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

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.

Though an order was made by the Convention of Ratisbon¹¹⁴¹ in 742, that every commander of an army should have along with him two bishops, with priests and chaplains, and that every colonel should be attended by a confessor, no mention is to be found either of field-hospitals or army-surgeons belonging to the first Christian armies in the writings of the middle ages. We read, however, in the works of Paracelsus, Thurneyser, Lottich and others, that they were present at battles and sieges; but it can be proved that they were not appointed as army-surgeons, but served merely as soldiers.

The field-surgeons, who occur as accompanying armies in the beginning of the fifteenth century, were destined rather for the use of the commanders and principal officers, than for the service of the field-hospital. Their number was too small for a whole army; and as they were authorised by their commission to receive prisoners and booty, and, like the knights, were obliged to bring with them archers, it is highly probable that to fight was a part of their duty also.

When Henry V. of England carried on war with France in 1415, he took into his service Nicholas Colnet, as field-surgeon, for a year¹¹⁴². He was bound to carry with him three archers on horseback, and to accompany the king wherever he went. In return he was to receive yearly forty marks or pounds, to be paid at the rate of ten marks every quarter. He was allowed also twelve pennies per day as subsistence money, and each of his archers had twenty marks a year, and six pennies daily for subsistence. The chief army-surgeon, Morstede, was engaged with fifteen men, three of whom were to be archers, and the remaining twelve surgeons. He received also ten pounds quarterly as pay, and twelve pennies daily for subsistence. His archers and surgeons were placed on an equal footing; each was to receive quarterly five pounds, and six pennies daily as subsistence. Both Colnet and Morstede could receive prisoners and plunder; but when the latter amounted to more than twenty pounds in value, a third part of it was to be given to the king. Both these head-men had a quarter’s pay in advance; and, that they might always have security for the next quarter, the king engaged to put into their hands, by way of pledge, as many jewels or other articles as might be equivalent to one quarter’s pay and subsistence.

Harte, in his Life of Gustavus Adolphus, seems to believe that this prince first appointed four surgeons to each regiment, which he reduced from the number of two or three thousand, first to 1200, and afterwards to 1008; and he is of opinion that it may with certainty be believed that the imperial troops at that time had no surgeons, because Tilly himself, after the battle at Leipsic, was obliged to cause his wounds to be dressed by a surgeon established at Halle. He adds in a note, that he was told that the Austrians, till about the year 1718, had no regimental surgeons regularly appointed. However this may be, it is certain that the field-hospital establishments of the imperial army, till the beginning of the eighteenth century, were on a very bad footing. Even in the year 1718, they had no field-surgeons; but at this period the company surgeons were dismissed, and a regimental surgeon, with six assistants, was appointed to each regiment; and beside the field medicine-chest, surgical instruments were provided at the emperor’s expense¹¹⁴³.

The establishment of field-hospitals in Germany is certainly much older; for Fronsperger, who wrote in the middle of the sixteenth century, does not speak of field-surgeons, army-surgeons and their servants, as if they had been then newly introduced; but in such a manner as shows that the need of them had been generally acknowledged long before that period¹¹⁴⁴. According to his statement, it was necessary that there should be along with the commander-in-chief, or, according to the modern phrase, the general staff, a field-surgeon-in-chief, a doctor who had the inspection of the field-surgeons, the barbers and their servants, whose duty was to drag the wounded from the heaps of slain and to convey them to the former. He was obliged to keep by him instruments and medicines, and at each mustering to examine the instruments and apparatus of the field-surgeons; he decided also, in disputed cases, how much soldiers whose wounds had been cured ought to pay to the field-surgeon. During marches he was bound to remain with the commander-in-chief. Fronsperger says also, that there ought to be with the artillery a field-surgeon of arckelley, and with each company a particular field-surgeon, not however a paltry beard-scraper (bart-scherer), but a regularly instructed, experienced and well-practised man. This person was bound always to accompany, with able servants, the ensign, and he received double pay.

[To give a description of all the hospitals, infirmaries and dispensaries in this country would fill volumes. It may be sufficient here to observe, that there are ten large hospitals in the metropolis, each of which receives a considerable number of patients into the house, and a still larger number of out-door patients are prescribed for and supplied with medicines, but attend at the establishments. In the largest of these, which is that of St. Bartholomew, the annual number of patients, both in-door and out, is about 12,000; about three-fifths of these are out-door patients. The number of beds in the hospital amounts to upwards of 550.

There are twenty-eight dispensaries; such patients as are able, attend at these establishments; those who are incapable, are visited and relieved at their own homes.

Moreover, there are in the metropolis ten midwifery establishments, three ophthalmic institutions, three public lunatic asylums, a venereal hospital, a small-pox and a fever hospital, as also one for patients suffering from consumption.

There are also ninety-seven county hospitals, infirmaries and dispensaries¹¹⁴⁵.

Admission to the hospitals is gained by the presentation of a petition signed by a governor, on a certain day in each week; of course, out of the number of patients who apply, the worst cases have the preference. Accidents and very severe cases are admitted at any time, and without any petition or recommendation. The out-patients require no recommendation. The same general rule gains attendance at the other medical establishments.]