The Santas Casas da Misericórdia:
five centuries of philanthropy.
As Santas Casas da Misericórdia:
cinco séculos de filantropia.
Henrique Seiji Ivamoto, Rosilene Morales,
Liliana Soares Ivamoto, Eduardo Soares Maia Vieira de Souza
(*)
Serviço de Neurocirurgia da Santa Casa
da Misericórdia de Santos, Unisantos e Faculdade de Ciências
Médicas de Santos.
Summary
Lady Leonor de Lencastre,
widow of King Dom João II, founded the Irmandade da Misericórdia
de Lisboa (Fraternity of the Mercy of Lisbon) on August
15, 1498, installing it in the Capela da Nossa Senhora da
Piedade (Chapel of Our Lady of the Piety). She nominated her
confessor, Friar Miguel de Contreras, as its provedor
(provector, president). The Fraternity took over the maintenance
of the Hospital de Nossa Senhora do Amparo (Hospital of Our
Lady of the Aid ) and later of the Hospital Real de Todos
os Santos (Royal Hospital of All the Saints). Thousands of
Irmandades da Misericórdia (Fraternities of the Mercy),
also called Misericórdias (Mercies), consisting of
lay people from the local communities, and their hospitals,
known as Santas Casas da Misericórdia (Holy Houses
of the Mercy), were created in Portugal and in its colonies.
They play an important role in the medical and hospital care
in their regions, accounting for two thirds of the hospital
beds in Brazil alone.The predecessor of the Mercies was Lady
Isabel of Aragon, the Saint Queen, wife of Dom Dinis, ‘The
Farmer’. The outstanding Fraternities of the Mercy are
among the most widespread and longer lasting humanitarian
institutions.
Although the Mercies are
well known in Portuguese-speaking countries, they are almost
unknown in the rest of the world. For this reason, this article
is written in English.
Key words:
History of Medicine. Humanism. Hospitals, voluntary. Teaching.:
History of Medicine. Humanism. Hospitals, voluntary. Teaching.
Resumo
Dona Leonor de Lencastre,
viúva do rei D. João II, fundou a Irmandade da Misericórdia
de Lisboa em 15 de agosto de 1498, instalando-a na Capela
de Nossa Senhora da Piedade. Nomeou seu confessor, Frei Miguel
de Contreras para o cargo de provedor. A Irmandade assumiu
a manutenção do Hospital de Nossa Senhora do Amparo e depois
do Hospital Real de Todos os Santos. Centenas de Irmandades
de Misericórdia, também chamadas Misericórdias, formadas por
pessoas leigas das comunidades locais, e seus hospitais, conhecidos
como Santas Casas da Misericórdia, foram criadas em Portugal
e em suas colônias. Elas são responsáveis por importante parcela
da assistência médica e hospitalar em suas regiões. São seus,
dois terços dos leitos hospitalares no Brasil. A precursora
das Misericórdias foi Dona Isabel de Aragão, a Rainha Santa,
esposa de D. Dinis, "O Lavrador". As notáveis Irmandades
de Misericórdia estão entre as mais difundidas e duradouras
instituições humanitárias.
Embora as Misericórdias
sejam bastante conhecidas nos países de língua portuguesa,
não o são no resto do mundo. Por essa razão, este artigo está
redigido em Inglês.
Descritores:
História da Medicina. Humanismo. Hospitais filantrópicos.
Ensino.
INTRODUCTION
Half a millenium ago, on the 15th day
of August, 1498, the Irmandade da Misericórdia (Fraternity
of the Mercy) was founded in Lisbon, the first of thousands
that were created throughout Portugal and its colonies. Besides
medical, hospital and social assistance, they also rendered
spiritual services in the past. Their establishment is due
to the merciful soul of two ladies of the Lusitanian court.
ISABEL
OF ARAGON, THE PREDECESSOR
Lady Isabel, the Saint
Queen, daughter of Dom Pedro III of Aragon and wife of the
King Dom Dinis, ‘The Farmer’, founded the Hospital
de Santa Elizabeth, the Hospital Meninos de Santarém (1321),
the Hospital de Rocamador, the Hospital de Torres Vedras (1310),
and the Hospital do Espírito Santo de Alenquer (1320). The
Irmandade de Nossa Senhora da Piedade (Fraternity of Our Lady
of Piety), founded by Dom Dinis in attention to his wife's
request, was dedicated to burying the dead, caring for the
sick and the poor and assisting the convicts. Lady Isabel,
distinguished by her charitable activities, having founded
hospitals, churches and orphanages, was canonized by Pope
Urbane VIII in 1625. She is considered the predecessor of
the Mercies.
LADY LEONOR OF LENCASTRE, THE ESTABLISHER
Greatgranddaughter
of the founder of the dinasty of Avis, Lady Leonor of Lencastre
became known as ‘The Pious’ and ‘Queen of the
Sufferers’6,
being considered the establisher of the Irmandades da Misericórdia
(Fraternities of the Mercy). At the age of 12 she married
a cousin, heir of the House of Avis. Her husband ascended
the throne as Dom João II in 1481, and, having decided to
strengthen royal power at the expenses of the properties,
rights and privileges of the nobles, sought the support of
the bourgeoisie, beginning a bloody dispute in the court.
Dom Fernando, Duke of
Bragança, owner of one third of the Portuguese lands, was
nephew of the King and brother-in-law of Lady Leonor. With
the disclosure of documents indicating his involvement in
conspiratorial activities, he was tried and found guilty of
treason, for which he was punished with decapitation. Learning
that the Duke of Viseu, one of the Queen’s brothers,
was unwilling to yield to his ambitions, the King went to
Setubal and stabbed him to death at a private interview. Many
other noblemen who stood in the ambitious and merciless path
of the monarch (known as ‘the Perfect Prince’ as
a young man), were eliminated by ax, sword or dagger. Lady
Leonor was unable to avoid the tragic fate of her relatives.
Following the sequence of familial tragedies, her only son,
Dom Afonso, fell from a horse, dying while being rescued in
the net of shrimp fishermen.
Dom João II renamed the Cape of the Torments,
so called by its discoverer Bartolomeu Dias, as Cape of the
Good Hope. With the discovery of the America by the Spaniards,
the agressive Lusitanian monarch repeled the Bula Intercoetera,
favorable to his neighbors, threathening them with war. In
1494 he signed the conciliatory treaty in Tordesilhas, dividing
the world with his Spanish neighbor. The king, who in his
turbulent reign had centralized power and obtained rights
over vast extensions of lands in the New World, died on October
25, 1495, being succeded by Dom Manuel, brother of Lady Leonor.
Widowed
and disturbed by her family tragedies, Lady Leonor started
to dedicate herself intensely to sufferers, artists and writers.
On August 15, 1498, she founded the Irmandade da Misericórdia
de Lisboa (Fraternity of the Mercy of Lisbon), establishing
it in the Capela da Nossa Senhora da Piedade 'da Terra Solta'
(Chapel of Our Lady of Piety 'of the Free Land'), erected
by Dom Dinis in the cloister of the See of Lisbon. The ordinance
of the Irmandade da Misericórdia de Lisboa was similar to
that of an older Florentine organization, which seemed to
result from observations made by travellers in China2,6.
The Templo da Conceição Velha (Temple of the Old Conception)
was erected to house it and the fraternity took over the administration
of the Hospital de Nossa Senhora do Amparo1
(Hospital of Our Lady of the Aid). Dom Manuel and his successors
encouraged the creation of Irmandades da Misericórdia
throughout the entire kingdom, granting fiscal and other royal
privileges to them and to their members. Caring for the sick,
poor, orphans, and prisoners, they relieved the State of many
of its social duties. When Lady Leonor died, on November 17,
1525, there were around sixty Misericórdias, which
later spread throughout Brasil, Africa, India, China, Japan
and the Middle East.
Of important assistance
to Lady Leonor in the establishment of the Mercy of Lisbon
was her confessor, the Spanish Trinitarian Friar Miguel de
Contreras, its first provedor (provector), name used
for their presidents.
Dom
João II (reign: 1481-1495) obtained papal permission to reorganize
and unify several small hospitals belonging to various associations
such as the shoemen, the seamen, and the goldsmiths, as well
as asylums and charitable organizations. On May 15, 1492,
construction began on the Hospital Real de Todos os Santos
de Lisboa and was finished in 1501, under the reign of D.
Manuel. It came under the management of the Irmandade da Misericórdia
in 1564 and it was in this model hospital that the School
of Medicine of the University of Lisbon was later created.
THE FRATERNITIES OF THE MERCY
The Irmandade da Misericórdia
de Lisboa was formed by one hundred men:
'of good fame, sane conscience and honest life, fearful of
God and keepers of His commandments, peaceful and submissive
to all the service of God and of the said fraternity, that
were intended to accomplish among themselves and for every
and any needed the fourteen works of Misericórdia, having
as model the Gospel of Saint Mathews and following the norms
dictated by Saint Paul: Work and support the charges of each
other'.
It
was ruled by an ordinance called Compromise, printed eighteen
years later3,8.
At the time of their creation,
the Irmandades da Misericórdia, like most Portuguese
institutions, had a strong religious content and spiritual
functions besides the 'corporeals'. They were formed by volunteer
members of the local community, and their administrative boards
were led by high ranking officers of public administration,
prestigious professionals or wealthy citizens, being independent
from the civil or ecclesiastic authorities. With the passing
of the centuries, they lost their spiritual functions and,
particularly in Brazil, became devoted almost entirely to
the medical and hospital assistance, besides other services
of a social nature. Currently, the Fraternities of Mercy are
open and democratic philanthropic societies, without any religious
or politicial restrictions.
During
the reign of D. Manuel (1495-1521) ‘The Fortunate’,
Portugal witnessed the expansion of its domains. In 1551 Dom
Manuel's son Dom João III (reign: 1521-1557) conceded a charter
of privileges to the fraternity and hospital that Braz Cubas
had founded in 1543, the first in Brazil, in the then settlement
of the Port of São Vicente, later the Village of Santos7.
THE MISERICÓRDIAS IN BRAZIL
The thousands
of Brazilian Santas Casas da Misericórdia account for two
thirds of the hospital beds in the country3.
At least sixty percent of their services are dedicated to
the poor. They have also served for medical teaching, commonly
being requested by the medical schools. Victims of a chronic
lack of interest towards public health, they survive thanks
to the efforts of those who work in them5
and to the volunteer work of members of the local communities.
Their administrative boards try to bridge the differences
between the high costs of modern medicine and the oft-delayed
token fees, seeking income by assisting private paying clients
and saving with their own production of certain medicines,
food, coffins and other goods. Often the presidents have to
struggle tiresomely with authorities in order to obtain the
payment of fees owed to their hospitals.The Misericórdias
used to be recipients of donations, being included in private
wills, a tradition that has almost disappeared with the institution
of official and private health insurance plans.
CONCLUSION
Despite material difficulties,
a constant factor throughout the centuries, the Irmandades
da Misericórdia have grown, spreading throughout the Portuguese-speaking
world, and have accomplished their mission. The admirable
Misericórdias are among the most dedicated, extensive,
persevering and durable humanitarian institutions.
REFERENCES
-
Andrade
WTF: Conexões da história: Santos e Portugal. Leopoldianum
1996; 22: 67-84.
-
Campos ES: Santa Casa
da Misericórdia de Santos - Primeiro hospital fundado
no Brasil. São Paulo, 1943.
-
Ferreira AA: As Santas
Casas da Misericórdia e os hospitais filantrópicos: 500
anos de história. In Silva MF: D. Leonor e as Misericórdias
Portuguesas. Lisboa: Rei dos Livros, 1998, p. 510.
-
Freitas D.G: As misericórdias
no Brasil, in Actas do IV Congresso das Misericórdias.
Lisboa, 1959; p. 230.
-
Ivamoto HS: Médicas,
mães paternais, heroínas anônimas. Santos: A Tribuna July
17, 1996, p. 18.
-
Macedo Soares JC:
Address as president of the opening session. In Lopes
AA: Memórias dos festejos comemorativos do 4º centenário
da fundação do hospital, em Novembro de 1943. São Paulo:
Empresa Grafica da Revista dos Tribunais Ltda 1947, p.
85.
-
Santos
FM: História de Santos. São Vicente: Editora Caudex Ltda,
2a. ed., 1986.
-
Silva MF:
A Rainha D. Leonor e as Misericórdias Portuguesas. Lisboa:
Reis dos Livros, 1998.
(*)
Os autores: H. S. Ivamoto, editor da Acta Medica Misericordiæ,
é chefe do Serviço de Neurociurgia da Santa Casa da Misericórdia
de Santos, membro fundador da Soc. Bras. Hist. Medicina, membro
do corpo editorial do Journal of Microsurgery, membro titular
da Soc. Bras. Neurocirurgia, Soc. Bras. Med. Legal, Surg.
Soc. New York Med. College, e diplomado pelo Commonwealth
of Pennsylvania. R. Morales, assistente do Serviço de Neurocirurgia
da SCMS é membro fundadora da Soc. Bras. Hist. Medicina e
membro titular da Soc. Bras. Neurocirurgia. L. S. Ivamoto,
bacharel em Direito pela Unimes, é docente da Soc.Bras.Cult.
Inglesa e aluna da Unisantos. E. S. M. Vieira de Souza é aluno
da Fac. Ciênc.Méd. Santos e interno da SCMS.
Endereço/address:
Henrique Seiji Ivamoto,
M.D.
Santa Casa da Misericordia de Santos
Av. Dr. Claudio Luis da Costa, 50
Santos, S.P., CEP 11075-900 - Brasil
hivamoto@hotmail.com
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