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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.

Ivamoto HS, Morales R, Ivamoto LS, Vieira de Souza, ESM. The Santas Casas da Misericórdia: five centuries of philanthropy. Acta Medica Misericordiæ 1(1):11-13, 1998

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

1. Andrade WTF: Conexões da história: Santos e Portugal. Leopoldianum 1996; 22: 67-84.

2. Campos ES: Santa Casa da Misericórdia de Santos - Primeiro hospital fundado no Brasil. São Paulo, 1943.

3. 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.

4. Freitas D.G: As misericórdias no Brasil, in Actas do IV Congresso das Misericórdias. Lisboa, 1959; p. 230.

5. Ivamoto HS: Médicas, mães paternais, heroínas anônimas. Santos: A Tribuna July 17, 1996, p. 18.

6. 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.

7. Santos FM: História de Santos. São Vicente: Editora Caudex Ltda, 2a. ed., 1986.

8. Silva MF: A Rainha D. Leonor e as Misericórdias Portuguesas. Lisboa: Reis dos Livros, 1998.

THE AUTHORS: H. S. Ivamoto, editor of the Acta Medica Misericordiæ, is chief of the Neurosurgery Service of the Santa Casa da Misericórdia de Santos, founding member of the Brazilian Society for the History of Medicine, review editor for the Journal of Microsurgery during its existence, licensed in Medicine by the Commonwealth of Pennsylvania. R. Morales is assistant neurosurgeron, founding member of the Brazilian Society for the History of Medicine. L. S. Ivamoto, graduated in Law is teacher of English at the Brazilian Society for English Culture. E. S. M. Vieira de Souza é a student at the Medical Sciences School of Santos and intern at the Santa Casa of Santos.

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@yahoo.com.br, hivamoto@hotmail.com, www.actamedica.org.br

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