Caring for the sick and injured largely free of charge, today hospitals treat a wide array of patients during what is hoped will be a short-term stay. But, as Sheila Sweetinburgh reveals, this was not always the case in the medieval period…
In the Middle Ages there were very broadly four types of hospital: for lepers; for poor (and sick) pilgrims; for the poor and infirm; and almshouses or bedehouses. This last form of hospital often included the explicit instruction that the brothers and sisters (those who resided there as long-term inmates), should pray daily for the souls of the house’s founders and benefactors – the term ‘bede’ meaning prayer.
Poor pilgrims often just stayed overnight at a hospital, and while some medieval hospitals took in the sick, others seem to have cared only for the old and infirm. Indeed, professional medical care by physicians or doctors seems to have been rare. There are a few references relating to such provision at London hospitals in the late Middles Ages and in 1524, for example, Henry VII’s Savoy Hospital (founded by the king in 1505) was expected to have a doctor and surgeon.
We probably know more about the founders of the 850-plus medieval hospitals and almshouses in England than we do about those who resided there long-term (the brothers and sisters), and we know almost nothing about the people who were cared for in hospitals. These shadowy figures can only be glimpsed indirectly, through for example the provision at St Thomas’s Hospital in Canterbury where sick pilgrims could stay for more than the typical one night and if they died rather than recovered they would be buried in Canterbury Cathedral’s lay cemetery. Not far away, at St John’s Hospital, Sandwich, the sick-poor and women in labour could stay in the three rooms at the back of the hospital that included a room called the “chamber for strange women” – that is, women who were strangers in Sandwich.
Hospitals were not spread evenly across England and the medieval equivalent of today’s ‘postcode lottery’ meant, for example, that provision was sparse in Worcestershire but much better in Gloucestershire. Some leper hospitals, which housed those believed to have leprosy, also took in those suffering from general infirmity, and by the later Middles Ages many of these leper hospitals no longer housed any lepers at all, instead taking in the old and infirm. Additionally, most hospitals accommodated no more than 20 brothers and sisters, 12 being the most common along with a priest. St Leonard’s Hospital in York was truly exceptional, having around 225 beds.
Leper House – from a miniature in Vincent de Beauvais’s ‘Miroir Historical’, a 13th-century manuscript. (Photo by Culture Club/Getty Images)
The decision as to who entered the hospital generally rested with the patron, and some prospective entrants sought help from influential backers who might also provide the entrance fee. But having a financial backer was not always enough: the patron of Christchurch Priory, Canterbury, turned down Queen Philippa’s request in the mid-14th century for her maidservant to join St James’s Hospital near the city. Queen Philippa’s request was for a corrody (a provision for maintenance) at the hospital, which means she was prepared to pay, but perhaps not enough!
Many hospitals frowned upon this practice, yet it seems to have been remarkably common. The going rate varied over time, between and within hospitals, but at St John’s Hospital in Sandwich most new brothers and sisters paid 6s 8d. (A Margery Warner paid with 1,000 tiles, perhaps floor tiles), whereas at neighbouring St Bartholomew’s the fee to remain at the hospital for the remainder of the inmate’s life might be as high as £19 (the equivalent of around £8,500 today). Although this sounds expensive the new brother or sister might pay in installments and live for several decades at the hospital, expecting in return to receive board and lodging, clothing, shoes, fuel and other necessities, without further payment.
Early hospitals (of which the first to be founded after the Norman Conquest was St John’s Hospital, Canterbury) often provided separate dormitories for men and women with an adjoining chapel that also segregated the sexes. This meant the brothers and sisters could easily attend divine service, where they would recite specific prayers – each inmate at St Andrew’s Hospital at Hythe, Kent, daily provided 300 Pater Nosters, Ave Marias and Credos for their benefactors.
St John’s Hospital, Oxford. Drawing from a 15th-century manuscript. (Photo by Culture Club/Getty Images)
But brothers and sisters hardly spent all day on their knees – we know that at some hospitals the brothers in particular worked on the home farm, while the sisters worked in the brew house and bake house, and presumably also tended the kitchen garden and any sick people at the hospital.
This communal lifestyle extended to the kitchen. At St Bartholomew’s, Sandwich, it was stipulated that each person should daily put their piece of meat (or fish on Fridays, during Advent and Lent) into the common cauldron of pottage and then receive a share once it was cooked. The daily allowance of bread (a half-penny loaf, about 10 ounces) and ale (about 1.75 pints single ale) was supplemented by cheese and fruit, including apples. This was a much better diet than at some hospitals, which largely depended on sub-standard produce that had been rejected by market officials.
Whether hospitals such as St Bartholomew’s were always able to deliver this level of provision is impossible to know for sure. Certainly in the early 14th century, in particular, numerous hospitals were pleading poverty and some were completely wiped out by the Black Death.
Doctors in consultation around a sick person (14th century), glass, Canterbury Cathedral (Unesco World Heritage List, 1988). (Photo by DeAgostini/Getty Images)
Corrupt hospital officials could also prove problematic – hospitals whose patrons were located nearby generally appear to have experienced fewer problems. Yet disputes did occur and discipline might involve corporal punishment, fines or expulsion. For example, Petronella Boys joined St John’s, Sandwich, following the death of her husband, who had been a brother there. Initially all was well but a decade later Petronella refused to do what the authorities required and was expelled.
Nevertheless, compared to life outside, a hospital place would have been seen by many as commodious if not luxurious, offering a degree of security in a generally uncertain world.
Sheila Sweetinburgh is the author of The Role of the Hospital in Medieval England: Gift-giving and the Spiritual Economy (Dublin, 2004) and editor of Later Medieval Kent, 1220–1540 (Woodbridge, 2010) and Early Medieval Kent, 800–1220 (Woodbridge, 2016).