generally recognized that the disease was so contagious, that when it once gained a foothold in a hospital ward nearly every patient suffering from an open wound was likely to be affected by it.