By Lucie Laumonier
When you had to share your hospital bed – a look at how medieval hospitals were managed and what kind of care a person could expect in them.
In a recent article, we’ve looked at the early medieval hospitals. Established by the Church and supported by early medieval and Carolingian rulers, hospitals offered shelter and food to travelers and pilgrims, as well as to the poor. The golden age of medieval hospitals is embedded with the “charitable revolution” of the High Middle Ages, during which the Church promoted charity and works of mercy as a way to redeem one’s sins. The “charitable revolution” unfolded in a context of religious contestation (heresies), when lay people were seeking out ways to get involved in charitable work, and connected to the creation of new religious orders, some of which with a strong hospitality vocation (such as the Hospitallers). New hospitals were founded on the orders’ compounds in the late twelfth and early thirteenth centuries.
Laypeople followed suit and took it upon themselves to create and fund small hospitals in their communities. Meanwhile, urbanization and the structuration of municipalities opened a new era in the social organization of medieval societies. Municipal authorities saw in hospitals a way to undertake charitable work for the common good. They established hospitals and began managing older institutions established earlier on – for instance those started by cathedral chapters. In England alone, more than 300 hospitals, hospices and leper houses were established between c. 1100 and 1250. The plague increased the mass of the poor and the need for hospitals.
At the end of the Middle Ages, Paris, the capital city of the kingdom of France, counted 60 hospitals, for a population of over 100,000 people. The city of Lyon counted 20 hospitals around the year 1320. In Toulouse at the end of the fifteenth century, some 15 hospitals were fostered to the needs of a 25,000 inhabitants population. There were about 54 hospitals in the diocese of Grenoble at the close of the fifteenth century. This article looks at the late medieval hospitals of the kingdom of France at the end of the Middle Ages and asks how they were managed, how large they were, and what daily life was like in these charitable institutions.
Management of Medieval Hospitals
The way in which hospitals were managed very much depended on the nature of the hospital itself. If the hospital had been established by a monastic order (St. Anthony, St. John of Jerusalem), then the hospital’s management followed the order’s rule. If the hospital depended on the local bishop or the archbishop, he would appoint its administrators and ensure the proper financing of the institution. Episcopal hospitals usually followed the rule of St. Augustine. If the hospital was ruled by a city, the municipal officials would appoint the administrators and pay for the hospital’s expenses. Hospitals founded by laypeople followed a similar model; but the founders usually sought out some sort of protection, whether pontifical, episcopal, or municipal.
Hospital administrators or “governors” were appointed to run and manage the institution. When starting the position, they took an oath to the bishop or the city’s officials and would proceed to inventory the hospital’s goods and estates. Some administrators remained in service for decades. In Narbonne, the administrator of the Hospital St. Paul managed the institution for 16 years, from 1285 to 1302. Women could sometimes be appointed administrators of a hospital. In Montpellier, two widows, named Florence and Ricarda were appointed in 1364 as the governors of the hospital St. Éloi, which focused on poor people and foundlings.
Who tended to the poor’s needs? If the hospital was monastic, the members of the order were supposed to work in the hospital. They were usually assisted by lay brothers and sisters, who received food, shelter and clothing in exchange for their work. In Trinquetaille, Provence, the hospital of the Hospitallers counted, in 1338, 12 brothers and 6 lay people working in the commandery. Some orders, however, completely delegated the management of the hospital and even the poor’s care. At the hospital of Beaulieu, in Arles, Provence, the sisters’ hospital was managed by an outsider and all the “employees” were lay brothers and sisters who were not part of the monastic order.
Lay brothers and sisters had to take vows of stability and obedience, and, from the thirteenth century, of chastity. Privately-run hospitals and municipally-run hospitals relied heavily on these lay individuals to function. Hospitals also employed lay people to support their operations. Servants, bakers and cooks were among the external employees who worked in hospitals. Together with the (lay) brothers and sisters, they formed the hospital’s familia. The larger the hospital, the larger the hospital’s familia. At Paris’ Hôtel-Dieu, at least 100 people worked to serve the 400 to 500 sick and poor laying on the 300 beds the hospital counted (yes, the poor had to share their hospital bed!).
The Size of Medieval Hospitals
Hospitals founded by monastic orders were usually adjacent to the monastery, while hospitals established by bishops were close to the cathedral church. Those institutions established by laypeople were often in a single home that had been transformed into a small hospital. Most medieval hospitals were of modest size. Historians have suggested that the size of hospitals is directly correlated with the size of a community. Villages and small towns had between 10 and 25 hospital beds. Medium size cities counted between 30 and 100 hospital beds, while large cities, like Avignon, Lyon or Paris counted over 100 beds. Their total capacity was twice as large, for two people usually shared one bed.
In the large city of Avignon, the seat of the papacy in the fourteenth century, the 17 hospitals attested at the end of the fourteenth century only counted 160 beds in total (10 beds per hospital on average). The hospital of the village of Caderousse, in rural Provence, only had 8 beds, but the hospital St. Paul, in the town of Narbonne, had 16 beds for men and 6 beds for women, plus one bed for the servants and three beds for the lay brothers and sisters. In larger cities, some hospitals had a greater capacity. The hospital of the Holy Spirit in Marseille counted 40 beds for men and 24 beds for women in 1340. Right after the plague, more beds were installed in the rooms to support the sick and poor. In 1350, the hospital had 60 beds for men and 27 for women.
Some large cities had created sizable hospital complexes. In Paris, the Hôtel-Dieu had been established in the Carolingian era by the cathedral chapter, on the ‘île de la cité’, a small island on the Seine River. This first hospital was taken down when Notre-Dame Cathedral was built. The Hôtel-Dieu was then rebuilt close to the cathedral. It formed a large parallelogram bordering the Seine river. The buildings surrounded large courtyards. There were several rooms for the sick, a chapel, the brothers’ and sisters’ dormitories, a kitchen, chicken hens, stables and a laundry room. A small port had been created on the island to facilitate the hospital’s provisioning. The hospital counted 300 beds – including the brothers’ and sisters’ – and could shelter between 400 and 500 poor.
Coming to a Hospital
The poor who came to a hospital were welcomed during a ceremony aiming at cleansing their body and soul. The hospital’s personnel would wash their feet and give them new clothes. In some hospitals, like the ones of the Holy Spirit, the brothers and sisters would cut the poor’s hair. Then, the poor should confess their sins to enter the hospital with a clean soul. In the (very) large Hôtel-Dieu in Paris, in the mid-fifteenth century, there were confessors speaking German, English and Flemish to serve the travelers and pilgrims who did not know French. Then, the poor were then given a bed (or a half-bed). Women went to the women’s room, and men to the men’s room.
The poor and sick who could walk ate their meals together. Those staying in bed were served food there. Chaplains visited the sick and heard their confessions. Masses were held regularly. The dying received the last sacraments and funerary masses were held for the dead. Larger hospitals usually had their own cemeteries where the dead were buried. Some did not, and their dead were buried in close-by cemeteries. The dead of the Hôtel-Dieu of Paris were buried at the cimetière des Innocents or at the cimetière de la Trinité. Hospitals were indeed a place of relief and palliative care, rather than a curative institution. In early sixteenth-century Nantes, western France, 70% of the poor of the Hôtel-Dieu died at the institution, and 30% walked away alive.
The curative and health purpose of the medieval hospital mainly developed in the fourteenth and fifteenth centuries. In Marseille, barbers and surgeons worked at the hospital of the Holy Spirit from 1325 onwards and were joined by a physician from 1333. In Lille, northern France, midwives were hired by the St. Jacques hospital for women from 1431. At the end of the Middle Ages, when the hospitals were becoming gradually more oriented towards medicine, brothers and sisters would “triage” the poor based on their needs and afflictions. At the very end of the fifteenth century, the Hôtel-Dieu in Paris had an “enfermerie” with 54 beds for the poor and the dying; a “St-Denis” room for the pre- and post-surgery patients (80 beds), a room for women with 85 beds, a room for pregnant women and women who had just given birth (24 beds) and a “St-Thomas” room for those in remission (60 beds).
Hospitals were commonplace in the later Middle Ages. Foundations multiplied in the twelfth, thirteenth and fourteenth century to the point where even villages and small communities had their own hospital. Dedicated to travelers and pilgrims, the poor, the elderly, hospitals offered primarily poverty relief and palliative care. At the end of the Middle Ages, however, they slowly turned into health provders and began offering more curative services.
Ziegler, T. A., Medieval Healthcare and the Rise of Charitable Institutions: The History of the Municipal Hospital. (Palgrave Macmillan, 2018)
Brasher, S. M., Hospitals and Charity: Religious Culture and Civic Life in Medieval Northern Italy. (Manchester University Press, 2017)
Top Image: A 16th-century woodcut showing the Hôtel Dieu in Paris – its interior showing patients being nursed by monks and nuns. Image courtesy the Wellcome Collection