By Ellie Phillips

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. 

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.

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. 

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.

Other Resources

The Great Hospital online http://www.thegreathospital.co.uk/index.html (where a full transcript of the 1550-51 account may be found)

Carole Rawcliffe, Medicine for the Soul: The life, death and resurrection of an English Medieval Hospital (Stroud, 1999)