A History of Inventions, Discoveries, and Origins, Volume II (of 2)

But as the principal and most dangerous pilgrimages were made to Palestine, which is situated beyond the boundaries of Europe, where no countrymen, and not even Christians, one of whose religious duties it is to be compassionate, could be expected, institutions for the reception of sound as well as of sick pilgrims were erected by the clergy at a very early period on the road thither, and also at the holy places. Thus Jerome built an hospital at Bethlem; and his friend Paula caused several to be erected on the road to that village, in order that the devout idlers, as she says, might fare better than the mother of God, who, on her necessary journey thither, could find no inn1110. In the like manner, the Scots and Irish erected hospitals in France for the use of their countrymen, who, on their pilgrimage to Rome, might be desirous of passing through that kingdom1111.

But hospitals were most necessary in wild and desert parts, where human habitations were not to be expected; and particularly in woody mountainous districts, and on the banks of broad rivers, where travellers were stopped for the want of bridges, and collected together in great numbers. It is probable that many of these hospitals may have given rise to the villages which are still found in such situations.

Pope Adrian I. recommended to the notice of Charlemagne1112 the hospitals built in the Alps; and in the year 855, the emperor Louis II. caused those situated on mountains to be visited and repaired1113. The ruins of many of these edifices still exist.

Towards the end of the eleventh century, brotherhoods, which undertook to provide for the wants of sick pilgrims, were formed in the Holy Land; and these became richer and more numerous as the crusades increased. It was not uncommon for opulent persons, when dying, to bequeathe their property to establishments in which they had found consolation and relief; and very often those who had experienced a cure gave their money and effects, or a considerable part of them, to some brotherhood, either in consequence of a vow, or in order to show their gratitude. On this account the hospitals in Palestine could be constructed on a larger scale, and provided with better accommodations, than any before seen in Europe. They were therefore considered as models; and princes and rich persons, on returning safe from their pilgrimages, caused similar ones to be established in their own countries. Many princes even brought with them to Europe members of these brotherhoods, which in the course of time were converted into orders of knighthood, that they might employ them in the erection of hospitals. Instances of this circumstance have been given by Möhsen, in his History of the Sciences in the Mark of Brandenburg, and these might be easily increased. In the same author may be seen an account of the establishment of houses for the reception of persons afflicted with cutaneous disorders, and of their conversion into pest-houses. I shall here only remark, that these inns and hospitals contributed, in no small degree, to facilitate the travelling of mercantile people, who in the infancy of trade, when the roads were insecure and no means of conveyance established, were obliged to accompany their merchandise themselves.

The assertion of Muratori, however, that the oldest hospitals were not properly established for sick travellers, but rather for the sound, is undoubtedly true; and it appears that hospitals, according to the meaning of the word at present, that is, such as were destined for the sick alone, were not introduced before the eleventh century. The above author quotes1114 from the life of St. Lanfranc, who was archbishop of Canterbury in the year 1070, that he caused an hospital to be built there, and fitted up in such a manner, that one part of it was destined for sick men, and the other for sick women. It is probable, or rather almost certain, that this prelate formed the institution here mentioned after the model of those which he had seen in his native country, Italy. After this period similar establishments for the sick are mentioned in various other parts.

The first hospitals, at least in general, were built close to cathedrals or monasteries; and the bishops themselves had the inspection of them; but afterwards, either for the greater convenience or the want of leisure, when their occupations increased, they committed this charge to the deacons. In the course of time, when houses for the sick were erected by laymen, and entirely separate from monasteries, the bishops asserted their right, often confirmed to them by imperial as well as pontifical laws, of visiting these institutions. We find, however, that in later times they were deprived of this privilege by princes and sovereigns, either because they wished to omit no opportunity of lessening the power of the clergy, or because the latter had given reason to suspect that the incomes destined for the use of the hospitals were not always applied to the intended purpose. Instances are found also, where, by the letters of foundation, the whole management is consigned to the sovereign or the heirs of the founder. These institutions, however, have the appearance of ecclesiastical establishments, and still retain in many cases similar privileges. As such they are free from all taxes, are spared as much as possible in war, and enjoy the same rank as churches.

Of the internal œconomy of the oldest houses for the reception of the sick, no information, however, is to be found. It is not even known whether physicians and surgeons belonged to them, nor in what manner they were supplied with medicines. Apothecary shops were not then established; and those found in hospitals at present, are but of modern existence.

In the hospitals at Jerusalem the knights and brothers attended the sick themselves, bound up their wounds, and, in imitation of the Grecian heroes, Hercules, Achilles and others, acted as their physicians. Thus we find in Amadis, and other books of knight-errantry written in the middle ages, how much the knights exerted themselves to obtain the best balsamic mixtures, and that, in general, they dressed each other’s wounds. The well-known baume de commendeur is one of the oldest compositions of this kind, belonging to the times of knighthood.

Profound or extensive knowledge of medicine could not be expected among these knights, were we even unacquainted with the account given of their skill by Guy de Chauliac. This author, who wrote his book on the healing of wounds in the year 1363, mentions the different medical sects, and among these names the German knights as the fourth sect, who, he says, cured wounds by exorcism, beverages, oil, wool, and cabbage-leaves, and trusted to the belief that God had conferred a supernatural power upon words, plants, and stones1115.

The oldest mention of physicians and surgeons, established in houses for the sick belonging to the order of Templars, is under the government of John de Lastic, who, in 1437, undertook the office of grand-master, and defined very exactly the duty of physician and surgeon1116. It however appears to me, as it does to Möhsen, that the hospitals had regular and learned physicians at a period much earlier.

But, as long as this was not the case, they could afford no instruction to young physicians in the theory or practice of their art, like our hospitals at present. We, however, find a very singular account in regard to Persia, where it is said that some Nestorian priests had an hospital adjacent to their monastery, together with an institute or school for young physicians, who under certain prescribed rules were allowed to visit the sick. This establishment was in a town called Gandisapora, or, as Professor Sprengel writes it, Dschandisabor, the medical school of which is not unfrequently mentioned after the seventh century. The pupils who were desirous of attending the hospital for their improvement, were first obliged to submit to a trial, and to read the psalms of David and the New Testament. Many of those who had here studied medicine attained to high ecclesiastical dignity, which is the more surprising as the rest of the Nestorian schools in the East pay attention only to theology, and prohibit the young clergy entirely from studying medicine1117.

Mad-houses, or houses for the reception and cure of insane persons, seem also to have been first established in the East. Zimmerman, in his work on Solitude, says that as early as the year 491 there was a house of this kind at Jerusalem, the chief object of which was to take care of such monks as became insane in the monasteries, or such hermits as were visited by the same affliction in the deserts; but, as usual, he has given no proofs. In the twelfth century, when the Jew, Benjamin of Tudela, was in Bagdad, he found many hospitals having nearly sixty shops or dispensaries belonging to them, which distributed, at the public expense, the necessary medicines. A large building called Dal almeraphtan, that is, the House of Grace, was destined for the reception of those who lost their reason in summer. They were kept there in chains till they were cured; and every month this house was visited by magistrates, who examined the state of the patients and suffered those who had recovered their reason to return to their relations or friends.

To those police establishments which form the subject of this article belong also hospitals for invalids. Though it may be true, that among many ancient nations the soldiers, as sailors in some privateers at present, served voluntarily and without pay, in the hope of acquiring by plunder a sufficient compensation for the expenses, labour, and dangers to which they were exposed in war, it was at any rate considered as a general duty to make such provision for the indigent, and also for those become incapable of military service, when they had no means of support, that they might not be a burthen on the public. If any one should be so devoid of feeling as to suppose that our soldiers, after enjoying years of peace without much waste of their bodily powers or laborious occupation, free from care, amidst every necessary of life, and the enjoyment of rank above those members of the state from which they were taken, ought to consider it no hardship to perform military service when war renders it necessary; it still remains a duty incumbent on the government to provide for soldiers incapable of further service, who are destitute of support; and besides, political prudence requires it, in order that others may not be deterred from defending their native country or sovereign, but rather by the confident hope of a future provision may have their courage and fidelity strengthened; which, notwithstanding the strictest subordination, and though fire-arms require less personal bravery than bows and arrows, is still indispensably necessary. This truth seems to have been fully acknowledged in the oldest periods.

Solon deducted something from the pay of soldiers, and employed it for the education of children whose fathers had fallen in battle, in order that others might be encouraged to bravery1118. Pisistratus, following this example, made an order that those who had lost any of their limbs in war should be maintained at the public expense. The pensions granted do not seem at all times to have been equally great, and they appear to have been even modified according to circumstances1119.

Of the attention paid by the Romans to the care of their invalids, milites causarii, or soldiers become unfit for service, either by wounds or old-age, many instances may be found, some of which occur in the Justinian and several in the Theodosian code1120. They were not only exempted from taxes, but frequently obtained lands and cattle as well as money, and were assigned over, to be taken care of by rich families and communities1121. The assertion, however, that the Romans had particular houses for invalids, in which soldiers worn out by the fatigues of war were taken care of, and that the taberna meritoria was a house of this kind, is one of the many errors of Peter von Andlo, canon of Colmer, who is entitled to the merit of having written in the fifteenth century, and with a great deal of freedom, the first work on the German public law1122.

How such an idea could be conceived by this author I do not know, for the following is the only account of the taberna meritoria to be found among the ancients. In the first place we are told by Valerius Maximus1123, that a traveller was murdered in one of them in which he lodged. Judging from this circumstance, the taberna meritoria appears to have been a public tavern or inn, a meaning which writers on jurisprudence seem always to have adopted1124. In the next place Eusebius, who died in the year 340, relates in his Chronicon1125, that under the second or third year of the reign of Augustus, an oil issued from the earth in a taberna meritoria, on the other side of the Tiber, and continued flowing without interruption the whole day; but I cannot see what relation this phenomenon can have to Jesus Christ. In the third place, the same thing is related by Orosius1126, who lived about the year 416; but he makes the time of this event much later, that is to say, in the year 730 or 731 after the building of the city, which would be about twenty years before the birth of Christ. Nevertheless, Martinus Polonus said, in the thirteenth century, that this oil appeared at the birth of Christ1127. Damasus (Pope Formosus? in the ninth century) added that, on this account, Pope Callistus I., so early as the third century, caused a Christian church to be built in that place; and some modern writers believe, contrary to the assertion of Platina1128, that it is the present church of St. Mary Transtiberina, Maria in Trastevere; and in this church a stone is still shown with the inscription fons olei. To render the building of a church in the third century probable, some moderns have conjectured that this taberna was the cook’s shop purchased by the Christians under the reign of Alexander Severus, who assigned it to them with the observation that “it was better that God should be served in any manner in that place, than that tavern-keepers, cooks, or perhaps the ministers of voluptuousness, popinarii, should there carry on their occupations1129.” Our writers on historical criticism positively deny that Callistus I. built a church at Rome1130. It is to be observed also, that Donatus, who died in 1640, confidently asserts that the taberna meritoria was the house where the people of Ravenna lodged when they came to Rome to see the public spectacles; but he does not tell us whence he derived this information1131. What I have here collected in regard to the taberna meritoria may serve to correct a false and often repeated relation; but all I can prove from it is, that this taberna was not an hospital for invalids.

Hardouin also was of opinion that there were hospitals for invalids at Rome, one of which was built by Metellus, the son-in-law of Pompey; but for proof he refers only to a coin with the image of Metellus, on the reverse of which is the naked figure of a man walking, who holds in his right-hand the palladium, and bears on his left shoulder a naked man, with the inscription on the face, “Q. Metellus Pius.” From this Hardouin infers that Metellus built an Hôtel des Invalides for sick or wounded soldiers, which he dedicated to Pallas, and that on this account he obtained the surname of Pius1132. It is indeed remarkable, that two coins having the same reverse, and the inscription pietas, occur in Patin. I shall leave to the judgement of the critics this opinion of Hardouin; but I must confess that the explanation of ambiguous figures on coins, has a resemblance to the far-fetched derivations of etymologists. Both may be learned, ingenious, and probable; but they cannot be employed alone as evidence, except to add more force to a truth already proved. These coins, perhaps, allude to some other attention paid to wounded soldiers, of which Metellus, Herennius, and Cæsar may have given examples; and the people are always weak enough to set too high a value on every mark of compassion or benevolence exhibited by their sovereigns or commanders, because it is seldom that they observe as they ought the general duties incumbent upon them.

I do not consider it a reproach to the Romans, notwithstanding their propensity to war and robbery, that they had no hospitals for invalids; because the remark already made in regard to orphan-houses is applicable also to them. Magnificent buildings, fitted up at great expense, afford a proof of the wealth and perhaps the liberality of the founder; but there can be no doubt that, with the capital employed, a greater number of invalids might be maintained, and in a manner much more beneficial to the public; that is to say, by making such arrangements that the invalids could be distributed throughout the country, and placed out at board and lodging for a certain sum. In this case many families would be glad to receive them, both on account of the money, and because these invalids could be of great assistance to them in their domestic œconomy, either by labouring themselves or overlooking others. People may praise large and expensive hospitals as much as they please; but the sight of so many men who have lost their health or limbs in war is but a melancholy spectacle, and gives too great occasion to reflect how much mankind suffer from the avarice, pride, and revenge of sovereigns, without which wars would be less frequent.

The first establishment for the reception of invalids which, as far as I know at present, occurs in history, was that formed at Constantinople by the emperor Alexius Comnenus, at the end of the eleventh century. A complete description of it may be found in the history of that prince, written by his learned daughter Anna Comnena, who says that the emperor caused a great number of buildings standing around a church to be fitted up as an hospital, which undoubtedly was never exceeded in size; though other historians relate that Alexius only revived and enlarged in an uncommon degree an old institution. It was indeed called the Orphan-house; but sick and indigent persons of both sexes and of every age, and, as the female historian expressly says, soldiers dismissed from service, were admitted into it, and provided with bed, board, and clothing1133. Though the emperor secured to this institution several sources of revenue, it however appears not to have long existed; at any rate, in the time of George Codinus, that is, in the fifteenth century, the high office of director or manager had long been disused.

Of the hospitals for invalids existing at present, the oldest and largest is the Hôtel des Invalides at Paris. The kings of France enjoyed from the earliest times what was called droit d’oblat, which consisted in the power of sending to abbeys and monasteries, in order to be maintained, officers and soldiers unfit for further service, and particularly such as had been wounded. Traces of this practice are said to occur under the reign of Charles the Great; at least Seissel, in the Life of Louis XII., relates that there was an old tradition in an abbey in Languedoc, that the abbot had been punished by that prince, because he would not receive the soldiers assigned to him. It may be readily conceived how unpleasant these guests must have been to the clergy, and how little the ideas, mode of living, and manners of these two classes would accord with each other. The complaints on this subject had become so great under Henry IV., that he at length resolved to cause all invalids to be lodged and maintained together in a palace called “La Maison Royale de la Charité Chretienne.” But as the revenues destined for the support of this establishment were not sufficient, it was abolished under the same sovereign, and the invalids were again distributed among the abbeys and convents. In the course of time these houses purchased exemption from this burthen, by giving an annual pension to their guests; but they soon spent their money, and then fell into a state of the greatest poverty. On this account Louis XIII. renewed the experiment of founding an hospital for invalids, which through the want of money was never completed. At length Louis XIV., in the year 1670, began to build the Hôtel des Invalides, the extravagant magnificence of which is rather a proof and monument of the profusion and pride of that sovereign, than of his care for meritorious soldiers.

In the year 1682, the hospital for soldiers at Chelsea was founded in England by Charles II.1134, carried on by James II., and completed by William III. But far larger and more magnificent is the hospital for seamen at Greenwich, which was first suggested by Queen Mary, the consort of King William. The building, determined on in the year 1694, was begun in 1695, and from time to time enlarged and beautified1135. As France was the first country in Europe that maintained a standing army of national troops, it had therefore first occasion to make provision for its native soldiers when disabled by service. As long as military men consisted chiefly of foreigners, who served during a certain period for pay and plunder, sovereigns believed that when a war was ended, they were no further indebted to these aliens; they consequently suffered them to retire wherever they thought proper, and gave themselves no further trouble respecting them.

In the last place, I shall here consider the question, Since what time have regular surgeons been appointed to armies? and lay before the reader the little I have been able to collect towards answering it. In the Trojan war they were indeed not known. At that period many of the principal heroes had acquired some knowledge of surgery, and, like the knights in the time of the crusades, undertook the office of assisting and curing the wounded1136. Such persons in armies were particularly honoured, and considered to be of great value, as appears from what Idomeneus, speaking of Machaon, says:

Ιητρὸς γὰρ ἀνὴρ πολλῶν ἀντάξιος ἂλλον.

Medicus vir multis æquiparandus aliis1137.

Yet the instance of Machaon shows how little care was then taken of the wounded; for Virgil makes him even, whose assistance must every moment have been necessary, mount into the wooden horse, and he was the first who came out of it1138. There is reason to think that the armies in Homer, and until the introduction of Christianity, and the invention of gunpowder, had in every battle but few wounded, and always a much greater proportion of killed than in modern times. Hostile bands stood nearer to each other; all came to close action; prisoners were not exchanged, but made slaves, and among the Romans sold to the infamous schools for gladiators. Wounded prisoners were a burthen to the victorious party; such as could not escape defended themselves to the last, and were put to death by the conquerors.

In Achilles Tatius1139, who seems to have lived in the third century of the Christian æra, I find that an army-physician, exercitus medicus, was called in to a sick person; and one might almost believe that a regular physician appointed to attend an army is here meant, especially as Salmasius, on this passage, says that each cohort had in general a physician, and therefore the appellations medicus cohortis, medicus legionis, were found in ancient inscriptions. I will not venture to contradict so great an authority on a subject of this kind; but I am sorry that I have not been able to find any other evidence of such army-physicians.

The first traces of field-hospitals, or, as they are commonly called at present, flying-hospitals, occur perhaps in the East. At any rate, the emperor Mauricius, in the sixth century, had along with his armies deputati, whose duty he describes, as did also the emperor Leo VI. in the ninth century, who has copied many things verbatim from the work of that prince. These deputati were distributed in the armies among the cavalry, and were obliged to carry off those wounded in battle. On this account they had on the left side of the saddle two stirrups, in order that they might more easily take up the wounded behind them; and for every person thus saved, they obtained a certain reward. They were obliged also to carry with them a bottle containing water, for the purpose of reviving those who might have fainted through the loss of blood. Leo, besides the officers necessary for each band or company of a regiment, mentions expressly not only the deputati, but also physicians and attendants on the sick1140.