Early Modern Hospitals Research Articles

Spital und Verwaltungsorganisation. Das Bodenpersonal der Versorgung von Insassinnen und Insassen in frühmodernen österreichischen Spitälern

Though we have some key studies for Austrian hospitals covering aspects such as economic history or some profound “History of Our House”, historical research still feels the need for historical approaches to the history of staff within early modern hospitals. Little is known about the history of male and female wardens and attendants in hospitals. The Austrian hospital system in early modern times is characterized by contrasts; some big hospitals such as the imperial hospital in Vienna (“Hofspital”) were confronted with many small hospitals for six or twelve inmates. In small hospitals “healthy” inmates served as caretakers for older and sicker inmates – sound inmates also had a large share in running small hospitals in general. Therefore, distinct divisions between inmates and staff in those hospitals are hard to find. Big hospitals, on the other hand, had a structured and multilayered administrative hierarchy. At the top we normally find a “superintendent”, a high-ranking person as delegate of the city council, followed, on the second level, by a hospital master who was in charge of the hospital’s internal affairs. On the third level “house officers” are found and finally, the basic level comprised hospital staff such as hospital stewards, cooks and caretakers. Beside the writing control of the hospitals (such as the hospital recorder) and the administering supervision (such as custodian of the grain) the care taking in hospitals was an essential part of managing such houses: male and female nurses, master of infirm people (“Siechenmeister”), custodians for orphans can be found in larger institutions. Based on instructions and house rules, fields of activity of the care taking staff in hospitals form core questions of the following paper. Little is known about the history of wardens in hospitals: the recruitment of those people, pension schemes and income levels have not yet been scientifically examined.

Krankenpflege als soziale Praxis in den Hospitälern der Barmherzigen Brüder in Österreich im 17. und 18. Jahrhundert. Eine Übersicht auf Grundlage insbesondere des „Manuale oder Hand-Büchlein Religions B. Joannis Dei“ von 1681 sowie der Wiener und Grazer Hospitalinventare

This article deals with nursing within the Austrian hospitals of the Order of St. John of God during the 17th and 18th centuries. As far as possible, it casts light on the actual nursing practices, primarily displaying and analysing contemporary internal nursing guidelines and sources like inventories, pictures and administrative patients’ records. Thus, the paper attempts to “reconstruct” at least the expected and/or typical shape of some fundamental aspects of nursing care based on such indirect hints, being well aware, however, that this can only serve as a modest substitute for an – impossible − actual observation. Furthermore, scrutinizing guidelines, administrative records and similar material can easily lead to misinterpretations regarding the relation of norms and actual behavior; therefore, we must also bear in mind that variations and deviations are probably under-represented within such sources. This considered, some elementary insights drawn from the mentioned sources, are: The early modern hospitals of the “Barmherzige Bruder” – which already served as medical hospitals for acute diseases – disposed of remarkably well-equipped pharmacies and a well-educated staff. The brethren themselves conducted most of the nursing duties. A “Manuale” for their use from 1681 elaborately describes aims, but also problems in nurse-patient communication, moreover the necessary observation of vital functions in very “weak” patients, and several aspects of hygiene of the body, the beds, the laundry and the wards, as well as the nutrition of the patients – who were i. e. supposed to drink either boiled water or wine according to the individual diet prescribed by the physician and had two main meals a day, breakfast and dinner. The handling of the excretions was a matter discussed in less detail, but it was not avoided in total. Clothing is mentioned primarily with respect to the change of wear that was scheduled to take place during admission and regarding the correct storage of the ‘secular’ costumes until discharge. Rest and sleep was a matter of interest, too. The brethren were obviously well aware of the potentially conflicting target of securing the prior on the one hand, and effective nursing care, particularly in urgent cases, on the other. Moreover, the themes of movement and occupation possibilities for the patients are displayed. The aspect of sexuality is dealt with in the “Manuale” primarily with reference to specific demands of the staff’s clerical celibacy, only casually referring to the sick themselves. ‘Security’ is only marginally dealt with by the nursing guidelines, but, apart from hygienic prescriptions, does not play a prominent role. Yet, by other sources it becomes sufficiently clear, that there were specific security measures for distinct categories of patients, such as “mad” patients regarded dangerous for themselves or others. On the contrary, the “Manuale” pays ample attention towards the spiritual offers to and demands of the patients, which were closely linked to the strict daily routine of the brethren, largely filled by manifold and extent religious rituals.

Verbotene Sexualität in frühneuzeitlichen Hospitälern

In early modern hospitals, it was generally the case that only married couples were allowed to be sexually active, but those responsible feared that particularly younger women and men could have children for which the hospital would have had to provide. It is very difficult to find archival sources relating to this topic, which suggests that there was usually a negative view of generally life-affirming sexuality. Under the guise of secrecy, sexual activities largely had to take place in the privy, in stables, in the field and the grass, in church, etc. and those involved had to make sure that nobody was watching them. As they could get caught in the act, they often kept their clothes on and the sexual act had to take place quickly. This contribution uses examples to demonstrate that not only sexuality played a significant role in hospitals – which also pertains to penitentiaries, for instance – but that love was also quite important. It should not be denied that many inhabitants were raped and abused, particularly women with disabilities. If a man and a woman wanted to get married, they were usually prevented from doing so because they did not have any possessions and because of their lack of material goods. If inhabitants wanted to marry someone in the hospital, they had to give up their benefices. Sex between unmarried inhabitants in the hospital could cause a scandal, which could lead to a reduction of alms for the entire house. Despite the negative view of sexual activities in the hospital outlined in this paper, it can be assumed that pleasurable sexual intercourse took place both between the inhabitants as well as between the inhabitants and the staff.

Death in the sun: the bioarchaeology of an early post-medieval hospital in Gibraltar

SUMMARY: In 2014, during construction work at the ex-Civil Hospital in Gibraltar, excavations led by the Gibraltar Museum revealed a major, previously unknown burial ground containing more than 200 skeletons. We present the historical, archaeological and radiometric dating evidence from the site alongside the results of initial osteological analyses. The data indicate that the burials pertain to an earlier 16th-century Spanish hospice, and therefore stand to offer new insights into the functioning of this early modern hospital and the health and movements of people at a time of incipient globalization.

“Man does not live by bread alone” : Feeding Confraternity in Early Modern Nuremberg Leprosaria

Looking beyond the history of food, feeding and nutrition, this article aims to capture the cultural history of food and feeding in Renaissance leper hospitals in Nuremberg. When attempting to understand the early modern hospital community and determining how hospital patients actually spent their time, one rapidly recognizes that such groups of patients spent most of their time praying and eating collectively. The article, therefore, focuses on the function of meals inside late medieval and early modern hospitals in generating a sense of community. The example of the Nuremberg hospitals, especially the four leprosaria around the imperial city, clearly indicates the way in which daily routine was structured by meals and prayers. Furthermore, the function of feeding within almsgiving is discussed using the example of a Nuremberg charity specifically for foreign lepers, which in the fifteenth and sixteenth centuries, fed hundreds and thousands of non-native lepers in the very centre of the imperial city dur...

Indian hospitals and government in the colonial Andes.

This article examines the reception of the early modern hospital among the indigenous people of the Andes under Spanish colonial rule. During the period covered by this study (sixteenth to mid-eighteenth centuries), the hospital was conceived primarily as a manifestation of the sovereign’s paternalistic concern for his subjects’ spiritual well being. Hospitals in the Spanish American colonies were organised along racial lines, and those catering to Indians were meant to complement the missionary endeavour. Besides establishing hospitals in the main urban centres, Spanish colonial legislation instituted hospitals for Indians in provincial towns and in small rural jurisdictions throughout the Peruvian viceroyalty. Indian hospitals often met with the suspicion and even hostility of their supposed beneficiaries, especially indigenous rulers. By conceptualising the Indian hospital as a tool of colonial government, this article investigates the reasons behind its negative reception, the work of adaptation that allowed a few of them to thrive, and the eventual failure of most of these institutions.

An der Wende zur Moderne: Die hessischen Hohen Hospitäler im 18. und 19. Jahrhundert (review)

Reviewed by: An der Wende zur Moderne: Die hessischen Hohen Hospitäler im 18. und 19. Jahrhundert Mary Lindemann Arnd Friedrich, Irmtraut Sahmland, and Christina Vanja, eds. An der Wende zur Moderne: Die hessischen Hohen Hospitäler im 18. und 19. Jahrhundert. Historische Schriftenreihe des Landeswohlfahrtsverbandes Hessen Quellen und Studien Band 14. Petersberg, Germany: Michael Imhof Verlag, 2008. 424 pp. Ill. €24.90 (978-3-86568-427-1). In 1533, Phillip the Magnanimous of Hesse laid the groundwork for a set of social welfare institutions collectively known as the Hohen Hospitäler. Of the four original foundations, three continue to serve the state of Hesse today. Thus, the Hohen Hospitäler can look back over an unbroken history of 475 years. An earlier anniversary (the 450th in 1983) occasioned the publication of a volume treating the territory-wide institution over its first two hundred years. An der [End Page 132] Wende zur Moderne picks up the story and carries it forward through the end of the nineteenth century. Although An der Wende zur Moderne is a commemorative volume and possesses many of its associated qualities (excellent reproductions, glossy paper, and solid bindings), there is nothing lightweight about its content. The several authors explore a series of questions about how hospitals became "modern," inquiries that continue to animate medical historical research in the twenty-first century. Four parts—on medical care and "discipline," on patients, on administration and personnel, and on physical plants—trace the changes the hospitals underwent between 1700 and 1900. From their inception, the four Hohen Hospitäler—in Haina, Merxhausen, Hofheim bei Darmstadt, and in the old Benedictine cloister Gronau near St. Goar—both resembled and differed from other institutions of care and cure. Unusual were the common, territory-wide administration supervised by a general director (Obervorsteher) and the charge to accept indigent subjects from throughout Hesse. Early modern hospitals were, of course, usually (if not invariably) set in cities. The modernization process these hospitals underwent in the eighteenth and nineteenth centuries involved an evolution from their original status as multifunctional hospitals to specialized institutions, such as the designation of the two hospitals in Haina and Merxhausen exclusively for patients suffering mental disturbances. The great strength of these articles derives equally from an extensive exploitation of a rich archival base and the authors' engagement with up-to-date medical historiography. Although, of course, the records of the Hohen Hospitäler are not without gaps—sometimes significant ones—the generally excellent documentary situation allows the contributors to craft lively portraits of individuals, detail daily routines, and follow trends meticulously over decades, as well as test a series of historical interpretations about the development of hospitals more generally. There are many examples of this, but a few will suffice to demonstrate how even a Festschrift (a generally celebratory publication and one not often marked by analytical rigor) can successfully address major historical topics in a convincing and accessible manner. Christina Vanja, for example, considers whether a "trade in lunacy" such as that often described for eighteenth-century England also existed in Hesse. Her study of the documentation leads her to conclude that "one cannot speak of a 'trade in lunacy' in the Hohen Hospitäler" (p. 238). Instead of profiting from wealthier, private patients, these organizations actually lost money on them. Christoph Friedrich takes on—and refutes—the old chestnut that the poor, and especially those living in rural areas, lacked all recourse to prescribed medicines and could draw on only a "very restricted range" (p. 154) of medications. His analysis of the Merxhausen hospital around 1760 reveals a large pharmacopeia. He also uncovers in rural apothecaries an independent production of medicines of almost startling dimensions. Other authors take on other significant medical historical topics: investigating the role of surgeons, the character of care for the mentally ill, the delivery of corpses to university anatomy theaters, provisions for Jewish patients, the tasks and origins of personnel, the development (retarded) of a true psychiatric practice, and so on. These contributors comment intelligently [End Page 133] on the quality and characteristics of medical care during a transformative period. Although the authors frequently confirm the findings of others, they remain especially attuned...

Florian Steger and Kay Peter Jankrift (eds), Gesundheit – Krankheit. Kulturtransfer medizinischen Wissens von der Spätantike bis in die Frühe Neuzeit, Cologne, Böhlau Verlag, 2004, pp. vi, 270, €34.90 (hardback 3-412-13803-7).

The scope of this volume is ambitious, spanning a millennium, covering both western Europe and the east, and including topics as diverse as surgery in the Frankish states and “paleness” as an illness in early modern poetry. Three papers are in English (Peregrine Horden, John Henderson, Piers Mitchell), with German summaries, but unfortunately English summaries are not given for the German contributions, something which would have broadened the appeal of this volume for those with a phobia for German. Nevertheless, it is worth venturing in, as there is much of interest here. The volume is organized chronologically, and divides into three sections: late antique, medieval, and early modern. Mischa Meier's paper centres around the intriguing hypothesis that the writing of history altered in response to the experience of plague in the late antique world. She focuses principally on eastern authors but concludes with Pope Gregory the Great and Gregory of Tours in the west. Gernot Kirchner picks up where Meier ends, discussing Gregory of Tours' concept of healing, the literary models he draws on, and his attitudes towards doctors. As with Meier's paper, the principal emphasis is on the literary representation of illness and healing rather than medical practice. Peregrine Horden, in contrast, starts with the development in late antiquity in the east of the physical space designated as a “hospital”, but argues that it was brought into existence—and gained its symbolic force—as part of the theological and political power struggle between groupings within Christianity (“Arian” and “Catholic”). There is then a slightly uncomfortable jump in chronology from late antiquity to the Crusades, perhaps inevitable in a single volume attempting such a large chronological sweep. However, with three papers on late antiquity, one could have covered at least part of the seventh to tenth centuries, perhaps focusing on the manuscript transmission and use of medical texts from antiquity to the middle ages. What is good in this volume, however, is the balance between east and west, and this is exemplified by Johannes Pahlitzsch's fascinating exploration of the mobility of Christian, Jewish and Samaritan doctors in the east across political and religious borders. Jewish doctors, this time in the west, are also the focus of Peter Kay Jankrift's contribution. The mobility of these doctors in the west, however, means that evidence about their activities is sparse and Jankrift persuasively argues that historians should respond to this by taking a broad comparative approach between regions. Piers Mitchell also grapples with a lack of direct evidence for types of elective surgery performed in the Frankish states and instead he mines court records, chronicles and Arab sources to infer the types of elective surgical procedures (such as cauterization, treatment of haemorrhoids and possibly also cutting of gums for scurvy) that patients expected surgeons to perform successfully. The early modern section of the volume opens with John Henderson's paper on early modern hospitals. In a welcome departure from the overwhelmingly literary source base of the volume as a whole, he draws on iconographic as well as textual evidence in order to attempt to reconstruct a patient's experience from entry to discharge (or death) in Renaissance hospitals in Florence. This is followed by a timely look by Renate Wittern at the contemporary reception of Andreas Vesalius' famous anatomical work De fabrica, not least by Vesalius' own former teacher, Jacobus Sylvius. Florian Steger focuses on a perhaps less universally famous, but nevertheless important, figure of the medical Renaissance, Georgius Agricola, and specifically his 1528 dialogue ‘Bermannus sive de re metallica’. Steger argues that Agricola's dialogue should be viewed as part of the ongoing contemporary debate on what constituted “true” or “right” anatomy or medicine. Daniel Schafer's paper is the most closely focused in the collection on the concrete transmission of medical texts from antiquity to the Renaissance. Sensibly, rather than attempting a complete survey, he focuses on a single theme which is now receiving increasing attention from historians, namely texts relating to ageing and prolonging life. Sandra Pott, in contrast, considers poetry about the plague and “paleness”. She argues that not only did a “medicalization” of poetry take place in the early modern period, but that in turn medical discourse was influenced by poetry. Overall, this collection has some strong contributions and although few contributors discuss it explicitly, they collectively deal with the concept of “transmission” in a creative way, considering the transmission not just of medical texts but also of medical personnel, medical knowledge and language across linguistic, chronological, political and religious boundaries.

Escape fromAlphaville: Introducing Paul Virilio'sCity of Panic

Escape from<i>Alphaville</i>: Introducing Paul Virilio's<i>City of Panic</i>

Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush

Reviewed by: Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival, and Benjamin Rush Lisa Rosner Lisbeth Haakonssen. Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival, and Benjamin Rush. Clio Medica, vol. 44. Wellcome Institute Series in the History of Medicine. Amsterdam: Editions Rodopi, 1997. x + 247 pp. $19.50; Hfl. 37.50; £11.50 (paperbound). Philosophers of the Scottish Enlightenment dealt with many of the enduring questions of human society, and in this book Lisbeth Haakonssen examines their influence on three seminal writers on medical ethics. She successfully lays to rest the contention that the “ethics” of the period was really about “etiquette” or “professional decorum,” demonstrating that it was, instead, thoroughly grounded in moral and legal philosophy and fully deserved to be called an ethical system. In the first chapter, “Interpreting Eighteenth-Century Medical Ethics,” Haakonssen examines the scholarship on medical ethics in the period and provides a framework for her own analysis as intellectual history. The second chapter, “John Gregory: Medical Ethics and Common Sense,” discusses Gregory’s application of Francis Bacon’s and Thomas Reid’s ideas to medicine and medical practice. In the third chapter, “Thomas Percival: The Duty of Public Office,” the author places Percival in the context of Dissenting intellectual life. She argues that though Percival was interested in adapting the traditional discussion of the physician-patient relationship to the new circumstances of hospital practice, he was not merely producing a practical guide for the hospital physician. Instead, his discussion was informed both by earlier writers—including Gregory—and by the idea of contract developed in British legal theory. In the last chapter, “Benjamin Rush: Medical Ethics for a New Republic,” she analyzes Rush’s connection to Scottish moral philosophy and his view of the physician-patient relationship. Haakonssen is to be commended for providing the first philosophically grounded discussion of Percival’s work: no scholar will be able to maintain that he wrote on etiquette, not ethics, from now on. But the book as a whole is uneven. There is a lack of attention to detail: the footnotes in the first chapter are misnumbered, and the biographical material on all three men owes little to original research. More attention to their actual clinical experience, and their own relationships with their patients, would have been helpful. It would also have been helpful to examine more closely the assumption that hospital patients were docile and had to obey the physician’s orders. We know from surviving clinical records of early modern hospitals that patients were not nearly as compliant as writers like John Aikin assumed: Percival’s writings become more complex if viewed as prescriptive for patients as well as practitioners. Benjamin Rush’s connection with the other writers is never made clear, beyond the fact that he studied at Edinburgh. He was a fluid and facile writer who commented on almost any medical topic of interest, and though he may indeed have aspired to write a “Medical Ethics” for American conditions, the book does not demonstrate that he did so. Medicine and Morals is nevertheless valuable in tracing the intellectual origins [End Page 148] of some of the most important writers on medical ethics in the Enlightenment. It will be of interest to historians of medicine and ethics. Lisa Rosner Richard Stockton College Copyright © 1999 The Johns Hopkins University Press

Vom Armenhospital zum Grossklinikum: Die Geschichte des Krankenhauses vom 18. Jahrhundert bis zur Gegenwart (review)

Reviewed by: Vom Armenhospital zum Großklinikum: Die Geschichte des Krankenhauses vom 18. Jahrhundert bis zur Gegenwart Alfons Labisch Axel Hinrich Murken. Vom Armenhospital zum Großklinikum: Die Geschichte des Krankenhauses vom 18. Jahrhundert bis zur Gegenwart. 3d ed., rev. Cologne: Dumont, 1995. 307 pp. Ill. DM 39.80 (softcover). The fact that a third and revised edition of Axel Hinrich Murken’s well-known book From Hospital for the Poor to Clinical Centerhas now been published shows that [End Page 539]the book has advanced to the status of standard reading on the history of German hospitals. Therefore this review has essentially to restrict itself to the revisions only. In addition, some references to the modern history of hospitals would seem appropriate. The book contains the following chapters: (1) Hospitals and Isolation Hospitals; (2) The Transition of the Infirmary to the Hospital; (3) The Development of the Hospital at the End of the Eighteenth Century; (4) The Hospital during the Biedermeier Period; (5) Between the Restoration and the Gründerzeit Period; (6) The Era of the Pavilion Hospital; (7) The Pavilion Hospital in Germany from 1868 to 1918; (8) The Hospital from 1900 to 1985. Following these, a “Chronological Summary of Important Hospital Construction Projects in Germany,” a glossary, a bibliography, and an index of places and names conclude the richly illustrated book. The author does not mention new approaches or aspects in his revised preface. The changes are scattered carefully throughout the text. Here and there names of architects, dates, and new hospital buildings have been added. Sometimes old paragraphs have been divided into new ones, without alteration to their contents. With only one exception (fig. 139a), the illustrations are fully identical. Thus the newer edition is by and large identical to the former one. One is tempted to ask why an author should make alterations at all in such a successful book. Some remarks may be in order here, in view of the current international and national work on the history of hospitals. Although Murken mentions the role of the hospital in society and its social importance, the first edition of his work did not contain much information about issues, methods, and results in (general) history, especially not in the social history of the periods discussed. Murken’s repeated references to the influence of poverty on hospital organization during the early periods of industrialization displayed a touching helplessness. Although many aspects of the influence of hospital care on society and vice versa were mentioned, the substantial influence that poverty and the pauper classes had on the early modern hospital, and the mechanisms through which this influence occurred, were not explained at all. The present edition also leaves out newer developments in the (general) history of medicine, and especially in the history of hospitals. Without explanation, the wider history of hospital care is reduced to one methodical approach, and thus to one single aspect: “particularly in Germany the most important stages of development of hospital building are shown by a large number of examples, thus giving a demonstrating manual to its history” (p. 8)—that is, the idea should speak for itself via such sources as the construction plans or pictures of the buildings. However, the author should at least be aware of the fact that the modern historiography of hospital care goes beyond the concept of constructional and architectural history and tries to elucidate the relationships between hospital, medicine, and society. Some relevant questions would be: Who built hospitals, and who ran them? What were the reasons for building a particular hospital, and what were the real interests behind it? [End Page 540] The modern history of hospital care is more profound because it also studies the internal organization of the hospital, including patient care, hospital management, and many other aspects. Who provided the financial means for the hospital? How did this aspect influence the type of patients? What patient group was the hospital originally built for, and which patients were treated in the end? What kind of disease and mortality patterns were seen in the hospital compared to the overall morbidity and mortality? What happened to the patients during their stay? How did nurses and...

The Hospital in History

If one assumes, as I did before reading this book, that the hospital of long ago was basically the same in form, function, scope, and intent as the hospital of today (minus, of course, high tech and physician-specialists) then one is in for a surprise on reading The Hospital in History . About all that the hospital of 100 to 500 years ago shares with the hospital of today is the name. What emerges is that medieval and early modern hospitals were not primarily medical institutions—most of their patients were not even sick. And doctors had little control over hospitals until recently. Hospitals were controlled by the donor (for the benefit of the donor's immortal soul) or the church or monastery as a sort of employee benefit program for aged monks and nuns or by the government (which largely ignored the hospital unless political considerations forced it to do otherwise). The