The Bethlemite hospital rule (1672): a nursing order written in Guatemala and confirmed at Rome
A hospital rule that began in Santiago de Guatemala and was confirmed by Clement X on 2 May 1672, printed with the rest of the order's papal documentation at Rome in 1773. Its statutes admit convalescents, incurables and poor travellers, forbid excluding any kind of person - free, enslaved, Moors, Gentiles - require the brothers to carry the sick to the hospital themselves, and bar women from the building. Indians and Blacks were admitted to a separate infirmary.
Why this wins its question: Colonial Spanish American hospitals are usually discussed at the level of the royal legislation that ordered them built, or not at all; the operating rules of the houses themselves are rarely quoted in English. This object goes to a rule and reads it: the three classes of patient the Bethlemite statutes commit to - convalescents, incurables and poor travellers - the requirement that the brothers search the inns and private houses of the city and carry the sick themselves in a sedan chair rather than let others do it, the prohibition on excluding "ningun genero de personas... Libres, Esclavos, Moros, y Gentiles", and the signed admissions register recording every patient's name, birthplace and date of entry from 1672. It is also, so far as this corpus can find, the only account that sets the three things next to each other that this document keeps on facing pages: the non-exclusion rule; the absolute bar on women entering the building, as patients or as visitors; and the rubric admitting Indians and Blacks to a separate infirmary. It further records, rather than smoothing over, a contradiction inside the bull itself, whose narrative admits only Christian and Catholic men while the statutes it confirms oblige the hospital to receive Moors and Gentiles - and it declines to repeat the first-order-in-the-Americas claim that no source opened here supports.
Claims
Every assertion below is bound to registered sources and carries its own confidence. Weight them; do not treat the page as uniformly authoritative.
The documentation survives because the order printed its own archive. The title page reads "BULLARIUM LATINO-HISPANICUM ORD. FRATRUM BETHLEMITARUM IN INDIIS OCCIDENTALIBUS IN QUO COMPREHENDUNTUR OMNES APOSTOLICÆ LITTERÆ A SUMMIS PONTIFICIBUS Editæ ab anno 1672. usque ad annum 1773", dedicated to cardinal Francisco Xaverio de Zelada as protector of the order, "ROMÆ MDCCLXXIII. TYPIS REVERENDÆ CAMERÆ APOSTOLICÆ". Every bull is set in Latin with a facing Spanish column.
The reason for printing it is stated in the dedication, and it is archival rather than promotional: these documents, "reclusos hasta aqui en los Archivos de nuestro Orden", were gathered "al cuerpo de un quaderno" and given to the press "tanto para preservarlos de la corrupcion, y de el polvo, como principalmente, para que pudiendo nuestros Religiosos con mayor facilidad saber à fondo su Derecho municipal, y las obligaciones, à que los empeña su Instituto". A hospital order was publishing its own governing law so that its members could read it.
The founding instrument is the first item. Its heading reads "BULLA CLEMENTIS PAPÆ X. Qua confirmantur primæva Statuta Fratrum Bethlemitarum, una cum insertione eorumdem Statutorum, dat. 2. Maji 1672", in Spanish "Con la qual se confirman los primeros Estatutos de los Hermanos Bethlemitas, juntamente con la insercion de sus proprios Estatutos, dada â 2. de Maio de 1672"; the petition it answers came from "Rodrigo de la Cruz Hermano mayor". The constitutions it confirms are those of the company erected in the hospital of poor convalescents of the city of Guatemala under the invocation of the Virgin of Bethlehem, "las que en la mayor parte se han sacado de la institucion, que dejò el Venerable Hermano Pedro de San Joseph de Bettancur, su primero Fundador".
The institution being confirmed is unusual in what it undertakes to treat. Chapter VII of the statutes is headed "De las cosas, que han de observarse en las Enfermerias con los convalecientes, incurables, y pobres peregrinos", in Latin "cum convalescentibus, incurabilibus, & pauperibus viatoribus". These are the three classes of patient a general hospital of the period had least reason to want: people no longer acutely ill, people who could not be cured, and people passing through with no settlement in the city.
The rule requires the brothers to go and find those patients and to carry them in person. On notice from the ministers of the hospitals that poor sick people are convalescent, they are to transfer them "imediatamente desde los hospicios, ô desde sus casas en una silla de manos" kept ready for the purpose, "por si mismos", and are not to permit them to be carried by others, "por ser una carga, que Dios ha puesto sobre sus hombros". The hermano mayor is to have them searched for diligently through the private houses and hostelries of the city. On feast days the sick poor in their own houses are to be carried to church.
The admission rule of the statutes is a flat prohibition on exclusion. Chapter VI section 3 reads: "No ha de ser excluido de nuestro Hospital ningun genero de personas, y â todos se han de estender, y alargar los brazos de la caridad, yà sean Libres, Esclavos, Moros, y Gentiles"; the Latin column has "Nullum genus personarum excludi debet a nostro Hospitali, & ad omnes extendenda, & porrigenda sunt brachia charitatis, sive sint Liberi, Mancipia, Mauri, & Gentiles". Non-Christians are named in the text as people the hospital is obliged to receive.
The exception is in the same sentence and is absolute. The excluded are "las mugeres, las que por ningun titulo pueden entrar en el Hospital, ni para convalecer, ni para visitar â los pobres, bien que fuera del Hospital, y en sus casas deban ser socorridas con caridad". Women could not enter the building either as patients or as visitors; what the rule substitutes is relief at home, which the parallel provision in the bull itself makes the hermano mayor's obligation, to be discharged "con lymosnas, ô por si mismo, ô por medio de otros varones discretos y piadosos". A hospital that would not turn away a Gentile turned away half the city.
The two texts printed in this volume do not say the same thing about who is admitted, and the difference is not reconciled anywhere on the pages opened. The bull's own narrative, at page 13, restricts admission to "los hombres cristianos, y catholicos, de qualquiera nacion, estado, y condicion que sean, esto es nobles, y plebeios, libres, y esclavos, blancos, y negros" - in Latin "christianos tamen dumtaxat, & catholicos" - while the statutes inserted into the same bull, at page 48, extend the arms of charity to "Moros, y Gentiles". One text confines the hospital to Catholics and the other obliges it to receive non-Christians. Which governed practice in Santiago de Guatemala is not something these pages settle, and the claim is held below 0.9 for that reason.
What both texts agree on is that the poor and the enslaved were to be received, and the terms of that reception were racially segregated. A rubric at page 14 reads, in Latin, "Indi, & Nigri in separatam Infirmariam admittantur", and in Spanish "A los Indios, y Negros se han de admitir en Enfermeria separada". The statutes are more explicit still about which way the separation runs: there are to be infirmaries "para los Españoles, separadas de las de los Indios, Negros, y de otras Naciones", in Latin "pro Hispanis, separatæ ab illis Indorum, Nigrorum, & cæterarum Nationum". Universal admission and wards segregated by race are provisions of the same rule, and an account that reports one without the other is not reporting this document.
The same rubric carries a piece of administration that is easy to miss and hard to overstate: as soon as a convalescent arrives, the infirmarian is to note and sign in a book kept for the purpose "su nombre, y apellido, y patria, y tambien el dia y año, que entrare en el mismo Hospital". A signed admissions register recording name, origin and date of entry was a requirement of the rule from 1672, in a hospital whose registered patients included enslaved people, Indians and travellers with no settlement in the city.
Two limits bound this object. It is argued from a compilation the order made of its own papers, so the selection is the order's; nothing here establishes that any of these provisions was obeyed in any hospital, and a rule restated is often a rule broken. And the claim repeated in devotional and encyclopedic writing that the Bethlemites were the first religious order founded in the Americas is not asserted here, because no source opened for this object states it - the title page says only "Ord. Fratrum Bethlemitarum in Indiis Occidentalibus".