Medieval Hospitals of England
During the Middle Ages, writes Courtney Dainton, English hospitals continued to flourish until the beginning of the fifteenth century.
Over seven hundred hospitals were founded in England between the Norman conquest and the middle of the sixteenth century. This number is surprisingly large, for at no time did the population of the country exceed four million. Of course, many of them were not really hospitals as we know them today. Their name indicated their primary function; it was derived from the Latin word hospitalis, meaning being concerned with hospites, or guests, and guests were any persons who needed shelter.
Some of the hospitals were, therefore, erected for the use of pilgrims and other travellers; others were really almshouses, intended chiefly for the poor and the aged. Nevertheless, a considerable number of them provided accommodation where the sick could receive care and even some primitive form of treatment for their ailments.
Many of the early hospitals were erected for sufferers from leprosy, the common scourge of the Middle Ages. Some time before 1089 Archbishop Lanfranc built a leper hospital at Harbledown, near Canterbury; it had room for one hundred inmates. In the following century another Kentish hospital, also used mainly by lepers, was erected by monks at Buckland by Dover.
Because lepers were seldom cured they usually became permanent inmates, and becoming a patient in a leper hospital was almost like entering a monastery. At Buckland there were strict rules regarding the type of leper admitted, and the actual admission was accompanied by a religious ceremony.
No leper could be admitted unless the other patients gave their consent; it was probably thought that this measure would help to maintain peace among the long-term inmates. The new patient also had to give one hundred shillings to the funds of the hospital; in those days that was a considerable sum, so that only a fairly wealthy leper could gain admission.
On being admitted the leper was required to take the following oath:
‘I... do promise before God and St. Bartholomew and all saints, that to the best of my power I will be faithful and useful to the hospital, obedient to my superior and have love to my brethren and sisters. I will be sober and chaste of body; and a moiety of the goods I shall die possessed of shall belong to the house. I will pray for the peace of the church and realm of England, and for the king and queen, and for the prior and convent of St. Martin, and for the burgesses of Dover on sea and land, and especially for all our benefactors, living and dead.’
After making this vow the leper was sprinkled with holy water and then escorted to the altar. There he knelt to receive the warden’s blessing. That completed his formal admission to the hospital, but every day that he remained there he had to say two hundred Paternosters and Aves during daylight hours, and every night the dormitory bell awakened him in order that he could sit erect in bed and say another two hundred.
One of the largest hospitals in the country was St. Leonard’s at York. It was built during the reign of Stephen to replace a Saxon establishment which had been destroyed by fire. It accommodated over two hundred sick and poor, and in addition there were twenty-three boys, for it also served as a children’s home. The staff included bakers, brewers, carters, cooks, smiths, boatmen, a ferry-woman, and sixteen male and female servants.
There appears to have been a woman in charge corresponding to the modern matron, for an old document relating to the hospital refers to Matilda la hus-wyf, and in 1416 a sum of money was bequeathed to the staff and inmates with instructions that it should be distributed by Alice materfamilias.
Henry III directed that the hospital should be allowed ‘to take what they need in the forest of Yorkshire for building and burning, and also of herbage and pasture for flocks and anything needful for their ease.’ The hospital also collected a tax known as the thraves of St. Leonard; a thrave probably consisted of twenty-four sheaves of corn. This tax was collected in respect of every plough used in the archbishopric of York, an area covering the modern counties of Cumbria, Lancashire, and North, South and West Yorkshire.
When times were prosperous the hospital’s income from the thraves was considerable: in 1369-70 it amounted to £1,369, while expenditure was only £938. In bad times, when there was war or plague or famine, the hospital naturally suffered; in 1409 the income fell to £546. In another year the situation became so bad that the master resorted to pawning the hospital chalices and ornaments, but the patients strongly disapproved of this action and sent a petition to the King about the matter.
In most hospitals the master was appointed by the patron, but at a few of them he was elected by the staff. One such hospital was St. John’s at Oxford, which was founded in 1213 by Henry III ‘that therein infirm people and strangers might receive remedy of their health and necessity.’ The master of St. John’s was chosen from the three Augustinian chaplains, who, with six lay brothers and six sisters, formed the staff, although a number of artisans and farm workers were also employed.
A high standard of conduct was expected of a hospital master. At Wells in Somerset he had to be ‘circumspect and expert in spiritual and temporal things, and free from all infamous vice.’ At Heytesbury in Wiltshire he was forbidden to visit the alehouse, go hunting, or play cards or handball. He was not allowed to be away from the hospital at night; if he went away during the daytime his absence must only be of short duration; and in addition to being in charge of the hospital he also had to be master of the village school.
Usually only a few of the ‘brothers’ and ‘sisters’ were responsible for caring for the sick. The others were allotted various non-nursing duties. Often one of the brothers was called the proctor; it was his duty to collect alms.
The hospitals were largely dependent on charity, but some received regular payments from their patrons, and some owned land or houses for which they collected rents. A number of hospitals raised money by holding annual fairs under a charter granted by the sovereign. The largest of these fairs was that at Sturbridge near Cambridge; it was authorised in 1211 by a charter which King John granted to the lepers of the hospital of St. Mary Magdalene.
Other hospitals had the right to levy tolls on local produce. At Carlisle the lepers received a pot of ale from each brewhouse every Sunday, and a farthing loaf from every baker. At Shrewsbury they took handfuls of corn or flour from the sacks in the market. In a few places the tolls were in cash; the lepers at Southampton received a penny for each tun of wine that entered the port.
The rules governing the conduct of both patients and staff were usually very strict, and often the master or warden was required to hold a weekly meeting for the purpose of dealing with infringements and punishing offenders. Punishment might be by means of fines, or by flogging or fasting. At the hospital at Reading a patient guilty of any misbehaviour had to sit in the centre of the dining hall during mealtimes and eat only bread and water, while his share of the food and ale was distributed to the other patients.
The food was usually plain but plentiful. At Sherburn in County Durham each patient received a loaf and a gallon of beer daily; there was meat three times a week, and on the meatless days there were eggs, vegetables and cheese.
The beds in the earliest hospitals consisted of pallets of straw, but before the end of the twelfth century there were probably wooden bedsteads. These were usually large and had to accommodate two or more patients. How frequently the bedding was washed is not known; that it was washed from time to time is clear from the records of St. Thomas’ Hospital at Canterbury, where the warden and his wife were paid 46s. 8d. annually for ‘wasshyng of the bedds for poure people.’
It also appears that each new patient received clean sheets; there was an inquiry at London’s Savoy Hospital in 1535 and one of the matters investigated was ‘whether any poore man do he in any shetes unwasshed that any other lay in bifore.’
One of the most famous hospitals in the country was founded in the twelfth century. It is now the oldest hospital still in use and still standing on its original site. About 1123 a man named Rahere, who is described as ‘a courtier though a cleric’, went on a pilgrimage to Rome. There he was taken seriously ill, and he vowed to build a hospital if he recovered.
When he was restored to health he returned to England and asked the Bishop of London to help him to carry out his vow. The bishop persuaded Henry I to provide some land at Smithfield, and there the hospital was erected. It was dedicated to St. Bartholomew because Rahere had seen this saint in a vision during his illness.
It appears that Rahere assisted in the treatment of the patients, although the methods he used were hardly those of a man with medical knowledge. We are told that when a woman with a badly swollen tongue was brought to him, he dipped his relics of the Cross in water, wished the woman’s tongue was better, and painted the sign of the cross on it. Less than an hour later the swelling had disappeared, and the woman returned home ‘gladde and hole’.
The hospital’s records contain no particulars of the patients or their treatment in those early days, except in cases where it appeared that a cure had been effected miraculously. For example, there was a beggar named Wolmer who was very badly deformed. He had sat begging in St. Paul’s Cathedral every day for thirty years, and so he was well known in the city.
His friends took him to the new hospital, where he was placed before the altar in the church. This appears to have been sufficient to effect a cure, without any other form of treatment, for ‘by and by euery crokidness of his body a litill and litill losid’ and eventually ‘all his membris yn naturale ordir was disposid’.
A better idea of the medical treatment at St. Bartholomew’s is obtained from the Breviarium Bartholomei, written by John Mirfield and published in 1387. For instance, when a patient suffered from rheumatism, the pharmacist placed some olive oil in a clean vessel and then made the sign of the cross and said two prayers. The vessel was then put over a fire and had to remain there while part of a psalm, the Gloria and two prayers were recited seven times.
The heated olive oil was then applied to the affected limbs. It will be seen that religion appears to have played a large part in the treatment; it has been suggested, however, that in those days, when there were no watches and very few clocks, the recitation of psalms and prayers was a means of timing the heating of the olive oil.
When Rahere founded St. Bartholomew’s he directed that it should have a master, eight brethren and four sisters. The master was to have ‘a servant fit for his place, who is to stay continuously in the infirmary and wait upon the sick with diligence and care in all gentleness.’ This servant was also to prepare the patients’ food, ‘show their water to the physician, and take a careful note of how they ought to diet themselves.’
The master was usually a priest, and three of the eight brethren were chaplains. The four sisters were nuns and devoted their whole lives to the service of the hospital. They wore grey tunics; the hospital’s rules said that these must not reach below their ankles. They shared their daily rations of seven loaves, a dish of cooked food and half a flagon of ale, and they all slept in a dormitory.
Another famous London hospital, St. Thomas’s, was also in existence in the twelfth century, although the exact date of its foundation is not known. It formed part of a priory at Southwark, but after being destroyed by fire it was rebuilt on a new site in Borough High Street in 1215. The new hospital appears to have had forty beds, but each of these was shared by two or three patients.
The hospital derived a large part of its income from the rents received from land it owned. There were also many bequests and gifts. These sources of income were greatly reduced during the time of the Black Death, which also increased the number of patients. In 1357, in an attempt to win new benefactors, the brethren appealed to the Pope to grant an indulgence of two years and eighty days to everybody who assisted the hospital, but the maximum indulgence which he would allow was only half this length.
A new ward for unmarried mothers was added to the hospital with money provided by Dick Whittington when he was Lord Mayor of London. This gift to ‘Thomas Spetylle’, as the hospital was called, is described in a survey made by a later Lord Mayor:
‘And at that same place ys an ospytalyte for pore men and wymen, and that noble marchaunt, Rycharde Whytyngdon, made a newe chambyr with viii beddys for yong wymen that had done a-mysse in trust of good mendement. And he commaunded that alle the thyngys that ben don in that chambyr shulde be kepte secrete with owte forthe, yn payne of lesyng of hyr levynge; for he wolde not shame no yonge women in noo wyse, for hit myght be cause of hyr lettyng (i.e. hindrance) of hyr maryage.’
There were complaints about the behaviour of the staff at St. Thomas’s during the early part of the fourteenth century. In 1323 the Bishop of Winchester reprimanded the master because the brethren and the sisters were leading irregular lives. The master was also told that he must have his meals with the other members of the staff.
Allegations such as those made against the staff of St. Thomas’s appear to have been only too common during the fourteenth and fifteenth centuries. They were one of the reasons for the gradual decline of the hospitals. Another was the fact that the spirit of public service and religious zeal that had led to the founding of so many of them was waning. There was also considerable abuse by the patrons, who often expected the hospitals to provide free lodging for themselves and retinues of their retainers.
Some of the patrons sent their aged servants to the hospitals, with orders that they should be allowed to stay there for the remainder of their lives. Edward II appeared to consider that this was the prime function of hospitals; he declared that they had all been established ‘for the admission of poor and weak persons, and especially of those in the King’s service who are unable to work.’
Probably the chief factor contributing to the decline of the hospitals was mismanagement by the wardens; the records contain numerous instances of this. In 1348 it was stated that the warden of St. Leonard’s Hospital at Derby ‘neglects the duties of the wardenship and has dissipated and consumed the goods and alienated the lands to the great decay of the hospital’. Wardenships were often given by patrons to their relatives or their personal friends.
Often these wardens did not live at the hospitals; some did not even bother to visit the establishments supposed to be under their supervision; others were masters of several different hospitals. A Bishop of Winchester appointed his eighteen-year-old nephew as warden of two hospitals, one at Portsmouth and the other at Winchester; in addition, this young man had an archdeaconry and two canonries.
People who should have received care inside the hospitals often died neglected outside them. The description contained in a poem, The hye-way to the Spytell house, written by Robert Copland about 1536, was true of many hospitals:
‘For I haue sene at sondry hospytalles That many haue lyen dead without the walles And for lacke of socour haue dyed wretchedly Unto your foundacyon I thynke contrary. Moche people resorte here and haue lodgyng, But yet I maruell greatly of one thyng That in the night so many lodge without.’
In 1414 Parliament decided that it would have to take action to halt the deterioration, and a statute for the reformation of hospitals was passed. The preamble to the statute summed up the situation, stating that many hospitals ‘be now for the most part decayed, and the goods and profits of the same, by divers persons, spiritual and temporal, withdrawn and spent to the use of others, whereby many men and women have died in great misery for default of aid, livelihood and succour.’
The statute had little effect. It was not until the Wars of the Roses had ended and the Tudor era brought prosperity accompanied by a spirit of civic responsibility that new hospitals were founded to replace those which had been established as acts of religious charity. The foundation of these hospitals was but a small step towards the realisation of the Utopian dream of that great Tudor statesman Sir Thomas More:
‘But first and chiefly of all, in respect of the sycke that be cured in the hospitalles. For in the circuit of the citie a little without the walls they have four hospitalles so big, so wide, so ample and so large that they may seem four little towns; which were devised of that bigness, partly to the intent the sycke, be they never so many in number, should not lie in throng or straight, and therefore uneasily or incommodiously; and partly that they which were taken and holden with contagious diseases such as would by infection to crape from one to another might be laid apart from the company of the residue.
These hospitalles be so well appointed and with all things necessary to health so furnished; and moreover so diligent attendance through the continual presence of cunning physicians is given, that though no man be sent thither against his will, yet notwithstanding there is no sick person in all the citie that had not rather lie there than in his own house.’
More was looking far beyond his own times. Henry VIII’s statutes for the suppression of religious houses brought about the disappearance of many hospitals, for most of them were closely associated with monasteries or churches, and a desperate situation was created, particularly in London. Some of the leading citizens persuaded the Lord Mayor to submit a petition to the King for the refoundation of St. Bartholomew’s and St. Thomas’s Hospitals, which were among those that had ceased to function.
Henry authorised the refoundation of St. Bartholomew’s, and Edward VI instructed the citizens to repair St. Thomas’s. The young King also authorised the foundation of Christ’s Hospital for orphans and Bridewell for the correction of idle vagabonds. Thus in the capital a spirit of civic responsibility helped towards the establishment of new hospitals, but in the provinces little progress was made until the eighteenth century.