Medieval Studies Hospitals in the Middle Ages
by
Sethina Watson
  • LAST MODIFIED: 27 June 2017
  • DOI: 10.1093/obo/9780195396584-0233

Introduction

“Hospital” is an umbrella term for the diverse array of charitable institutions that arose in the Middle Ages. The word originated as a Latin version of the Greek xenodochium (“house for strangers”) and early hospitales (from hospes, or stranger/guest), like their Byzantine counterparts, accommodated poor travelers and pilgrims. By c. 1200 “hospital” might refer to diverse kinds of houses of aid. An elite few did provide medical treatment, but the majority did not. They were welfare institutions, offering food, shelter, spiritual or other physical care. They varied widely, in staffing and routines, in scale, and in who they served and how: feeding the hungry, sheltering the poor, or accommodating the blind, aged priests, orphans, or those with leprosy They might support three to 300 persons, although many adhered to an apostolic twelve or thirteen. They were an unusually dynamic feature of medieval life. New houses (and types of house) arose, and existing houses were refashioned, in response to changing cultures of power, wealth, piety, and regulation. Studies often examine a distinct era in charitable foundation, such as the targeted facilities of early Byzantium, early xenodochia in the West, 12th-century leper-houses, or the increasingly specialist hospitals, domus Dei, and secular almshouses of the later Middle Ages. In particular, scholars have identified c. 1150–c. 1250 as a period of “charitable revolution” due to its surge of foundations, especially by lay men and women. What fueled this wave and what subsequently happened to the houses, and to charitable impulses generally, structures much scholarly investigation. Hospitals attracted largely antiquarian interest until the early 20th century, when a new generation of scholars placed hospitals within a wider national story, one that charted changing patterns of foundation, management, and types of care. With the rise of social history in the 1970s, hospital scholarship came of age, led by French and Belgian studies on poverty and its institutions. The archives of major urban hospitals form the basis of rich case studies, revealing houses embedded within local economic, political, or religious milieu. Agendas have multiplied as scholars wrestle with the diverse secular and spiritual functions of hospitals. These include their relationships to professed religious and the secular church, as well as royal, aristocratic, and urban patrons; their role in lay devotional life and within spiritual (and material) economies of late-medieval towns; the varieties of institutional arrangements and specialist care; sites and buildings, internal routines, and the influence of liturgy, music, medicine, and the material environment. Increasingly, attention has focused on the experience of those within hospitals, staff and inmate or visitor, and to cultivating comparative study across national borders. This bibliography considers the field in European perspective and aims to provide access to scholarship on hospitals across Europe. It also lays out research tools for the British Isles and offers English-language entry points for students of all levels.

General Overviews

Wide-ranging, accessible, and alive to agendas of scholarship, Orme and Webster 1995 remains the fundamental introduction to English hospitals. For France, Mollat’s essays in Imbert 1982 remain influential. Scheutz, et al. 2008 provides regional introductions to scholarship from across Europe, including emerging fields in the former eastern Europe, while Brodman 2009 offers a European-wide perspective on the religious momentum behind charity.

  • Brodman, James William. Charity and Religion in Medieval Europe. Washington, DC: Catholic University of America, 2009.

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    This wide-ranging overview of charity in the Western church includes a general survey of hospitals in the European context. Drawn from Spanish, Italian, French, German, and English scholarship, it is particularly useful for its discussion of religious ideals and religious hospital orders.

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  • Imbert, Jean, ed. Histoire des Hôpitaux en France. Toulouse, France: Éditions Privat, 1982.

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    Scholarly survey of French hospitals from the Merovingian era onward. Its medieval chapters, written by Michel Mollat, address the function, administration, and routines of hospitals and include extended discussions of religious rules, papal reform efforts, and the effects of the Hundred Years’ War.

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  • Orme, Nicholas, and Margaret Webster. The English Hospital 1070–1570. London: Yale University Press, 1995.

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    Part I provides a highly accessible introduction to hospitals in England, which is especially strong on their siting, organization, and resources, and on the late Middle Ages through Reformation. Part II gives histories of individual hospitals in Devon and Cornwall, counties missing from the Victoria County History.

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  • Scheutz, Martin, Andrea Sommerlechner, Herwig Weigl, and Alfred Stefan Weiß, eds. Europäisches Spitalwesen: Institutionelle Fürsorge in Mittelalter und Früher Neuzeit/Hospitals and Institutional Care in Medieval and Early Modern Europe. Mitteilungen des Instituts für Österreichische Geschichtsforschung, Ergänzungsband 51. Vienna: Oldenbourg Verlag, 2008.

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    Provides introductions by leading scholars to the study of hospitals in regions across Europe, including England, regions of Italy, Austria, Germany, the Czech Republic, and Hungary. Chapters are in English or German.

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Foundational Studies

Medieval hospitals first attracted the attention of antiquarian scholars who produced accounts of individual houses. Modern academic investigation began in the late-19th and early 20th century, with major studies that aimed to define hospitals within their national context. These remain relevant for the models they proposed, especially for the 13th and 14th centuries, and the intellectual agendas they have established. For France, Le Grand 1896 argues that hospitals underwent a program of religious reform, as ecclesiastical authorities worked to bring hospitals under religious rules. For Germany, Reicke 1932 offers a model of “communalisation,” with ecclesiastical houses brought under municipal supervision. Hernández Inglesias 1876 places medieval forms in a longer narrative of institutional development, while for England Clay 1909 focuses on the types of care, arguing that the spiritual took precedence over the medical. Superseded in their detail by recent monographs, each retains a defining influence on the scholarship of its respective country. Rarely considered side by side, they propose distinct (and still alluring) narratives for the creation of hospitals and the nature of subsequent change.

Collections of Essays

A great deal of hospital scholarship has been stimulated by congresses and published in collections of essays. The first such efforts gathered case studies from a region, as did Vicaire 1978 for Languedoc and Riu 1980–1982 for Catalonia. Since Languedoc was the birthplace of many religious orders of hospitallers, Vicaire 1978 includes influential treatments of these orders alongside studies of specific hospitals. A pobreza 1973 offers a more thematic study of poverty and assistance in Portugal and Spain. With the millennium came new efforts in France, then Germany, to generate comparative study of hospitals, in what has been termed a “renaissance of hospital research.” French initiatives have tended to draw together case studies, largely of towns in France, to propel new intellectual agendas: Dufour and Platelle 1999 places hospitals in wider contexts of charity; Montaubin and Schwerdroffer 2004 considers the siting of leper-houses and other hospitals; and Le Clech-Charton 2010 explores three themes as they relate to later medieval hospitals. German initiatives have extended the geographical boundaries of the field, with a particular interest in linking East and West. Collections in Scheutz, et al. 2008 (cited under General Overviews) and Scheutz, et al. 2010 (cited under European Perspectives) are leading products of such initiatives. Brunner 2007 (cited under Regional Studies: Southern and Eastern Europe) publishes studies of Poland, Dalmatia, and the Baltic, while Bulst and Speiß 2007 looks at regions across Europe to create social histories of hospitals. Finally, Drossbach 2007 presents a carefully managed comparison, in sources from France, Germany, and Italy. Breaking down national boundaries in the study of these varied, highly localized institutions is the new frontier. At this early stage, the approach is less to create synthetic or comparative treatments than to gather diverse case studies. As a result, these collections contain many essays on individual houses, towns, or regions across Europe, which lay out the source materials and bibliographies for specific houses, as well as a variety of methodologies and historiographical approaches.

  • A pobreza e a assistência aos pobres na península ibérica durante a idade média: Actas das 1.as jornadas luso-espanholas de história medieval, Lisboa, 25–30 de setembro de 1972. Lisbon: Centro de Estudos Históricos de Faculdade de Letras da Universidade de Lisboa, Instituto de Alta Cultura, 1973.

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    An early, innovative collection on poverty and charity in regions throughout the Iberian peninsula. It acknowledges hospitals as one of a range of institutional and cultural responses.

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  • Bulst, Neithard, and Karl Heinz Speiß, eds. Sozialgeschichte mittelalterlicher Hospitäler. Ostfildern, Germany: Jan Thorbecke, 2007.

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    Geographically wide-ranging collection, with studies from Byzantium to England. The focus is on the people, with particular interest in how those who supported hospitals shaped the care within.

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  • Drossbach, Gisela, ed. Hospitäler in Mittelalter und Früher Neuzeit: Frankreich, Deutschland und Italien. Eine vergleichende Geschichte. Munich: Oldenbourg, 2007.

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    A source-based approach underpins these studies on rules, financial transactions, food, staffing, and liturgy. It uses case studies in France, Germany, and Italy during the 13th and 16th centuries and includes editions of a range of sources.

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  • Dufour, Jean, and Henri Platelle, eds. Fondations et oeuvres charitables au Moyen Âge: actes du 121e congrès national des sociétés historiques et scientifiques, section histoire médiévale et philologie. Paris: CTHS, 1999.

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    Via case studies of hospitals in cities around France, this collection looks at diverse forms of charity from the 6th to the 16th century but especially c. 1170 onward.

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  • Le Clech-Charton, Sylvie, ed. Les établissements hospitaliers en France du Moyen Âge au XIXe siècle: Espaces, objets et populations. Dijon, France: Éditions universitaires de Dijon, 2010.

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    Regional and individual case studies, focused on France between the late 12th and 15th centuries, arranged under three main themes: spaces, objects, and populations.

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  • Montaubin, Pascal, and Joël Schwerdroffer, eds. Hôpitaux et maladreries au moyen âge: espace et environnement: actes du colloque international d’Amiens-Beauvais, 22, 23 et 24 novembre 2002. Histoire médiévale et archéologie 17. Amiens, France: CAHMER, 2004.

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    Essays explore the location and networks of leper-houses and of poor or pilgrim hospitals, largely in France.

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  • Riu, Manuel, ed. La pobreza y la assistencia a los pobres en la Cataluña medieval. 2 vols. Barcelona: CSIC, 1980–1982.

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    Case studies of different charitable institutions in Catalonia during the 12th to 15th centuries, with a focus on Barcelona.

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  • Vicaire, M. -H., ed. Assistance et charité. Cahiers de Fanjeaux, Collection d’histoire religieuse du Languedoc au XIIIe et au début du XIVe siècles 13. Toulouse, France: Edouard Privat, 1978.

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    Pioneering collection of essays on the towns and countryside of Languedoc, offering studies of local hospitals as well as the Orders of the Holy Spirit, Aubrac, Roncevaux, and St. Anthony of Vienne.

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Reference Works

The majority of hospitals were local houses, of independent constitution and under the supervision of a local authority (in the form of lord, bishop, abbey, or town) or, occasionally, the Crown. Only a minority belonged to a religious order of hospitallers and so, in the hands of the papacy, to a congregation that transcended national boundaries. Because hospitals are studied within their urban or regional setting, resources for study vary by country and locality. To lay out the scope of reference materials and their implications, the following takes one regional example: Britain. Starting points for study in other regions can be found in Collections of Essays, Sources and Regional Studies, as well as for hospital orders in Religious Orders.

Gazetteers

Among the most valuable of reference tools for the researcher are a series of gazetteers. Three gazetteers of medieval religious houses include a section for hospitals: Knowles and Hadcock 1971 (for England and Wales), Cowan and Easson 1976 (for Scotland), and Gwynn and Hadcock 1988 (for Ireland). These list known charitable houses and give basic information about each house, imposing a rudimentary system of categorization, by type of house or inmate. For England, a new gazetteer of early leper-houses is offered in Satchell 1998. Because they list any known house, including many that only fleetingly appear on the historical record, gazetteers reveal the huge array of charities, their geographic spread in town and countryside, and the small size, informality, and impermanence of so many. They therefore present a picture that complements and often contrasts to those developed within monographic studies, which take as their subject well-archived (and so typically larger) urban and more ecclesiastical hospitals. McIntosh 2012 (cited under Regional Studies: England) considers the implications of a quantitative approach, drawing on data for late medieval hospitals and almshouses.

Other Reference Works

For research into hospitals and their local contexts, the Victoria County Histories (Page, et al. 1900–) offer basic, and sometimes exceptional, histories of individual English houses. Town maps in the British Atlas of Historic Towns (Lobel 1969–) assist in the identification of the sites and environments of hospitals, while Davis, et al. 2010 catalogues known cartularies.

  • Davis, G. R. C., Claire Breay, Julian Harrison, and David M. Smith, eds. Medieval Cartularies of Great Britain and Ireland. London: British Library, 2010.

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    This revised edition of Davis’ 1958 work catalogues manuscript cartularies and their modern editions. It includes hospitals in its first part, on religious houses.

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  • Lobel, Mary D. et al., ed. British Atlas of Historic Towns. London: Lovell Johns, 1969–.

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    Collections of town maps, with historical commentaries, which include hospitals when known. Five volumes with fifteen towns or cities, including London and York, have been published, many available online at the British Historic Towns Atlas.

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  • Page, W. H., K. J. Allison, P. M. Tillott, and University of London Institute of Historical Research, eds. Victoria County History. London: St. Catherine, 1900–.

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    Accounts of individual hospitals are included in the volumes on “Religious Houses”, although the extent and quality of treatment varies significantly by county. Those published postwar, notably Cheshire, Shropshire, Staffordshire, Suffolk, and Wiltshire, are particularly strong. Many are available on British History Online.

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Sources

Sources for hospitals are diverse and can often survive among the archives of any authority with a supervisory or protective interest in a charitable house. The following presents an introduction to a range of sources, highlighting basic research tools for hospitals in European perspective, key or representative collections for England, and general introductions to other regional archives.

European Perspectives

Scheutz, et al. 2010 introduces a range of source material for regions across Europe. To this might be added several specific collections. Bird 2001 edits writings by a leading Parisian scholar and reformer. Other sermons for lepers and the sick are also edited in Bériou and Touati 1991 (cited under Leprosy and Leper-Houses: Their Place in the Church). In an influential study, Le Grand 1901 presents the statutes of hospitals and leper-houses in France. Finally, Die Register Innocenz’ III 1964– (The Register of Innocent III) is a scholarly example of a source whose routine compilation captures diverse materials relating to many individual hospitals.

  • Bird, Jessalynn. “Texts on Hospitals: Translation of Jacques de Vitry, Historia Occidentalis 29, and Edition of Jacques de Vitry’s Sermons to Hospitallers.” In Religion and Medicine in the Middle Ages. Edited by Peter Biller and Joseph Ziegler, 109–134. Woodbridge, UK: York Medieval Press, 2001.

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    A new edition of the oft-cited passage on hospital reform by Jacques de Vitry (c. 1160—1240) together with two sermons directed at those caring for the sick in hospitals.

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  • Die Register Innocenz’ III. Edited by Othmar Hageneder et al. Publikationen des Historischen Instituts beim Österreichischen Kulturinstitut in Rom. Vienna: Österreichische Akademie der Wissenschaften, 1964–.

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    This ongoing edition now covers thirteen years of the registers of Innocent III (1198–1216). They include papal letters regarding hospitaller orders as well as individual local houses across Europe, including confirmations of foundation or properties, licenses for chapels and cemeteries, and approval of rules.

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  • Le Grand, Léon, ed. Statuts d’hôtels-dieu et de léproseries: recueil de textes du XIIe au XIVe siècle. Paris: Picard, 1901.

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    Seminal edition of the rules or statutes for hospitals and leper-houses in France. Its introduction lays out an influential model for the application of written, often Augustinian, rules to hospitals.

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  • Scheutz, Martin, Andrea Sommerlechner, Herwig Weigl, and Alfred Stefan Weiss, eds. Quellen zur europäischen Spitalgeschichte in Mittelalter und Früher Neuzeit = Sources for the History of Hospitals in Medieval and Early Modern Europe. Quelleneditionen des Instituts für Österreichische Geschichtsforschung 5. Vienna: Böhlau, 2010.

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    Collections of sources from countries across Europe, edited and contextualized by leading scholars.

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Archives

Because the study of hospitals relies heavily on local archives, bibliographies for specific houses are best pursued through relevant monographic or case studies (see Collections of Essays and Regional Studies). More general works of reference include catalogues of cartularies such as Davis, et al. 2010 (cited under Reference Works: Other Reference Works) for England, Touati 1993 for northern France, and Jeanne 2012 for Normandy. For archives, Touati 1996 offers a regional analysis; there are also catalogues for Paris, as seen in Riché 2000, and the Low Countries, as explained in Persoons, et al. 1989. Most catalogue materials for leper-houses. Rawcliffe 2002 is an excellent introduction to the culture of record making and loss in late-medieval English hospitals.

  • Jeanne, Damien. “Une ‘machina memorialis’: Les cartulaires des léproseries de la province ecclésiastique de Rouen.” Tabularia Études 12 (2012): 29–62.

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    Catalogues seven Norman cartularies for leper-houses, discussing their contents.

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  • Persoons, Ernest, Walter de Keyzer, Marleen Forrier, and Michel van der Eychen, eds. La lèpre dans les Pays-Bas (XIIe-XVIIIe siècles). Archives générale du royaume. Service éducatif. Dossier 6. Brussels: Archives générales du Royaume, 1989.

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    For leper-houses in the Low Countries.

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  • Rawcliffe, Carole. “Passports to Paradise: How English Medieval Hospitals and Almshouses Kept their Archives.” Archives 27 (2002): 2–22.

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    Rich in examples, this article explores the range of written material in late-medieval archives and the many reasons for its destruction at the Dissolution.

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  • Riché, Sophie. Des hôpitaux à Paris: État des fonds des Archives de l’AP-HP, XIIe-XXe siècles. Paris: Assistance Publique-Hôpitaux de Paris, 2000.

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    Inventory and guide to the archives of the hospitals of Paris.

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  • Touati, François-Olivier. “Cartulaires de léproserie dans la France du Nord (XIIIe-XVe siècle).” In Les cartulaires. Actes de la table ronde organisée par l’École nationale des chartres. Edited by Olivier Guyotjeannin, Laurent Morelle, and Michel Parisse, 467–501. Mémoires et documents de l’École des chartres 39. Paris: École des chartres, 1993.

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    Catalogues, with analytical discussion, of the cartularies of leper-houses in northern France.

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  • Touati, François-Olivier. Archives de la lèpre: Atlas des léproseries entre Loire et Marne au Moyen Age. Mémoires et documents d’histoire médiévale et de philologie 7. Paris: Comité des Travaux Historiques et Scientifiques, 1996.

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    Catalogues the documentary material for leper-houses in the archdiocese of Sens. Introductory essays, maps, and extensive bibliographies of printed sources make this a wide-ranging research tool for the study of leprosy and leper-houses.

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Collections for England

Dugdale 1817–1830 remains fundamental because it includes documents that are not edited elsewhere, some of them now lost. English Episcopal Acta 1980– edits bishops’ charters, including a number that relate to hospitals during their early centuries of foundation. Ramsay and Willoughby 2009 catalogues the lost books of late-medieval hospitals. For individual hospitals, our main documentary material is in the form of charters and cartularies (registers that gather, copy, and organize charters). Cartularies have been catalogued in Davis, et al. 2010 (cited under Reference Works: Other Reference Works). Among the published cartularies for individual houses, several might serve as exemplars or good entry points into the field. For sheer volume of material, Salter 1914–1917 (for Oxford’s royal hospital) remains a gold standard, while Harper-Bill 1994 provides a modern scholarly offering, gathering material for Bury’s monastic hospitals. Finally, the cartularies of Kaye 1976 and Underwood 2008, for the urban foundations of Southampton and Cambridge, offer a variety of material, much of it in English translation, making the latter a particularly accessible source collection for students. Both contain rentals (lists of tenants and tenements), those from Southampton so extensive that Kaye wrote histories of individual tenements from the 13th to the 17th centuries.

  • Dugdale, William. Monasticon Anglicanum: A History of the Abbies and Other Monasteries, Hospitals, Frieries, and Cathedral and Collegiate Churches, with their Dependencies in England and Wales. 6 vols. New edition by John Caley, Henry Ellis, and Bulkeley Bandinel. London: Longman, 1817–1830.

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    Volume 6 part 2 of this antiquarian collection of documents gathers material for larger hospitals, especially charters and inquisitions relating to foundation, patronage and rights. Other volumes contain notices of smaller houses that belonged to monastic communities.

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  • English Episcopal Acta. Oxford: British Academy, 1980–.

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    This series records and edits the acta of bishops in English dioceses, from the Norman Conquest to the onset of registration. Its volumes (now over forty) contain many charters, ordinances, and several rules for individual hospitals.

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  • Harper-Bill, Christopher, ed. Charters of the Medieval Hospitals of Bury St. Edmunds. Suffolk Records Society: Suffolk Charters 14. Woodbridge, UK: Boydell & Brewer, 1994.

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    Edits the charters of four hospitals, for paupers or for lepers, under the Benedictine abbey of Bury St. Edmunds.

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  • Kaye, J. M., ed. The Cartulary of God’s House, Southampton. 2 vols. Southampton Record Series 19 and 20. Southampton, UK: Southampton University Press,1976.

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    The diverse material includes charters, oaths of inmates and tenants, daily prayers, and feast days. Appendices list the rentals that survive to 1602 and give the history of individual tenements.

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  • Ramsay, Nigel, and James M. W. Willoughby, eds. Corpus of British Medieval Library Catalogues XIV: Hospitals, Towns, and the Professions. Oxford: British Library, 2009.

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    Edits book lists, largely late medieval, for fifty-two hospitals, shedding light on lost libraries and book collections. Its scholarly analysis includes brief histories of each hospital, revised and with updated bibliographies.

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  • Salter, H. E., ed. A Cartulary of the Hospital of St. John the Baptist. 3 vols. Oxford: Oxford Historical Society, 1914–1917.

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    Rather than edit the 170 charters in this hospital’s late-13th-century cartulary, Salter made new cartulary by editing the 900 original deeds that survive.

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  • Underwood, Malcolm, ed. The Cartulary of the Hospital of St John the Evangelist. Cambridge. Cambridge Records Society 18. Cambridge, UK: Cambridge Records Society, 2008.

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    Provides summaries in English of all material in the cartulary, translating selected texts of this urban foundation under episcopal control. Material includes 13th- and 14th-century rentals and daily food accounts from 1343–1344.

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Journals and Societies

Articles on hospitals appear in many leading historical journals, but they have not tended to congregate in any particular journal. Nor, as English-speaking students might assume, do they appear in journals specializing in medical history. Instead, hospital scholarship has been propelled by special congresses and published in their proceedings (see Collections of Essays). Societies have also played a leading role. The French Society for the History of Hospitals (Société française d’Histoire des Hôpitaux) and its sister society in Belgium (Société belge d’Histoire des Hôpitaux) were founded by leading medieval scholars; the Belgian Society’s Annales contains many studies on local hospitals and their archives. Medieval and renaissance scholarship remains at the core of the current international network for scholars, the International Network for the History of Hospitals.

Early Hospitals

The early centuries of charitable foundation is attracting growing attention. Initial work focused on the early medieval West as the link between the early charities of the Eastern Empire and the surge of foundations in the West after 1100. Recent studies investigate Merovingian and Carolingian hospitals within their own legal, ecclesiastical, and geographical contexts. The wider Mediterranean setting, and cross-cultural exchange, grows increasingly important. Institutions in Byzantium, Egypt, and the Islamic lands have been offered as earlier, innovative, highly medicalized institutions, and so forbears of modern hospitals.

Non-Western Traditions

The early Christian Byzantine Empire gave rise to a range of charitable institutions, including several that cared for the sick. Scholars interested in the origins of medical institutions have found here the birth of the curative hospital. Its leading proponent is Miller 1985, which argues that Byzantine innovations developed the medicalized hospital; Crislip 2005 adds a new perspective from late antique Egypt. The arguments have proven controversial, both for their teleological models and for the distinctions they make between care and cure. Horden 2005 offers a nuanced corrective, with a cross-cultural bibliography. Dols 1983 takes a longer perspective on the Islamic response to lepers.

Medieval West

The large amount of conciliar legislation to survive from Merovingian/Carolingian Italy and Francia shape the study of early charitable institutions in the West, which has tended to think in terms of charitable policy (religious, political, and legal). Drawing on the decrees, Schönfeld 1922 provides the early definitional study, while Ullmann 1971 and Imbert 1999 propose wider contexts for (and motives behind) the work of councils. Recent work looks at the institutions themselves. Imbert 1982 (cited under General Overviews) and Sternberg 1991 offer regional histories, while the focus of Le Maho 1999 on Rouen province permits a more dynamic exploration of the ways in which xenodochia were cultivated through the 9th century. During this period, Rome was unusual in the number and variety of its charitable institutions, for which Santangeli Valenzani 1996–1997 remains the leading study. Between the end of the Carolingian empire and the charitable revolution of the 12th century, secular cathedral chapters established hospitals for travelers. Montaubin 2008 offers a scholarly history of this capitular activity.

  • Imbert, Jean. “Les conciles et les hôpitaux IXe siècle.” In Fondations et oeuvres charitables au Moyen Âge. Edited by Jean Dufour and Henri Platelle, 39–47. Paris: CTHS, 1999.

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    Uses later decrees to argue that, as the empire decayed, lawmakers turned to bishops to restore failing charities.

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  • Le Maho, Jacques. “Hospices et xenodochia du diocèse de Rouen à l’époque prénormande (VIe–IXe siècles).” In Fondations et oeuvres charitables au Moyen Âge. Edited by Jean Dufour and Henri Platelle, 49–61. Paris: CTHS, 1999.

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    Uses saints’ lives and other material to explore xenodochia within the wider ecclesiastical landscape in Normandy, wherein early episcopal foundations on major roads gave way to monastic hostels for travelers.

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  • Montaubin, Pascal. “Origine et mise en place des hôpitaux cathédraux de la province ecclésiastique de Reims, IVe-XIIIe siècle.” In Les hôpitaux, enjeux de pouvoir: France du Nord et Belgique (IVe–XXe siècle). Edited by Marie-Claude Dinet-Lecomte, 13–46. Collection Histoire 22. Villeneuve-d'Ascq, France: Revue du Nord, 2008.

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    Wide-ranging account of hospitals under cathedral chapters in northern France and Belgium, from their earliest examples. Pays close attention to the reforms of the 816 council of Aix and to communities and their regulation in the 13th century. Includes introductory bibliographies for the cathedral hospitals in the cities of Reims province.

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  • Santangeli Valenzani, Riccardo. “Pellegrini, senatori e papi. Gli xenodochia a Roma tra il V e il IX secolo.” Rivista dell’Istituto Nazionale d’Archeologia e Storia dell’Arte, serie III 19–20 (1996–1997): 203–226.

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    Discerns patterns of lay and ecclesiastical foundation in Rome during the 5th through 9th centuries.

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  • Schönfeld, Walther. “Die Xenodochien in Italien und Frankreich im frühen Mittelalter”. Zeitschrift der Savigny-Stiftung für Rechtsgeschichte, Kanonistiche Abteilung 12 (1922): 1–54.

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    An early and influential study of the nature, foundation, and administration of xenodochia in Italy and Francia. Notable for its intensive interrogation of primary (and largely legal) material.

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  • Sternberg, Thomas. Orientalium more secutus: Räume und Institutionen de Caritas des 5. bis 7. Jahrhunderts in Gallien. Münster, Germany: Aschendorff, 1991.

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    This study of Merovingian charity in Gaul includes a substantial section on xenodochia, with maps.

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  • Ullmann, Walter. “Public Welfare and Social Legislation in the Early Medieval Councils.” In Councils and Assemblies. Edited by G. J. Cuming and Derek Baker, 1–39. Studies in Church History 7. Cambridge, UK: Cambridge University Press, 1971.

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    Wide-ranging contextual study, which sees hospitals as part of a broader agenda by bishops to manifest a Christian ideal of concern for the poor into material forms of care.

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Religious Orders

It is commonplace, especially on the Internet, to show that medieval hospitals were run by the church and staffed by monks. In fact, the relationships to regular religious and to religion were far more varied, nuanced, and complicated. A number were founded by monastic houses or secular colleges of priests, and others were served by congregations of vowed religious, but many were lay foundations under the supervision of the crown, aristocratic patron, or town. Yet we should beware, too, of any simple binary of religious/worldly: even the most religious hospitals offered their charity to those in or of the world and the most secular could be objects of almsgiving, penance, and pious service. In this bibliography, analytical categories are therefore drawn by thinking in terms of internal practices and external movements or affiliations. The pious and curative regimes within independent houses are addressed in a separate section (see Internal Regimen and the Nature of Care). This section addresses connections with external religious movements and, especially, papally recognized religious orders. Individual hospitals might be connected to religious or pious movements, or with particular orders of monks, nuns, or canons. Such relationships were particularly fertile during the 12th to early 13th centuries, when hospitals were at the center of new kinds of religious life. In the 12th century, there also appeared several religious orders dedicated to the care of pilgrims to Jerusalem or Compostela. Several soon became military orders, including the Knights of the Hospital of St. John of Jerusalem (The Hospitallers), who retained little of their charitable roots beyond their name and the great Jerusalem hospital. Finally, religious congregations might emerge in local hospitals. Aiming to tend the sick or liberate captives, several evolved into hospitaller orders, under a monastic or canonical rule and subject to bishop or papacy. Such networks of religious hospitaller orders served in a small minority of local hospitals, but their reputation could travel far, as did their alms collectors. Scholarship of such orders has been, perhaps inevitably, drawn to the politics of the rise and development of the order, their charitable duties tending to fall out of focus.

Connections with Religious Houses and Religious Movements

Wealthy monastic houses could found or take custody of hospitals and leper-houses, as did the Benedictine abbey of Bury St. Edmunds, in Harper-Bill 1994 (cited under Collections for England). Here, the institutional distinction between an abbey and its off-site dependencies remained clear. The more complex problem of hospitals that emerged alongside or developed into religious houses has been explored for English priories in Thompson 1991 and colleges in Cullum 2008. In several regions, there were religious movements that embraced care for the pilgrim, pauper, or leper as part of their pious service, among them the beguines of the Low Countries, as seen in Simons 2001, and Cistercian convents in Champagne, as explained in Lester 2011. Individual hospitals could also adopt religious routines and even rules. Here, the Augustinian rule exerted a particular influence, as Touati 2009 has most recently discussed. Finally, De Miramon 1999 considers hospitals within a wider study of laity who offered themselves to God in the later Middle Ages.

  • Cullum, Patricia. “Medieval Colleges and Charity.” In The Late Medieval English College and its Context. Edited by Clive Burgess and Martin Heale, 140–153. Woodbridge, UK: Boydell & Brewer, 2008.

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    An institutional approach to the charity of collegiate foundations, which suggests that the line between college and hospital was blurred in the 11th and 14th centuries.

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  • De Miramon, Charles. Les “donnés” au Moyen Âge: Une forme de vie religieuse laïque v.1180-v.1500. Paris: Les Éditions du Cerf, 1999.

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    This study of the theological and legal context of donats (semireligious or corrodians who pledged themselves to religious houses) includes a chapter on French hospitals.

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  • Lester, Anne E. Creating Cistercian Nuns: The Women’s Religious Movement and Its Reform in Thirteenth-Century Champagne. Ithaca, NY: Cornell University Press, 2011.

    DOI: 10.7591/cornell/9780801449895.001.0001Save Citation »Export Citation » Share Citation »

    Examines the many groups of religious women who adopted the Cistercian rule in Champagne, c. 1220–1240, a number emerging from within, and others assuming care over, leper-houses and poor hospitals.

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  • Simons, Walter. Cities of Ladies: Beguine Communities in the Medieval Low Countries, 1200–1565. Philadelphia: University of Pennsylvania Press, 2001.

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    This study of beguinages underscores how many early communities arose as, or beside, hospitals.

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  • Thompson, Sally. Woman Religious: The Founding of English Nunneries after the Norman Conquest. Oxford: Oxford University Press, 1991.

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    A chapter on “Links with Hospitals” explores the relationships between hospitals and new religious communities of women in the 12th century.

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  • Touati, François-Olivier. “‘Aime et fais ce que tu veux’: Les chanoines réguliers et la révolution de charité au Moyen Âge.” In Les Chanoines réguliers: Émergence et expansion (XIe-XIIIe siècles), Actes du sixième colloque international du CERCOR, 2006. Edited by Michel Parisse, 159–210. Saint-Étienne, France: University of Saint-Étienne, 2009.

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    This survey of charity in Augustinian communities from the 9th century onward considers the influence of the rule on early leper-houses and later poor hospitals in France.

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Military Orders in the Latin East: Knights of St John of Jerusalem and Templars

The Hospitaller Knights of St. John of Jerusalem began as a community serving a hospital for pilgrims in Jerusalem, but within years they, like the Templars, had become a military order, dedicated to the defense then reclamation of the Holy Land. These great orders constitute their own fields of study and only in a few ways can they be related to wider movements in hospital or charitable care. Luttrell 1997 explores the Hospitallers’ origins and transformation into an international military order. In an influential article, Miller 1978 proposes that the Hospitallers transmitted Eastern models of medical care to the West, an argument challenged by many, notably Luttrell 1994. Their military mission meant that, in practice, Hospitaller and Templar houses in the West operated as feeders of money and men to the Holy Land. How far they practiced any sustained charity is a question opened up in Nicholson 1998, its scope more fully recognized in Barber 2000, an accessible introduction to the subject. Arguments against and in favor of their charity in the West are offered by Forey 2003 and Nicholson 2007, respectively. The care (and medical treatment) offered in the great hospital of Jerusalem is explored in essays in Nicholson 1998, while Mitchell 2004 considers the order’s facilities in the Holy Land, with particular interest in their facilities to treat wounded brothers and return them to the battlefield.

  • Barber, Malcolm C. “The Charitable and Military Activities of the Hospitallers and Templars.” In A History of Pastoral Care. Edited by G. R. Evans, 148–168. London: Cassell, 2000.

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    An early assessment of and introduction to the orders’ charitable work in the West.

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  • Forey, A. J. “The Charitable Activities of the Templars.” Viator 34 (2003): 109–141.

    DOI: 10.1484/J.VIATOR.2.300384Save Citation »Export Citation » Share Citation »

    This important study seeks to determine to what extent Templars engaged in almsgiving, hospitality, and sheltering pilgrims, in the Holy Land and the West.

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  • Luttrell, Anthony. “The Hospitallers’ Medical Tradition: 1291–1530.” In The Military Orders: Fighting for the Faith and Caring for the Sick. Edited by Malcolm Barber, 64–81. Aldershot, UK: Ashgate, 1994.

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    Assesses the care offered by Hospitallers to pilgrims and within their own conventual infirmary, contrasting the limited charitable provision in the West to their medical facilities in the Latin East.

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  • Luttrell, Anthony T. “The Earliest Hospitallers.” In Montjoie: Studies in Crusade History in Honour of Hans Eberhard Mayer. Edited by Benjamin Z. Kedar, Jonathan Riley-Smith, and Rudolf Hiestand, 37–54. Aldershot, UK: Ashgate, 1997.

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    The early development of the order from its charitable beginnings in Jerusalem.

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  • Miller, Timothy. “The Knights of Saint John and the Hospitals of the Latin West.” Speculum 53 (1978): 709–733.

    DOI: 10.2307/2849782Save Citation »Export Citation » Share Citation »

    Argues that the Hospitallers in the Latin East adopted Byzantine models of institutional and medical care that were disseminated (via their rule) to hospitals in the West.

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  • Mitchell, Piers D. Medicine in the Crusades: Warfare, Wounds and the Medieval Surgeon. Cambridge, UK: Cambridge University Press, 2004.

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    The first dedicated examination of medical treatment in the Latin East, this interdisciplinary study looks at the hospitals of the military orders and considers possible relationships to Byzantine and Islamic hospitals.

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  • Nicholson, Helen J. “Relations between Houses of the Order of the Temple in Britain and their Local Communities, as Indicated during the Trial of the Templars, 1307–12.” In Knighthoods of Christ: Essays on the History of the Crusades and the Knights Templar Presented to Malcolm Barber. Edited by Norman Housley, 196–208. Aldershot, UK: Ashgate, 2007.

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    Focuses on the sites and populations of local English houses to suggest that the order was more welcoming to guests and pilgrims than has been appreciated.

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  • Nicholson, Helen, ed. The Military Orders: Vol. 2, Welfare and Warfare. Aldershot UK: Ashgate, 1998.

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    Multiple essays explore the charitable or medical activities of the military orders, especially the Hospitallers. Includes the major studies of medical provision in the Jerusalem hospital by Benjamin Z. Kedar and Susan Edgington.

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Other Military Orders

The Templars and Hospitallers emerged from a wider charitable and military milieu, centered on pilgrimage routes and fed by Crusades in the Latin East, Spain, and the Baltic. They include the Spanish order of Santiago and the Teutonic Order of St. Mary of the Germans. Richard 1982 offers a local context for early hospital activity in Jerusalem. Several other military orders, headquartered in the Latin East, undertook limited charitable work in their houses in the Christian West. Jankrift 1996 offers the main institutional study of the Order of St. Lazarus, the “leper knights” who often received gifts of leper-houses by local patrons; Marcombe 2003 gives the English perspective. The history of the Order of St. Thomas of Acre, the only native English order, is recounted in Forey 1977, its documents laid bare in Watney 1892.

  • Forey, Alan J. “The Military Order of St. Thomas of Acre.” English Historical Review 92 (1977): 481–503.

    DOI: 10.1093/ehr/XCII.CCCLXIV.481Save Citation »Export Citation » Share Citation »

    A study of the origins of this order, whose charitable aims were soon overtaken by its military mission. It retained several local hospitals, entrusted by patrons to the order’s care.

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  • Jankrift, Kay Peter. Leprose als Streiter Gottes: institutionalisierung und organisation des ordens vom Heiligen Lazarus zu Jerusalem von seinen anfängen bis zum jahre 1350. Vita Regularis 4. Münster, Germany: LIT, 1996.

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    An institutional study of the order of St. Lazarus, including its origins, European development, key texts, and organizational structure.

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  • Marcombe, David. Leper Knights: The Order of St Lazarus of Jerusalem in England, c. 1150–1544. Studies in the History of Medieval Religion. Woodbridge, UK: Boydell & Brewer, 2003.

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    Accessible history of this order, paying attention to its handful of leper-houses in England.

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  • Richard, Jean. “Hospitals and Hospital Congregations in the Latin Kingdom of Jerusalem during the First Period of the Frankish Conquest.” In Outremer: Studies in the History of the Crusading Kingdom of Jerusalem presented to Joshua Prawer. Edited by Benjamin Z. Kedar, Hans E. Mayer, and Raymond C. Smail, 89–100. Jerusalem: Yad Izhak Ben-Zvi Institute, 1982.

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    A wider survey of charitable hospitals in the Latin East.

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  • Watney, J. Some Account of the Hospital of St. Thomas of Acon, in the Cheap, London, and of the Plate of the Mercers’ Company. London: Blades, East and Blades, 1892.

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    Early history with a useful digest of documents, including an account of the cartulary; catalogue of burials and gifts of plate; and 16th-century accounts, deeds, and inventories.

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Religious Orders of Hospitallers (Nonmilitary)

In the West there arose a number of religious hospitaller orders, which retained their distinctive charitable mission. These typically developed from a single house, wherein a religious congregation grew up, secured its own rule, and acquired daughter houses. The congregations of Aubrac, Roncesvalles (Roncevaux), and Somport were among the earliest and served pilgrims crossing the Pyrenees; the first two are treated in Jugnot 1978. The 13th-century order of St. Anthony of Vienne, dedicated to sufferers of ergotism, is given fuller treatment in Mischlewski 1995, the early emergence of its mother house introduced in Le Blévec 1989. In general, these orders have received surprisingly little attention, a pattern that has recently been reversed for two orders. Drossbach 2005 presents a comprehensive history of the Order of the Holy Spirit in Saxia, an order for the poor orchestrated by Innocent III. Another of Innocent’s projects, the Trinitarians, dedicated (like the Spanish Order of Merced) to the ransom of captives, are now the object of vibrant and multidisciplinary study in Cipollone 2007. Brodman 2009 (cited under General Overviews) offers an accessible introduction to most of these orders and many smaller ones in regions across Europe.

  • Cipollone, Giulio, ed. La liberation dei “captivi” tra Cristianità e Islam. Oltre la Crociata e il Gihād: tolleranza e servizio umanitario. Atti del Congresso interdisciplinare di studi storici (Roma, 16–19 settembre 1998). Collectanea Archivi Vaticani. Rome: Archivio Segreto Vaticano, 2007.

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    Originally published in 2000. Diverse collection of essays on the Trinitarian Order, and especially its origins, its rule, and the practice of ransom in cross-cultural perspective.

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  • Drossbach, Gisela. Christliche Caritas als Rechtsinstitut: Hospital und Orden von Santo Spirito in Sassina (1198–1378). Paderborn, Germany: F. Schöningh, 2005.

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    Definitive study of this European order, which situates it in the context of contemporary religious orders and is alive to issues of papal politics, canon law, and the routines of the house in Rome.

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  • Jugnot, Gérard. “Deux fondations augustiniennes en faveur des Pèlerins: Aubrac et Roncevaux.” In Assistance et charité. Edited by M. –H. Vicaire, 321–341. Cahiers de Fanjeaux, Collection d’histoire religieuse du Languedoc au XIIIe et au début du XIVe siècles 13. Toulouse: Edouard Privat, 1978.

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    An introductory history of the religious orders of Aubrac and Roncevaux, established in the mid-12th century for pilgrims to Compostella.

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  • Le Blévec, Daniel. “L’ordre canonial et hospitalier des Antonins.” In Le Monde des chanoines (XIe–XIVe s.). Edited by Marie-Humbert Vicaire, 237–254. Cahiers de Fanjeaux 24. Toulouse: Privat, 1989.

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    Lays out the development of this small lay community into an Augustinian congregation and international order.

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  • Mischlewski, Adalbert. Un ordre hospitalier au Moyen Âge: Les chanoines réguliers Saint-Antoine-en-Viennois. Translated by Hermann Kuhn and Denise Kuhn. Grenoble, France: Presses Universitaires de Grenoble, 1995.

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    Surveys the history of the order of St. Anthony of Vienne, across the Middle Ages.

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Regional Studies

The many monograph studies of individual hospitals came under attack in Guy 1985 but saw robust defense in Horden 1988. Since then, such monographs—many centered on a well-archived hospital—have only grown in number and vibrancy. Together, they reinforce Horden’s arguments that hospitals obey no single narrative. Their studies expose diverse, often contradictory local responses to poverty, piety, economic shifts, and demographic catastrophe. Individual or regional case studies thus remain the backbone of the field. Rubin 1987 and Rawcliffe 1999 (cited under Regional Studies: England) are two of the best such examples in English, mastering difficult archives and complex local conditions to reflect upon broader, but quite different, historical questions. Each regional study tackles multiple themes and, responding to its archive, draws its own chronological, intellectual, or material frame. They are thus treated here as studies in the round and have been arranged not by theme but by region, since geography (and language) continue to shape the study of hospitals.

Low Countries and France

Between 1962 and 1974, Michel Mollat ran a now-famous seminar at the Sorbonne on “The Poor and Poverty,” which inspired the study of charitable institutions in a regional context. Le Blévec 2000 is one of the best such studies, significant for its detail and breadth but also for its examination of phenomena distinct to its region such as the Avignon papacy and bridge-building confraternities. Earlier studies remain influential: Caille 1978 is a model treatment of diverse houses in a single city, Saint-Denis 1983 a penetrating study of a single house in its local milieu, while Gonthier 1978 (cited under The Poor) considers hospitals within a wider exploration late-medieval poverty. These efforts were mirrored in Belgium, where Bonenfant 1965 sounded a call for histories of hospitals, to be set within changing social and religious conditions of the region. Maréchal 1978 offers a leading response in an urban study of charity in Bruges. De Spiegeler 1987 remains one of the best studies of urban charity, drawing out local circumstances to reflect upon wider scholarship. For the scholar, Lacroix 1977 offers an intensive investigation of hospital statutes. Standing apart from this tradition, an early work in English (republished as Mundy 2006) is notable for its consideration of charity as a barometer of lay Christianity during periods of religious contest.

  • Bonenfant, Paul, ed. Special Issue: Hôpitaux et bienfaisance publique dans les anciens Pays-bas des origines à la fin du XVIIIe siècle. Annales de la Société Belge d’Histoire des Hôpitaux 3 (1965).

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    Collection of essays, drawn from decades of archival work, on charities in the Low Countries, notably the hospital of St. John and the lepers of St. Peter’s in Brussels; and institutional change, 5th through 15th centuries.

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  • Caille, Jacqueline. Hôpitaux et charité publique à Narbonne au moyen-âge de la fin du XIe à la fin du XVe siècle. Toulouse, France: Privat, 1978.

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    Narbonne saw sustained charitable foundation into the 14th century, among them several hospitaller orders. This dedicated urban study pays close attention to topography, the many obscure houses, and the activity of ecclesiastical and lay authorities. Appendices include inventories of a leper-house and poor hospital.

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  • De Spiegeler, Pierre. Les hôpitaux et l’assistance à Liège (Xe–XVe siècles): aspects institutionnels et sociaux. Paris: Société d'éditions Les Belles lettres, 1987.

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    This examination of charitable institutions in Liège focuses on hospitals but includes episcopal alms, monastic almonries, and municipal distributions to the poor. It explores, with particular lucidity, the changing forms of charity and the shifting jurisdictional claims of civic, religious, and episcopal authorities.

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  • Lacroix, Marie-Therese. L’Hopital Saint-Nicolas du Bruille (Saint André) à Tournai de sa Fondation a sa mutation en Cloitre (± 1230–1611). 2 vols. Institut d’Etudes Médiévales 2nd ser. 1. Louvain, Belgium: Université Catholique de Louvain, 1977.

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    Detailed study of the archives and history of the Tournai hospital, especially its structures of governance and the textual influences, observances, and customs of its mid-15th-century rule.

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  • Le Blévec, Daniel. La Part du Pauvre: L’Assistance dans les pays du Bas-Rhône du XIIe siècle au milieu du XVe siècle. 2 vols. Collection de l’École Française de Rome 265. Rome: École française de Rome, 2000.

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    Substantial study of charity in the lower Rhône, a region distinguished by the Avignon papacy, bridge-building confraternities, and large number of houses of the Hospitaller knights. Part 3 addresses local hospitals, including chronology and typology, foundation and reform, systems of management, care of the poor, and specialist facilities.

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  • Maréchal, Griet. De sociale en politieke gebondenheid van het Brugse hospitaalwezen in de Middeleeuwen. Anciens Pays et assemblées d’Etats 73. Kortriik-Heule, Belgium: UGA, 1978.

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    Studies the hospitals in Bruges, arguing for early civic involvement.

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  • Mundy, John Hine. Studies in the Ecclesiastical and Social History of Toulouse in the Age of the Cathars. Aldershot, UK: Ashgate, 2006.

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    A long essay sets out the waves of charitable foundation (c. 1100–c. 1250), led by the laity during periods of religious reform and dissent. A second essay surveys hospitals and leper-houses c. 1400.

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  • Saint-Denis, Alain. L’Hotel-Dieu de Laon 1150–1300: Institution hospitalière et société aux XIIe et XIIIe siècles. Nancy, France: Université de Nancy, 1983.

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    Examines this Carolingian capitular foundation through its 12th-century flourishing and 13th-century decline. Situates its changing form and fortunes firmly within the social, economic, and religious conditions of its region.

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England

The modern study of English hospitals was launched by Rubin 1987. This pivotal monograph introduced English-speaking audiences to continental agendas (of Mollat and Bonenfant), while setting out new religious and economic contexts for the rise then erosion of institutional charity. To this has been added a second major study in Rawcliffe 1999. A model case study of a single house, it exploits diverse source material to consider liturgical, financial, charitable, and spatial aspects of a late-medieval hospital that survived the Dissolution. McIntosh 2012 considers the changes to hospitals and almshouses across the Dissolution. Other major studies use a region or institution to pose wider questions of charity, service, or devotion: Sweetinburgh 2004 explores the act of giving, Cullum 1991 daily routines and recipients of care, and Goodall 2001 architecture’s ability to embody religious ideals.

  • Cullum, Patricia, Cremetts and Corrodies: Care of the Poor and Sick at St. Leonard’s Hospital, York in the Middle Ages. Borthwick Papers. York, UK: Borthwick Institute, 1991.

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    Masters the diverse source material for York’s great hospital to lay out its internal workings in the late 13th and 14th centuries. Pays particular attention to the nature and objects of care, especially corrodians who purchased beds for life in the hospital.

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  • Goodall, John A. A. God’s House at Ewelme: Life, Devotion and Architecture in a Fifteenth-Century Almshouse. Aldershot, UK: Ashgate, 2001.

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    An architectural study of the late-medieval almshouse as an expression of the beliefs of those who supported and populated it, setting it within the tradition of perpetual chantry foundations.

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  • McIntosh, Marjorie Keniston. Poor Relief in England: 1350–1600. Cambridge, UK: Cambridge University Press, 2012.

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    This study across the Dissolution includes a reappraisal of late-medieval and Tudor hospitals and almshouses, drawing data from an unpublished database of known houses in England, 1350 to 1600.

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  • Rawcliffe, Carole. Medicine for the Soul: The Life, Death and Resurrection of an English Medieval Hospital: St Giles’s Norwich, c. 1249–1550. Stroud, UK: Sutton, 1999.

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    Monumental study of an unusually well-documented provincial hospital. Deploys charters, statutes, material fabric, and the exceptional late-medieval financial accounts to bring to life routines and ritual as well as the buildings, finances, doles, and benefaction of this episcopal foundation.

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  • Rubin, Miri. Charity and Community in Medieval Cambridge. Cambridge, UK: Cambridge University Press, 1987.

    DOI: 10.1017/CBO9780511522444Save Citation »Export Citation » Share Citation »

    Groundbreaking study that takes as its focus the town of Cambridge, and especially the hospital (later University college) of St. John. It poses influential questions of how shifting ideas of charity played out in a changing economy and developing urban community in the late Middle Ages.

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  • Sweetinburgh, Sheila. The Role of the Hospital in Medieval England: Gift-Giving and the Spiritual Economy. Dublin: Four Courts, 2004.

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    Examines hospitals in Kent, focusing upon reciprocal gift exchange between benefactor and recipient. Significant chapters explore late-medieval giving to hospitals in the smaller towns of Dover and Sandwich.

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Southern and Eastern Europe

As the leading study and synthesis of work on the Crown of Aragon, Brodman 1998 remains the best way to access scholarship on Spain and Portugal. Jetter 1966–1987 surveys Germany, Spain, and Vienna, while Brunner 2007 opens up the newest theatres of hospital scholarship in Croatia and northeast Europe. Italy has been the object of sustained study, typically through examination of an individual city, as laid out in Alberzoni and Grassi 1989. Italian studies written in English have been drawn to the late-medieval hospital, as part of a renaissance ideal of the city. Where high medieval studies focus on church and state, these renaissance works embrace more cultural approaches, with a stress of the specialization of late-medieval institutions. Gavitt 1990 and Henderson 2006 offer leading examples, exploring how political, religious, civic, and medical ideals were personified in the towering architectural forms of Florentine hospitals.

  • Alberzoni, Maria Pia, and Onorato Grassi, eds. La carità a Milano nei secoli XII-XV: Atti del Convegno di Studi Milano, 6–7 novembre 1987. Milan: Editoriale Jaca Book, 1989.

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    Wide-ranging collection of essays that address assistance, charity, and specific houses in Milan and its environs.

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  • Brodman, James William. Charity and Welfare: Hospitals and the Poor in Medieval Catalonia. Philadelphia: University of Pennsylvania Press, 1998.

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    Examines Catalan charity in comparative context. Focuses on “public policy,” that is, changing ideas as to the objects of charity and the types of assistance offered.

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  • Brunner, Karl, ed. Special Issue: Themenschwerpunkt Europäische Spitäler. Mitteilungen des Instituts für Österreichische Geschichtsforschung 115.3–4 (2007).

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    Essays consider hospitals in regions of eastern Europe, with medieval studies from Poland, Livonia, and Dalmatia.

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  • Gavitt, Philip. Charity and Children in Renaissance Florence: The Ospedale degli Innocenti 1410–1536. Ann Arbor: University of Michigan Press, 1990.

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    A close study of a single institution, which distinguishes the intentions of governors from the experience of those in need. Argues that contemporary Florentine ideas of civic responsibility, childhood, and family shaped this 15th-century municipal charity for abandoned children.

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  • Henderson, John. The Renaissance Hospital: Healing the Body and Healing the Soul. New Haven, CT: Yale University Press, 2006.

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    Examines the late-medieval hospitals of Florence, and especially S. Maria Nuova, as spaces that brought together ideals of spiritual and medical care and became architectural, artistic, and administrative symbols of the health of the late-medieval city.

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  • Jetter, Dieter. Geschichte des Hospitals. 6 vols. Wiesbaden, Germany: Franz Steiner Verlag, 1966–1987.

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    Extensive surveys of hospitals in different regions through the 19th century, notably Volumes I (West Germany), IV (Spain), V (Vienna), and VI (Santiago, Toledo, and Grenada).

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Law and Legislation

Scholars agree that hospitals were a distinct class of institution, but they have yet to find consensus as to the legal definition of that form. Debates therefore focus on the place of hospitals in law, how the array of welfare houses were related to other institutions, and, especially, how far and in what ways hospitals were ecclesiastical. Two early studies remain seminal: Imbert 1947 offers the canon law context and a legal model; Le Grand 1901 (cited under Sources: European Perspective) offers a regulatory framework. Rocca 1956 follows on from that work, adding the Italian picture. Subsequent studies proposed legal contexts for the emergence of hospitals, from obligations enjoined upon bishops (Caron 1962), to theological agendas of poor relief and public welfare (Tierney 1959). Recent work has attempted to integrate local practice with wider ideals. Drossbach 2001 offers a reconceptualization of the limited canon law touching hospitals, and Frank 2010 explores the reformist ideals of late-medieval canonists; Watson 2006 turns away from canon law to examine the principles that underlay English foundation and regulation in practice.

  • Caron, Pier Giovanni. “L’evoluzione dalla quarta pauperum alla pia fundatio a scopo ospedaliero in alcuni testi della letteratura decretistica.” Il Diritto Ecclesiastico 73 (1962): 137–159.

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    Considers ideals in Christian law to argue that a responsibility to care for the poor gave rise to the hospital, a new ecclesiastical institution in the 12th century.

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  • Drossbach, Gisela. “Das Hospital—eine kirchenrechtliche Institution? (ca. 1150–ca. 1350).” Zeitschrift der Savigny–Stiftung für Rechtsgeschichte: Kanonistische Abteilung 87 (2001): 510–522.

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    Considers legislation and German practice to argue that the 13th-century church forged a place for hospitals in canon law, one modeled on monastic houses.

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  • Frank, Thomas. “Spätmittelalterliche Hospitalreformen und Kanonistik.” Reti Medievali Rivista 11 (2010): 1–40.

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    Perceptive study of the ideals of hospital reform as articulated by later medieval canonists, 1319–1440.

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  • Imbert, Jean. Les hopitaux en droit canonique (du décret de Gratien à la sécularisation de l’administration de l’Hôtel–Dieu de Paris en 1505). L’Eglise et L’Etat au Moyen Age 8. Paris: Vrin, 1947.

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    Formidable account that moves from classical precedents to late canonists. It draws its definitions from legal pronouncements but explores, too, the form in practice, especially in late-medieval France. Includes discussions of foundation, purpose, administration and income of French hospitals, c. 1200–c. 1400.

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  • Rocca, Emilio Nasalli. Il diritto ospedaliero nei suoi lineamenti storici. Biblioteca della Rivista di storia del diritto italiano 20. Milan: Fondazione Sergio Mochi Onory, 1956.

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    Survey from pagan hospitality to the modern hospital. Medieval chapters treat Justinian and Carolingian legislation, military and hospital orders, and the statutes of Italian hospitals, c. 1200–1400.

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  • Tierney, Brian. Medieval Poor Law: A Sketch of Canonical Theory and Its Application in England. Berkeley: University of California Press, 1959.

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    Lucid examination of the arguments of canonists in the wake of Gratian. Hospitals receive only fleeting attention, as part of wider discussions of public welfare, but its consideration of the status of the poor and, especially, of the deserving and undeserving poor remains influential to our understanding of late-medieval hospitals.

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  • Watson, Sethina. “The Origins of the English Hospital.” Transactions of the Royal Historical Society 6th ser. 16 (2006): 75–94.

    DOI: 10.1017/S0080440106000466Save Citation »Export Citation » Share Citation »

    Unpicks the pattern of statutes and charters for English hospitals to argue that these houses were, at root, a form of endowed, ongoing almsgiving.

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Founders and Patrons

The urban focus of most monographic studies has ensured that foundation, patronage, and administration by the urban elite has received close attention, notably, in Rubin 1987 (cited under Regional Studies: England), Henderson 2006 (cited under Regional Studies: Southern and Eastern Europe), De Spiegeler 1987, and Mundy 2006 (cited under Regional Studies: Low Countries and France). Since the main contest over control of hospitals is seen to be between municipal and diocesan authorities, many of these studies have also paid close attention to the local bishop; Rawcliffe 1999 (cited under Regional Studies: England) reverses this perspective, focusing on the bishop as founder. Because aristocratic or royal patrons often have only walk-on parts in civic studies, examination of their involvement as hospital patrons tends to belong more to the field of seigneurial rather than civic history; Huffman 2006 is an exception, placing lords at the center of civic disputes in Cologne. On royalty, Kealey 1981 offers an engaging, if now primitive, assessment, while Wheatley 2002 (cited under Recipients of Charity: Other Groups and the Specialization of Care) addresses Louis IX’s charity. Studies of aristocratic patrons tend to take the form of individual case studies, which map their initiative onto contemporary ideals of lordship, as seen in Mesmin 1982; piety, as explained in Courtenay 2007; or family, discussed in Watson 2011. Women, often absent from civic studies, are the subject of the latter two and are also noticed in Cullum 1994, an important study of the smaller initiatives of the urban middle class. Its challenge to the model of late-medieval decline is echoed by Rawcliffe 2007, which explores patronage as an identity, commemorated in the fabric of the late-medieval hospital.

  • Courtenay, Lynn T. “The Hospital of Notre-Dame des Fontenilles at Tonnerre: Medicine as Misericordia.” In The Medieval Hospital and Medical Practice. Edited by Barbara S. Bowers, 123–132. Aldershot, UK: Ashgate, 2007.

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    Interdisciplinary study of Marguerite of Burgundy’s 13th-century foundation. Considers how architecture, space, organization, and medical care all reflected Marguerite’s vision.

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  • Cullum, Patricia H. “‘For Pore People Harberles’: What was the Function of the Maisonsdieu?” In Trade, Devotion and Governance: Papers in Later Medieval History. Edited by Dorothy J. Clayton, Richard G. Davies, and Peter McNiven, 36–54. Stroud, UK: Alan Sutton, 1994.

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    Identifies the many maisons dieu of late-medieval York: small, often improvised and temporary hostels created by citizens of more limited means. Argues for a wave of charitable activity post–Black Death.

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  • Huffman, Joseph P. “Potens et Pauper: Charity and Authority in Jurisdictional Disputes over the Poor in Medieval Cologne.” In Plenitude of Power: The Doctrines and Exercise of Authority in the Middle Ages. Edited by Robert C. Figueira, 107–124. Aldershot, UK: Ashgate, 2006.

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    Examples from 12th- to 13th-century Cologne stress how a hospital’s fortunes were tied to those of its patron and recognizes hospitals as a theatre for disputes between local powers (seigneurial, religious, and civic).

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  • Kealey, Edward J. Medieval Medicus: A Social History of Anglo-Norman Medicine. Baltimore: John Hopkins University Press, 1981.

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    Observant if idiosyncratic take on early hospital foundation, which sees the increase in numbers of doctors and hospitals during the reign of Henry I (1100–1135) as part of a court-led revolution in public healthcare.

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  • Mesmin, Simone C. “Waleran, Count of Meulan and the Leper Hospital of S. Gilles de Pont-Audemer.” Annales de Normandie 32 (1982): 3–19.

    DOI: 10.3406/annor.1982.5469Save Citation »Export Citation » Share Citation »

    Deploys vivid charter material to illuminate the work of a founder, and lord of the town, in creating a religious house of lepers in the first half of the 12th century.

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  • Rawcliffe, Carole. “A Word from our Sponsor: Advertising the Patron in the Medieval Hospital.” In The Impact of Hospitals 300–2000. Edited by John Henderson, Peregrine Horden, and Alessandro Pastore, 167–193. Bern, Switzerland: Peter Lang, 2007.

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    Explores how the material culture of hospitals (gatehouses, tombs, windows, chapels, and memorials) was used to commemorate the late-medieval patron.

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  • Watson, Sethina. “A Mother’s Past and Her Children’s Futures: Female Inheritance, Family and Dynastic Hospitals in the Thirteenth Century.” In Motherhood, Religion, and Society in Medieval Europe, 400–1400. Edited by Conrad Leyser and Lesley Smith, 213–250. Farnham, UK: Ashgate, 2011.

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    Unravels the messy record trails of three hospitals to reveal forgotten women founders, heiresses who shaped their houses to serve changing family fortunes.

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Hospitals and the City

Most hospitals were founded in or near urban centers. It is perhaps natural, then, that the nature of their relationships to urban government, economy, piety, and landscape—and how this changed from the 12th to the 15th century—remains a key theme of scholarship. Reicke 1932 (cited under Foundational Studies) argues that hospitals were religious houses that underwent a process of municipalization (and secularization) from the 13th century. It remains influential as a framework to interpret both the experience of urban hospitals from c. 1250 and their development as an institutional form. Sydow 1970 revisits and nuances Reicke’s model, while Rubin 1990 addresses that change from an English perspective. Recent work explores hospitals as integral to 12th-century urban development (Cullum 1991) and c. 1200 civic government (Watson 2010), as well as to later-medieval urban society (see Henderson 2006 (cited under Regional Studies: Southern and Eastern Europe); environment (Rawcliffe 2005); and economy (Davis 2013), the latter building on Rubin 1987 (cited under Regional Studies: England). Trexler 1973 uses charity to reflect on changing identities in urban society. Satchell 2007 is at the vanguard of a new agenda to break away from the hegemony of towns to begin dedicated study of rural hospitals.

  • Cullum, P. H. “Leperhouses and Borough Status in the Thirteenth Century.” In Thirteenth Century England III, Proceedings of the Newcastle Upon Tyne Conference. Edited by P. R. Coss and S. D. Lloyd, 37–46. Woodbridge, UK: Boydell, 1991.

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    Pioneering study that puts Yorkshire leper-houses into historical and geographical contexts, establishing correlation between these houses and emerging boroughs.

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  • Davis, Adam J. “The Economic Power of a Hospital in Thirteenth-Century Provins.” In Center and Periphery: Studies on Power in the Medieval World in Honor of William Chester Jordan. Edited by Katherine L. Jansen, G. Geltner, and Anne E. Lester, 121–134. Leiden, The Netherlands: Brill, 2013.

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    Uses the Provins’ hôtel-dieu to reflect on the significant local power of a hospital, as property-owner, landlord, and creditor.

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  • Rawcliffe, Carole. “The Earthly and Spiritual Topography of Suburban Hospitals.” In Town and Country in the Middle Ages: Contrasts, Contacts and Interconnections 1100–1500. Edited by Kate Giles and Christopher Dyer, 251–274. Society for Medieval Archaeology. Leeds, UK: Maney, 2005.

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    The cultural, religious, and economic significance of suburban locations of hospitals in late-medieval towns.

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  • Rubin, Miri. “Development and Change in English Hospitals, 1100–1500.” In The Hospital in History. Edited by Lindsay Granshaw and Roy Porter, 41–59. London: Routledge, 1990.

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    Early and important draft for an English model of institutional change. Cambridge is the core case study for its argument that charitable forms shifted from religious to civic, driven by expectations of benefactors.

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  • Satchell, Max. “Towards a Landscape History of the Rural Hospital in England, 1100–1300.” In The Impact of Hospitals 300–2000. Edited by John Henderson, Peregrine Horden, and Alessandro Pastore, 237–256. Bern, Switzerland: Peter Lang, 2007.

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    Puts the rural hospital back on the map, using a geographic approach to consider locations and their meaning.

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  • Sydow, Jürgen. “Spital und Stadt in Kanonistik und Verfassungsgeschichte des 14. Jahrhunderts.” In Der deutsche Territorialstaat im 14. Jahrhundert. Edited by Hans Patze, 175–195. Vorträge u. Forschungen 13. Sigmaringen, Germany: Thorbecke 1970.

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    Challenges easy binaries of church/city, exploring how later medieval hospitals were drawn into the economic and political policies of the city and its citizens.

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  • Trexler, Richard. “Charity and the Defense of Urban Elites in the Italian Communes.” In The Rich, the Well-Born and the Powerful: Elites and Upper Classes in History. Edited by Frederic Cople Jaher, 64–109. Urbana: University of Illinois Press, 1973.

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    A social definition of poverty and charity, one created by Italian civic elites and recognizing poverty as deprivation within one’s social station.

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  • Watson, Sethina. “City as Charter: Charity and the Lordship of English Towns, 1170–1250.” In Cities, Texts and Social Networks 400–1500: Experiences and Perceptions of Medieval Urban Space. Edited by Caroline Goodson, Anne E. Lester, and Carole Symes, 235–262. Aldershot, UK: Ashgate, 2010.

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    Identifies hospital foundation as an early and integral component of urban lordship and emerging civic government in the late 12th and early 13th centuries.

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Leprosy and Leper-Houses

The study of leper-houses is bound up with arguments as to the place of leprosy within medieval society: its cultural meanings, institutional contexts, and the political, religious, and medical treatment of lepers. This has been one of the most active fields of debate in recent decades, inspiring work of wide range and sophistication.

Their Place in the Church

The most significant single act by the medieval church concerning lepers was the Lateran III (1179) decree, guaranteeing the right of leper communities, living outside society, to have a chapel and cemetery. Avril 1981 remains our fundamental study of its context and application. The decree illustrates the core debate regarding ecclesiastical sources: Was the church offering lepers a refuge and even a religious role, or condemning them by removing them from Christian society? Influential theses Brody 1974, Moore 2007, and Bériac 1988 advance cases for a systematic exclusion of lepers, fed by cultural associations of leprosy with sin and the leper with ritual death. These arguments have come under sustained attack in recent years, through major regional studies (see Regional Studies) and thematic investigations that reinterpret leper-houses as a form of religious life (Bériou and Touati 1991); reappraise the role of medicine in the diagnosis of leprosy (Demaitre 2007); and place the leper at the center of devotional life (Peyroux 2000 and Rawcliffe 2001). Dols 1983 (cited under Non-Western Traditions) reflects upon the Christian leper from a non-Western perspective.

  • Avril, Joseph. “Le IIIe Concile du Latran et les communautés de lépreux.” Revue Mabillon. Archives de la France monastiques 60 (1981): 21–76.

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    Densely researched examination of the context of the Lateran decree which uses French material to argue that the decree reinforced a movement to organize groups of lepers into religious communities.

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  • Bériac, Françoise. Histoire des Lépreux au Moyen Age: une société d’exclus. Paris: Imago, 1988.

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    Pioneering, accessible study of the trauma of leprosy, as it was embedded in Christian culture. Its first half tackles medical, biblical, theological, and literary treatments of lepers, stressing leprosy as bound up with sin; the second examines leper-houses, especially in France, stressing themes of separation and segregation.

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  • Bériou, Nicole, and François-Olivier Touati. Voluntate dei leprosus: les Lépreux entre conversion et exclusion aux XIIème et XIIIème siècles. Testi, Studi, Strumenti 4. Spoleto, Italy: Centro Italiano di Studi sull’Alto Medioevo, 1991.

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    Twin studies stress the increasingly ecclesiastical elements of leper-houses during the 12th century, proposing entry into a leper-house as a conversion to religious life. Includes editions of nine sermons.

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  • Brody, Saul. The Disease of the Soul: Leprosy in Medieval Literature. Ithaca, NY: Cornell University Press, 1974.

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    Much-cited thesis that leprosy was a moral condition and often treated brutally. Includes medical, legal, and literary approaches, yet its chapter on the church has drawn most attention, with its discussion of the “leper mass,” wherein the leper is ritually buried, at its core.

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  • Demaitre, Luke. Leprosy in Premodern Medicine: A Malady of the Whole Body. Baltimore: Johns Hopkins University Press, 2007.

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    Brings together years of study to argue that physicians moved to the fore in the diagnosis of leprosy from the 13th century. Examines evolving interpretations of the disease and the processes by which suspect individuals were diagnosed (or cleared), the latter speaking directly to leper-houses and the place of lepers.

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  • Moore, R. I. The Formation of a Persecuting Society: Authority and Deviance in Western Europe 950–1250. 2d ed. Oxford: Blackwell, 2007.

    DOI: 10.1002/9780470773987Save Citation »Export Citation » Share Citation »

    First published in 1987. Highly influential argument that ties the 12th-century segregation of lepers into wider, intensifying cultures of intolerance, notably of Jews and heretics.

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  • Peyroux, Catherine. “The Leper’s Kiss.” In Monks and Nuns, Saints and Outcasts: Religion in Medieval Society: Essays in Honor of Lester K. Littlle. Edited by Sharon Farmer and Barbara H. Rosenwein, 172–188. Ithaca, NY: Cornell University Press, 2000.

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    Places the leper in the center of a changing religious culture, as miraculous cure gives way to the saintly act of embracing lepers as an object of disgust.

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  • Rawcliffe, Carole. “Learning to Love the Leper: Aspects of Institutional Charity in Anglo-Norman England.” In Anglo-Norman Studies 23: Proceedings of the Battle Conference 2000. Edited by John Gillingham, 231–250. Woodbridge, UK: Boydell, 2001.

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    Rich in medical and religious examples, this essay offers an accessible and spirited recasting of the leper, from a figure of rejection to a potent symbol of human (and Christ’s own) suffering.

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Regional Studies

In recent decades the place of “the leper” in medieval culture, and so the role of leper-houses, has been overturned by two monumental and heavily archival studies: Touati 1998, focusing on the province of Sens (France), 12th through the 14th century, and Rawcliffe 2006, on England, mid-13th through the 15th century. Because of this work, Richards 1977 is now outdated, although it remains an accessible introduction for undergraduates to leprosy as a historical disease. Touati 1996 (cited under Sources: Archives) and Satchell 1998 (cited under Reference Works: Gazeteers) provide scholarly catalogues of leper-houses in Sens and England, using these to re-evaluate the chronology, distribution, and impetus behind creation, in the long 12th century. Uhrmacher 2001 offers a German picture of creation and change. Brenner 2015 considers leprosaria from a more recent (and urban) perspective, with Brenner 2010 challenging simplistic interpretations of exclusion in the city of Rouen. New agendas can be found in Tabuteau 2000, which inaugurates comparative discussion with its collection of European case studies, and Stemmle 2015, which turns the tables to seek the contibutions of those with leprosy to the creation of leper communities.

  • Brenner, Elma. “Outside the City Walls: Leprosy, Exclusion, and Social Identity in Twelfth- and Thirteenth-Century Rouen.” In Difference and Identity in Francia and Medieval France. Edited by Meredith Cohen and Justine Firnhaber-Baker, 139–155. Farnham, UK: Ashgate, 2010.

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    Topographical study of Rouen, stressing the fluidity of spatial boundaries and lepers as integral to urban charity.

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  • Brenner, Elma. Leprosy and Charity in Medieval Rouen. Royal Historical Society Studies in History New Series. Woodbridge, UK: Boydell & Brewer, 2015.

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    A fresh exploration of leper-houses in an urban context, with Rouen’s two great houses of Mont-aux-Malades and Salle-aux-Puelles at its center. Keenly aware of social, medical, and religious change across the centuries.

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  • Rawcliffe, Carole. Leprosy in Medieval England. Woodbridge, UK: Boydell & Brewer, 2006.

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    Groundbreaking study, meticulously researched and richly illustrated. Unpicks the array of often paradoxical responses as mediated through medieval religion, medicine, and law. A chapter on leper-houses stresses their religious character and special provision for body and soul.

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  • Richards, Peter. The Medieval Leper and his Northern Heirs. Cambridge, UK: Brewer, 1977.

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    Introductory textbook that predates the stimulating modern developments of the field. Remains useful for its comparative discussion of leper-houses in Scandinavia, its illustrations of the disease, and its translated documents from England, Denmark, Sweden, Finland, and Iceland.

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  • Stemmle, Jennifer. “From Cure to Care: Indignation, Assistance and Leprosy in the High Middle Ages.” In Experiences of Charity, 1250–1650. Edited by Anne M. Scott, 43–78. Farnham, UK: Ashgate, 2015.

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    Poses innovative questions as to the agency of lepers in the creation of leper communities, drawing material from the diocese of Liège, c. 800 to 1350.

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  • Tabuteau, Bruno, ed. Lépreux et sociabilité du Moyen Age aux Temps modernes. Sociabilité, Culture et Patrimoine: Cahiers du GRHIS 11. Rouen, France: Université de Rouen, 2000.

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    Collection of essays that focus on the communities within and beyond leper houses, in Cambrai, Falaise, Reims, Chichester, the Crusader States, and early modern Germany.

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  • Touati, François-Olivier. Maladie et société au Moyen Âge: La lèpre, les lépreux et les léproseries dans la province ecclésiastique de Sens jusqu’au milieu du XIVe siècle. Bibliothèque du Moyen Age 11. Brussels: De Boeck Université, 1998.

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    Revolutionary study that challenged the core conceits regarding medieval leprosy. A monumental work of scholarship, deploying archaeology, art, seals, topography, and a wide array of documentary material. Argues that leper-houses were not fear responses to a new disease but part of a profound cultural, fundamentally religious engagement, which deteriorated over the following centuries.

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  • Uhrmacher, Martin. Lepra und Leprosorien im rheinischen Raum vom 12. bis zum 18 Jahrhundert. Beiträge zur Landes- und Kulturgeschichte 8: Publications du CLUDEM 36. Trier, Germany: Porta Alba, 2001.

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    Leprosy and leper-houses in the Rhineland, from their appearance in 1190 to the 18th century.

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Recipients of Charity

Hospitals could be entrusted with one, or several, of a wide range of duties. Who they served and how they served them were at the core of a house’s mission, as were its routines and personnel. But this service was not fixed. Charitable aims changed over time: new forms of aid and so types of house appeared, and existing houses could be reformed. Through the 11th century, hospitals in the West tended to serve the poor, travelers, and pilgrims. In the long 12th century, large numbers of houses for lepers or the friendless or sick poor were established. In following centuries, as the objects of charity multiplied, individual hospitals could specialize in a particular group in need of shelter, care, or redemption. Houses might cater solely (or in part) for the sick poor, aged priests, the blind or mentally ill, prostitutes, widows, or abandoned children, or they could support young scholars in their education. In the late Middle Ages, almshouses for the noble poor provided residences for urban elite who had fallen on hard times, and hospitals were increasingly accused of welcoming corrodians (those aged or ailing people of means who paid to live out their days in the security of a hospital as a retirement community). As the Middle Ages drew to a close, and especially in Italy, a city’s hospitals might be brought into a scheme that consolidated specialized care in particular houses, including plague hospitals, as part of a wider program of civic government and even public health. Two categories of recipients first secured the attention of scholars, the poor and lepers. Lepers are addressed under Leprosy and Leper-Houses. More recent work appreciates the different objects of charity and so the diversity of institutional responses and arrangements.

The Poor

Michel Mollat’s Paris seminar (cited under Regional Studies: Low Countries and France) defined new agendas for the study of the poor. These were showcased in Mollat 1978, a pioneering if unwieldy synthesis that remains impressive for its sweep of examples, and the more focused case study of Gonthier 1978. Mollat 1975 looks at changing ideas of social responsibility for the poor. The “poor” was neither a single nor a static category. Geremek 1971 considers many different marginalized groups, while Farmer 2002 illuminates the ways in which gender, migration, and life cycle shape the demands and resources of the poor. This is part of a new initiative in scholarship: to uncover the experiences of the poor. Saunier 1993 offered an early and influential investigation of the treatment of poor in hospitals; Farmer 2002 focuses on the poor, glimpsing the targeted aid of hospitals within a wider struggle for daily survival.

  • Farmer, Sharon. Surviving Poverty in Medieval Paris: Gender, Ideology and the Daily Lives of the Poor. Ithaca, NY: Cornell University Press, 2002.

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    Uses miracle stories to study the lives of the poor, stressing how mutual assistance, gender, and migration shaped poverty. Hospitals are noticed particularly for their work with the nonworking disabled poor.

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  • Geremek, Bronislaw. The Margins of Society in Late Medieval Paris. Translated by Jean Birrell. Cambridge, UK: Cambridge University Press, 1987.

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    Translation of the author’s Ludzie marginesu w średniowiecznym Paryzu, XIV–XV wiek (Warsaw: Ossolineum, 1971). This study of marginalized groups includes an exploration of hospitals as refuges for many such groups, with a consideration of who they accommodated and how.

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  • Gonthier, Nicole. Lyon et ses pauvres au moyen-âge (1350–1500). Les Hommes et les Lettres: Documents. Lyon, France: L’Hermès, 1978.

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    Discusses the many Lyon hospitals, within its wider consideration of changing attitudes toward the poor in the later Middle Ages.

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  • Mollat, Michel. “Hospitalité et assistance au début du XIIIe siècle.” In Poverty in the Middle Ages. Edited by David Flood, 37–51. Franziskanische Forschungen 27. Werl, Germany: Dietrich-Coelde-Verlag, 1975.

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    Examines the surge in urban lay charity c. 1200, in response to catastrophes and a sense of moral responsibility to the poor that was expounded by Parisian theologians.

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  • Mollat, Michel. The Poor in the Middle Ages: An Essay in Social History. Translated by Arthur Goldhammer. New Haven, CT: Yale University Press, 1986.

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    Translation of the author’s Les Pauvres au Moyen âge, étude sociale (Paris: Hachette, 1978). Wide-ranging survey of the changing definitions of poverty, shaped by economic, political, and religious conditions. Includes hospitals throughout, with dedicated discussion of their roles in social care of the poor from c. 1200.

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  • Saunier, Annie. “Le pauvre malade” dans le cadre hospitalier médiéval: France du nord, vers 1300–1500. Paris: Editions Arguments, 1993.

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    Deploys a range of source material to examine changing social attitudes toward the sick poor as well as evidence for their treatment within hospitals, from diet and spiritual care to medical treatment.

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Other Groups and the Specialization of Care

Recent decades have seen renewed focus on the different forms of care that were developed from the 12th century and the increasing specialization of hospitals in the late Middle Ages The major groups were, of course, lepers and the poor. Those for pilgrims or the ransoming of captives are treated under Religious Orders: Religious Orders of Hospitallers (Nonmilitary). The diverse specializations from the mid-13th century contribute to many wider fields (such as the study of childhood, old age, disability, and extreme mental or emotional states). Key studies on hospitals, which also constitute entry points to these wider fields, include Gavitt 1990 (cited under Regional Studies: Southern and Eastern Europe) on abandoned children; Orme 1988 on aged, ill, or disabled priests; Andrews, et al. 1997 on the mentally ill; and Rawcliffe 2002 on education and its contexts. Cullum 1991 (cited under Regional Studies: England) addresses corrodies and corrodians, and Goodall 2001 (cited under Regional Studies: England) almshouses, and so the growing use of many houses for retirement. Brodman 1998 and Henderson 2006 (both cited under Regional Studies: Southern and Eastern Europe) provide case studies from Catalonia and Florence that treat specialization in urban hospitals, which could be part of a wider civic policy to consolidate care for the sick in a large, general hospital. New initiatives, as discussed in Wheatley 2002, draw from disability studies to explore charitable institutions within wider cultural understandings of a human state or experience, in Wheatley’s case, blindness.

Internal Regimen and the Nature of Care

The study of the routines (or regimen) in hospitals contains within it a debate on their nature as institutions. At its core is a perceived tension between religion and medicine. Early work stressed the religious regimen, and Le Grand 1891 remains fundamental for its treatment of pious communities and the rules that structured their service. The question of medical intervention has particularly engaged English scholars from whose work has emerged a field of inquiry dedicated to the extent and nature of interventive care. Carlin 1990 provides an influential early assessment, which concisely countered easy assumptions that hospitals were medical facilities; more recent work, as seen in Horden 2007 and Rawcliffe 2008, sees religion and healing as fundamentally intertwined. Essays in collections explore institutional settings for medieval medicine (Bowers 2007), and medical care in the great Jerusalem hospital in Nicholson 1998 (cited under Military Orders in the Latin East: Knights of St John of Jerusalem and Templars). The question of those who served within hospitals has focused largely on the lay women, sometimes under vows: Touati 1996 distinguishes the (largely religious) motives of those who populated 12th- to 13th-century hospitals and Rawcliffe 1998 the lives of nurses, both devout and (increasingly) secular, at the end of the Middle Ages. Inspired by recent work on emotions, Davis 2010 demonstrates how preachers recognized the very human challenges faced by both the sick and those who tended them.

  • Bowers, Barbara S., ed. The Medieval Hospital and Medical Practice. AVISTA Studies in the History of Medieval Technology, Science and Art 3. Aldershot, UK: Ashgate, 2007.

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    Multidisciplinary essays on medicine that address leprosy, archaeology, and health care, as well as the medical environment of hospitals and monastic infirmaries, in Europe, Byzantium, and the Latin East.

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  • Carlin, Martha. “Medieval English Hospitals.” In The Hospital in History. Edited by Lindsay Granshaw and Roy Porter, 21–39. London: Routledge, 1990.

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    Introductory overview, drawing upon the data in Knowles and Hadcock 1971 (cited under Reference Works: Gazetteers). Considers functions, spacial arrangement and personnel, stressing late-medieval decay and the deficit of specialized medical treatment.

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  • Davis, Adam J. “Preaching in Thirteenth-Century Hospitals.” Journal of Medieval History 36.1 (2010): 72–89.

    DOI: 10.1016/j.jmedhist.2009.12.002Save Citation »Export Citation » Share Citation »

    Examines ad status sermons to the sick poor and their careers, shedding light on the religious, moral, and emotional worlds of those within the hospital.

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  • Horden, Peregrine. “A Non–natural Environment: Medicine without Doctors and the Medieval European Hospital.” In The Medieval Hospital and Medical Practice. Edited by Barbara S. Bowers, 133–145. Aldershot, UK: Ashgate, 2007.

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    Important intervention that calls attention to the diverse ways in which hospitals practiced interventive care, acting to heal those who were ailing.

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  • Le Grand, Léon. “Les maisons-dieu: leur régime Intérieur au moyen âge.” Revue des Questions Historiques 63 (1891): 99–147.

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    Examines governance and routines as laid out in statutes for French hospitals.

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  • Rawcliffe, Carole. “Hospital Nurses and Their Work.” In Daily Life in the Late Middle Ages. Edited by Richard Britnell, 43–64. Stroud, UK: Sutton, 1998.

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    Considers the duties and quality of life of women who tended the sick poor in 15th- to 16th-century hospitals.

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  • Rawcliffe, Carole. “Christ the Physician Walks the Wards: Celestial Therapeutics in the Medieval Hospital.” In London and the Kingdom: Essays in Honour of Caroline M. Barron. Edited by Matthew P. Davies and Andrew Prescott, 78–97. Harlaxton Medieval Studies 16. Donington, UK: Shaun Tyas, 2008.

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    Takes stock of the wealth of lost material culture for later hospitals. This exemplified a regimen of health through symbiotic relationships between environment and ritual as well as spiritual and physical health.

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  • Touati, François-Olivier. “Les groupes des laïcs dans les hôpitaux et les léproseries au Moyen Âge.” In Les mouvances laïques des ordres religieux. Edited by Nicole Bouter, 137–162. Saint-Étienne, France: Université de Saint-Étienne, 1996.

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    Gives shape to the wave of lay support, fundamentally devotional in nature, that fueled the creation and administration of hospitals. Recognizes the variety of groups (and so motives) of those who elected to serve in or retire to these houses.

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The Physical Environment

Work on the physical environment of hospitals is still in its infancy, although it is rapidly gaining ground. Archaeological investigations of sites and buried remains, and especially of leper houses, has laid the groundwork; in the past few years, historians and art historians have begun to take up the challenge, opening up questions of locations, buildings, and the use of space.

Archaeological Approaches

Over the past two decades, archaeology has become integral to the study of hospitals. It can provide insights that go beyond what is available in the documentary record, via material evidence of diet and daily life, skeletal evidence for health and disease, and the layout of sites, cemeteries, and watercourses. Gilchrist 1995 (on all forms of hospitals) and Roffey 2012 (on leper-houses) take stock of published excavations and building remains to reflect on the changing nature of these local houses. Key excavations of specific sites include Magilton, et al. 2008 of a leper-house; Price and Ponsford 1998 of a smaller hospital; and Connell, et al. 2012 of the considerable human remains at a major London hospital.

  • Connell, Brian, Amy Gray Jones, Rebecca Redfern, and Don Walker. A Bioarchaeological Study of Medieval Burials on the Site of St. Mary Spital: Excavations at Spitalfields Market, London E1, 1991–2007. Museum of London Archaeology Monograph Series 60. London: Museum of London Archaeology, 2012.

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    Long-awaited publication of the excavation and osteological analysis of 10,500 skeletons from the 12th to 16th century shedding light on patterns of disease, diet, injury, medical treatment, and epidemics in London.

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  • Gilchrist, Roberta. Contemplation and Action: The Other Monasticism. London: Leicester University Press, 1995.

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    Pioneering survey of the archeological evidence for a series of types of hospitals. Deploys extensive examples to reflect upon site, distinctions within the community, medical treatment, and standards of living.

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  • Magilton, John, Frances Lee, and Anthea Boylston. Lepers Outside the Gate: Excavations at the Cemetery of the Hospital of St James and St Mary Magdalene, Chichester, 1986–87 and 1993. Chichester Excavations 10. York, UK: Council for British Archaeology, 2008.

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    This excavation of an early leper-house examines the cemetery of almost 400 burials, the palaeopathology of skeletal finds, and the changing use of the site as lepers were replaced by an almshouse for sick poor.

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  • Price, Roger, and Michael Ponsford. St. Bartholomew’s Hospital, Bristol: The Excavation of a Medieval Hospital: 1976–8. CBA Research Report 110. York, UK: Council for British Archaeology, 1998.

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    Considers the site from prehospital occupation through foundation (c. 1234), reconstruction, close, and post-medieval reoccupation, with discussion of finds.

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  • Roffey, Simon. “Medieval Leper Hospitals in England: An Archaeological Perspective.” Medieval Archaeology 56 (2012): 203–233.

    DOI: 10.1179/0076609712Z.0000000007Save Citation »Export Citation » Share Citation »

    Synthesizes recent findings to reflect on archaeological evidence for the location, buildings, cemeteries, and material culture of leper-houses. Reports, too, on a Winchester house that may have pre-Conquest burials.

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Site, Space and Architecture

The fabric of hospitals is only now re-emerging as a focus of historical and (less so) art-historical attention. Cullum 1993 offered a first step, integrating archaeological and documentary evidence to think about buildings, people, and routines. Rawcliffe 2002 and Rawcliffe 2008 (both cited under Internal Regimen and the Nature of Care) demonstrates the importance of site, furnishings, books, and objects in the devotional life and intercessory role of late-medieval hospitals. New historical agendas for the study of site, space, and objects are laid out in Le Clech-Charton 2010 and Montaubin and Schwerdroffer 2004 (cited under Collections of Essays). Architecture remains surprisingly little studied, although types of building plans are widely recognized, as well as the late-medieval compartmentalization of open space into living quarters. The field still relies on surveys across a long chronology, for England, as discussed in Godfrey 1955 and Europe, as seen in Leistikow 1967. Prescott 1992 gives an introductory overview to the remains of buildings in England. Welcome new approaches, among the first concerted efforts to interrogate architecture, topography, and use of space, can be found among the essays in Touati 2004 and case studies from the 13th century Tonnerre (see Courtenay 2007, cited under Founders and Patrons), and 15th-century Ewelme and Florence in Goodall 2001 (cited under Regional Studies: England) and Henderson 2006 (cited under Regional Studies: Southern and Eastern Europe).

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