Continuing my reading of Guenter Risse’s Mending Bodies, Saving Souls, I encounter the following vivid description of the look, feel, administration, and theological underpinnings of those first medieval hospitals. This was not some blip in the history of medicine, but rather the way hospitals were run for many centuries from their medieval inception:
“Until the time of Purchard’s rule at St. Gall [monastery in Switzerland: Purchard was abbot from 958 to 971], hospitals in the West had been mostly small shelters established mainly for the homeless poor and travelers, including pilgrims. Some were located in cities, attached to a bishop’s palace; others operated near major roads, on mountain passes, or in monasteries alongside infirmaries restricted for sick monks. Hospitals comprised a lodging hall with 12 – 15 beds, an attached kitchen, and a chapel. Dormitories featured suspended mattresses filled with straw, pillows, bed sheets, and blankets. The large beds held two or three inmates.” (106)
“All hospitals were sponsored by the Church, primarily to achieve the goals of physical segregation, spiritual salvation, and physical comfort. Although often brought together by the vicissitudes of human suffering, hospital inmates were viewed primarily as members of a new spiritual community, temporarily living in a locus religiosus. This idea was compatible with the concept that such institutionalization was a form of penance. Those housed in hospitals hoped to achieve redemption through their suffering. Moreover, like monks, martyrs, saints, and finally apostles, the sick could function as mediators between God and His people. Their intercessional prayers on behalf of patrons and caregivers were believed to be valuable. Chronically in short supply, Western lay medical professionals were only minimally involved with those institutions since many monks were skilled healers.” (106)
“Because of their religious character, hospitals remained under strict clerical authority, staffed by administrators, priests, and caregivers who had received canonical instruction. Most of the latter were required to be healthy, stay celibate, take vows of poverty, and pass a probationary period. Regarding administrative matters, the supervising bishops expected a full and honest accounting since institutional success was closely linked to the good management of grants and endowments. Service to the sick was structured as another penitential existence: a life of discipline, hardship, silence, and prayer. The hospital’s religious status also ruled the behavior expected of inmates. Rituals were designed to control them, as well as to provide reassurance and protection. Like poor people, the sick could be instrumental in providing their sponsors with means of salvation.” (107)
This picture would last only until the 11th century (the 1000s A.D.). After that, hospitals began to “secularize,” but not in the sense of that word that we use today. For many centuries more, at least until the Enlightenment, hospitals in the West continued to operate within the jurisdiction and ideals of the Christian church.