III.Causes of the Hospital's Secularization
The Hospital's secularization took place in the late medieval and early modern times.It experienced the Reformation,in which the abolition and rebuilding of hospitals showed the secularization was a tortuous process.Why did the hospital's secularization happen?The causes are varied and interacted.
The problems of the church were an important cause for the secularization of hospitals.With corruption and degeneration in the church,the hospital,as the subordinate institution,also degenerated.At the same time,the society was in serious need of relief because of its development,which promoted the secular society to build secular hospitals.Therefore,early secularization took place when the secular society was dealing with the realistic problems.
In the late medieval period,with the rapid economic development,and the secularization of the church,hospitals also changed gradually and their conventional salvage spirit declined,with free-cost clinics also decreasing.Impelled by economic interests,administrators often appropriated the property of the church,and this,together with more and more monks going outside the church to heal the sick to get income was an indication of these shifting priorities.At that time,the church's administration was very careless,so it was unable to avoid all these elements of degeneration.These regulations guided the clergy with admonishing in their treatment of the sick,but lacked specific rules,rewards and punishment measures.This administrative system required the workmen to abide by the tenets consciously,which in reality were very weak.Because of the lack of study and practice of the doctrines,many monks departed from the commandment,and even degenerated by the influence of the bad social habits.The church's social reputation declined rapidly.In 1311,Pope ClementⅤcriticized the hospitals,claiming that they could not deal with their jobs well,and were negligent in caring for the sick.In 1316,two local judges found that the administrator was guilty of negligence,dishonesty and arbitrarily deducting hospital workers’salaries.[19]In 1414,a proposal made by Oxford University said:the aims of hospital is to care the sick and other disadvantaged,but the aim was abandoned at present,the administrators of the hospitals make the property into their own pockets…these sins happened not only in the small hospitals.[20]Under such circumstances,appeals to reform the hospital system were very strong.By 1414,HenryⅤsigned the order authorizing secular government to investigate all the hospitals of the kingdom,and instructed the church to reform hospitals,but because of the ecclesiastic predilection,the church did not enact the order seriously.The hospitals’degeneration continued.Funds and subscriptions became less and less.Monastery economy,which was a major source of funds,waned Monasteries with estates were poorly operated,and as a result,hospitals connected to these estates could barely make ends meet,let alone find the funds to operate small-sized independent church hospitals.The glory of ecclesiastical hospitals was disappearing.In the late 14th and early 15th century,there were no newly-built hospitals,and the surviving hospitals almost all declined.The functions of social relief were weakening.But in late medieval England,the process of urbanization accelerated,and with the proto accumulation of capital,more and more peasants came into the city to find jobs.Consequently,many more people needed social relief,especially due to the economic recession,and the plague.Resolving these problems was very important for maintaining social order,and to save more energy for overseas competition.But as an important relief institution,the hospitals could not bear the duty.All these show that,with the rapid development of society,it was difficult for charitable relief itself to fulfil such public responsibilities as caring for the sick and the poor,together with helping to maintain social stability.
Reformation was the roll booster for the hospital's secularization.After the reformation,secular governments replaced the church to act as the real administrators of hospitals,which promoted both outer and inner secularization.
In 1530s and 1540s,the Reformation took place in England.Although hospitals were not the main cause,or the main problems of the Reformation,they were engulfed by it because of their close relationship with the church.As a result,most hospitals ingloriously ended their existence.According to John Stow's Survey of London,there were almost no hospitals in London in mid-15th century because they were abolished in 1530s during the reign of HenryⅧ.[21]Hospitals in other regions could not survive.According to Medieval Religious Houses edited by David Knowles and R.Neville Hadcock,we reach the same conclusion.From the Statutes of the Realm we find the scene of the hospitals’abolishment.In 1536,the Parliament passed the acts to disband small abbeys whose annual income was below£100.In England,there were 372 such abbeys,and because most the hospitals were small,and had a small amount of annual income,they were included in the scope of the disbandment.
Hospitals were different from other corrupted ecclesiastical institutions,for they had an important function of social relief.The abolishment of the hospitals aroused people's complaints concerning the absence of social relief institutions.The lack of hospitals made it impossible to accommodate large numbers of poor and homeless people.This aggravated the social disorder,and impacted on the traditional social and moral norms.By 1538,the mayor of London complained that the poor,the sick,the blind,the aged and the handicapped lay on the streets.Shocked at these wretched conditions,other European countries now thought that England was a barbarian country without service for the sick and the poor,and had no hospitals for the disadvantaged.As a result,this was called the darkest chapter in British history.By 1538,the citizens of London appealed to the king:in order to help the homeless,the sick and poor,the blind,the aged and other disadvantaged,we ask for the Majesty to authorize us to rebuild the hospitals of St.Mary,St.Bartholomew and St.Thomas[22]The monks of St.Augustine abbey wrote to Thomas Cromwell requesting the government to arrange some honest women to care for the sick monks,because they were helpless.But the king did not give any proactive response to these questions.People at that time were dissatisfied with the reformation and subsequent scholars criticized HenryⅧnot for his abolishment of Monasticism,but for the worsening living conditions of the poor caused by his plunder of wealth and seizing power.
In the long run,although Henry did not have any program for the public health,the Reformation was meaningful,because it weakened the church's control of the public health.The Taiwanese scholar WANG Chunyuan thought that,‘Reformation at the reign of HenryⅧ,disbanded abbeys,which separates the charity,education and public health from the church and makes them develop independently.’[23]The distinguished English historian Professor Paul Slack,thought that the abolition of abbeys meant that social relief in 15th century was not a problem of rebuilding or complementing the existing relief system,but a problem of building an utterly new one by the secular government[24].The Reformation paved the way for the secularization of hospitals,with their religious functions gradually vanishing.In order to keep social order,the secular government took over the responsibility of rebuilding of hospitals,and reshaped its functions of social relief,which showed that the English government had experienced a breakthrough in the relief activities of the church and political control.Hospitals had experienced a transformation from a loosely organized religious institution to a comparatively closely-knit secular relief institution.After the Reformation,we can hardly find the ecclesiastical hospitals which were controlled only by the church.[25]Even when the hospital's affairs were carried out by the clergy,the rights were authorized by the government,including the rights of administration.Undoubtedly,hospitals in early modern times inherited some characteristics of the Middle Ages hospitals,such as clinical functions,and the emphasis on social relief,which was the transforming character of English society in early modern times.
The spread of humanism and the development of iatrology had provided necessary conditions for the hospital's secularization.
The Renaissance had shifted people's attention from the world of God to the world of human.The latter was called humanism,and was the key in this process.Medical science also developed in this atmosphere.All these lead doctors and citizens to become more concerned about the development of the clinics.
In the middle ages,according to original sin Christianity,the body was the result of soul's degeneration.Ailments and the body's suffering should be cured by prayer and repentance.Medical relief activities were controlled by the church,and its functions were limited.After the Renaissance,following the spread of humanism and the development of science,people now had more knowledge of their own bodies,and abandoned the idea that the body was attached to the soul.Instead,they now accepted Descartes’dualist idea about the body and the soul,i.e.the body and soul being independent.The body's independence made people pay more attention to their own bodies and health.The notable physician at that time,Robert Boyle proclaimed that there was no more important thing than health.Contemporary physical books showed that more people attached importance to medicine and public health.For example,Thomas Willis,a well-known physician pointed out that people who were not infected by plague should keep healthy by following these simple measures:clear air,clean abode,rational diet etc.[26]Ideas of the distinguished T.Sydenham were more important,which claimed that the physician should observe the patient's physical state,and use this to find the cause of the illness.All these medical ideas paid more attention to alleviate the patient's pain.This approach would be helpful to cast off the bondage of the old medical ideas of the middle ages,and promote the secularization of new hospitals.
Hospitals experienced a long and complex transformation throughout English history,from the original charitable institution to a modern professional medical institution.In the Middle Ages,English hospitals were similar to hospitals in other western countries.But in the late medieval period and early modern times,compared with other hospitals in other countries,English hospitals transformed greatly,with many new characteristics of secularization.Consequently,this period may be called the‘hospital's secularization’.This transformation was important for the growing specialization of hospitals.Although religious hospitals provided the model and humanist aims,the shaping of such key factors as the professional status of medical personnel,the treatment model,and organization in modern professional hospitals were the results of the secularization in late medieval and early modern times.Besides,concerning the problem of the relations between specialization and secularization,I think the hospital's secularization began beforehand,in which specialization gradually infiltrated with the development of social economy,politics and people's ideas.Of course,it also was related more to the development of medical science.Secularization and specialization have deep interaction,and they both have taken roots in the whole historical context.
【注释】
[1]Lindsay Granshaw and Roy Porter(eds.),The Hospital in History(London,1989).
[2]《世界历史》2006年第1期(World History,1(2006))。
[3]罗伊·波特编著:《剑桥医学史》,张大庆,李志平等译,长春:吉林人民出版社,2000年,第383页(Roy Porter(ed.),The Cambridge Illustrated History of Medicine,trans.ZHANG Daqing and LI Zhiping et al.,Changchun:Jilin People's Publishing House,2000,383)。
[4]Vanessa Harding,A Short History of Early Modern London,1500-1700(Cambridge,2004),127.
[5]Martha Carlin,‘Medieval English Hospitals’,in Lindsay Granshaw and Roy Porter(eds.),The Hospital in History,21.
[6]Edward J.Kealey,Medieval Medicus(Baltimore,1981),83.
[7]1215,the fourth Latern Council passed canons and became a part of cannon law later.In this cannon,the clergy-doctor must save sick person's soul first and then he can heal the sick person's body.We can see in Darrel W.Amundsen,Medicine,Society,(https://www.daowen.com)
[8]Ernst Hirschfeld,‘Deontologische Texte des Frühen Mittelaters’,Archiv Für Geschichte der Medizin,20(1928),363.
[9]Sheila Sweetinburgh,The Role of the Hospital in Medieval England:Gift-giving and the Spiritual Economy(Dublin,2004),22.
[10]Carol Kazmierczak Manzione,Christ's Hospital of London,1552-1598:A Passing Deed of Pity,(Selinsgrove,1995),27.
[11]W.K.Jordan,The Charities of London,1480-1660:the Aspirations and the Achievements of the Urban Society(Hamden,1974),187.These five hospitals include St.Bartholomew Hospital,St.Thomas Hospital,Christ Hospital,St.Chathelin,St.Bridewell.
[12]W.K.Jordan,The Charities of London,1480-1660;the Aspirations and the Achievements of the Urban Society,195.
[13]F.N.L.Poynter,Medicine and Man(London,1971),32.
[14]Magarate Pelling,The Common Lot:Sickness,Medical Occupations and the Urban Poor in Early Modern England(London,1998),88.
[15]Martin McKee and Judith Healy,Hospitals in a Changing Europe(Buckingham,2002),15.
[16]The four royal hospitals include Bart Hospital,Christ Hospital,St.Thomas Hospital and Bridweli Hospital.
[17]Carol Kazmierczak Manzione,Christ's Hospital of London,1552-1598:A Passing Deed of Pity,56.
[18]Carol Kazmierczak Manzione,Christ's Hospital of London,1552-1598:A Passing Deed of Pity,81.
[19]Nicholas Orme and Margaret Webster,The English Hospital 1070-1570(New Haven,1995),131-132.
[20]Nicholas Orme and Margaret Webster,The English Hospital 1070-1570,135-136.
[21]John Stow,The Survey of London(London,160),438-440.
[22]Fredrick F.Cartwright,A Social History of Medicine(London,1977),33.
[23]王春元:《伊丽莎白女王时期的英国》,台湾:书林出版有限公司,2000 年,第101页。(WANG Chunyuan,Elizabethan England,Taiwan:Shulin Publishing Limited Company,2000,101)
[24]Paul Slack,Poverty and Policy in Tudor and Stuart England(London,1988), 13.
[25]The modern religionary hospital is different from the old ones,it is the professional institution after the specialization of medine.
[26]Thomas Willis,A Plain and Easy Method for Preserving Those That are Well from the Infection of the Plague and for Curing such as are infected with it(London,1666).