to
correct {273} abuses which still continue to be some of the thorny
problems of hospital management. For instance, the danger was
recognized of having the expenses of administration outrun those of
the hospital proper, and of having the number of attendants, or at
least of persons living upon the hospital revenues, greater than was
absolutely needed for the care of patients. There are various Papal
decrees and decisions of diocesan synods in this matter. Pope Honorius
III., who occupied the Papal See from 1216 to 1227, and must be
considered as a very worthy successor of the first great Pope of the
century, Innocent III., in approving the union of two hospital
foundations at Ghent, required that only a certain limited number of
Brothers and Sisters for nursing purposes should be received, in order
that the community expenses proper might not impair to too great a
degree the resources of the hospital for its real purpose of taking
care of patients. Previously, he had insisted by a decree that the
number of Brothers and Sisters in the hospital community at Louvain
should not exceed the proportion of more than one to nine of the
patients. Synodal decrees in various bishoprics allowed only board and
clothing, but nothing more, to attendants in hospitals. In the
thirteenth century the personal satisfaction of accomplishing a
charitable work in attendance upon the sick was expected to make up
for any further remuneration.

The other serious problem of hospital management was to keep those not
really suffering from serious disease, malingerers of various kinds,
from occupying beds and claiming attention, to the deprivation of
those who were genuinely ill. Various regulations were made looking to
the careful examinations of such persons, {274} though in most places
with the affirmation of a standing rule, that all those complaining of
illness were to be received into the hospital for at least one day,
until their cases could be examined with sufficient care to decide how
much of reality and how much of simulation there might be in their
pretended symptoms. The tramp, of course, has always been in the
world, and probably always will be, and so what are called the sturdy
vagrants (validi vagrantes) received the special attention of those
wishing to eliminate hospital abuses, and various decrees were made in
order to prevent them from receiving sustenance from the hospitals, or
in any other way abusing the privileges of these