Regulations and Constitutions of the Hospital del Espíritu Santo of Sevilla, year 1590. “The nurses work”"

1 NOVEMBER 2016 |   Document 1.

Special thanks

We wish to thank to Archivo de la Diputación de Sevilla the facilities borrowed to publish this document.

1. Scanned images of the document

Four high-resolution scanned images are included.

- F. 13r //
- F. 13v //
- F. 14r //
- F. 14v //

Personal use of the cited document is permitted, as well as for research purposes; its reproduction, copy or publication is not permitted without the express approval of Diputación Provincial de Sevilla

2. Title, place and date

Regulations and Constitutions of the Hospital del Espíritu Santo of Sevilla. 26 April 1590.

3. Depository institution and catalogue number

Archive of Diputación Provincial de Sevilla. Hospital del Espíritu Santo, file 2C, ff. 13r-14v. Regulations and constitutions of the Hospital del Espíritu Santo of Sevilla, 26 April 1590.

4. Physical description

Book with 18 manuscript folios and three blank ones; parchment binding. Italics Roman writing.

5. Significance of the documen

The 1590 Regulations of the Hospital del Espíritu Santo of Sevilla represent a really important change compared to those with similar characteristics developed for peer hospitals of the same city as they include very specific chapters on the treatments to be applied to hospitalized patients, and the intervention of medical specialists is shown in their writing. In addition, they have a special value so as to know the evolution of the nursing profession in Spain as they deal with the tasks entrusted to the major nurse and the minor nurses, notably highlighting their relevance in the caregiving task and the need to have a good training (folios 13r to 14v reproduced here).

6. Ten key ideas for the History of Nursing. 16th century

1.- Hospital constitutions represent an important source for the study of the Spanish Nursing History. 2.- Lay nurses develop an important nursing task, just as relevant as that of religious nurses in Sevilla during the 16th century.
3.- Similar number of male and female nurses working in Sevillian hospitals.
4.- In the 16th century, nurses work for a wage, as it is reflected in the administrative documentations kept in this hospital.
5.- High qualification required for nurses.
6.- Nurses’ specialization in treatments.
7.- Institutional recognition of the nurses work appears in the Hospital Regulations.
8.- Apart from physical treatment, modern hospital also deal with spiritual, psychological and religious aspects.
9.- In the Hospital del Espíritu Santo of Sevilla there are two different categories of nurses: “major nurse” and “nurses”.
10.- Starting point for the long road to specialization of the nursing profession in Spain.

7. Historical context

The Hospital del Espíritu Santo of Sevilla, together with the Hospital del Amor de Dios of the same city, were built to provide admittance to the patients hospitalized in the several small hospitals of Sevilla, which had few resources, in the 16th century. This took place under the process of hospital reduction carried out throughout the Spanish Crown during the reign of Felipe II (already started under the Catholic Monarchs reign), a process that started bearing fruit since 1587 onwards.

8. Brief Chronology

- 1488. First attempts of hospital unification/reduction in Castilla, promoted by Cardinal Diego Hurtado de Mendoza.
- 1522. New attempts of hospital unification in Castilla, promoted by Archbishop Brother Diego de Deza.
- 1556. Coronation of Felipe II as King of Spain.
- 1584. Fresh impetus to the process of hospital reduction with favourable results, promoted by Cardinal Rodrigo de Castro. This began in Sevilla and other Andalusian cities.
- 1584. Beginning of Sevillian hospital unification by Archbishop Rodrigo de Castro.
- 1588-1596. Building of the Hospital del Espíritu Santo of Sevilla.
- 1590. Creation of the Regulations and Constitutions of the Hospital del Espíritu Santo of Sevilla.
- 1591. The hospital admits the first patients, although the building works were still in process.
- 1837. Closure of Hospital. - 1847. Demolition of Hospital and building of San Fernando Theatre.

9. Transcription of the document

The rules set by the International Commission of Diplomatics have been followed for the transcription of the document

13r/ENFERMERO MAYOR y los demás enfermeros

1. The role of the head nurse is highly relevant because on him depends most of the healing process and welfare of nurses, so this person must inspire great confidence and must be in charge of all the infirmaries and nurses, distributing and monitoring what must be done, telling each nurse what to do according to these constitutions and the order given by the administrator.

2. The head nurse must practice medicine and surgery and, if this were not possible, at least, the head nurse must be competent in the relationship with the doctor and surgeon in relation to the diseases of the sick and their consequences, and must be able to help in the sudden cases that occur during day and night.

3. Diseases normally bring discontent and desperation, and the poor sick who come to the hospitals tend to be difficult to treat and correct in their behaviour, so it is really important to seek charity and love in the head nurse and this, at the same time, must assure that the other nurses and servants, and he himself, treat the patients with great love and patience and, even if they are given cause, the must not use the wrong words or treat them with surliness and, if some of them got carried away, the same person must confess it to the administrator to receive the appropriate punishment and even be despised if there is no possible correction. However, this does not mean that there will be no punishment for those nurses who overdid it and were disobedient, and they would be punished as the administrator considers.

4. The head nurse must be given an inventory of all the beds in the infirmaries and of the bedclothes, tables, benches, tablecloths, clothes for the poor and all other elements of service available in the infirmaries.

5. All the beds in the infirmaries will be noted down on /13v a list in a most visible place in the infirmary, organized by order and number, and it is the head nurse’s responsibility to write down or order to do write down the name of the sick at his/her admission in the hospital, including in it the day, month and year of admission and, on the discharge or death of the patient, the name must be erased so that it is easily possible to know the number of patients being treated and in which beds they are.

6. The head nurse must accompany the administrator, doctor and surgeon to the reception of patients and a minor nurse must be in charge of taking the patient to confess with the priest, have his/her hair cut and get undressed in the allocated room for this purpose or where it is convenient at the moment, and the patient must be given clean clothes and slippers, then showing him/her the bed where the healing will be done and the number of the same.

7. The person in charge of the clothes must receive those of the patient by the order given in the title and, be it necessary, he will give the order of washing the patient’s feet.

8. The head nurse must accompany the doctor and surgeon in their visits, and must note down in some charts consigned for the same purpose the numbers of beds and the food prescribed to each of the patients and the time it must be given to them, as it is not necessarily at the same time the other patients eat.

9. The head nurse will also note down the bleedings, syrups, purgatives or any other medicine or remedy prescribed by the doctor and the surgeon in the order and at the time agreed, taking a special care and vigilance to do it in the way they ordered.

10. Once the visit is finished, one of the priests will accompany the head nurse and they must take the book or chart where lunch or dinner were noted down to count the portions of hen, chicken or ram, ratatouille, almonds, panatela (a type of big and slim sponge cake) or any other kind of food or diet, writing in a piece of paper or logbook how many portions of each type of food must be administerd in the following way.

/14r 11. One pound and a quarter or ram for every three portions and for four portions of poultry meat. A hen for two portions. A chicken, not being prescribed by the doctor, can be given to the discretion of the nurse. Once noted down, the person in charge of the pantry will be summoned and ordered to keep what is prescribed, and the cook must be told to receive it and cook it for the time thus prescribed.

12. The meals shall be given all together at the time prescribed and there will be a table for the same purpose. The priest and the head nurse will distribute the food to each patient according to the notes from the visit and referring to the number assigned to the beds. The administrator will help, as well as the other ministers, to organize what was ordered to ingest, and the person in charge of the pantry will note down this meals and the portions.

13. The administrator, together with the doctor and surgeon, and in agreement with the head nurse, will advise the number of patients that should normally be treated, increasing or decreasing this number according to the sufferers and the diseases.

14. The administrator will assign, in agreement with the head nurse, one of the minor nurses the task of keeping count of the sufferers, sorting those who shall eat together in the table assigned for them and all the necessary elements for the service. This minor nurse will bring the food and make their beds, and will keep the infirmary clean.

15. Minor nurses must hold the responsibility of sweeping the infirmaries, distributing themselves among the beds assigned to them and keeping them clean and neat, making the same beds, at least, twice a day, one in the morning and one in the evening after dinner..

16. A minor nurse will attend to the plates and porringers, which must be made of pewter, as well as to the glasses, tablecloths, knives and salt-cellars. /14v This minor nurse will have a sideboard or table to set all this and the head nurse will put him in charge of it. The minor nurse will also take the responsibility of lighting the infirmary lamps with some perfume on them so that there is no stink, and this will be made every morning, prior to the doctor’s visit.

17. Each minor nurse must give each patient the necessary utensils to eat and must clean everything, and when the patients finish and stand up, the minor nurse shall put them their slippers and clothes on, helping them to lift themselves and directing them to their beds, then taking the utensils to wash them.

18. All minor nurses must go to the kitchen and to the pantry to bring the food and the pitcher with water to the sideboard, and they must go to the place assigned for the distribution of the same and give the portions to each minor nurse in his charge. These minor nurses must open the recipients and do everything necessary for the service.

19. Three minor nurses must be on call every night, distributing them according to their shifts and alternating them so that the one who is not on call is on call the next day.

20. There must be a sweeper who keeps the place clean and helps in everything necessary for the services given, also assisting the cook.

21. After sunset and after the ringing out of the bells to tidy everything up, nobody must walk in or pass through the infirmaries if it is not necessary, and those on call must take special care on being silent so as not to disturb the sufferers.

10. Lecturas recomendadas.

- Calvo Calvo, M. Á.: "Aspectos sociolaborales de los enfermeros del Hospital del Espíritu Santo de Sevilla a finales del siglo XVI”. En Híades. Revista de Historia de la Enfermería, núm. 8, pp. 355-379
- Carmona García, Juan Ignacio (2005), Enfermedad y sociedad en los primeros tiempos modernos, Sevilla.
- Carmona García, J. I.: El sistema de la  hospitalidad pública en la Sevilla del Antiguo Régimen. Sevilla, 1979.
- García Martínez, A. C.: "Las constituciones de los hospitales y los cuidados enfermeros en la España de los Austrias (siglos XVI-XVII)". En Erebea, Revista de Humanidades y Ciencias Sociales. Núm. 4 (2014), pp. 43-80.
- García Martínez, Manuel Jesús (2014), “La hospitalización y la peste en el siglo XVII en “Directorio de Enfermeros”, de Simón López”. En Erebea. Revista de Humanidades y Ciencias Sociales, 4, pp. 119-143, Huelva.
- García Martínez, Manuel Jesús; García Martínez, A. C. (1998), “La enseñanza de la enfermería en la España del siglo XVII. El manual de enfermería de Simón López (1668)”, Cultura de los Cuidados. Revista de Enfermería y Humanidades, n.º 3, pp. 15-23. Alicante. 
- Martínez García, C.: El Hospital del Espíritu Santo de Sevilla (1587-1837). Memoria de Licenciatura.
- Recio Mir, Á. : "La reducción de los hospitales sevillanos de 1587: repercusiones artísticas y burocracia constructiva". En Laboratoria de Arte, Núm. 13 (2000), pp. 39-57.