HOSPITALS, THEIR ORIGIN AND EVOLUTION 487
The revenues of the hospitals were derived usually from endowments, either given as private bequests or by church authorities. In times of unusual need special taxes were levied on commodities such as oil, salt, wheat, etc. Some hospitals owned houses, farms, vineyards and even whole villages as sources of income. Various societies and guilds were also established in aid of hospitals, and frequently diocesan laws re- quired the clergy, especially the canons of cathedrals, to contribute. The complete foundations for hospitals, as well as the establishment of beds and contributions for heating and lighting, etc., were frequently made by lay persons.
As the hospitals increased in wealth and the religious orders grew lax in their discipline various abuses arose. Inefficient supervision by ecclesiastical authorities, too many attendants, too few beds, and impo- sition on the hospital by malingerers were among the evils which ulti- mately resulted in a loss of efficiency in these institutions. In spite of these drawbacks, however, says Virchow, "we have much to learn from the calumniated middle-ages, much that we with far more abun- dant means can emulate for the sake of God and man as well."
Pastoral medicine predominated up to the twelfth century and medi- cal as well as surgical treatment was administered by monks and clerics. But with the rise of the university schools of medicine — Salerno, Mont- pellier, Bologna and Eome — and the development of such surgeons as Wm, Salicetto or Salicet, Henry Mondeville, Lanfranc and Guy de Chauliac during the thirteenth and fourteenth centuries, clerical medi- cal practise began to wane.
It was deemed improper that a priest should shed blood and the church discouraged the practise of surgery by clerics as well as the prac- tise of medicine for fees. Penalties for violating the,se precepts were laid down at the Council of Clermont (1130), Eheims (1131) and the Second and Fourth Lateran Councils (1134-1215).
The influence of the university-trained physician and surgeon on the hospital dates from this period. More and more we find lay prac- titioners called to attend hospital patients. In the sixteenth century we find the lay physician's connection with the Italian hospitals to be essentially the same as that in vogue at the present day. In 1524 Henry VIII. received a letter from the rector of the Hospital of Santa Maria Nuova in Florence, answering a request for information concern- ing the management of that hospital. From this letter we learn that three adstantes, or internes, attended patients and reported on their con- dition daily to six visiting physicians from the city. These six visiting physicians then outlined treatment and gave directions for the care of patients. Attached to the hospital was a dispensary for ambulatory cases. This was attended by an eminent surgeon and three assistants, all of whom gave their services without charge. Lallemand in his