St Lazarus’s Hospital

We do not know the year in which this hospital was established, but everything suggests that its foundation dates back to the end of the 15th century. On 25 July 1512 permission was given for the ‘house of the leper hospital to move to Santa Catarina (‘St Catherine’) and Santa Catarina to it. . . . , safeguarding what pertains to the charges of the said house of Santa Catarina’. It seems, however, that St Lazarus’s Hospital (Hospital de São Lázaro) remained where it had been established, since there was no further mention of its transfer.

In 1515 the Council of Funchal resolved ‘that all who are sick with the disease of St Lazarus shall go to the house of São Lázaro...... & that the officers shall go through the streets & all whom they find to be sick with the said disease they shall at once make go to São Lázaro or leave the city’. The same Council further resolved that those who served the lepers should carry small wooden tablets so that they could be recognised, and that lepers found in the city after they had been assigned a place should be publicly flogged.

At first the lepers received 30 réis (old Portuguese money of account; 1$000 = 1,000 réis, 1:000$000 = one conto = 1,000,000 réis) a day for their food. On 26 January 1641, however, they began to receive an allowance of 40 réis paid by the Council, which was raised to 80 réis in the 18th century and to 100 réis on 4 September 1801.

On 24 April 1835 the Council resolved to supply the patients of St Lazarus’s Hospital with food directly, and the councillor (vereador) holding the relevant portfolio (ballot ball (pelouro)) was to present a monthly account of the expenses incurred on that food. In 1910 the patients’ diets were costed at 145 réis a day, and at its session of 17 November the Municipality resolved to grant up to 200 réis a day for that purpose.

A royal warrant (provisão régia) of 1685 entrusted the administration of the lepers, previously in the hands of the bishop, to the governor-general. By the warrant (provisão) of 1693, however, the supervision of these patients passed to the juiz de fora (crown-appointed judge from outside the district), while their expenses continued to be met by the Council of Funchal. An old decree ordered that the lepers ‘should be sent to the island of Maio’.

Dr Julião Fernandes da Silva, author of the Carta Critica sobre o metodo curativo dos médicos funchalenses, attributed the cases of elephantiasis that have appeared on the island since the 15th century to the eating of salted fish, broad beans, sour wine and yams. He added that badly cured venereal diseases and the suppression of haemorrhoids could also give rise to the disease. For that distinguished 18th-century physician, elephantiasis was contagious, and there ought therefore to be ‘enclosure for those who suffer from the disease’. Dr Barral, however, writing in 1853, says that although the disease is hereditary in a good many cases, it never appeared to be contagious on the island. Many modern doctors regard elephantiasis as a contagious disease, but we have known several male and female nurses of the now closed hospital of São Lázaro who, after living in close contact for years with patients suffering from that terrible illness, never had even the slightest skin eruption.

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St Lazarus’s Hospital,’ says Dr Barral, ‘situated in the locality (sítio) of Santa Catarina, to the west of the city, is a small, old house intended to take in patients afflicted with elephantiasis, and maintained by the municipality. It holds more or less twenty-six patients, of both sexes and of different ages, and has at times sheltered more than thirty-four. There they find a home, a bed, food, a physician’s care and medicines. As a work of art the building, although it was intended for this purpose from the outset, is of very poor and insignificant construction. It is well ventilated, because it is always possible to keep the windows open, small though they are, and it meets the principal conditions of healthiness. We found no foul smell there, although in the women’s ward the partitions and curtains, of which we disapprove, could well contribute to one. The patients sheltered there receive sufficient and wholesome food and some palliative or other remedies to combat the more troublesome symptoms of the disease, or of intercurrent illnesses.

On 5 June 1912, on the proposal of Dr Fernando Tolentino da Costa, the Council resolved to close St Lazarus’s Hospital, which then held only four patients, two belonging to the municipality (concelho) of Funchal and two to that of Ponta do Sol (‘point of the sun’). On 19 June of the following year the same Council decided that the Civil Gaol should be installed in the building of the closed hospital, since the terms on which the Government was provisionally lending the Pico fortress (Fortaleza do Pico) to house the prisoners were very costly.

On 28 December 1912 the President of the Council drew up an inventory of all the furniture and utensils at São Lázaro. However, it was only in February of the following year that the two lepers still in the hospital at that time were moved to a hovel in the Travessa do Cascalho, after thought had been given to sending them to the hospital of São José or to that of the University of Coimbra (Universidade de Coimbra). The last hospital pay-sheets of São Lázaro settled by the Council were for expenses incurred in that month of February.

Besides the subsidy of 10,000 réis (old Portuguese money of account; 1$000 = 1,000 réis, 1:000$000 = one conto = 1,000,000 réis) a month granted by the Government, the hospital of São Lázaro had the income of two legacies, one from António Ferreira de Araújo Guimarães of the city of Porto and the other from the Baron of Castelo de Paiva. In 1912 the Council was spending 1,693,000 réis on the establishment, a sum that included the employees’ salaries, amounting to 693,600 réis. There is a warrant (provisão) from Bishop Dom João do Nascimento, dated 16 December 1748, authorising the creation of a confraternity, based in the church of São Pedro (St Peter), to help maintain the hospital of São Lázaro.

The land for the new church of the Lepers was bought for 8,000 in 1665, and on 17 May 1779 a cemetery was completed for the burial of patients who died in the hospital, since it had been recognised that the church itself could not provide graves for all of them. The prisoners were installed in the São Lázaro gaol on 29 November 1913, even though the contract for the works to complete the building was not awarded until February 1915.

At the end of 1890 and the beginning of 1891 Dr Julio Goldschmidt administered Robert Koch’s tuberculin to several patients at the hospital of São Lázaro, but in none of them did it halt the course of the disease, from which all of them eventually died. The consumptive patients inoculated with the same tuberculin at that time likewise obtained no satisfactory results from this method of treatment.

Over the last 30 years St Lazarus’s Hospital rarely housed more than ten lepers, most of them natives of the municipalities of Ponta do Sol and Calheta (‘small cove’). Elephantiasis of the Greeks is the most common form on the island. Those who suffer from it show tubercles or ulcerations on the face, hands, legs, etc., have difficulty breathing and seldom reach the age of 50; the disease almost always appears between the ages of 15 and 25. Of the patients we knew in the hospital, almost all died suddenly, from suffocation caused by oedema of the respiratory organs.

Of particular interest on the subject of this article are Dr Augusto da Silva Carvalho’s book Historia da Lepra em Portugal, which contains a chapter on the hospital of São Lázaro in Funchal; Dr Julio Goldschmidt’s pamphlet La Lèpre, which includes the lengthy clinical observations that this physician made in the said hospital; and the Arquivo Historico da Madeira, vol. I, pp. 107 ff., which contains some valuable notes on its history.

In the Diário de Noticias of Funchal of 12 March 1937, Dr Vicente Henriques de Gouveia published a substantial article entitled ‘Haverá alguma relação entre o inhame e a elefantiase?’ (‘Is there any connection between the yam and elephantiasis?’), which is of particular interest to those who wish to gain a broader knowledge of the subject.