Vincentian Mission in Health Care

by:

SISTER LOUISE SULLIVAN, DC, a Daughter of Charity of the Province of St. Louise, is a Professor Emerita at Niagara University where she was Chair of the Department of Foreign Languages and taught French Language, Literature, and Civilization for 23 years. She has a BS in French and Education from St. Joseph’s College, Emmitsburg, MD; an MA in French Language and Literature from the Catholic University of America; and a Ph.D. from the University of Paris IV: Sorbonne in French and Comparative Literature. She edited and translated from the French The Spiritual Writings of Saint Louise de Marillac and authored the definitive biography of Sister Rosalie Rendu: Sister Rosalie Rendu: a Daughter of Charity on Fire with Love for the Poor. She also wrote The Core Values of Vincentian Education, The Vincentian Mission in Health Care’ as well as numerous articles on Saint Louise de Marillac. She does presentations, retreats, and sessions on Vincentian Heritage topics nationally and internationally.

Introduction

As the sixteenth century was drawing to a close in France, the Wars of Religion, which had ravaged the nation for more than thirty years, at last ended. When Henri IV ascended the throne in 1593, he brought tolerance and an impetus toward reform as part of his “grand design" for the future of the country. (Miquel 1:176-185) At the same time, the decrees of the Council of Trent (1545-1563) were making belated inroads into France. In 1615, they were finally promulgated by the Assembly of the Clergy, in the name of the Church of France, rather than officially on behalf of the realm. (Poinsenet 2) Nevertheless, the Catholic Counter Reformation, with its heavy mphasis on "works of charity" was flourishing. (lmbert Hôpitaux 25)

The major religious orders, reformed from within after the stormy years of the Protestant Reformation, returned to Paris. (Miquel 1:188). However, their new found vitality to channel their energies into contemplation rather than "good works" such as hospitals which many among them had staffed since the Middle Ages. Moreover, nursing congregations had suffered greatly since the height of their medieval power not only on account of the Reformation but also because exposure to disease, particularly plague had radically reduced their numbers.

Thus the bishops, for whom hospitals had once again become a central focus of their social ministry, faced a crisis. The institutions themselves badly needed reform and health care providers had to be found. The task of responding to this challenge would become the specialty of a new type of religious woman -— one who would serve outside the cloister. (Molette 12-15)

This latter group was to develop in a way which would make a major contribution to the organization of charity, particularly health care, prior to the French Revolution of 1789. Despite its anti-clerical overtones, a plaque at the Museum of Public Assistance in Paris acknowledges that such women were "the most representative of health care providers" of the era and that they symbolized "the foundational values of the hospital: hospitality and compassion." Nevertheless, the very ubiquity of their presence --- they were in more than 1500 hospitals, large and small, throughout France before the suppression of religious orders in 1792 (Jones 10) --- made them so banal a reality as to be easily overlooked. They became so timeless a phenomenon that radicality of their specifically seventeenth-century French origins could readily be forgotten. Yet when Louis Xlll ascended the throne in 1610, they did not exist.

The creation, during the first half of the seventeenth century of communities of religious women of the active life --- the most common in the nineteenth and twentieth centuries --- required two extraordinary people: Vincent de Paul, the peasant priest who was to become the confidant of and the advisor to the nobility, and Louise de Marillac, the "natural daughter" of a member of the mighty, if ill-starred Marillac clan, whose friends were among the most powerful in the land. Together this man and woman of widely different up-bringing and personalities was succeeded in bridging, in a rigidly hierarchical society, the gap between the wealthy upper-classes and the young women of menial, generally peasant background, who were to become the first Daughters of Charity, the largest and most influential group of religious women of the active life in the era. Vincent de Paul and Louise de Marillac used their prestige, their experience, and their diplomacy to overcome the resistance of a church which desperately needed the services of such women but which, while admitting active orders of men, continued to see the cloister as the only safe and suitable environment for religious women. Indeed, the Council of Trent had legislated inclosure for the few groups of active religious that existed in the sixteenth century. To further complicate the issue in France, Louis XIII decreed that royal approbation would be accorded only to congregations pronouncing solemn vows that is, for all practical purposes, cloistered. (Molette 29-30)

Despite these seemingly insurmountable obstacles, some forty groups of active women religious, mostly small nursing communities, developed at this time. While Vincent de Paul played an important role in the organization of many of them, the most important of them for our purposes would be the Daughters of Charity which he co-founded with Louise de Marillac in 1633. Their work was never limited to health care -- - they were also involved in education and social welfare --- however the service of the "sick poor" was central to their vocation from their origin. The first act of approbation of the Company signed by Jean-François-Paul de Gondi, coadjutor Bishop of Paris, dated 20 November 1646, speaks of their establishment "for the assistance and comfort of the sick poor." (Coste Xlll:557) The original statutes, approved the same day, refer to the sisters as servants of the sick poor." (Coste XIII:559)

The approbation of the Company of the Daughters of Charity by ecclesiastical authority bears eloquent testimony to the deep concern of Vincent de Paul and Louise de Marillac for the poor, particularly the sick poor. It also reveals the painstaking process by which they achieved acceptance for a way of life which was to transform not only religious congregations but also the role of women in the work place. By so doing, they brought to nursing care in seventeenth century France a level of competence and a quality of service that other nations would not experience, in a generalized way, until the Florence Nightingale era (1820-1910). (Jones 7)

Nursing care and hospital administration have evolved greatly since the first five Daughters of Charity gathered together in Louise de Marillac's home on 27 November 1633 and began to bring food and medicine to the sick poor of the parishes of Paris. Nevertheless, the values inherent in the original works may well serve as an instructive model for contemporary health care reform efforts.

Before examining this early service of the sick poor, it would be well to look more closely at the man and woman whose charism infused what was to become "Vincentian" health care. While it is not our purpose here to recount in any detail the lives of Vincent de Paul and Louise de Marillac, it is nonetheless essential to reflect briefly on the circumstances which directly or indirectly influenced their approach to the service of the sick. A further observation also appears useful here. For both of them, everything was rooted in life, in events, and in their personal experiences. Any attempt to delimit or define their views and the resultant works for the care of the sick poor must take into consideration, as applying equally to both of them and to all their undertakings, the oft-repeated statement with which Vincent de Paul concluded his letter of 5 August 1642 to Bernard Codoing, "Such is my faith and such is my experience." (Coste II:282)

Despite their extraordinary intellectual and organizational abilities, Vincent de Paul and Louise de Marillac were, in the final analysis, a man and woman of faith seeking to discern the will of God and to find pragmatic solutions to the overwhelming needs of the poor of their era. They prayerfully sought to read the signs of the times and to discover the voice of God speaking to them in the sometimes commonplace, sometimes dramatic events of their personal spiritual journeys.

Faith and Experience of Vincent de Paul: 1581-1625

On the surface there is little in the early life of Vincent de Paul that foreshadows the "Great Saint of the Great Century" as his biographer Pierre Coste, C.M. would later call him. There is perhaps still less that seems to prepare him for his future role as a health care reformer and innovator. Born in 1581 in Pouy, a tiny village in southwestern France, into a family of simple, hard-working peasants, he, like all the children of the village, shared in the work of the farm and remained, for all practical purposes, illiterate until the age of fifteen. He, himself, tells us, "I am the son of a poor tiller of the soil and I lived in the country until I was fifteen years old." (Coste lX:81)

It was only then that his father, Jean de Paul, decided to send Vincent to study at the Coll?ge des Cordeliers in the nearby city of Dax. He hoped by doing so that his boy, who had already exhibited keen intelligence, would one day be ordained a priest and that, like the son of a neighboring family in similar economic circumstances, he could, as his first biographer, Abelly, tells us, "receive a benefice, and while serving the Church, might help to support his family." (Abelly l:36l)

Thus, in 1595, the journey toward ordination began for the young Vincent. One should not be too quick, however, to judge his father harshly. While his desire to see his son become a priest undoubtedly had motives that were more human than spiritual, it must be remembered that the church was the sole means for a boy of his class to escape, if not poverty, at least a modest, difficult life. Moreover, if Vincent de Paul was hardly "Saint Vincent" at the age of fifteen and shared fully in his father’s ambitions for him, he was, nevertheless, a young man with solid faith and moral values which he had developed in the midst of his family. When speaking later of poor peasants like those among whom he had spent his childhood, he exclaimed, "lf there is a true religion ... it is among them; it is among those poor people that true religion and a living faith are preserved." (Coste Xl:200-201) The grace of God and of vocation had good soil in which to grow.

Vincent spent two years as a student in Dax. There he attracted the attention of a certain Monsieur de Comet, a lawyer at the Presidial Court of Dax as well as a judge in Pouy. The lawyer became his patron and brought him into his home as a tutor for his children thus introducing Vincent to teaching, an avocation at which he would excel. Encouraged by Monsieur de Comet, Vincent then entered the prestigious University of Toulouse to pursue a Bachelor of Theology degree that he earned in 1604, four years after his ordination to the priesthood on 23 September 1600.

Jean de Paul did not live to see his dreams for his son realized. He died during Vincent’s first year at the University of Toulouse. The financial strain placed on the family by his death led Vincent to turn once again to teaching to earn his livelihood. This proved so successful that he was running a school for boys in Toulouse when he completed his studies.

Education, therefore, would appear to be the work of predilection for Vincent de Paul. And so it would prove to be. The reformer and educator of the clergy was born. Nevertheless, these early years also formed the future Apostle of Charity preparing him for the works he would later accomplish in health care as well as in social welfare.

Most significant for our purposes is his peasant background. While the success of the health care initiatives that he would later undertake depended on the collaboration and financial support of the wealthy --- particularly rich women --- nevertheless the Daughters of Charity, who would give life and form to most of these undertaking came largely from peasant background. His own peasant roots enabled hm to discern and to call forth the spiritual depth, the giftedness, and the generosity of those young country girls who, as unlikely as it appeared, were later to transform nursing care and provide a durable model for modern health care reform.

The time of the great enterprise, however, had not yet come. The years immediately following the conferral of his Bachelor of had not yet come. The years immediately following the conferral of his Bachelor of Theology degree in no way foreshadow them. Rather they read like an adventure novel. It suffices to say here that when the twenty-seven year old Vincent decided to seek his fortune in Paris in 1608, he was still in quest of an "honest retirement." (Coste I:18) The conversion of 1617 and the resultant works for the service of the poor were still in the distant future.

Of the multiple events leading to 1617, one is significant for our study of Vincent de Paul as a health care innovator and reformer, namely his personal experience of the hospitals of Paris. In 1610, while still seeking a profitable benefice, he became, through the influence of friends, a chaplain in the household of the immensely wealthy Queen Marguerite de Valois. Queen Margot, as she was popularly known, had been Henri lV’s wife before their marriage was annulled.

Vincent’s primary task, as was that of all chaplains of the period, was to distribute alms on behalf of his benefactress. Thus he assisted the many poor who came to the door. The young priest was surely kind and compassionate toward those whom he assisted but Luigi Mezzadri, C.M. is probably correct when he asserts concerning Vincent at this period, "He distributed alms rather than performed acts of charity. He filled hands not hearts. The gesture revealed a simple attitude, not a conversion." (Mezzadri 15)

Nevertheless, this attitude was important. It prepared the soil to receive the graces of these years, graces that would come in the midst of Vincent’s own spiritual turmoil and lead this still ambitious young man to commit himself to personal service of the poor. Of significance for our purposes is the fact that this commitment took the form of regular visits to the sick in the nearby Charity Hospital.

Unlike the larger Parisian hospitals, this institution was quite new. The Queen, Marie de Medici, had established it in 1601 when she invited four Brothers of Saint John of God from Florence to come to Paris to assume responsibility for running it. When Vincent began visiting the sick there in 1610, it was still in a very primitive state and much needed to be done to improve conditions for the care of the sick. (Coste Life I:49) Despite this, it must have been, perhaps because of its smaller capacity and more recent origin, a vast improvement on the deplorable conditions in the hospitals elsewhere in the city. While we have no record of Vincent’s visits to these institutions at this time, he more than likely circulated among them and was most certainly aware of the state of affairs in them.

At the time that the twenty-nine-year old Vincent was introduced to the world of Parisian hospitals, the population of the city was about 450,000. (Dodin, Ceux qui souffrent 21) What he experienced within the walls of the Hôtel-Dieu, the Petites Maisons, Saint-Louis or the Salpétriére was certainly more horrifying than the terrible scenes in Maurice CIoche’s realistic film, "Monsieur Vincent." Marcel Marion echoes other historians when he describes the situation at the Hôtel-Dieu: The twenty-five wards of the Hôtel-Dieu lack light and air. The stench from the lower floors constantly seeps up to the higher ones. It is impossible to renew the air ... What is truly an odious abuse is the crowding together of several persons in the same bed ... There are sometimes ... even eight patients sleeping together ... Those with contagious diseases share a bed with those who suffer from nothing transmittable. The bed is never cleaned or aired. (Marion 276)

In these chambers taken from Dante’s Inferno, Vincent found huddled together all the world’s miseries. There was no plague at the period, as there had been earlier and would be again in 1625, nonetheless there were other contagious diseases as well as lung, stomach, liver, and heart ailments. Moreover, the mentally ill and beggars with no symptoms of physical illness found themselves in the same wards and even the same beds as the seriously ill and dying.

This spectacle of human misery called forth Vincent’s compassion and generosity. Bringing spiritual solace to others, he found relief for his own spiritual ills. The total gift of himself to God for the service of the poor was as yet a few years away but the ministry to the sick was leading him quickly in that direction.

Perhaps the surest indication of a profound change in attitude toward the goals of his life occurred 19 October 1611. On that day, he received a rather large gift of 15,000 pounds from Jean Latanne, Master of the Paris Mint. For a man who was far from rich and for whom financial security for himself and for his family had been a driving force since he began his studies for the priesthood in 1595, he made an extraordinary gesture, the very next day. He donated the money to the Charity Hospital so that the Brothers of Saint John of God might continue "to tend and nurse the sick poor" there (Coste Xlll:14) and that he might "be a participant in the prayers and the good deeds of the said hospital." (Coste XIII:16).

It is evident that Vincent de Paul is no longer the same man who had written to his mother in 1609 lamenting his need to remain in Paris in order "to regain [his] chances for advancement." (Coste I:15) The direct service of the sick poor was a major factor in his transformation as was the influence of the future Cardinal Pierre de Bérulle, whom he had met while he was a chaplain for Queen Marguerite. At Bérulle’s insistence, he left the queen’s service in 1611 to become the pastor at Clichy, outside Paris. There he experienced, during an otherwise turbulent era in his life, sixteen months of calm and happiness among parishioners whom he described as "such good-hearted people." (Coste IX:646)

In 1613, Bérulle once again asked Vincent to make a change in his life and to become a chaplain in the household of Philippe Emmanuel de Gondi, General of the Galleys. It was an enviable position for a still ambitious thirty-three year old man. He was tutor for the oldest son, Pierre, and spiritual director for Madame de Gondi. He was also placed in charge of the spiritual needs of the large household staff of this family which was among the wealthiest and most influential in the realm. He seemed at last to have found the security and the "honorable retirement" (Coste I:17) for which he had longed since his youth. Having attained it, however, he was dissatisfied. The soil of his soul was at last ready for conversion in the truest sense of the word.

It is generally accepted among Vincentian scholars that the year 1617 marks the turning point in Vincent de Paul’s life. We learn from him that twice between January and August of that year God intervened directly and perceptibly in his life. On both occasions an event caused him to pause, to reflect before God, and to undertake a course of action which would radically alter his future. Moreover, of significance for his later role as a health care reformer and innovator is the fact that these seminal events mark the beginning of what may well be Vincent de Paul’s most singular accomplishment, namely the mission of charity which he confided to the laity and particularly to women. In 1617, women would play a pivotal role in the two episodes that transformed him and his mission to the poor. He would later number them among his closest friends and collaborators upon whom he could count in his charitable endeavors particularly the care of the sick poor.

Folleville: But let us return to January 1617 when it all began. The incident that occurred when Vincent accompanied the Gondi family to their estates at Folleville in Picardy is, at first glance, quite commonplace in the life of a parish priest: he was called to hear the confession of a dying man considered virtuous by everyone who knew him. However, after receiving absolution, the penitent professed his joy to anyone who would listen of at last being freed of the serious sins of a lifetime. Since the thirty-six year old Vincent had in fact very little direct experience as a parish priest --- sixteen months in sixteen years --- it is quite possible, according to the Vincentian scholar, Jean Morin, C.M., that the peasant’s avowal of his long-term spiritual distress would never have led to the first "sermon of the mission" (Coste Xl:4), with its resultant works for country people and for the formation of the clergy, had it not been for the intervention of a woman, in this case Madame de Gondi. It was she who first reacted after the old man’s confession; she who pushed Vincent to preach the following day on general confession; and she who asked Vincent to continue the work begun at Folleville in other villages on her vast estates. Scrupulous by nature, with a tendency to dramatize, Madame de Gondi drew a generalization from the old man’s revelation and feared for the spiritual welfare of the peasants on her lands. Thus she challenged Vincent to address the need. He responded by preaching to the people. He tells us the result, "God had such a regard for the confidence and good faith of this woman ... that He blessed my discourse and all those good people were so touched by God that all came to make a general confession ...We then went to other villages belonging to Madame ... and God bestowed His blessings everywhere". (Coste Xl:4).

Chatillon: It is certain that, after the experience of Folleville, Vincent de Paul was a changed man. Exactly how changed we do not know. What we do know is that suddenly in July 1617, he abandoned the easy life of the chateau to become on 1 August the parish priest in a little town of 2,000 inhabitants in southeastern France, near Lyons, which, according to one historian, "was losing its soul." (Dodin SVP 23) The story is well known since Vincent himself recounts it. There was nothing out of the ordinary in this incident either. It would, however, have far reaching consequences. It proved to be the first act in Vincentian health care --- the service of the sick poor in their homes.

On 21 August, while he was vesting for mass, he was informed that there was a family in the parish in great misery because they were all poor and sick and had no one to care for them. His immediate reaction was to preach and he obtained the desired result. Some fifty women of the parish rushed to the aid of the family as did Vincent himself. (Coste IX:208-209) The very amplitude of the response caused him to consider the efficacy of this outpouring of generosity. Abelly offers us Vincent’s reflections on the experience: This undoubtedly shows that these people have great charity, but is it well organized? The poor sick family will be overwhelmed with so much in such a short time, most of which will spoil. Afterward they will be no better off than before. (Abelly l:72)

That very evening, the notoriously slow acting Vincent had laid the foundation for home health care. At the end of his own account of the incident he relates what he did the following day, "l proposed to all those good ladies, who had been animated by charity to visit these people, to group together to make soup, each on her own day and not only for them but for those who might come afterwards." (Coste lX:209)

At Folleville, Vincent de Paul had become aware of the full extent of the spiritual abandonment of the rural poor due to a lack of good priests to assist them. This realization would give birth to his missionary vocation and lead ultimately to the foundation, in 1625, of the Congregation of the Mission which would seek to remedy this double problem. (Coste XIII|:197-198) .

A woman, Madame de Gondi, who had played a significant role in the incident at Folleville, would continue to support these efforts until her death in 1625. She would also become deeply involved with the Confraternities of Charity. (Coste Xlll:444, 457, 466, 482, 519)

Later on we will examine the Rule for the Confraternity of Châtillon because it is the prototype for all subsequent rules, including the Rule of the Daughters of Charity. In it we also find details relative to this first form of Vincentian health care -- home nursing. Before doing so, let us first reflect on some more general outcomes of the events in Châtillon.

Firstly, Vincent de Paul felt himself challenged on this occasion as never before by a social condition, by physical human misery for which he was personally called upon to find a solution. This goes beyond the hospitals of Paris where he did what he could to provide spiritual solace for the sick and where he also distributed alms. Now, in Châtillon, he must do something practical immediately. And he did. Moreover, this first rule contains the two adverbs that will henceforth characterize Vincentian service, particularly health care: "corporally and spiritually." (Coste Xlll:423)

Vincent would stress the fact that, for the members of the confraternity and later for the Daughters of Charity and the Priests of the Mission, these two elements of service are inseparable. He told the sisters, "You should bring two sorts of food to the sick poor: food for the body and food for the soul." (Coste lX:593) Vincent likewise reminded the priests, "If any of you think that you are on a mission to evangelize the poor and not to comfort them, to remedy their spiritual ills and not their material ones, I answer that we must assist them ourselves or through others in every possible way." (Coste XII:87-89) Uniting the experiences of Folleville and Châtillon, Vincent de Paul will hereafter envision all service of the poor as holistic, that is human and spiritual, touching body, mind, and spirit.

The second important outcome of the incident at Chatillon is Vincent de Paul’s newfound consciousness of the role of the laity, particularly lay women, in the ministry of the church. He had worked with women prior to Châtillon but this was different. It was an evolution, albeit a revolution, of which he was keenly aware. Lay and religious women had certainly taken care of the bodily needs of the poor prior to 1617 but, for them, evangelization and spiritual ministry were the prerogatives of the clergy. In 1657 Vincent would point this out to the Ladies of Charity of Paris, the group which evolved from the first confraternity. He stated: It has been 800 years or so since women have had public roles in the Church. Previously, There had been some, called deaconesses, who were charged with grouping women together in the churches and instructing them on the ceremonies which were then in use. However, about the time of Charlemagne, by the secret plan of Divine Providence, this practice ceased and your sex was deprived of any role and has had none since. Now this same Providence has called upon some of you, in our day, to supply for the needs of the sick poor of the Hotel-Dieu. (Coste Xlll:809-10)

Elsewhere he said to the same group of women, "You are undertaking the work of the widows of the early church, which is to take care of the corporal needs of the poor and also of [their] spiritual ones." (Coste XIII:764) Reflecting on the experience of Châtillon, Vincent reached a new concept of the responsibility of the priest and the role of the laity. He became convinced of the necessity, for both evangelization and service of the poor, of a concerted effort among the Christian people, priest and laity, men and women. The women of Châtillon had instructed him well in the process of collaboration.

These women were neither as extraordinarily wealthy nor as deeply spiritual as Madame de Gondi. Indeed, Coste describes Francoise Baschet, the wife of the lord of the manor of La Chassaigne, who would be the first president of the confraternity, and Charlotte de Brie, wife of the lord of the manor of Brunand, and its first treasurer as "very wealthy, very worldly, [thinking] of nothing but dances, amusements, and feasting." (Coste Life I:79) In his report of eye-witness accounts of Vincent’s brief stay in Châtillon,Charles Demia attributes the transformation in these two fashionable women to the influence of the new pastor whose first sermon moved them to change their lives. (Coste XIII: 45-49) Indeed, it was Francoise Baschet who had told Vincent about the family where "everyone was sick" (Coste Life I:82I and who would work closely with him in the organization of the confraternity. This collaboration with lay women would grow and solidify through the years with incalculable results for the service of the poor especially for the reform of health care.

Subsequent to the events at Chatillon, Vincent de Paul could have remained a contented country priest, combining in his life and parish, evangelization and service of the poor. Two hundred years later Jean-Marie Vianney would do exactly that in the tiny village of Ars just a few miles from there. Strangely enough, or better yet, providentially, it was a woman, once again Madame de Gondi, who would draw him away from Châtillon and assist him on the next step of his journey toward the total gift of himself to God for the service of the poor. To convince him to return to Paris and to her household, she would speak not of security and position but of "the seven or eight thousand souls" that were living on her lands. (Abelly l:66)

Vincent did, indeed, return. This time he had a clearly defined goal: to preach missions as he had at Folleville and to establish in each locality visited a Confraternity of Charity modeled on that of Châtillon. On 17 April 1625, with Madame de Gondi’s support, he founded the Congregation of the Mission to formalize and provide structure for their common aspiration: the assistance of poor country people. (Coste Xlll:197-202)

Extensive as were the Gondi lands – they covered several dioceses --- they were not the vast terrain on which the future Apostle of Charity was to be called to labor. That work would require the collaboration of two women whom, in 1617, he had yet to meet. The first was a young mother, the wife of Antoine Le Gras, secretary to the queen, better known by her maiden name, Louise de Marillac. The other was a shepherdess from the village of Suresnes who, in 1617, was just setting about learning the alphabet, Marguerite Naseau. Together with them and the women surrounding them, Vincent de Paul would transform the social order of the France of his day and bring the healing hands of Providence to all categories of poor.

Let us turn now to the first of these two women, the one who would become his friend and collaborator of thirty-six years, Louise de Marillac.

Faith and Experience of Louise de Marillac: 1591-1625

The friendship and collaboration between Vincent de Paul and Louise de Marillac, two widely differing personalities, began somewhat inauspiciously, some time between the end of 1624 and the early part of 1625. Indeed, it is hard to imagine two people less likely to spend the major part of their adult lives working together. Their friendship, nonetheless, was to prove to be of incalculable significance for the church and for the poor.

The first contacts would be difficult for the peasant priest and the aristocratic woman but they would both come to appreciate the need they had, spiritually and apostolically, for one another. The differences would remain and even produce some conflict over the years but they would also form the base of their complementarity as they combined their considerable gifts of nature and grace for the service of God and the poor. According to Louise’s biographer, Jean Calvet, Vincentian works became "what they were because Louise de Marillac put her hand to them." (Calvet 14) Health care was destined to become a vast and fertile field for their collaborative endeavors.

Louise de MarilIac’s background and early life experiences were the antithesis of Vincent de Paul’s. Born on 12 August 1591, the "natural" daughter of Louis de Marillac and an unknown mother, she never experienced the love and security of family life. Although she would live well beyond the average life expectancy of the period --- to the age of 70 --- her health was always delicate due, in no small measure, to the conditions in war-torn lFrance at the time of her birth. Her later ability to compassionate with the sick and to encourage them, where possible, to overcome their physical limitations and to go on to lead rich, productive lives had its roots in her life-long battle with recurring illness.

Although Vincent de Paul had a much more robust constitution, he too lived with chronic illness. Thus they both understood from personal experience the suffering of the sick. Both could say, as Vincent frequently did in an effort to lift the spirits of the ill and infirm, "Do not be too concerned ... l had this same illness ... and l survived ... Have patience... your troubles will pass." (Abelly I:252)

And for those whose troubles did not pass, Louise de Marillac was an example of the ability, through quiet courage and deep spirituality, to turn adversity into positive energy. Life had taught her that her vocation was to unite herself to Christ dying on the cross. In a very early spiritual reflection she wrote, "God, who has granted me so many graces, led me to understand that it was His holy will that I go to Him by way of the Cross. His goodness chose to mark me with it from my birth and He hardly ever left me, at any age, without some occasion for suffering." (Spiritual Writings 711) Later, when forming the first Daughters of Charity to care for the sick poor she would inculcate in them the necessity for gentle compassion no matter how trying the situation might be. (Spiritual Writings 773)

Let us turn our attention once again to the early years of Louise de MariI|ac’s life particularly to those experiences which shaped her future and influenced her approach to health care: Poissy, the boarding house of Paris, and her marriage to Antoine Le Gras.

Poissy: Louis de Marillac recognized his infant daughter shortly after her birth. She thus became a member of the illustrious Marillac family, which held positions of power and influence in the court of Marie de Medici and Louis XIII. Nevertheless, despite her father’s love for her and her loyalty during times of family crises, she always felt herself an outsider. This was reinforced when she was placed at Poissy.

The exact date of Louise’s arrival at the Royal Monastery of Saint-Louis, like much in her childhood, is unknown. She may well have been an infant but was most certainly no more than three years old when she was confided to the care of her aunt, another Louise de Marillac, who was a Dominican nun at Poissy.

On 12 January 1595, Louis de Marillac had remarried and his baby daughter seems to have had no place in his new home. However God, who often writes straight with crooked lines, provided her with a rich spiritual and intellectual environment that prepared her, when the time came, to educate and form peasant girls to serve the sick poor. Under the direction of the Dominican nuns, Louise and other little girls of her social class were introduced to the arts and the humanities. Moreover, they learned to know and to love God and to discover the divine presence, as the patron of the monastery, Saint Louis, had, hidden under the rags of the poor. This experience later enabled her to live and work with equal ease with the rich and with the poor country girls who were to become the first Daughters of Charity. It also instilled in her what was to be an essential attribute of Vincentian health care --- the awareness of what Bossuet referred to as "the eminent dignity of the poor. "

Given this environment and Louise’s contemplative bent, it is not at all surprising that, as she grew older, she thought of entering the cloister. How shattered she must have been when Father Honoré de Champigny, provincial of the Capuchins, refused her request for admission. His reasons are not clear, but his words proved prophetic when he told her that "God had other designs on her." (Gobillon I:7)

Nowhere do we have recorded Louise's reaction to this unexpected rejection. Her spiritual crisis of 1623, however, shows the extent to which she had been marked by it. Moreover, her desire for a life dedicated to reading and contemplation perdured well into her widowhood. Events, Providence, and Vincent de Paul would alter that.

If Poissy provided Louise de Marillac with an intellectual formation well beyond that of the vast majority of women, even of the aristocracy of the era, it hardly seemed the appropriate preparation for a woman who would later be responsible for training young women in the practical aspects of health care, education, and social welfare. That she would learn outside the walls of the cloister, in a modest boarding house of Paris.

Boarding House of Paris: It must be stated from the outset that what we know of this period is limited and often contradictory. Notwithstanding, it seems that following the death of her father in 1604, Louise left Poissy and spent an indeterminate time in a boarding house in Paris run by a woman known only as a “good, devout spinster." (Gobillon I:5) Whatever the circumstances, during these years Louise learned the practical things that are so unexpected in a woman who was both an intellectual and a mystic. The multiple details required to care for the sick and orphans and to educate little girls had to have been learned somewhere. The humble boarding house of Paris was the likely place.

One has to wonder if it was here that she was introduced to herbal medicine at which she became so skilled that later even the wealthy called on her expertise. (Spiritual Writings 609) Be that as it may, in November 1639, eight Daughters of Charity trained by Louise were able to assume full responsibility for the management of the nursing care at the hospital of Saint-Jean in Angers. (Documents 264-266)

Marriage: Denied admission into the cloister, Louise de Marillac could not but accept the only option open to her, marriage. The Marillacs, for their interests rather than hers, arranged Louise’s marriage, on 4 February 1613, to Antoine Le Gras, personal secretary to the regent, Marie de Medici. Although Antoine's family was not of the aristocracy (the circumstances of Louise’s birth precluded her from marrying into the nobility) it was highly respected and "noted for its love for the poor and for having founded a hospital in Puy" in Auvergne. (Gobillon l:8) Moreover, it seems to have been a happy union especially after the birth of their son, Michel.

During the first years of her married life Louise found joy, love, and security. She devoted herself to her little family while at the same time taking an active part in the social life of the court and of the fashionable Marais district in which she lived. She had not, however, forgotten the lesson of Poissy.

What is significant for our purposes is the fact that Louise’s initial service of the poor was directed toward the sick. Gobillon tells us that she visited them in their hovels "gave them bouillon and remedies, made their beds, instructed and consoled them, disposed them to receive the sacraments and prepared those who died for burial." (Gobillon I:8-9) Moreover, her assistance went beyond the homes of the sick into the hospitals. She visited the patients, brought them some "little delicacies" and performed the "humblest and most disagreeable services" for them. (Gobillon l:9)

Her service, however, was not strictly personal. Foreshadowing the organization of health care which would be a major part of her life’s work, she motivated other women of her social class to collaborate with her to alleviate the misery of the sick poor. In Paris, as in Châtillon, Vincentian health care was taking form but as yet the two main players in the drama, Vincent de Paul and Louise de Marillac, were unaware of it.

This period of happiness was to prove short-lived for Louise. Michel began to show signs of the problems that would make him a permanent source of anxiety for her. Then, in 1621-1622, Antoine Le Gras became chronically and eventually terminally ill. Louise’s apprenticeship as a nurse began in earnest. Through some four long years she devoted herself to caring for him personally. She watched in dismay the change in personality wrought by disease in this man she had grown to love deeply. He became increasingly more "irritable and resentful" (Gobillon I:17) as his condition worsened. At the school of their shared suffering, Louise learned the importance of holistic care; of care that sought to relieve the physical, spiritual, and emotional distress of the patient.

Antoine Le Gras died during the night of 21 December 1625, alone with his wife. His final agony was terrible but he was at peace with his God, his family, and himself (Gobillon I:20-21). His thirty-four year old widow was physically, spiritually, and emotionally drained. The memory of the effects of Anoine Le Gras’ illness on his family would later influence her approach to home nursing: the need to support the family as well as care for the patien't.

Despite her exhaustion, the worst of Louise de Marillac's "dark night of the soul" had passed prior to her husband’s death. Her Pentecost experience of 1623 (Spiritual Writings 1) had brought her a measure of peace. Moreover the spiritual director she had foreseen at the time had become a part of her life. He was Vincent de Paul.

Their first contacts were tentative. As Louise opened her heart to him, Vincent responded with quiet wisdom and gentleness. To have acted otherwise, to have demanded from the outset that the young widow forget herself, cast aside her anxiety, and enter joyfully into the service of God and the poor would have compromised the whole process. It was a time for slow, tiny steps to call forth the full potential of this woman who had borne more than her share of suffering but who was also well advanced in the spiritual life and given to works of charity for the poor.

The year 1633 and the great undertaking is still veiled from both of them but the common journey has begun. The roots of Vincentian health care have been firmly planted in their faith and in their experience.

Initial Collaboration in Health Care: 1625-1633

Little by little, as their relationship grew, Vincent began to involve Louise in his charitable endeavors. Her contributions at first were modest. Her spiritual director felt that she needed to rebuild her own life before embarking on greater things. Then, on 6 May 1629, he was convinced that she was ready so he sent her to visit the Confraternity of Charity of Montmirail.

The confraternities had flourished in the early years and had spread throughout France. With the passage of time, some of them had lost their original spirit and Vincent feared that the care of the sick poor was suffering. Someone had to visit them, study their activities, correct abuses, and rekindle the zeal of the members. What is significant for us in this attitude of Vincent is the process of self-evaluation. He was never satisfied that a work of charity was the best it could be. He constantly examined it in the light of "experience" and sought to improve it. He had come to realize, after some four years of contact with her, that no one was better suited for the task than Louise de Marillac who now felt confident enough to emerge from her solitude and engage in personal charitable activity.

In Louise de Marillac’s Spiritual Writings we find detailed accounts of these visits. They reveal her keen intelligence, organizational ability, and capacity for leadership. The transformation in the introspective, shy widow is startling. She had become a woman of decision, Vincent de Paul’s collaborator and • equal. She had "put her hand" (Calvet 46) to the work and Vincentian health care began to take on the form that it has retained across the centuries and throughout the world.

Rule of the Confraternities of Charity: Let us now examine more closely the rule of the confraternities and the essential attributes it called for in the service of the sick poor. For Vincent de Paul, God had manifested himself in the event surrounding the family "where everyone was sick" that Sunday morning in Châtillon. (Coste lX:209) He and his parishioners had responded quickly and generously. And indeed, no matter how structured Vincentian health care was to become, it was always called upon to be flexible and available to answer the urgent calls of the poor. Notwithstanding, the practical Vincent, and later Louise, quickly saw the need for organization to insure effective, long lasting service.

Thus, 23 August 1617 he brought together some of the women who had assisted the family and together they drew up a rule for the group because, as Vincent pointed out in the text, the sick poor of the city had "sometimes suffered, not from a lack of charitable persons to care for them but rather from an absence of order in the service given.” (Coste Xlll:423) The rule, therefore, goes on to spell out in considerable detail who should direct the work; how responsibilities should be shared; how the work was to be financed; and, finally, how the sick poor were to be fed and cared for. (Coste Xlll:423-425) It must be added that medical care was limited. The main goal was to keep the patient clean, comfortable, and well nourished although later documents clearly speak of medications, probably herbal medicines and syrups.

Of importance here also is the stress placed on the spiritual assistance of the sick and the personal holiness of the members of the confraternity who were to be "women ... of known piety and virtue." (Coste XIII:423) Vincent sought to provide the women with the support needed to sustain them through the periods of weariness and discouragement which were inevitable in such an undertaking. He attempted to create and maintain a family of faith working together to meet the "corporal and spiritual" needs of the sick poor.

Such was the goal but it was not always attained. Enter Louise de Marillac. Her visits to the confraternities between 1629 and 1633 (Spiritual Writings 704-706; 720-725) did much to renew the zeal of the beginnings and to correct the abuses that had crept in but they also pointed to a major flaw in the entire system. The work had become too broad in scope, too demanding, and too time-consuming to be left exclusively to volunteers however generous they might be. This became even more apparent when the confraternities were established in Paris. In the capital the situation was radically different from that of the provinces. The members, the Ladies of Charity, as they were now called, came from the highest levels of the nobility and from the very wealthy bourgeoisie. The demands of their social life, particularly when Court was in session, were far greater than in more rural areas. Moreover, caring for the sick in their homes in an urban setting could also be dangerous. A solution needed to be found. It appeared in the person of Marguerite Naseau.

Marguerite Naseau: Who then is she? Unfortunately we have few facts on her life and personality. There are but ten references to her in the thirteen volumes of Coste (Coste I:76, 131, 185, 187; lX:77, 209, 244, 455, 602; X:101) Scant though they may be, they do enable us to form as idea of her remarkable character and of the affection and admiration that Vincent had for her. Whenever he spoke of the young cowherd from Suresnes, whom he considered "the first Sister who had the happiness of showing others the way," (Coste lX:77) one can easily detect those qualities he most admired in her: her creativity in teaching herself to read; her vocation to teach others; her courageous, even daring initiatives; her tenacity in face of adversity; and finally her heroic death.

The reaction of Pierre Fresnay, who portrays Vincent in the Jean Anouilh film, Monsieur Vincent, is probably an accurate expression of Vincent's joy when, leaving a particularly frustrating meeting of the Ladies of Charity in February 1630, he meets the young peasant woman come to offer her services to the confraternities. For the first time he sees the potential for charity in this "good village girl" and others like her.

A peasant himself, Vincent could not but hear in Marguerite’s story echoes of his own. A letter to Louise, dated 19 February 1630, reveals that he sent Marguerite to her immediately to be trained and formed for the service of the sick poor of the Confraternity of Charity in the parish of Saint-Sauveur. So pleased were the Ladies, that other Parisian confraternities asked for the assistance of country girls like Marguerite. Just as she attracted girls from the villages around Suresnes to assist in teaching others to read, so Marguerite brought other peasant women to the work of the confraternities.

Thus, three widely differing personal and spiritual journeys converged --- those of Vincent, Louise, and Marguerite. The service of the sick poor is about to be transformed but, as yet, these three major players in the process do not realize it. Vincent is concerned about the missions, Louise about the confraternities in their existing form. No one is thinking about founding a company of "widows and girls" for the service of the poor. Even Marguerite, whom Vincent called the "first sister" does not know it. She never will. She died of plague after sharing her room with a victim in February 1633, eight months prior to the founding of the Daughters of Charity.

The death of the prototype could well have proven ruinous for the entire project. It seems, on the contrary, to have accelerated the process. We know from the correspondence between Vincent and Louise at the time that other young peasant women had followed Marguerite’s example and offered themselves to Vincent to work in the confraternities. If they were considered suitable, they were generally sent to Louise for a brief period of training and then placed with the Ladies either in Paris or in a rural area.

Louise had seen early on how difficult and lonely such a life could be. Marguerite’s death reinforced this. There needed to be a support system, organized training, and spiritual formation if these young peasants were to continue on the arduous path of service of the sick poor on which they had embarked with such great generosity. Moreover, it was also apparent that the Confraternities of Charity could no longer function adequately without them.

Company of the Daughters of Charity: The awareness of the need for a stable work force led to the foundation of the Daughters of Charity on 29 November 1633. On that day a few of these young women gathered in Louise de Marillac’s home. Formed by her and by Vincent de Paul, they would transcend the strict class barriers of the day to work with the Ladies of Charity in the service of the sick poor. Moreover, these mostly peasant women, excluded by lack of wealth and education from traditional religious orders, would enter into a new form of consecrated life, called forth by the need to serve the sick poor, uniting contemplation and action.

Before leaving the Confraternities of Charity it would be well to look again briefly at the rule of Châtillon to determine the essential attributes that the "servants of the poor" were to bring to the care of the sick. These will be the same qualities that the founders will seek to develop in the Daughters of Charity. We have already pointed out the professional quality required of the care. We look now at the personal attributes of the care providers.

The rule states: They shall carefully practice humility, simplicity, and charity, deferring to their companions and to others and performing all their actions from a charitable motive toward the poor and with no concern for the approbation of others. (Coste Xlll:435)

Vincentian health care has reached a turning point. It will move beyond, but not away from, home nursing to general and specialized hospitals. Whatever the form, it will continue to demand close collaboration between men and women, laity and religious, rich and poor. And these collaborators will be united by their common vision of the service of God in the sick poor accomplished in a spirit of humility, simplicity, and charity.

General Hospitals:1634-1660

Hotel-Dieu of Paris: Hospital work began for the newly founded congregation as early as 1634. It was at first on a very modest scale in Paris' oldest and largest hospital, the Hotel-Dieu. Louise had begun visiting the sick there as a young married woman. It was there that she had met Genevieve Fayet, Madame Goussault, who was also bringing assistance to the patients. A very wealthy bourgeoise, Madame Goussault was destined to become the first president of the most influential group of Ladies of Charity and to be instrumental in introducing the Daughters of Charity to hospital work.

Visiting the hospital, the women soon discovered that the sick lacked many things that the hospital could not or would not provide. They urged Vincent to allow them to organize service to meet some of those needs. The notoriously prudent Vincent was understandably hesitant. He found himself in the delicate situation of trying to improve service in a functioning institution over which neither he, nor Louise, nor the Ladies of Charity, despite their wealth and influence, had any control. Madame Goussault, however, was unwilling to accept "no" for an answer and soon four Daughters of Charity were assisting the Ladies of Charity of the Hotel-Dieu, as the group was known.

In a letter to Louise, Vincent had asked that she assign four of her "good" sisters to this service. (Coste I:231) As it turned out the four good ones were not deemed good enough and were summarily dismissed by the Ladies in favor of city women. They soon realized that they had miscalculated so they asked that the sisters return. They then rented a house, and had the sisters use it to prepare linens and food which they and the Ladies brought to the sick daily. It seems little enough but, if one bears in mind the conditions in the hospital at the time, it must have been no small consolation to the patients. Moreover, both groups became increasingly aware of the healing effects of spiritual service which was never to be separated from the physical assistance provided. (Coste I:234)

The simplicity set forth in the rule of Châtillon was reinforced in Paris. Vincent reminded these very wealthy women to “dress as simply as possible" (Abelly I:l56) when visiting the hospital so as not to "cause difficulty to these poor people [who] seeing the excesses and extremes of the rich ... think more of the things they do not have" ... (AbelIy I:156) Thus the great ladies of the realm and the humble peasant women worked together to bring a measure of spiritual and physical comfort to the abandoned patients of the Hotel-Dieu.

The work of the sisters and the Ladies had one practical result. They would soon no longer be obliged to serve bouillon since the administration of the hospital assumed that responsibility. A small thing surely, which we take for granted today but which marked a considerable gain at the time in the struggle to provide better care for the sick poor.

The work at the Hotel-Dieu was one of collaboration, a modest effort to improve service in an institution which, while good in many respects, had failed to evolve with the times and was often overwhelmed by the enormity of its task. Soon, however, the Daughters of Charity would be called upon to take complete charge of nursing care at the Hospital of Saint-Jean-l’Evangeliste in Angers. The lessons in collaboration and in the delicate balance between bringing needed assistance and interfering would be put to the test. Again, the force behind the undertaking would be Madame Goussault.

Angers: Because this would be the first hospital staffed by the Company, and as such, the prototype for those that would follow, it is essential to examine in detail the contract of establishment as well as the rule for the sisters serving there. Moreover the abundant correspondence from both Vincent v de Paul and Louise de Marillac relative to Angers reveals the importance they placed on a solid foundation for the work.

The hospital had a long and illustrious history. It had been founded about 1175 by Etienne de Marsai with the support of his lord, Henry ll of England, Count of Anjou. According to the tradition, the king wished by so doing to perform an act of expiation for the murder of Thomas Beckett.

The beautiful gothic structure, which still stands, rendered effective service to the sick for many centuries. It then fell on hard times. Documents in the departmental archives of Maine-et-Loire, show years of conflict and lawsuits between the city officials and the Canons Regular of Saint Augustine who ran the hospital. By 1639, when it came to the attention of Madame Goussault who had a residence in the area, it had fallen into complete disorder. (Baunard 252) Enraged, the city officials, who had assumed the direction of the hospital, turned to the church and to the king for a solution to the chaos that reigned there. They complained that the sick were destitute of all assistance, physical or spiritual. They asked Bishop Rueil to replace the Canons by secular priests, which he did. The care of the sick, however, was still neglected. Indeed, according to one historian, there were but thirty to forty patients, none from Angers, since even the poorest of the sick were unwilling to submit themselves to the conditions there. (Imbert Histoire 199) It was this spectacle that moved Madame Goussault to encourage the administrators to ask for the Daughters of Charity. The vicar-general of the diocese, Guy Lasnier, known as the Abbé de Vaux, was well acquainted with both Vincent de Paul and Louise de Marillac and was familiar with the work of the sisters in the confraternities. He would pressure them to comply with what turned out to be the dying wish of Madame Goussault. It is understandable that, despite their respect and even affection for Madame Goussault and the Abbé de Vaux, they were reluctant to send the sisters into such a situation. Believing, however, that it was a call from God to the Company, and that the service of the sick poor required it, they acquiesced, at least provisionally.

The decision to assume responsibility for the nursing care at this hospital was a major step for the as yet young group. Louise de Marillac thus decided to make the difficult two-week journey with the sisters. The correspondence between the founders dating from this period reveal the difficulty of the trip (Louise was seriously ill by the time she arrived in Angers) as well as the fact that plague had once again broken out in the city. Vincent’s deep concern is evident and surely well-founded. Nevertheless, all involved were determined to go forward with the work for "a period of experimentation." (Spiritual Writings 62)

The little group arrived in the capital of Anjou on 6 December 1639. (Coste I:609) Because of her illness, Louise, at Vincent’s urging, accepted the Abbé de Vaux’s offer of hospitality. She remained in his home only for a few days. She then joined her companions at the hospital and began with them the daunting task of assuming full charge of the management of the nursing care. (Misermont 73)

There is more abundant written documentation concerning this foundation than for any other work established during the lifetime of the founders. In addition to the contract with the city officials, and the Rule for the Sisters of the Hospital of Angers, there are better than one hundred letters of Vincent de Paul and Louise de Marillac dealing with all aspects of the work and life of the sisters there. Moreover, the Abbé de Vaux preserved the ninety-six letters he received from Louise as well as seven from Vincent de Paul.

What then do we know of this prototypal work of the Daughters of Charity in hospitals? What did Louise de Marillac find when she joined the sisters at the Hotel-Dieu of Angers in January 1640? According to “Lucien Misermont, C.M., she found less than forty patients, poorly cared for in unsanitary conditions by negligent and untrained workers. Despite considerable waste, the patients lacked nourishing food and linens. (Misermont 73) Prudence would have dictated strategic withdrawal after bringing the "period of experimentation" to a rapid end. That they chose not to do so, illustrates what o would prove to be an essential attribute of Vincentian health care during this era and beyond namely, risk taking. It was risk taking, however, accompanied by detailed organization involving collaboration and negotiation with all parties involved: ecclesiastical, civil, lay, and religious.

Until the establishment of the Company at Angers, the work of the Daughters of Charity had largely been as associates of the Ladies of Charity in the confraternities of charity in the parishes of Paris and in the provinces. While there will be a confraternity of charity attached to the hospital, the management of the nursing care will be the prerogative of the sisters. Thus, this establishment marks a movement away from an ancillary role toward one of responsibility. Nothing demonstrates this better than the contract for the sisters’ services drawn up with the city officials of Angers.

The evolution of this contract, which will be the model for all subsequent ones until the suppression the Company in 1792, is thus worth careful examination. We learn from the correspondence that, since the Daughters of Charity were going to Angers on a trial basis, no thought was given by either Vincent de Paul or Louise de Marillac to any kind of contractual arrangement. The hospital administrators, who were also city officials, however, had other ideas and wanted a written agreement. In response to Louise’s letter informing him of this, Vincent wrote: Seeing that those Gentlemen want to communicate in writing, do this, in nomine Domini. Have the contract drawn up in your name as Directress of the Daughters of Charity, servants of the sick poor in hospitals and parishes, under the authority of the Superior General of the Congregation of the Priests of the Mission, the Director of the aforesaid Daughters of Charity. (Coste II:1)

It is interesting to note in passing that at this time the Daughters of Charity had no official ecclesiastical or civil status. Vincent recognized that this could cause some problems in the negotiations with the city thus he advised Louise: if they ask you for letters of establishment of this body [the Daughters of Charity] you will say that they have no other than the power which has been given to the said Superior, Director of the Charity, as is done everywhere, especially in that diocese, in Bourgneuf, on Madame Goussault’s estates ... (Coste II:l-2)

Let us turn now to the text. (Documents 264-266) The first thing that strikes the reader is that it sets up clear lines of authority for the fledgling Company. The internal affairs of the community, the practice of the rule, and the placement of the sisters are the clear and exclusive prerogative of the superiors in Paris. (Art. 1) The text then goes on to stipulate just as clearly that the temporal administration is committed entirely to the four laymen or "Fathers of the Poor" named by the city and that the sisters are responsible to them for the service of the sick. (Art. 2)

In view of "better service" of their patients, the contract states that the sisters will have exclusive charge of the nursing care. (Art. 3) This would remain in effect in Angers until 1950 when the first lay nurse was hired. At that time, there were seventy Daughters of Charity on duty at the hospital. (Archives, Prov. of Rennes Dossier Angers)

The next articles spell out the financial arrangements in considerable detail. The sisters received no salary so the agreement specifies the responsibilities of the administration for their support. (Art. 4-6)

Finally there is an agreement allowing superiors in Paris to recall the sisters at their expense or for the administrators to dismiss up to three sisters at theirs. In the latter case, superiors in Paris are to be notified in ample time to provide replacements. (Art. 7)

The Rule for the Sisters of the Hospital of Angers was appended to the contract and likewise accepted by all the signatories. As Vincent de Paul had directed her, Louise de Marillac signed the agreement as "Directress of the Daughters servants of the sick poor under the authority of Monsieur Vincent, Superior General of the Congregation of the Mission and of the Daughters." (Documents 266) The date was 1 February 1640. Three of the four "Fathers of the Poor," Solimon, Gardeau, and Doublard, signed for the city. There were only five sisters in Angers when the contract was concluded: Elisabeth Martin, Cécile Angiboust, and Marguerite Francois, who signed the agreement, and Clémence Ferré and Barbe Toussaint who did not, probably because they could not write. Three other sisters: Marie-Marthe Trumeau, Madeleine Mongert, and Genevieve Caillou arrived at the end of March 1640, after Louise de Marillac’s departure for Paris. Their names would be added to the official Act of Establishment drawn up by the Clerk of the Presidial Court of Angers on 18 March 1641. (Documents 309-10)

File:-13.jpg?

The Daughters of Charity were officially installed in the Hospital of St.-Jean-l’Evangeliste of Angers on 1 February 1640. Vincentian health care has continued uninterrupted since that date and spread to five continents. Much has changed since this initial foundation but, in a very positive sense, "much has remained the same." To understand just how much, let us turn now to the text of the rule which gives us a clearer idea of the care provided and, more importantly for our purposes, the spirit and manner in which it was given.

Rule of the Sisters of the Hospital of Angers: There are three copies of this rule preserved in the National Archives in Paris. One is certainly a draft because of the numerous additions and corrections. This text is of particular interest because it establishes a clear link with the rule for the confraternity of Châtillon and the basic principles upon which all forms of Vincentian health care are founded.

In a first draft Vincent de Paul had said that the Daughters of Charity were going to Angers "to assist the sick poor" and "to honor Our Lord, Father of the Poor." (Archives Nationales S. 6160, Dossier Angers) He then crossed out the sentence and reversed the order, placing the spiritual motivation, "to honor Our Lord, Father of the Poor," first, thus giving us the text as it appeared on 1 February 1640. The change is not stylistic. It recognizes the spiritual basis necessary for all effective health care. Moreover, it then goes on to repeat the adverbs associated with the service of the sick poor since 1617, "corporally" and "spiritually." (Documents 247)

Let us lock first at the physical care of the sick. What was it and what does it still have to tell us as we consider Vincentian health care on the eve of the twenty-first century? Since the first rule of the Confraternity of Charity of Châtillon, two elements had been central to the physical care of the sick namely, balanced nutrition and appropriate medication, administered on a timely basis. The rule for the hospital of Angers continues this focus in the nursing care provided.

First: Nutrition. The need for proper nutrition seems self-evident in our health conscious society. For the poor of seventeenth-century France, however, nothing could be farther from the truth. War and widespread misery meant that the poor frequently had little or nothing to eat. Debilitated bodies became the breeding ground for all manner of diseases. Thus the most urgent need was to provide nourishing food on a regular basis. When coupled with this and the cleanliness of the sick room, medication and treatments had some hope of success.

Vincent de Paul, and later Louise de Marillac, left nothing to chance in this area. From the rule of Châtillon to the rule of Angers everything was spelled out in great detail. We know exactly what was served, how it was prepared, and the time of meals. While this attention to detail may strike the modern reader as excessive, its necessity becomes apparent when one learns that prior to the arrival of the Daughters of Charity, "the hospital personnel in Angers, had let two to three hundred poor people die of hunger ... each year." (Imbert Hépitaux 21)

Dietitians in twentieth-century health care facilities would undoubtedly not build menus around bouillon and eggs. (Documents 250) They might be encouraged, however, by this early effort to provide not only healthful meals but "little delicacies" (Documents 251) designed to help the patient to recover a lost appetite and thus convalesce more quickly. A letter of Louise de Marillac, dated 18 August 1649, shows the importance the foundress continued to place on appetizing, nourishing food as a part of quality nursing care. She wrote: ...You should not hesitate to add some cloves to [the soup] since it is the custom of the region. Likewise ... please prepare consommés for the gravely ill who need them. You should also go to the trouble of preparing tasty stews and seasonings for the convalescing patients. This costs no more and they regain their strength much more quickly. Sometimes it only takes a little to satisfy the most difficult. (Spiritual Writings 296-97)

Secondly: Medications. The second essential element of the physical care of the sick was the administration of medications. When the Daughters of Charity arrived at Angers there were 91 servants but only one doctor, who came once a week, a surgeon who came periodically and a pharmacist. (Huchard 6) The sisters had to see to it that the medicines were administered as prescribed by the physician. The term "faire mediciner" used in the various rules meant "to give care and to distribute remedies." (Delort 7) In the text which Vincent de Paul submitted to the Archbishop of Paris in 1645 seeking the approbation of the Company of the Daughters of Charity, he specified that the sisters were called upon to "let blood, to prepare enemas and to give them, and to dress wounds." (Coste 549) In the same text, he states that they carried out these duties "only after having been trained to perform them by Mlle.Le Gras." (Coste 549)

During this era, bloodletting and purging were the two generally accepted remedies and almost the only ones used in the care of the sick poor. While bloodletting was a time-honored procedure, it was also a dangerous one. The rules and correspondence of the founders stress this point. They remind the sisters repeatedly that they were to let blood only when a surgeon was not available (as in rural areas) and if they possessed the necessary competence. (Spiritual Writings 763).

Purgations were another frequently employed remedy of the era. While surely less dangerous than bloodletting, they were not without risk. The sisters, thus, had to be trained to prepare syrups and to give enemas, the latter procedure being the one most commonly used in hospitals. Documents 251) Louise de Marillac’s correspondence contains numerous practical suggestions for the preparation of purgative syrups.

Dressing wounds was also an important part of the nursing care given by the sisters in the homes of the sick as well as in hospitals. Before training the sisters to do this, Louise de Marillac had, herself, acquired practical experience in this procedure by dressing the sores of the many poor who came for assistance to the motherhouse. Her letters reveal a surprising level of knowledge and skill in this area. (Spiritual Writings 347, 492)

While such was not the case in the early days in Angers, little by little the sisters assumed full responsibility for the running of the pharmacy in the hospitals where they were charged with the nursing care. This would happen in Nantes, where they went in 1646.

The care of the sick, however, was not limited to balanced nutrition, blood letting, purgatives, the dressing of wounds or the distribution of remedies. The founders, and under their influence, the sisters, were aware of the healing properties of psychological and emotional support for their patients. They understood the beneficial effect of the concrete manifestation, in their service, of the love of God which motivated it. This is why both Vincent and Louise, in letters and conferences to the sisters, reminded them repeatedly of the attitude of compassion, mildness, cordiality, respect, and devotion (Common Rules Chap VII, Art. 7) that had to characterize their service.

The founders also attached great importance to the personal care and hygiene of the patient as well as to the cleanliness of the sick room. The task of overcoming the stench and squalor that greeted the sisters upon their arrival in Angers was nearly overwhelming. Thus the maintenance of cleanliness was a constant preoccupation and all the sisters shared in it, each one performing the most menial and unpleasant chores. (Documents 249, 251) The concern for cleanliness would lead later to their taking over the laundry. What is revealed here that is of significance for contemporary Vincentian health care is the integrated service. Everything is patient centered. The efforts of everyone involved, administrators, chaplains, medical personal, support staff, are directed toward quality care for the patient, in an atmosphere that reflects the foundational quality of hospitals from their origin, namely hospitality. (Museum of Public Assistance, Paris) The letters of Louise de Marillac reveal this concern as she makes practical suggestions to insure the comfort and well-being of the sick. While the limits of medical care in the seventeenth century left much to be desired in the service provided, the Daughters of Charity and their collaborations in Angers brought to the service of the sick "a renewal of devotedness and competence" (lmbert Hopitaux 25) which proved to be a major step in health care reform in seventeenth-century France. Moreover, in its essentials, it offers valuable insights for modern efforts in that regard.

The physical and psychological care of the sick, as important as it was, was but a part of overall Vincentian health care. The other essential aspect was the spiritual care of the patients. Let us now turn our attention to it.

From all that has been said, it is clear that Vincent de Paul, Louise de Marillac, and the early Daughters of Charity sought to provide the best care possible with the personnel and resources at their disposition. The detail they bring to the physical aspects of care should not, however, cause us to lose sight of the prominent place of spiritual care in the service of the sick. Vincent de Paul made this clear when he introduced the Rule of the Hospital of Angers by stating that the "The Daughters of Charity of the Sick Poor are going to Angers to honor Our Lord, Father of the Poor." (Art 1) In the French of the seventeenth-century, "to honor" meant to imitate. So it was that the sisters were called upon to be what Sister Suzanne Guillemin called "the vehicle of divine tenderness." (Guillemin 122)

The rule shows that the sisters spent the better part of each day with the sick. When physical care was not required, they were to bring spiritual comfort and instruction to help the sick to live and to die well. They were also to share their own prayer life with them. (Documents 249-252)

Lest the demands of care of the sick lead the sisters to neglect this all-important aspect of their service, the founders reminded them repeatedly of its necessity. In a conference on Article 12 of the Common Rules concerning the care of the sick, Vincent de Paul said: ...it is indeed something to assist the sick as far as their bodies are concerned but, in truth, it was never Our Lord’s intention, in founding your Company, for you to take care only of the body ... to give ... food, medicine and other things. (Coste X:333-334)

The founder then goes on to tell them that they must always join "spiritual assistance" to the physical care provided. He recognizes the time pressures involved in caring for "thirty patients," but he urges them "to raise their hearts to God and to find [there] a word of consolation for the sick poor." (Coste X:334) As much as healing bodies, they are called upon to "touch the hearts" of their patients and to "influence" them to know and to love God." (Coste X:336)

Such was the formula for holistic Vincentian health care. It was to be a service of the sick which sought to bring healing to the body, soul, mind, and heart of every patient confided to it. It was a process begun at Châtillon, continued in Angers and prolonged into the twenty-first century throughout the world.

For the ideal to become a reality, however, other conditions were essential. The first of these, without which the whole process was doomed to failure, was the personal quality of the health care provider. Both Vincent de Paul and Louise de Marillac were practical people. They were fully aware that competence was a sine qua non of effective care. It is certain that, by modern standards, the nursing skills of the early Daughters of Charity were limited. What they did know how to do, however, they did very well. Historians in general, who document the development of hospitals and of nursing give unqualified recognition to this (Imbert, 25 Jones, Ill Masson 32) and attribute much of it to the training provided by Louise de Marillac. By 1642, when the motherhouse was transferred to the Saint-Denis district near Saint-Lazare, the motherhouse of the Congregation of the Mission, it became a "training school" to prepare the sisters for their various apostolic insertions. The care of the sick sisters in the Infirmary as well as of the sick poor who came to the house for assistance gave them numerous opportunities for "hands-on" experience. Within the parameters established by contract as well as prudence, they were able to carry out their responsibilities well. Moreover, Louise de Marillac, who provided much of their initial nursing formation, continued to supervise their work, to evaluate it, and to up-grade their skills as needed. Numerous letters from her to the sisters bear witness to this.

The formation of the sisters was in no way limited to the skill level. The founders knew only too well how difficult, even impossible, it was to persevere in their chosen vocation without "solid virtue." Louise de Marillac spoke of this to the sisters of Angers: ...it is not enough to be engaged in the service of the sick in a hospital, although this is a blessing you will never be able to esteem enough. What is necessary is to have the true and solid virtues which you know are essential to carry out well the work in which you are so happy as to be employed. Without that, my Sisters, your work will be almost useless to you. (Spiritual Writings 128-30)

Collin Jones saw these "solid virtues" as "mental fortitude, physical toughness ... and a strong, disaster-proof sense of vocation (Jones 101) The founders, on the other hand, in conferences and letters, grouped them into categories: those required for the sisters’ spiritual lives and union with God; those needed to live and work harmoniously among themselves; those which would enable them to serve the poor faithfully and well; and finally those which would allow them to bridge gaps among peoples and collaborate with ecclesiastical and civil authority, men and women, religious and laity, the rich and the poor. No small task, and one which cloistered religious life had not demanded.

Spiritual Rootedness: Let us turn now to the first grouping -- to those qualities necessary for the sisters' spiritual life and their union with God. The new form of consecrated life to which they had been called "for the service of the poor", (Coste lX:534) unlike that of cloistered religious, demanded a combination of contemplation and action. To attain and maintain this delicate balance required a deep spiritual rootedness. The Daughters of Charity would not live out their vocation within the confines of the cloister but amidst those whom they served having:

• for monastery...the houses of the sick;

• for cell ... a rented room;

• for chapel ... the parish church;

• for cloister ... the streets of the city or the wards of hospitals.

• for enclosure. . . obedience;

• for grate ... the fear of God;

• for veil ... holy modesty ... (Common Rules, Chap. I Art. 2}

Such a life was unprecedented. It was even considered by some to be unsuitable for women. Thus, it demanded of those called to it, total commitment --- the gift of their lives and of their whole being to God. The Vincentian scholar, André Dodin, C.M., points out that, in his writings, Vincent de Paul repeats some form of the expression "Let us give ourselves to God," 573 times. (Dodin ceux qui souffrent 49)

During their own spiritual journeys, both Vincent de Paul and Louise de Marillac had learned that it was not enough to give one’s time or money for the service of the poor. Total dedication to God, present in the poor whom they served, was needed. It is interesting to note that this call for the gift of self in service was never viewed, by either of the founders, as reserved to the Daughters of Charity or the Congregation of the Mission. It is a wider call to all those, who in any way participate in the Vincentian mission of service, to develop deep spiritual roots. Without them no work of charity could long endure. Vincent de Paul was only too well aware of this when, in 1645, he petitioned the archbishop of Paris, Jean-François de Gondi, for approval of the Daughters of Charity. He wrote, "Works pertaining to the service of God come to an end ordinarily with those who begin them, if there is no spiritual bond among the persons involved in them." (Coste I:602) The continued Vincentian mission in health care around the world bears witness to the strength of this bond in what the late Joseph Cardinal Bernardin called "a family of faith" of those ministering to the sick. (Bernardin II)

Family of Faith: This notion of a "family of faith" leads to the second grouping of qualities or "solid virtues" required of the Daughters of Charity namely, those that proved to be essential if they were to live and work harmoniously together. Constitution 1.6 for the Daughters of Charity begins, "The Founders considered fraternal life one of the basic supports of the vocation of the Daughters of Charity." (Constitutions 6) Indeed, from the very beginning, when Vincent de Paul began sending her peasant girls to be trained for the service of the sick in the confraternities of charity of Paris, Louise de Marillac saw the need for a support system if these young women were to continue for any length of time in the exacting work to which they wished to dedicate themselves. Having been herself, in her youth, "disconnected," as modern parlance would put it, she was particularly sensitive to loneliness and to the need for the companionship of others who shared a common vision. She was fully aware of the need for a "spiritual bond" but she also knew that human ties were vital. lt would take a number of years and constant urging on her part before Vincent de Paul would share this belief and the Daughters of Charity would come into existence on 29 November 1633. In subsequent years, however, the building and maintaining of a vibrant community life became a major focus of the founders’ letters and conferences. Moreover, they were realists who recognized that the forming of "but one same body in several persons, united through the love of God for the same purpose," (Coste lX:98) in this case the service of the poor, was a formidable task. If their life and work together was to be a support for their vocation, it demanded, as Louise and Vincent repeatedly reminded the sisters, solid virtues, the chief among them being "humility, simplicity and charity." (Coste lX:595) These three fundamental virtues encompassed many others and translated them into practical manifestations at home and in the workplace. Living and working together as a "family of faith" called for mutual respect and forbearance, kindness, gentleness, forgiveness, indeed all the attributes of love as put forth by Saint Paul in Chapter 13 of his first letter to the Corinthians. This was how they were to live and work. These were the qualities they were to bring to their dealings with all those with whom they associated in and for the service of the poor. United to a deep personal spiritual rootedness, they were also the surest means for insuring quality service.

Holistic Service: Let us turn now to the third grouping, to those designed to enable the Daughters of Charity and those associated with them to serve the poor faithfully and applicable to all the forms of service provided by the sisters, our interest here is in those needed for the effective care of the sick. The Rule for the Sisters of the Hospital of Angers as well as Louise de Marillac’s correspondence are particularly revealing in this regard. We have already discussed competence, so we will now examine the other attributes required for quality care. Hospital historians (Imbert, Misermont) agree that chaos existed in Angers when the sisters arrived at the hospital. Thus, the most essential reform was to establish order. Translated into minute detail in the rule, this meant providing care in an exact and timely fashion in a setting that was, as far as possible at the time, conducive to the healing mission. Moreover, this quality care was to be provided through careful financial management. Waste more than a lack of resources had led to the degeneration of care at Angers. (Misermont 48-49) The rule and contract called for strict keeping and rendering of accounts. (Documents 247-252, 264-266) Louise de Marillac was particularly vigilant in this matter. (Spiritual Writings 291) She was careful to see to it that the patients had what they needed and even those little extras that could help them to recuperate more quickly. (Spiritual Writings 296-97) On the other hand, she urged the sisters to find ways to contain costs. When they took over the management of the pharmacy in the hospital in Nantes, she reminded them that it was unnecessary and undesirable to seek out exotic herbs for their medicines when ordinary ones were just as effective and less costly. (Spiritual Writings 214)

Collaboration with benefactors, in this case the Ladies of Charity, enabled them to provide better care within reasonable cost. While the hospital provided the essentials for all the sick, the Ladies of Charity supported the spiritual and humanistic mission as well as providing the little delicacies which it could not furnish. (Spiritual Writings 177) This ability to provide quality care at reasonable cost was no small factor in the spread of the Company into some 426 hospitals, large and small, throughout France as well as in Poland, Austria, and Silesia, on the eve of the Revolution of 1789. (lmbert 25-26) It probably also explains the early reestablishment of the Daughters of Charity by the Chaptal Decree of 1800 which allowed the superiors "to accept pupils for the service of hospitals." (Genesis of the Company 65) The newly reestablished group was known as the "Hospital and Teaching Congregation of the Daughters of Charity, called Sisters of Saint Vincent de Paul," and would, for a time at least, receive subsidies from the state. (Archives Nationaes TF 19-6348)

While competence and efficiency were essential ingredients of quality care, they were not its essence. The founders urged the sisters to care for the sick well. But this holistic service required other elements. Louise de Marillac’s correspondence furnishes valuable insight into the work at this first hospital where the sisters managed the nursing care. Because it was at a distance, Louise wrote often both to the sisters and to the Abbé de Vaux. What attributes of Vincentian Health Care do we discover in her letters?

Chief among these was respect for the person of the patient. The sick poor of seventeenth-century France were not only ill and destitute, they were also the outcasts of society, viewed with fear rather than compassion. Bossuet, in his Eminent Dignity of the Poor, had tried to change the image but it perdured. Thus Vincentian Health Care, with its emphasis on cordial respect (Spiritual Writings 765) for each patient, brought a desperately needed new dimension to the service of the sick. This respectful attitude, which was required of all involved in the health care ministry, had spiritual roots. The sick were viewed as a privileged place of encounter with God. At a time when the order of day was sacrosanct in religious congregations, the founders reminded the sisters that they were to leave prayer and even Mass when the needs of the sick required it. This was not because the sick were more important than God but because in the sick they would find God. (Coste IX:5) Such a conviction can but lead to profound respect for each patient.

This cordial respect was to be allied to gentleness (Spiritual Writings 144, 303, 605) even with the most difficult patients, compassion (Spiritual Writings 434, 741, 773, 810) and finally a joyous spirit in the midst of life’s miseries. (Spiritual Writings 70) While both Vincent and Louise called upon the sisters to serve the sick joyously, they were also realists who recognized the degree of personal asceticism that such an attitude could require. Louise told them "not to be upset if [their] senses rebel, God is satisfied with good will." (Spiritual Writings 81) She also knew that it meant starting again each day since difficulties, as well as joys, were inextricably interwoven in the "good care" of the sick. Thus, she tells them, and by extension all involved in Vincentian health care, "to arise each morning with new courage to serve God and the sick well." (Spiritual Writings 225)

Bridges of Unity: This overriding goal of serving God and the sick well leads to the fourth and final grouping of essential attributes, namely those which would allow the sisters to bridge gaps among people and to collaborate with ecclesiastical and civil authority, men and women, religious and laity, the rich and the poor. This collaboration and the spiritual and human qualities that it demanded of all involved may well be the most innovative aspect of the initial work of the Daughters of Charity in health care. Its character and scope was unprecedented. Until the seventeenth century, with rare exceptions, hospitals were run by cloistered orders of men or women and seldom involved collaboration with other groups. Bishops certainly had a role to play, as did civil authority, in the various cities where Hôtel-Dieu (modern general hospitals) were established. During the Middle Ages many bishops took their responsibility as "Fathers of the Poor very seriously and personally oversaw the works for the care of the sick poor in their dioceses. By the sixteenth century, however, this direct involvement had become less and less common. Thus, the Council of Trent (1545-1563) would intervene and strive to bring about reform. (lmbert Hôpitaux 24-25) By the time the Daughters of Charity arrived in Angers in December 1639, bishops were actively involved in the oversight of health care within their dioceses. (Misermont 50)

Devout, wealthy Catholics had long been a major source of support for hospitals. With the Reformation in the sixteenth century and the subsequent Wars of Religion, this support became less reliable. Thus city officials had to supply for the lack of dependable funding from this source. They also had to contend with financial abuses among some of the religious orders with the resultant decline in the quality of service to the sick. (lmbert Hôpitaux 20-12) To rectify the situation in Angers and elsewhere in France, these same city officials became the administrators, that is the "Fathers of the Poor" for the hospital. (Misermont 39)

If the wealthy were not as likely to endow Hôtel-Dieu at this epoch (they would continue to establish small hospitals in provincial towns), they did continue to contribute generously of their resources and to give of their time. This is best exemplified by women such as Madame Goussault in Paris and Angers and the Duchess d’Aiguillon in Richelieu. Moreover, the Ladies of Charity were an integral part of both the spiritual and humanistic care rendered in the hospitals.

It is clear, therefore, that the Daughters of Charity were called to a complex degree of collaboration which has some interesting and valuable insights to offer the Vincentian health care professionals on this eve of the twenty-first century. From the beginning, they had to learn to meet and to grapple with the multiple challenges inherent in forging partnerships and alliances designed to insure quality care for the sick. This task required "solid virtues" in an arena where no proven guidelines existed. The work of Vincent de Paul and Louise de Marillac, as well as their correspondence, allow us, nonetheless, to form a fairly clear idea of the meaning of Vincentian collaboration and the qualities demanded of all participants.

From the original contract and rule for Angers certain elements are apparent. The first of these, and the one that perhaps best explains the success of the efforts in this regard and the spread of the reputation of the Daughters of Charity in health care, was focus. The hospital historian, Collin Jones, contends that the Daughters of Charity were able to bridge the gaps between groups with widely differing agenda because they were "non-threatening" to the parties involved. (Jones 111) This was because their efforts were always focused on the well-being of the sick. The contracts and rules, while protecting the vital interests and prerogatives of the Company, make it clear that no gain, financial or political, was sought or even permitted. This visible gratuitousness insured collaboration rather than competition. (Spiritual Writings 729, 762)

This is not to say that lines of authority, with their concomitant rights and obligations were not spelled out in detail. (Documents 247-252, 264-266) In this area, Louise de Marillac revealed herself to be a skilled, and when the situation warranted it, even a "hard-nosed" negotiator. Moreover, once contracts were concluded, she was vigilant in their implementation. When fundamental differences arose in Le Mans over a clause of the contract concerning the placement of the sisters, they were withdrawn after a stay of only three weeks. (R?glement: Le Mans 20)

Louise’s letters contain constant reminders to the sisters of their obligations when dealing with the administrators. She also recognized the self-discipline and exactitude that this required. Things did not always run smoothly. Louise defended the rights of the sisters and refused to allow non-contracted services to be imposed upon them. She did not want them to be "overburdened" fearing its effects on their spiritual and physical well-being. Her focus, however, never wavered from the quality care owed to the sick. In a letter to the Abbé de Vaux in Angers, prompted by her concern that a proposed expansion of the hospital made by the administrators would have a detrimental effect both on the sisters and the patients, she wrote: I have learned, Monsieur, that the administrators of the Hôtel-Dieu have obtained a second house to lodge the sick and that our sisters are expected to care for them. l beg you ... to look into the matter. It is greatly to be feared that if the sisters are overburdened, they will fail in the order and cleanliness so necessary in hospitals and that people, not realizing how few of them there are, will consider them blameworthy. Most importantly, however, the sick will suffer the consequences. (Spiritual Writings 325)

While Louise de Marillac intervened when she and Vincent de Paul deemed it necessary, her letters are filled with advice to the sisters on ways to maintain a smooth relationship with administrators, physicians, and clergy. She urged them to carry out orders exactly and promptly, with an attitude that was respectful, humble, and patient. When differences arose, they were to be handled through proper channels and always with tact and discretion. The fact that there are some twenty references to all aspects of this collaboration indicates the importance the foundress placed upon it.

Her distress is also evident when the sisters forgot the necessity of successful collaboration, if the sick were to be well served, and allowed themselves to become involved in divisions within the hospital. Such would prove to be the case in Nantes where the Daughters of Charity assumed management for the nursing care and pharmacy in 1646. The beginnings were auspicious, indeed, but later quarrels had a negative effect on the life of the community there. In the eyes of Louise de Marillac this would inevitably prove detrimental to the care of the sick regardless of the competence with which the service was carried out. A particularly telling sentence appears in a letter dated 10 July 1647. She wrote, "every time I hear of the good done by our Company, l blush with embarrassment thinking of the disorders in Nantes." (Spiritual Writings 213)

In what appears to have been a single unfortunate case in the rapid expansion of the work of the Daughters of Charity in hospitals, focus was momentarily lost. Indeed, the sisters would withdraw from Nantes in 1668. The lessons learned there but reinforced the awareness of all involved in Vincentian health care of their obligation to be a bridge for unity in a "family of faith”. Only in that way could continued quality care of the sick be assured.

As the number of hospitals grew and the multiple partnerships increased, there was a deepening sensitivity to the distress caused in the lives of those who were displaced when the Daughters of Charity took over the management of the nursing care. This was first evinced in Angers where Louise de Marillac and the Abbé de Vaux worked together to find a suitable position for the woman who had been responsible for the nursing care before the arrival of the sisters. The respect and concern for the sick extended to all who were or who had been a part of their care. (Spiritual Writings 21)

All the attributes mentioned above combined to bring about the most significant and innovative reform in health care in seventeenth century France. From the "experiment" of Angers, (Spiritual Writings 62) the work would continue to expand as the "family of faith" of all involved in Vincentian health care collaborated to insure that the sick would be "well cared for."

Specialized Health Services

The work of the Daughters of Charity in general hospitals expanded rapidly following the initial insertion in Angers in 1640. By the death of the founders in 1660, the number of establishments had grown to sixteen. It is to be noted, however, that this institutional expansion was accompanied by even greater growth in home health care. (Archives Nationales L1054, dossier 52) In 1656, when there was question of opening a small hospital in Bernay, Louise de Marillac wrote to Sister Barbe Angiboust concerning it. The foundress encouraged the undertaking provided it did "not interfere with the work of the Confraternity of Charity." She went on to express her fear that, should such a thing happen "neither work [would] prosper." At the same time she exhibited confidence that Sister Barbe would "see to it that this [did] not occur." (Spiritual Writings 525) It appears that it did not. ln Bernay and elsewhere, both aspects of Vincentian health care continued to "prosper."

General hospitals and home health care formed the core of the Vincentian ministry to the sick. They were not, however, the only manifestations of it. Let us turn our attention now to some more specialized services, namely those for the mentally ill and the elderly and those elicited by crisis intervention. Because it was too vast and too complex an endeavor to be treated adequately here, we have chosen not to discuss the Foundling Hospital. While the sisters cared for the abandoned children when they were ill, the work went far beyond health care to include social services and education. Its importance, for our purposes, is that it illustrated, centuries ahead of its time, a cross-disciplinary approach to the service of the poor and marginalized. As such it offers both a model for and a challenge to modern health care facilities. The first service we will examine, therefore, is work with the mentally ill.

Petites-Maisons. There was, perhaps, no more marginalized group in seventeenth-century France than the mentally ill who were both feared and misunderstood. Thus, the decision of the founders to send the sisters to the mental hospital, called Petites-Maisons, in 1655, was a risk demanding considerable courage on the part of all involved.

Vincent de Paul had become acutely aware of the plight of the mentally ill when he established the motherhouse of the Congregation of the Mission in the Priory of Saint-Lazare in 1632. By taking over the establishment he had assumed responsibility for the sick and mentally ill "enclosed" there. His concern and compassion for them grew and he called upon the priests to minister spiritually to them. (Coste X|:22—24; Xll:88) He went so far as to say that, should the Congregation of the Mission ever be obliged to relinquish Saint-Lazare, the thing that would be the most painful for him would be "to no longer see these suffering souls and to be obliged to abandon their care and service." (Coste XI:21-22)

It is not surprising, then, when, in 1655, the city officials asked for the Daughters of Charity for the Petites-Maisons, that he was eager to comply. (Coste X:114) The full extent of the misery of the inmates confined there had become apparent to him when he preached a mission to them in 1639. (Abelly II:27) Thus, he and Louise de Marillac undertook the task of preparing sisters for ministry among them. .

On 18 December 1655, Vincent gave a conference to the Daughters of Charity reminding them that the mentally ill were a privileged place of encounter with God. Conditions at the Petites-Maisons were so bad (Coste XIll:596) that there was the danger that fear and frustration might lead them to lose, momentarily at least, their focus and the conviction that in these suffering people they would find God. He said, "you must know that He is present in these unfortunate people ... as He is in everyone else." (Coste X:126) Grounded in this belief, they were to serve them with the same compassion, respect, and devotion that they brought to the care of other patients. They were to enter this horrifying environment each day with the "joy, courage, perseverance, and love" (Coste lX:593) that should characterize all their service to the poor.

Their tasks were humble but the quality of their physical and spiritual care transformed the institution and their patients came to experience some degree of comfort. According to Abelly, "the administrators acknowledged that the Daughters of Charity had put an end to many disorders, including the serious financial loss of the institution, but especially the lack of care of the patients themselves." (Abelly lI:296)

The sisters succeeded so well that the number of patients grew and Vincent de Paul, himself, had difficulty placing someone there. (Coste Vll, 185) The most telling testimony to the quality care brought to these marginalized persons is the fact that the Daughters of Charity, after setting aside the habit, were allowed to continue their work at the Petites-Maisons throughout the Revolution and the Reign of Terror. (Annales LlX:5l) The Petites-Maisons are no more. Nevertheless, the call to bring care and comfort to the mentally ill and marginalized continues to be regarded as an integral part of the Vincentian mission in health care.

Hospice of the Holy Name of Jesus. In the work with the foundlings, Louise de Marillac had discovered misery in an institution, La Couche, that totally lacked the means to respond to the goals for which it had been established. She and the Daughters of Charity, therefore, reorganized the work, transferred the children to a more appropriate setting, and developed the first organized foster care program. At the Hôtel-Dieu of Paris, she and her sisters had worked, along with the Ladies of Charity, as volunteers in an institution that, while good in itself, had failed to evolve with the times. The lessons learned there would form the base for the health care they brought to the sick in the hospitals where they served throughout France. The work with the aged at the Hospice of the Holy Name of Jesus, on the other hand, would be a completely new creation for Louise de Marillac and the Daughters of Charity.

With funds given to him by a wealthy and anonymous benefactor, Vincent de Paul purchased two houses "to receive forty poor persons in the hospital, twenty men and twenty women, whom he housed and fed." (Abelly l:225) These poor were not professional beggars, of which there were thousands in Paris, but rather elderly artisans. Lacking persons of social secutiry, they had been reduced to destitution by age and infirmity,

Louise de Marillac received full responsibility for organizing the work, as well as for providing sisters to serve the aged. She gave herself wholeheartedly to the task, striving to meet the bodily and spiritual needs of the residents in a pleasant, productive atmosphere. The documents we possess (Documents 615-618, 629-631, 643-649) reveal Louise’s organizational skills as well as her deep respect for each person. They also show her creativity, since she incorporated concepts that foreshadowed modern occupational therapy. For example, she reached out into the community to bring in craftsmen to set up workrooms. There the residents could be employed at tasks in keeping with their diminishing strength but still interesting and profitable. Although the institution provided for all their needs, they were allowed to keep a quarter of what they earned from their work for personal spending. This was a small sum, surely, but it enabled the elderly to retain the dignity of former days as well as a feeling of usefulness and independence.

The work of the hospice never reached a large scale nor served many residents. Vincent de Paul and Louise de Marillac had deliberately decided that it should be as homelike as possible. Thanks to her creativity, this hospice provides a prototype for the ever-expanding need, within Vincentian health care, for services for the elderly.

Crisis intervention. War, both civil and foreign, opened up yet another area of service for the Daughters of Charity. New cries of anguish touched the hearts of the founders. Reaching out beyond the walls of the institutions where they served, they sent sisters to nurse the wounded on the battlefields. Some of them died there. (Spiritual Writings 519, 601) The image of the Daughter of Charity as the "Angel of the Battlefield," immortalized in art, was born in the midst of horror and quiet heroism.

In 1650, a civil war, known as the Fronde, swept through France. Vincent de Paul and the priests and brothers of the Congregation of the Mission responded with relief efforts for the refugees. The task was so enormous, however, that they asked for the help of sisters to be sent to care for the sick, the orphans, and the abandoned elderly. They also ran soup kitchens and distributed clothing. This collaborative, multifaceted work was carried out quietly and courageously despite the danger from rampaging armies as well as disease and famine. This effort, too, would cost the lives of some of the sisters.

The end of the Fronde did not bring about the end of the miseries of war. Devastation forced the population of entire villages to flee to Paris. Famine became a permanent condition to which the Vincentian family responded with all the resources they could muster. Soup kitchens were opened and packages sent to relief centers closer to the war-torn areas. Moreover, medical teams composed of a doctor and two sister nurses went to care for the sick and wounded in what remained of their homes. Flexibility, mobility, and courage to accept risks, enabled the Vincentian "family of faith" to intervene effectively in crisis situations and to provide integrated service to the sick, wounded, and destitute.

Essential Attributes of Vincentian Health Care

As one examines the Vincentian mission in health care during the lifetime of Vincent de Paul and Louise de Marillac, particularly after the founding of the Daughters of Charity in 1633, one cannot but be struck by its scope. It would be difficult to find a group in need of services excluded from their endeavors in the homes of the sick, hospitals, institutions for the elderly and the mentally ill, or on the battlefield. What were the essential attributes that they, and those who shared their mission, brought to this multifaceted service?

1. spiritually rooted - Vincentian health care recognizes the patient as a privileged place of encounter with God. Those involved in it form a "family of faith" which strives to serve the sick with cordial respect, compassion, and gentleness.

2. holistic - From its origin Vincentian health care has sought to serve the sick "corporally and spiritually" that is to minister to body, mind, and spirit.

3. integrated - Vincentian health care is patient focused, integrating all services, regardless of level, to provide comprehensive care and blending the humanistic with technical competence.

4. excellent - Vincentian health care places quality at the center of its mission. The health care providers must not only be competent but efficient and dedicated.

5. collaborative - By the gratuitousness of their patient centered service, those involved in Vincentian health care strive to be a bridge for unity in the multiple partnerships formed to insure better care for the sick. Vincentian health care seeks by such alliances to collaborate rather than to merely compete with other health care facilities.

6. flexible - Vincentian health care is ever ready to reach out beyond institutional walls to serve the sick where needed and to intervene in crises when necessary.

7. creative - Vincentian health care is ever seeking new or renewed ways to meet the changing needs of the sick while maintaining a clear "sense of the possible."

8. focused - From its origin for the service of the "sick poor," Vincentian health care has viewed a preferential option for the poor as central to its mission. It thus strives to integrate this vision into all aspects of its service and to keep the primacy of it alive among all those who share in their ministry of care of the sick.

CONCLUSION

In undertaking this project, the intention was to allow the essential attributes of Vincentian health care, as they appeared in the lived experiences of Vincent de Paul, Louise de Marillac, and the early Daughters of Charity, to emerge. The research conducted into the prototypal works of the Daughters of Charity in health care supports the major premise of this work namely that, despite the fact that treatment methods which proved successful in seventeenth-century France are now outmoded, the manner in which care was delivered and the qualities that characterized the service furnish an instructive model for subsequent eras. Medical practice has changed radically but the essential attributes of Vincentian health care remain for all who share the common vision of spiritually rooted quality care for the sick.

Chronology: St. Louise de Marillac – Health Care Innovator

1591 - Birth, Paris, France.

C.1592 - Placed as a boarder at the Royal Monastery of Poissy. Received a solid spiritual and humanistic education.

1604 - Death of her father, Louis de Marillac. Removed from Poissy and placed in a boarding house in Paris. Learned practical things needed for later charitable works.

1613 - Marries Antoine LeGras, Secretary to the Queen Marie de Medici. Birth of her son Michel.

1613-1625 - Visits the sick of the parish and of the Hotel-Dieu. Illness of her husband whom she nurses herself.

1623 - Light of Pentecost.

1624-1625 - Meets Vincent de Paul who becomes her spiritual director.

1625 - Death of her husband.

1629 - Begins to visit the Confraternities of Charity. Renews the zeal of the Ladies of Charity for the service of the sick. Begins to train girls to assist the Ladies of Charity with the care of the sick in the Confraternities of Charity of Paris.

1633 - Co-founds the Company of the Daughters of Charity (29 November). Assumes responsibility for the spiritual and professional formation of the sisters.

1634 - Sisters visit the sick of the Hôtel-Dieu of Paris.

1634 - Work in Confraternities of Charity expands.

1640 - Draws up and signs contract confiding the management of the nursing care at the Hopital St-Jean-|’Evangeliste in Angers to the Daughters of Charity (1 February).

1645 - Hospital of Saint-Denis.

1646 - Hospital of Le Mans. Hospital of Nantes.

1647 - Hospital of Fontainebleau.

1653 - Hospice of the Holy Name of Jesus; Hospital in Warsaw, Poland.

1650 - Hospital of Hennebont.

1650-1652 - Relief services for refugees.

1654 - Hospital of Chéteaudun; nursing of wounded soldiers.

1655 - Hospice of the Petites-Maisons.

1656 - Hospital of La Fere.

1657 - Nursing of the wounded in Calais.

1660 - Death of Louise de Marillac.

1920 - Beatified by Benedict XV.

1934 - Canonized by Pius XI.

1960 - Declared Patron of Christian Social Workers by John XXIII.

Chronology: St. Vince de Paul – Health Care Innovator

1581 - Birth, Pouy, France.

1595-1597 - Studies in Dax. Tutor to the children of M. Comet.

1597-1604 - Theological studies at the University of Toulouse.

1598 - Death of his father, Jean de Paul.

1600 - Ordination to the priesthood at Chateau-l’Evéque.

1604 - Arrival in Paris.

1610 - Becomes a chaplain in the household of Queen Marguerite de Valois. Visits the Charity Hospital.

1611 - Donates 15,000 pounds "to tend and nurse the sick poor" of the Charity Hospital.

1613-1617 - First period of residence with the Gondis.

1617 - Gannes-Folleville. Confession of the poor peasant leading to the first sermon of the Mission (25 January). Chatillon. Pastor. Sermon leading to the founding of the first Confraternity of Charity for the "corporal and spiritual service of the sick poor" (21-22 August).

1618 - Missions to the poor in rural areas. Establishment of additional Confraternities of ` Charity.

1624-1625 - Meets Louise de Marillac.

1625 - Foundation of the Congregation of the Mission.

1629 - Sends Louise de Marillac to visit the Confraternities of Charity to strengthen their activities for the service of the sick poor. Establishment of Confraternities of the Ladies of Charity in Paris.

1630 - Meets Marguerite Naseau and sends her, and other peasant girls, to Louise de Marillac to be trained to work with the Ladies of Charity in the service of the sick poor of the parishes of Paris.

1633 - Foundation of the Daughters of Charity (29 November).

1634 - Ladies of Charity and Daughters of Charity begin to visit the sick at the Hôtel-Dieu of Paris.

1640 - Daughters of Charity assume management of nursing care at the Hopital de St.-Jean-L’Evange|iste in Angers (1February).

1641-1660 - Daughters Ff Charity are established in hospitals and houses of charity for the service of the sick poor throughout France.

1650-1652 - Relief services for refugees.

1660 - Beatified by Benedict XIII.

1729 - Canonized by Clement XII.

1883 - Designated Patron of Charity in France by Leo XIII.

Appendix I: Foundation of the Confraternity of Charity in Châtillon

August 23.1617

JESUS, MARlA

In the name of the Father, and of the Son, and of the Holy Spirit.

On this day, August 23, 1617, the Ladies named below have charitably joined forces to take their turn to assist the sick poor of the town of Châtillon, having decided unanimously that, for an entire day only, each will be responsible for all those whom they have decided together to be in need of their help. To do so, they propose two aims, namely, to assist body and soul: the body by nourishing it and tending to its ailments; the soul by preparing those who seem to be tending toward death to die well, and preparing those who will recover to live a good life.

And because, when the Mother of God has been invoked and taken as patroness in important matters, everything can only go well and accrue to the glory of Jesus her Son, the Ladies take her for patroness and protector of the work, most humbly entreating her to take special care of it, as they also entreat Saint Martin and Saint Andrew, true examples of charity and patrons of Châillon.

Starting tomorrow, the feast of Saint Bartholomew, they will begin with God's help, to function in this good work in the order in which they are listed here:

First, the chatelaine on her day;

Mlle. de Brie on hers;

Mme. Philiberte, wife of M. des Hugonieres;

Benoite, daughter of M. Ennemond Prost;

Mme. Denise Beynier, wife of M. Claude Bouchonr;

One of the daughters of Mme. Perra;

Mme. Colette;

And, lastly, Mlle. de la Chassaigne.

After her the chatelaine will do the same service on another day, and the others will take their turns successively, according to the above order, unless one of them is unable for some justifiable reason to carry out this ministry on her day. In that case, she will notify the person next in line --- or have her notified --- that she will be unable to take her torn, so that she can replace her on that day in caring for those who are poor. If that Lady can do so, she should not refuse because, in so doing, she will be freed of the responsibility for the following day, which she would have had according to the above order. They should daily ask our good Jesus to kindly maintain this order and to shower with His divine blessings all those men and women who will work with their hands or contribute from their resources for its support. He will undoubtedly do so, since He Himself is the one who assures us by His own mouth that, on the great, awesome Day of Judgment, those who assist persons who are poor will hear that gentle, pleasing voice of His saying: "Come, you blessed of my Father, inherit the kingdom prepared for you from the creation of the world," and, on the contrary, those who have taken no care of them will be rejected by Him with those other harsh, appalling words: "Out of my sight, you condemned, go into that everlasting fire prepared for the devil and his angels.”

To the Father the Judge, to the Son, and to the Holy Spirit be honor and glory forever and ever. Amen. (CCD:XIIIb:3-5)

Appendix II: Rule of the Confraternity of Charity in Châtillon

November 1617

Since charity toward the neighbor is an infallible sign of the true children of God, and since one of its principal acts is to visit and bring food to the sick poor, some devout young women and virtuous inhabitants of the town of Chlâtillon-les-Dombes, in the Lyons diocese, wishing to obtain from God the mercy of being His true daughters, have decided among themselves to assist spiritually and corporally the people of their town who have sometimes suffered a great deal, more through a lack of organized assistance than from lack of charitable persons.

Because, however, it is to be feared that this good work, once begun, might die out in a short time if they do not have some union and spiritual bond among themselves to maintain it, they have arranged to form an association that can be set up as a confraternity with the regulations that follow. All of this is, nevertheless, subject to the good pleasure of their most honored Prelate the Archbishop, to whom this work is entirely subject.

The confraternity will be called Confraternity of Charity, in imitation of the Charity Hospital in Rome, and the persons of which it will be mainly composed will be called Servants of the Poor or of the Charity.

Patron and Purpose of the Work

Since, in all confraternities, the holy custom of the Church is to propose a patron, and since the works gain their value and dignity from the purpose for which they are performed, the Servants of the Poor will take for patron Our Lord Jesus and for its aim the accomplishment of His very ardent desire that Christians should practice among themselves the works of charity and mercy. This desire He makes clear to us in His own words: "Be merciful as my Father is merciful,” and in these words: "Come, blessed of my Father, inherit the kingdom prepared for you from the foundation of the world. For I was hungry, and you gave me to eat ... I was sick and you visited me ... for what you have done to the least of those, you did to me."

Members of the confraternity

The confraternity will be composed of women: widows, wives and unmarried women, whose piety and virtue are known and whose perseverance can be counted on. Nevertheless, the wives and unmarried women must have the permission of their husbands or parents and not otherwise. In addition, to avoid the confusion that comes from too large a number, it should be limited to twenty, until further orders.

And because there is reason to hope that there will be foundations made in aid of the confraternity, and that it is not appropriate for women to handle them on their own, the Servants of the Poor will elect as their Procurator some pious, devout priest or an inhabitant of the town who is virtuous, devoted to the good of persons who are poor, and not too caught up in temporal affairs. He will be considered a member of the confraternity and will participate in the indulgences granted to it, will come to the meetings, and, like the Servants, will have a voice in decisions regarding matters proposed during the time he is in office as Procurator, and no longer.

In addition, the confraternity will choose two respectable, devout poor women, who will be called Nurses of the Sick Poor' because their duty will be to watch over those who are alone and cannot move about and to serve them according to the instructions the Prioress will give them. They will pay them decently according to their work; consequently, they, too, will be considered members of the confraternity, will participate in the indulgences, and will come to the meetings but will not have a deliberative vote there.

Offices

One of the Servants of the Poor will be given the status of Prioress of the confraternity. So that everything may proceed in an orderly fashion, the others will love and respect her as their mother

and obey her in whatever concerns the property and service of those who are poor, all for the love of Our Lord Jesus, who became obedient unto death, even to the death of the Cross. It will be her duty to do her utmost to see that all the poor persons are fed and assisted in accordance with this organization; to admit into the care of the confraternity, during the period between meetings, those sick persons who are truly poor and to discharge those who are better. All this, however, will be done with the advice of her two Assistants, or of one of them. She can, nevertheless, without asking them, instruct the Treasurer to give what she thinks is necessary to do those things that cannot be postponed until the next meeting. When she admits any patients, she will notify immediately the Servant whose turn it is to be on duty that day.

For the counsel and ordinary assistance of the Prioress, two of the most humble and most discreet members of the Company will be given her to attend to the public good of those who are poor and the management of the confraternity.

One of her Assistants will be named Subprioress and Treasurer of the confraternity; it will be her duty to carry out the functions of the Prioress in her absence, to take in the money and give receipts for it, take care of the linen and other furnishings, buy and store the provisions needed for the assistance of poor persons, give the Servants each day whatever they need for the food of those who are poor, see that their linen is laundered, carry out the instructions of the Prioress, and keep a book in which she will write down whatever she receives and uses.

It will be the duty of the Procurator to manage and negotiate business involving funds for the temporal affairs of the confraternity, with the advice and direction of the Pastor, the Prioress, the Treasurer, and the other Assistant;' to explain at each meeting held for this purpose the state of the affairs he is managing; to keep a book in which he will record the decisions that will be made during it; to ask, on behalf of the confraternity, the Lord of the town of Châtillon, one of the Syndics, and the hospital Administrator to be present for the rendering of accounts of the confraternity. It will also be his duty to decorate its chapel, to have the Masses said, to look after the vestments and, with the advice of the above-mentioned persons, to purchase some when necessary.

Admission of the sick and how to assist and feed them

The Prioress will admit to the care of the confraternity those patients who are truly poor, and not those who have the means of taking care of themselves, with the advice, however, of the Treasurer and the Assistant, or of one of them. When she has admitted someone, she will notify the person whose day it is to be on duty, and the latter will go immediately to see him. The first thing she will do is to see if the patient needs a nightshirt so that, if that is the case, she may bring him one from the confraternity, along with some clean sheets, if they are needed and he is not in the hospital, where there are some. All of this is in the event that there is no way to launder them there.

When this has been done, she will see that the patient goes to confession in order to receive Communion the next morning because it is the intention of the confraternity that those who want to be aided by it go to confession and Communion. Before anything else, she will bring the patient a picture of the Crucifixion, which she will put up in a place where he can see it so that, by looking at it sometimes, he may reflect on what the Son of God suffered for him. She will also bring him other small items he needs, such as a bed tray, a napkin, a cup, a pitcher, a small plate and a spoon; afterward, she will notify the person whose turn it will be the following day to see that the patient's house is cleaned and adorned in preparation for him to receive Communion, and to bring him his everyday fare.

Each of the Servants of the Poor will prepare their food and serve them for an entire day. The Prioress will begin, the Treasurer will follow, then the Assistant, and so forth, one after the other, in the order in which they were received, up to the latest arrival. Afterward, the Prioress will start over, and the others will follow, observing the order begun, so that, by this continual rotation, the patients will be served always in line with this organization. Nevertheless, all will be done in such a way that, if one of them falls ill, she will be excused from her service, informing the Prioress so that the latter can continue the succession with the others. If, however, one of them is prevented for some other reason, she will see that someone else takes her place, substituting for her in a similar situation.

When the person whose turn it is has received from the Treasurer whatever is needed on her day for the food of the poor persons, she will prepare the dinner and take it to the patients, greeting them cheerfully and kindly. She will set up the tray on the bed, place on it a napkin, a cup, a spoon, and some bread, wash the patient's hands, and then say grace. She will pour the soup into a bowl, and put the meat on a plate. She will arrange everything on the bed tray, then kindly encourage the patient to eat for the love of Jesus and His holy Mother. She will do all this as lovingly as if she were serving her own son -- or rather God, who considers as done to Himself the good she does for persons who are poor.

She will say some little word to him about Our Lord, making an effort to cheer him up if he is very downhearted; sometimes she will cut his meat or pour him something to drink. Once she has him beginning to eat she will leave if he has someone with him, and will go to find another patient, acting with him in the same way, remembering to begin always with the person who has someone with him and to end with those who are alone so she can spend more time with them. Then, she will return in the evening to bring them their supper, using the same system and order as above.

Each patient will have as much bread as he needs, with a quarter of a pound of mutton or boiled veal for dinner and the same amount of roast meat for supper, except on Sundays and feast days, when they may be given boiled chicken for their dinner. Two or three times a week, they will be given ground meat for supper. Those who do not have a fever will receive a pint of wine daily, half in the morning, and half in the evening.

On Fridays, Saturdays, and other days of abstinence, they will be given two eggs, along with some soup and a little butter for their dinner, and the same for supper, with their eggs cooked the way they like. If fish can be found at a reasonable price, it will be given to them only at dinner.

Permission will be obtained for the seriously ill to eat meat during Lent and on other days when it is forbidden. Those who cannot eat solid meat will be given, three or four times a day, broth, soup with toast cut up in it, barley water, and fresh eggs.

Spiritual Assistance and Funerals

Because the aim of this organization is not only to assist poor persons corporally, but spiritually as well, the Servants of the Poor will strive and take great pains to dispose those who recuperate to live better, and those who seem to be approaching death, to die well. They will arrange their visit for this purpose and pray often for that, making some little elevation of their hearts to God for this intention. In addition, they will occasionally read some devotional book that might be useful to those listening who might profit from this, exhorting them to bear their illness patiently for the love of God and to believe that He has sent it to them for their greater good. They will have them make some acts of contrition, consisting in sorrow for having offended God, for love of Him, to ask His forgiveness and resolve never to offend Him again. In the event that their illness [becomes worse], they will see to it that they go to confession as soon as possible. For those who seem to be dying, they will be sure to notify the Pastor to administer Extreme Unction, encouraging them to trust in God, to reflect on the passion and death of Our Lord Jesus, and to commend themselves to the Blessed Virgin, the angels, and the saints, particularly the patron saints of the town and those whose names they bear. They will do all this with great zeal to cooperate in the salvation of souls and, so to speak, to lead them by the hand to God.

The Servants of the Charity will take care to have the dead interred at the expense of the confraternity, providing a shroud for them and having the grave dug if the deceased has no one else to do this, or the hospital Administrator does not take care of it, as he should be asked to do. They will also attend the funerals of those patients whom they have nursed, if they can do so conveniently, taking the place of mothers who accompany their children to the tomb. In this way, they will be practicing to the full and in an edifying manner the corporal and spiritual works of mercy.

Meetings: their purpose and the order to be followed during them

Because it is very useful for all holy communities to come together from time to time in some place intended for discussing the spiritual progress and what concerns the general welfare of the community, the Servants of the Poor will meet every third Sunday of the month in a chapel of the church in the town intended for this purpose, or in that of the hospital, where, on that same day or the next day, at a time agreed upon by them, a low Mass will be offered for the confraternity. In the afternoon, at a time convenient for them, they will meet in the same chapel to listen to a short spiritual exhortation and to discuss matters concerning the welfare of those who are poor and the support of the confraternity.

The order to be followed at the meetings will be to chant the Litany of Our Lord Jesus or of the Blessed Virgin before each work, and then say the prayers that follow. Next, the Pastor or his assistant will give the short exhortation aimed at the spiritual growth of the entire Company and the preservation and progress of the confraternity. After that he will propose what is to be done for the welfare of the sick poor, and will conclude by a plurality of votes, which he will collect for this purpose, beginning with the Servant of the Charity who was the last one received into the confraternity, and continuing by order of reception up to the Procurator, then the Treasurer and the Prioress. Lastly, he will cast his own vote, which will have deliberative weight, as that of the Servants of the Poor will have.

It will then be helpful to have someone read five or six articles of the organization; they will also charitably remind one another of the faults that have arisen in the service of the poor persons. All this, however, will be done without any fuss or disorder and with as few words as possible. Each time, they will devote half an hour after the exhortation for this meeting.

Administration of temporal goods and rendering of accounts

The Pastor, the Prioress, the two Assistants, and the Procurator will be responsible for all the temporal goods of the confraternity, movable as well as immovable. Consequently, they will have the authority to give orders in its name to the Procurator to do whatever is necessary for the preservation and collection of these goods.

The Treasurer will keep the money, documents, and furnishings, as has been stated, and give an annual report on the day after the holy feast of Pentecost, in presence of the Pastor, the Prioress, the Procurator, and the other Assistant, as well as the Lord, one of the Syndics, and the Administrator of the Châtillon Hospital, provided, however, that he be a member of the Roman Catholic apostolic religion. The latter three will always be requested, on behalf of the confraternity, to be present and will have faith in the declaration the Treasurer will make that her accounts are accurate, not allowing any article in them to be crossed out nor that either her husband or her children may be questioned regarding them because, being completely trustworthy-since only such persons are chosen for that, people may have entire confidence in her. Furthermore, if she were subjected to being questioned in this matter, none of the members would be willing to accept this office.

After his accounts have been reviewed, the Procurator will report to the same gathering the state of the temporal affairs of the confraternity and what he has administered and negotiated during the year so that the Lord, Syndic, Administrator, and Council members of the town may be adequately informed by the report of the management of the temporal welfare of the confraternity. If they find it faulty, they may have recourse to our most honored Prelate the Archbishop to have it put in order since the confraternity is totally subject to him. Should that be the case, the Council members are very humbly requested to do this for the love of God.

The Prioress will keep a book of expenditures, in which she will record the responsibilities of the Treasurer for the documents, money, and furnishings of the confraternity. In the event that neither she nor anyone else is willing to take on this responsibility, except for the furnishings and part of the money that will be needed for a few months for the food of those who are poor, the confraternity will instruct the Procurator to take charge of the rest and to give an account of it. He will be bound to do so, without being able to refuse the Treasurer anything the confraternity or the Prioress orders, which he will give her for the support and food of the poor persons.

The collection box in the church, placed there for the upkeep of the confraternity and the relief of those who are poor, will be opened every two months in the presence of the Pastor, the Prioress, the Treasurer, the Procurator, and the Assistant. The Treasurer will be given whatever is in it and will record the amount of what will be found there; if she is unwilling, the Procurator will do it, as has been said.

Elections and leaving office

The Prioress, the Treasurer, and the other Assistant will leave office on the Wednesday after the holy feast of Pentecost, and a new election will take place on the same day by a plurality of votes of the entire confraternity. The Prioress, Treasurer, and Assistant may not continue in office so that humility, the true basis of all virtue, may be perfectly honored in this holy institute.

In the event that the Pastor should be non-resident, or that his assistant does not take the responsibility required for the work, it will be permissible for the confraternity to take another Spiritual Father and Director of the work, accepted and approved for this purpose by the Archbishop.

The Prioress, Treasurer, and Assistant may be removed from office before the end of their term by the confraternity, if, in its judgment, they do not carry out their duty well.

The Procurator will remain in office as long as the confraternity sees fit, and no longer.

Those members of the confraternity who commit some public sin or neglect notably the care of those who are poor will be completely dismissed from the confraternity, after the warnings required in the Gospel have first been given to all those whom they wish to remove from office or dismiss from the confraternity.

Common Rules

The entire Company will go to confession and receive Communion four times a year, when they can do so conveniently, namely, on the feast of Pentecost, the feast of Our Lady in August, and the feasts of Saint Andrew and Saint Martin. This is done to honor the ardent desire of Our Lord Jesus that we love the sick poor and help them in their need. In order to fulfill this holy desire, they will ask for His blessings on the confraternity, that it may flourish more and more for His honor and glory, the relief of His members, and the salvation of the souls who serve Him in it or have given of their resources to it.

And so that the Company may be preserved in sincere friendship according to God, when one of the members is ill, the Prioress and the others will take care to visit her, see that she receives the last sacraments of the Church, and pray for her together and privately. When God is pleased to take from this world a member of the group, the others will attend her funeral with the same sentiment as if she were their own sister, whom they hope to see one day in heaven. Each will pray three rosaries for her intention and will have a low Mass celebrated in the chapel of the confraternity for the repose of her soul.

Personal Devotions

Upon awakening they will invoke Our Lord Jesus, making the Sign of the Cross and saying some other prayer to His Holy Mother. Then, having risen and dressed, they will take holy water, kneel at the foot of their bed before some holy picture, and thank God for the gifts, general as well as particular, they have received from His Divine Majesty. They will recite three Our Fathers and three Hail Marys in honor of the Blessed Trinity; one Creed, and one Hail Holy Queen, after which they will hear holy Mass, if convenient for them. They will be mindful of the reserve with which the Son of God carried out His actions on earth and, in honor of the imitation of these actions, will carry out their own in a reserved and tranquil manner.

Those who know how to read will read unhurriedly and attentively a chapter of the book by the Bishop of Geneva, entitled Introduction to the Devout Life. Before the reading, they will raise their minds to God and will implore His great mercy in order to derive the fruit of His love from this devotional practice.

When they have to go into society, they will offer this contact to Jesus Our Lord in honor of His contacts with people on earth; they will entreat Him to keep them from offending Him and will strive especially to give great honor and reverence interiorly to Our Lord Jesus and His Holy Mother, since this is one of the principal requirements this confraternity asks of those who aspire to it.

They will take care in practicing humility, simplicity, and charity, each deferring to her companion and to others, performing all their actions for the charitable intention of persons who are poor and with no human respect.

When the day has been spent in accord with the preceding observations, and the time to retire has come, they will make the examination of conscience and say three Our Fathers, three Hail Marys, and one De Profundis for the deceased. None of this, however, obliges under pain of mortal or venial sin (CCD:XIIIb:8-19).

List of Works Cited

Abelly, Louis. The Life of the Venerable Servant of God Vincent de Paul. J. Rybolt, C.M., ed., W. Quinn, F.S.C. trans. 3 vols. New Rochelle: New City, 1993.

Baunard, A. La Vénérable Louise de Marillac, Mademoiselle Le Gras, Fondatrice des Filles de la Charité de Saint Vincent de Paul. Paris: Poussielgue, 1898.

Bernadin, Joseph. "What Makes a Hospital Catholic -- A Response." America 174.15 (May 4, 1996) 9-11.

Calvet, Jean. Louise de Marillac: A Portrait. New York: Kennedy, 1959.

Charpy, Elisabeth, f.d.l.c., ed. La Comganie des Filles de la Charité: Documents. Tours: Mame, 1989.

Common Rules of the Daughters of Charity Servants of the Sick Poor. Emmitsburg: Saint Joseph’s Provincial House, 1976.

Constitutions of the Daughters of Charity of Saint Vincent de Paul. Emmitsburg: Saint Joseph’s Provincial House, 1983.

Coste, Pierre, C.M., ed. Saint Vincent de Paul: Correspondance, Entretiens, Documents. 14 vols. Paris: Lecoffre & Gabaldo, 1920-1925.

____ The Life and Works of Saint Vincent de Paul. 3 vols. Westminster: The Newman Press, 1952.

Delort, Blandine, f.d.I.c., Le soin des malades selon les Fondateurs et aujourd’hui. Paris: NP, 1980.

Dodin, André, C.M. Monsieur Vincent parle a ceux qui souffrent. Paris: Desclée de Brouwer, 1981.

____ Saint Vincent de Paul et la Charité. Paris: Seuil, 1960.

Gobillon, Nicolas. Louise de Marillac, veuve de M. Le Gras: Sa vie, ses vertus, son esprit. Bruges: Société St.-Augustin, 1986.

Guillemin, Suzanne, D.C. Circular Letters (1966-1968)Emmitsburg: Saint Joseph’s Provincial House, 1968.

Huchard, Viviane. Ancien hospital Saint-Jean, Angers: Paquereau, 1976.

lmbert, Jean, Les Hôpitaux en France. Paris: Presses Universitaires de France, 1994.

____ Histoire des hôpitaux en France. Toulouse: Privat, 1982.

Jones, Collin, The Charitable Imperative: Hospitals and Nursing in Ancien Regime and Revolutionary France. London: Routledge, 1989.

Marion, Marcel. Dictionnaire des institutions de la France aux XVII° et XVlll° siecles. Paris: Picard, 1968.

Masson, Madeleine. A Pictorial History of Nursing. London: Hamlyn, 1985.

Mezzadri, Luigi, C.M. Petite Vie de Vincent de Paul. J Gaziello, trans. Paris: Desclée de Brouwer, 1989.

Miquel, Pierre. Histoire de la France. 2 vols. Verviers: Collection Marabout Université, 1976.

Misermont, Lucien, C.M. Le Premier Hôpital des Filles de Ia Charité. 2° ed. Paris: Emile-Paul, 1913.

Molette, Charles. Guide des sources de l’histoire des congrégations feminines francaises de vie active. Paris: Editions de Paris, 1974.

Poisenet, M.D. France Religieuse de XVlI° Siecle. Paris: Casterman, 1952.

Sullivan, Louise, D.C., ed., trans. Spiritual Writings of Louise de Marillac: Correspondence and Thoughts. Brooklyn: New City, 1991.

____ Genesis of the Company. Emmitsburg: Saint Joseph’s Provincial House, 1968.