In this posting, I continue to share the historical insights I’ve been gleaning from reading Annie M. Brainard’s 1922 book, The Evolution of Public Health Nursing. I briefly touch on the Middle Ages and the Protestant Reformation which I’m sure made my eyes glaze over in school, but it is amazing what a little personal interest and application of knowledge does for one’s motivation to learn history!
The Middle Ages and the Institutionalization of Care for the Poor and Sick
Europe in the Middle Ages experienced large differences between the rich and poor, and the progress towards civil society was slowed if not reversed. It was a violent and chaotic time as small groups battled for control of lands, wealth and power. Brainard also notes that there were several centuries of devastating weather patterns, floods and earthquakes resulting in famines and outbreaks of disease including frequent and ravaging epidemics of the Black Plague. It is said that possibly 1/3 to 1/2 of the population of Europe died in the plague of 1348.
It was a dangerous time to be out and about, and the work of visiting the sick poor was largely limited to what noble women could do for the peasants employed on the lands of their husbands. As the years passed, care of the sick poor was centralized to a greater degree and administered by organized institutions such as early hospitals and monasteries. Early hospitals accommodated a wide range of people in need; travelers, locals, the poor and the sick. I would imagine that the wealthy would have availed themselves of private care, perhaps provided by physicians, in their homes.
Brainard mentions a few wealthy women from this era who dedicated their lives to caring for the sick poor and their fortunes to founding hospitals for their care. She tells of Fabiola, a wealthy Roman woman who founded the first hospital in Rome around the year 380. She also writes of Radegund, Queen of France around 550 CE who used the revenues of the lands she was granted at her wedding to establish hospices and to perform other charitable work on behalf of the poor.
Independent Sisterhoods in the Middle Ages
Brainard then covers the advent of sisterhoods that were independent of the formal Church structure. She sees in them the thread of public health nursing that started with the early deaconesses and was carried through the Middle Ages, a time in which there was not much concern for the sick poor. The first of these sisterhoods was the Beguines, a non-monastic, loosely affiliated group started in the late 1100s. They sought to serve God without retiring from the world and resisted the attempts of the church to cloister them and limit their independence. They tended to live on the outskirts of town and made their life’s work caring for the poor. Eventually, larger groups of Beguines came together to live in communities called a Beguinage, where they also built hospitals but they never stopped caring for the sick poor in their homes. By the 1300s the number of Beguines was estimated to be about 200,000. At various times throughout the centuries the church attempted to repress the movement and curtail their independence, but the service they provided to the community, and their desire to perform this role independent of the church, was so strong that the movement persisted.
Brainard mentions several other similar groups in Europe, who, like the Beguines, consisted of women who banded together to serve God by caring for the sick poor in their homes independent of the church. Among them were the Sisters of Mercy, The Sisters of the Common Life, and several others that were aligned with the Protestant Church after the Reformation. However, Brainard points out a couple of weaknesses in the system of independent sisterhoods. There was no central organization overseeing their actions, such as there was in the days of the deaconesses and nursing care was provided by each individual as she saw fit. Also, all too often there was a self-serving element, as visiting the sick poor had become a popular form of penance.
Stay tuned for future installments...