Join the committee of the International Network for the History of Hospitals (INHH) for our inaugural virtual workshop. Crisis can manifest in so many ways: hospitals going bankrupt, operating in a warzone, sex scandals, etc. But this idea of crisis extends beyond our sources to how we, as researchers, approach our work from funding issues to writer’s block. Presenting on the theme of Hospitals in Crisis:
Sex, Lies, and Parchment: Reputation and Regulationat Narbonne’s Hospital of the Bourg in the Fourteenth Century
This first meeting will set the stage for this ongoing series. The goal of these workshops is to provide graduate, postgraduate, early career, and precarious faculty with a space to discuss their thesis, research projects, and the questions and obstacles that arise from them. Too often we have worked alone on our hospitals, but the INHH is committed to creating a space where our community can come together and inspire each other’s research.
Between 1630 and 1631, the city of Florence suffered its last epidemic of plague. Some 12% of the city’s population of 75,000 perished.
In this edition of Not Just the Tudors, Professor Suzannah Lipscomb talks to Professor John Henderson, historian of epidemics, about how Florence suffered, fought and survived the impact of plague – and what we might have learned from the approach of the Florentine authorities during our own recent pandemic.
‘In our ninth episode, Dr. Jane Stevens Crawshaw guides our reading of Rocco Benedetti’s Accounts of some events taking place in Venice during the plague years of 1576-1577. The text is a first-hand account of one of the most devastating plague outbreaks to strike Venice in the early modern period. Its author was a notary, one of the few people allowed to move freely across the city in order to record wills and provide other services to the citizenry. His account is both informative and haunting. How did Benedetti’s work as a notary shape his views on this terrible episode of Venetian history? What did he think about the local plague hospitals’ performance and the lockdown practices ordered by the government? Find out in today’s episode!’
Prof. Henderson presented ‘The War of Torments: Imagining and Experiencing the Great Pox in Renaissance Florence’ on 11 November 2022 at 17:00 (CET) for the Centre for the Study of Medicine and the Body in the Renaissance (CSMBR).
His presentation explores the epidemic of the Great Pox and its impact on many aspects of early modern European society. In contrast to plague, which led to rapid rises in mortality, this new chronic disease led to long-drawn-out suffering, poverty, destitution and death, infecting all levels of society, from popes and cardinals to princes, courtesans and the poor.
This lecture is part of an ongoing project on how the Great Pox was imagined, received and experienced in Renaissance Italy. Building on the approaches and findings of recent studies of early modern England, Germany and Spain, this lecture will compare the experience and representation of female and male Pox patients through the examination of both written and visual evidence.
These will include contemporary written accounts, such as satirical and moralistic poems and plays, and visual evidence, ranging from broadsheets to medical illustrations.
It will be argued, that only by analysing these sources through the prism of contemporary medical understanding of the nature of the Pox and its symptoms can we begin to understand more clearly how this disease was perceived and represented in text and image in renaissance Italy.
The study of plague remains as relevant today as in pre-industrial Europe, especially as we struggle to combat the threat of Covid 19. In this lecture, John Henderson will provide a timely reminder that present-day policies of ‘containment, mitigation and quarantine’ have long historical precedents, just as human reactions of fear and panic are shared across the centuries. He will show how early modern Italy, though well-known as the birthplace of the Renaissance, was also renowned for the precocious development of its public health policies. These have provided the model not just for nineteenth-century policies in combatting plague, but also more recent epidemics from SARS to Ebola and the Corona virus.
This lecture focusses on the development of public health policies in seventeenth-century Tuscany within a wider Italian and European context. The aim is to go beyond traditional oppositions between rich and poor by examining the impact of regulations at the level of the neighbourhood, street and family. Looking behind the optimistic gloss of official printed accounts, John Henderson will examine the often moving and tragic stories of the individuals who ran hospitals, the doctors who treated plague victims, and, above all, of the ordinary men and women left bereft and confused by the sickness and death of family members as they sought to adopt strategies to survive during quarantine and lockdown.
Coping with Plague: Public Health and Epidemics
Royal College of Physicians of Edinburgh 2nd June 2019 Professor John Henderson, Professor of Italian Renaissance History, Birkbeck College, University of London Watch Coping with Plague: Public Health and Epidemics
Italy, though best known for the birth of the Renaissance, is also renowned for the precocious development of its public health policies in the 16th century. In this talk, Professor John Henderson argues that it is time to re-examine and reassess early modern Italian policies dealing with plague. Henderson’s approach is to examine the often moving and tragic stories of the individuals touched by plague from either side of the doctor-patient boundary. The way in which governments and individuals dealt with plague are as relevant today as they were 500 years ago.
Death in Florence: Plague, Prosecution, and the Poor in early Modern Florence
Plague remains a popular topic, as reflected in the continued popularity of the narrative accounts from Defoe to Manzoni to Camus which present vivid fictional recreations of what it was like to live through an epidemic. While it is the liveliness of this type of description which continues to fascinate, many histories of public health have traditionally tended to concentrate on chronicling government policies rather than the lived experience. The top-down approach also reflects the theme of contemporary political and medical rhetoric in surviving records, in which the lower levels of society were often blamed disproportionately as the spreaders and even cause of plague. In contrast, this lecture, which explores the last epidemic of plague to affect Florence in 1630-31, places less emphasis on official views. Instead it will seek to recreate the variety of experience and lively voices of the inhabitants in the city’s streets and neighbourhoods, as reflected in the wide range of trials against those who broke sanitary legislation. While analysing the extraordinary variety of ‘crimes’, from simply adopting survive strategies to robbing empty plague house, we shall also ask whether the draconian punishments prescribed in law were enforced as rigorously as in other Italian cities at the time.
Religion, Medicine and Art in the Time of Plague: Florence 1630-33
The subject of religion and medicine, and indeed religion as medicine, has recently become an important topic of research, particularly within the context of the history of late medieval and early medicine. The relationship between these fields has emerged as a fundamental aspect in understanding the nature of the contemporary holistic vision of how the human body worked and was treated through the complementary role of the doctor of the body and the doctor of the soul. This lecture will analyse the role of religion as medicine in the treatment of the sick body of both the city and the individual during the last major epidemic of plague to affect the city of Florence, 1630-1. It will examine the main religious strategies adopted by Church and State first to prevent and then to mitigate the impact of plague and finally to give thanks for the cessation of the epidemic. The strategies centred around three main holy sites: the Cathedral, the miraculous shrine at the Servite church of SS. Annunziata, and the Observant Dominican church of S. Marco, which housed the body of the 15th -century Florentine archbishop, St. Antoninus. The increased devotion at these important ecclesiastical centres led, furthermore, to a wide range of artistic commissions, including chapels, altarpieces, frescoes, costly silver candlesticks, and more humble ex-voti. Given this artistic outpouring during and following the epidemic, this lecture will explore the themes of commissions and how they placed emphasis on the representation of saintly figures and patrons and how far on showing the ravages of disease on the body of the sick. Furthermore, how far did the religious reactions and subjects of the artistic commissions associated with plague in 17th -century Florence conform or differ from those adopted by other cities in early modern Italy.
Plague Podcasts
Where does quarantine come from?
Professor John Henderson, Birkbeck College, University of London Octavian Report 13th July 2020
The new episode of our podcast features John Henderson, Professor of Italian Renaissance History at Birkbeck University of London, and author of Florence Under Siege: Surviving Plague in an Early Modern City and numerous other works of Italian history. We spoke with Professor Henderson about the history of quarantine itself and other aspects of how epidemic disease changed Italian society.
The Terrors of the Time: Lessons from Historic Plagues
Professor John Henderson, Birkbeck College, University of London Professor Vanessa Harding, Birkbeck College, University of London Aaron Columbus is a doctoral student examining how the London plague affected the poor in society at Birkbeck College, University of London CBC/Radio-Canada 17th April 2020
As this latest battle rages on, historians are looking at similarities in individual and collective response. Regardless of our modern understanding of disease and its spread, historians point to the need to find blame.
Professor John Henderson, Birkbeck College, University of London Birkbeck Arts Week: podcast
Listen to John Henderson on what an extraordinary image evoking what it was like to live through plague in Renaissance Florence, the subject of his new book Under Siege: Surviving Plague in an Early Modern City (Yale, 2019), and Yale have made a chapter available to read.
The Great Hospital has provided care for the local community continuously for almost 800 years. Few other charitable organisations in Europe can match this remarkable record and even fewer can boast such a rare combination of architectural and documentary riches. Although at the time of its foundation in 1249 the hospital of St Giles (as it was then known) was typical of many and far from unusual, the closure of most comparable institutions during or after the Dissolution of the Monasteries in the 1530s means that it is now unique in an English context. Indeed, because most other medieval hospital archives were then destroyed, that of the Great Hospital is now deemed to be so important that in 2011 UNESCO, the United Nations Educational, Scientific and Cultural Organisation, awarded it special Memory of the World status. Having in 1570 been transferred under lock and key to a special ‘treasury’ in the guildhall, it is now held in the Norfolk Record Office.
The medieval cloister of the Great Hospital Norwich Photographer: C. Bonfield
St Giles’ hospital was founded by Bishop Walter Suffield for sixty ‘infirm’ poor men sharing thirty beds, priests ‘broken with age’ and seven young scholars. Care for the soul was prioritised over that of the body and, as was then common, the regulations followed a monastic model based upon the Augustinian Rule. Unusually, however, the hospital was not only efficiently managed and free from scandal, but also closely integrated into the religious and political life of the city, which may in part explain why the rulers of Norwich were determined to save it from dissolution. They were also influenced by developments in communal health and welfare across the North Sea, and as a result took the radical step of acquiring the hospital from the crown in 1547 for conversion into an alms-house.
The Re-foundation Charter drawn up at that time (transcribed in Appendix 1) established the remit of the new ‘Howse of the Poor on Holme Street’, otherwise ‘Goddes Howse’, any doctrinally suspect connection with a Catholic saint having been abruptly terminated. The hospital was henceforward to maintain forty resident paupers, both men and women, for whom professional medical services were provided. The paid staff comprised the master (a Protestant cleric), a minister to the poor, a cook, five female nurses described as ‘keepers’, a surgeon, a barber and various administrators. Since it was initially planned to house a school on the premises, a schoolmaster and usher also feature on the original payroll. The provision of physical care now became a priority as the liturgical role of the hospital ceased. This shift is underscored by the fact that the account roll for the year 1550-51 is bound in a page torn from one of the medieval service books: a widespread practice which allowed for the recycling of forbidden material. We should note, too, that the accounts were henceforward compiled in English, which the hospital’s new managers could read, rather than Latin, the language of the Church.
Great Hospital account roll for the year 1550-51, wrapped in a page torn from a medieval missal (Norfolk Record Office, NCR, 24A)
Despite the care taken to secure an adequate landed income from rental properties in Norwich and estates in Norfolk, the hospital got off to difficult start because of the devastation caused during Kett’s Rebellion of August 1549. The insurgents may have deliberately targeted ‘Goddes Howse’ as an institution controlled by the ruling elite, and the first surviving account roll, which covers the year ending 24 June 1550, records the losses that ensued. Although the sale of the ‘quere’ (choir stalls) and the stone paving of the chancel raised the considerable sum of £25, plans to house the city’s grammar school there had to be abandoned on account of fire damage. Instead, the female paupers were eventually accommodated in what had once been a sacred space reserved for religious observance, while the men occupied the former infirmary. The account roll for the year 1570-71 confirms that the hospital authorities were now on a sufficiently secure financial footing to undertake major rebuilding work for the enlargement of both male and female quarters, while continuing to offer residents what was, by sixteenth-century standards, a comfortable old age. In 1566, the master promised that they would ‘be fedd with no courser bread then whole wheat’ and that he would ‘gently use and intreate’ them ‘withowt eny correccion or beatyng’ (Appendix 2).
These two accounts provide a fascinating insight into the development of the post-Dissolution hospital, as well as the wider religious, economic and social life of Tudor Norwich. They record the salaries of senior employees and the less generous day wages of labourers, as well as outgoings on food, drink, clothing (such as ‘lether for shooes for the poore folkes’), bedding, laundry and end-of-life essentials, including ‘shetes to bury the pore in’ and a ‘shoovel to make graves with’. Detailed information about the cost of building materials (bricks, lime, clay, straw, timber) and other necessities, such as ‘nayles for dores’, appears alongside expenditure on the preaching of sermons, which played a notable part in delivering the new Protestant message. And, like any other institution involved in the acquisition and management of a portfolio of rental and agricultural properties, the hospital had to pay for legal ‘advyse’, ‘pennyng the bookes’ and the cost of obtaining ‘diverse and sondrye wrightinges’ as documents of title.
Some entries in the accounts are particularly poignant. In 1575-6 a payment of 2s 8d was made to ‘Mary Cole one of the pore women in th’ospitall for a stylt after her leg was sawen of”. The following year, the unfortunate but resilient Mother Cole was attended by John Cropp, a Dutch surgeon who received 20s for healing her remaining leg. The inevitable clash of personalities involved in running a large and prestigious institution sometimes gave rise to public confrontations: on one occasion an argument between hospital staff and the civic authorities about accurate record-keeping resulted in an exchange of ‘stowte words’ which were later ‘rehersed openly’ in the mayor’s court.
The accounts
In accordance with an established medieval model, the primary aim of these documents was to show that the hospital was being efficiently and honestly run rather than to reveal profit or loss. Arrearages (uncollected receipts carried over from the previous year) were noted first, followed by charges (current receipts) and then expenditure, which would be noted in minute detail to prevent fraud. Any supplementary income, such as gifts or legacies, would be recorded separately. The accounts were audited annually by four surveyors (the aldermen and councillors charged with oversight of the hospital), who examined them for any errors or evidence of malpractice before signing off.
Total expenditure of £295 6d recorded in the account for 1550-51 from the Great Hospital Norwich Accounts
As might be expected given the complexity of the hospital’s finances and the extent of its outgoings, the account rolls grew larger: that for 1549-50 comprises 17 membranes measuring 31 x 34 cm, whereas by 1570-71 the dimensions had grown to 34 x 58 cm. The adoption of a clearer, more accessible layout devised by the city chamberlain, Robert Raynbald, made it much easier to locate individual entries, while the fine calligraphy and the elegant strap-work used as decoration by the scribe attest to the care that was given to the creation of these rare documents.
Health and Hygiene in Early-Modern Norwich: Account rolls of the Great Hospital, Norwich, 1549-50 and 1570-71 was edited by Ellie Phillips (published 2013) and is available from the Norfolk Record Society.
Space, in both its physical and conceptual manifestations, has been a part of how hospitals were designed, built, used, and understood within the wider community. By focusing on space, this conference will explore this subject through the lens of its architectural, socio-cultural, medical, economic, charitable, ideological, and public conceptualisations.
This conference is in partnership with “Hospitalis: Hospital Architecture in Portugal at the Dawn of Modernity” and “Royal Hospital of All Saints: city and public health” research projects.
As governments and societies across the globe endeavour to curb the spread of the COVID-19 pandemic, the economic, political and social significance of hospital structures has likely never been more obvious. Statistics that detail hospital admission rates and chart the health of the patients within the institutions are being used as important mechanisms for gauging the health of the wider populace and the current scale of the epidemic. For all of the data and governments’ commitments to being led by the science, there has been a concurrent recognition that public health measures – of which hospitals form an important part – are a series of compromises between competing priorities. The current pandemic has also afforded a stark reminder that neither diseases, nor their healthcare responses, are experienced equally by patients.
Tracing Hospital Boundaries: Integration and Segregation in Southeastern Europe and Beyond 1050-1970
A recently-published volume of collected essays from the INHH conference in Dubrovnik in 2015: Tracing Hospital Boundaries: Integration and Segregation in Southeastern Europe and Beyond, 1050 – 1970, explores the forces which shaped hospitals in the past and reveals that those same tensions surrounding opportunities and experiences of healthcare can be traced back across the centuries. The volume takes as its themes the concepts of integration and segregation and explores these in relation to the experiences of patients and the design and location of hospitals. Many of the essays draw on urban case studies, although Christina Vanja considers the healthcare facilities of eighteenth-century rural Germany and the treatment afforded to those with physical and mental illnesses.
The book uncovers the spatial, social and administrative divisions that were made between patients by class or race, with a vastly different standard of care provided to patient groups. Clement Masakure’s examination of hospitals in Rhodesia in the late nineteenth and early twentieth centuries reveals the intensity of debates regarding access to healthcare which pivoted around race. As he emphasises, these were complex and detailed discussions which affected patients and the nursing staff (who were drawn largely from the black, African population). The perceived danger associated with the presence and movement of Rhodesia’s Asian, ‘Coloured’ and African communities can be identified in earlier centuries in debates about the appropriate place for women in Renaissance Dubrovnik. The language of immorality or contagion was deployed in order to restrict the visibility of the city’s female population and prompted concern about households or institutions which lacked sufficient male oversight. In the same city, the foundlings (or orphans) which were accommodated in one of the city’s early hospitals faced financial hardship and, often, social ostracization. Throughout the period covered by this study, parts of society have been distinguished as particularly worthy of care or vulnerable whilst others have attracted fear, criticism or blame and these distinctions have informed healthcare policy and hospital structures directly.
Separation between patients was also often made on the basis of medical diagnosis. In the premodern period, dedicated institutions were developed to accommodate sufferers of leprosy, as explored vividly by Anna M. Peterson and Annemarie Kinzelbach. During the late nineteenth and early twentieth centuries in Italy, pellagra sufferers constituted a significant proportion of the patients within asylums. David Gentilcore and Egidio Priani consider the impact of hospital admission, treatment and discharge on patients by drawing on a rich database of patient case studies. During a similar period in Britain, the place of burn sufferers prompted reactions ranging from fear to compassion, which were used to justify separate structures and spaces for care. Jonathan Reinarz’s essay traces these debates alongside changing perceptions of burn injuries and the most effective forms of treatment which eventually necessitated the development of multi-disciplinary medical teams. In twentieth-century America, the place of chronic illness was a source of official oscillation and debate. George Weisz charts the dynamics of the economic and social forces which have shaped attitudes towards the long-term ill. The picture that emerges from the volume is of changing attitudes to illnesses and their patients: sometimes perceived as victims but at other times implicated as a drain on communal resources or a threat to their wider communities.
Hospitals locations and design have long been influenced by ideals beyond health. David Theodore examines the influence of efficiency and cleanliness which shaped the Friesen Concept Hospital, drawing on technologies of automation in order to shape the movement of objects, patients and staff within hospitals. Valentina Zivković uncovers the frequently-interwoven dynamics of charity and healthcare, tracing the issues of symbolic space and movements through what she terms the ‘sacral topography’ of premodern Kotor. The decisions regarding where to situate hospitals and how to use the internal space is often driven by considerations beyond what might be narrowly termed ‘medical’.
As a whole, these essays reveal the changing boundaries around and within ‘community’ or ‘official’ hospitals, which reflected altered purposes of the institutions. In the past, many groups had limited access to hospitals or were believed to require segregated spaces if not dedicated institutions. The language and justifications of such policies undoubtedly changed but a recognition of the vital ways in which hospitals were shaped by their political, economic and social contexts might encourage us to ask questions of our contemporary public health policies which probe at the experience of different groups within our communities and, in particular, to raise the profile of those in society whose opportunity for, and experience of, healthcare is limited.
Space, in both its physical and conceptual manifestations, has been a part of how hospitals were designed, built, used, and understood within the wider community. By focusing on space, this conference aims to explore this subject through the lens of its architectural, socio-cultural, medical, economic, charitable, ideological, and public conceptualisations.
Hospital Real de Todos os Santos, Wikimedia Commons
This thirteenth INHH conference will explore the relationship between space and hospitals throughout history by examining it through the lens of five themes: (1) ritual, space, and architecture; (2) hospitals as ‘model’ spaces; (3) the impact of medical practice and theory on space; (4) hospitality and social space; (5) sponsorship. Below are more details about how the conference themes will address along with related questions. The themes and questions presented are by no means an exhaustive list; however, we encourage the submission of an abstract that examines any aspects of space and the history of hospitals in innovative ways.
Key Themes and Questions to be explored:
1. Ritual, Space, and Architecture
How has the architectural designs of hospitals shaped their use? How has ritual impacted the built environment? How have these spaces been preserved and how are they presented to modern audiences? How were aesthetic changes integrated over time?
Examples: architectural design, death care and burials, patient rooms, religious spaces in medical environments, archaeological and/or architectural reconstructions, material culture, heritage studies.
2. Hospitals as ‘Model’ Spaces
How have hospitals, leprosaria, and other health care establishments been conceptualised as ‘model’ institutions, both architecturally and spatially? How were architectural models communicated and circulated? How did colonial ‘models’ inform both hospitals and the surrounding environment? How were these ‘models’ juxtaposed against pre-existing institutions and/or practices? Did bad ‘models’ exist, if so, what was the criteria for this categorisation?
Examples: Using plans from pre-existing hospitals; the imposition of a non-indigenous ‘model;’ hospitals in transition (i.e. colonial to postcolonial).
3. The Impact of Medical Theory and Practice on Space
How did prevailing medical theories influence the built environment? As these theories and practices changed, how were these changes made manifest?
Examples: colonial medicine and its impact on architecture and space of existing and ‘new’ hospitals; changes in space creating inclusive or exclusive environments; bioarchaeological studies of hospitals and their patients; care versus cure.
4. Hospitality as Social Space
How has the inclusion or exclusion of groups shaped care and space? How is this reflected in its architecture? How have hospitals been designed to be more welcoming? How were health and social activities balanced in a hospital’s built environment? How does the presence of hospitals and/or leprosaria impact urban planning?
Examples: segregation within hospitals; concierge services and creating a ‘public face;’ the role of gender and hospitality; hospitality and socio-economic status; psychological responses to space in hospitals.
5. Sponsorship
How have founders and donors affected the creation and/or development of a hospital? Did their donation change the social or cultural environment? How does this impact the hospital’s reputation?
Examples: Prioritising wings for specific illness or methods of care; perception of donors as individuals; impact of class and gender.
The Advisory Board of the INHH and the local organising committee wish to invite proposals for 20 minute papers or posters which address the conference theme. Potential contributors are asked to bear in mind that engagement with the theme of space and the hospital will be a key criterion in determining which papers are accepted onto the programme.
Abstracts should be a maximum of 300 words in length, in English and accompanied by a brief biography of no more than 200 words. Proposals should be sent to space.inhh@gmail.com by 30 September 2020. As with previous INHH conferences, it is intended that an edited volume of the conference papers will be published. Submissions are particularly encouraged from researchers who have not previously given a paper at an INHH conference.
Upon provision of full receipts, we hope to be able to support attendance at this conference, particularly for postgraduates and early career researchers. Speakers will be asked to make use of alternative sources of funding where these are available. Any queries may be directed to space.inhh@gmail.com.
INHH 