The medieval hospital is a vexing institution, as it fits into so many categories that it can frustrate a researcher. This is why James Brodman has accurately described their history as ‘something messy’, while Miri Rubin, in her Imagining Medieval Hospitals: Considerations on the Cultural Meaning of Institutional Change (1991), laments about the fragmentary nature of the extant sources. Despite the difficulties posed by these institutions, they present a unique opportunity to explore several cross sections of medieval society: sick and healthy, poor and wealthy, secular and ecclesiastical.
Hospitals and charity grapples with this problem as it emphasises how in Italian cities there was always friction between ecclesiastical and municipal authorities, with many of the bishops’ powers being chipped away by the local government. It is against this backdrop that hospitals emerged in the twelfth century and struggled to maintain their institutional identity throughout the High and Late Middle Ages. This ultimately ended with many of these hospitals being consolidated or outright replaced by larger, more centralised hospitals.
Brasher’s book is divided into six chapters and includes an appendix which lists the cities and their hospitals. The first chapter provides an overview of charity and poverty in the Middle Ages, highlighting how changes in personal piety, wealth, and urban demographics created an environment ripe for a surge in hospital foundations beginning in the twelfth century. This transitions into the second chapter which explores the political, social, and local reasons behind these establishments of these institutions in the twelfth and thirteenth centuries, as well as an analysis of the provisions written into their foundation charters. Chapter three focuses on the administrators and internal management of these houses, while the fourth chapter focuses on the hospitals’ physical locations, daily life, the social status of the familia, and internal statutes. The final two chapters examine jurisdictional issues, and the centralisation and bureaucratisation of these hospitals respectively.
Previously, Brasher’s work has focused on the role of women in the Humiliati, a group which had close ties to urban hospitals and charity in medieval Italy. She has indeed played to her strengths by continuing to focus on the interplay between ecclesiastical and civic life in these cities, as well as the charitable works of the laity. Her decision to focus on Lombard hospitals is also a welcome one, considering that, historiographically speaking, the most studied region for Italian hospitals is Tuscany, particularly Siena and Florence.
Brasher’s work is solidly argued, clearly written, and the cases she chose are very illustrative. Her book is an excellent survey of the function, development, and role of hospitals in medieval Lombardy, as well as a strong introduction into the study of medieval hospitals in general. The final two chapters, ‘Jurisdictional disputes’ and ‘Reform and consolidation’, are the most instructive in regards to how these institutions interacted and adapted to shifts in secular and ecclesiastical authority. She also highlights the role of women in these institutions, a group who are often overlooked. The appendix is very helpful for keeping track of the various hospitals mentioned in the texts, which is also a beneficial tool for those who wish to further investigate these establishments. Ultimately, this book’s focus on the Northern Italian hospitals and their examination through the usual framework of charity makes this work extremely accessible and a useful companion to Guiliana Albini’s own work on this topic and region.
There are some points, however, which deserved further analysis. The discussion of charity is valuable, although the absence of Vauchez’s historiographical concept of the ‘Charitable Revolution’ to help situate the sudden increase in hospital foundations is puzzling. Furthermore, terms such as medicalisation and secularisation should have been clearly defined, and in the case of the former, outline the varied approaches to their use vis-à-vis hospitals. Additionally, the first chapter would benefit from a discussion of the more recent studies on the themes of charity, such as the role of preaching in hospitals — which is touched on very briefly— and voluntary poverty. For example, Adam J. Davis article, ‘Preaching in thirteen-century hospitals’, and Jessalynn Bird’s book chapter, ‘Medicine for Body and Soul: Jacques de Vitry’s Sermons to Hospitallers and their Changes’, both explore this phenomenon. Additionally, Sharon Farmer has edited volume entitled, Approaches to Poverty in Medieval Europe: Complexities, Contradictions, Transformations, c. 1100-1500, which provides some new avenues of discussion regarding the poor in this period. Considering this book is billed as a survey, it would have been beneficial to the reader if Brasher had placed this study within the wider historiography of medieval hospitals, or at the very least Italian hospitals for this period. There are few large-scale historiographies of medieval hospitals. To my knowledge the most recent is Brodman’s 2009 book chapter ‘Hospitals in the Middle Ages’ Finally, the section on medicalisation focuses largely on the ecclesiastical response to medicine, which somewhat downplays the state of medical knowledge in the wake of the twelfth-century medical renaissance. Nevertheless, Brasher’s Hospitals and charity is a well written and comprehensive introduction to medieval hospitals in Northern Italy.
Sally Mayall Brasher. Hospitals and charity: Religious culture and civic life in Medieval Northern Italy. Manchester: Manchester University Press; 2017, 224 p. ISBN: 978-1-5261-1928-5. £70
Reviewer: Anna Peterson Pontifical Institute of Mediaeval Studies, Toronto