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)

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

Professor John Henderson, a founding member of the International History of Hospitals Network, has  a new book published by Yale on the 9th July 2019. (Get a discount by downloading this form (PDF).

In Florence Under Siege: Surviving Plague in an Early Modern City, John Henderson examines how a major European city suffered, resisted and survived plague. This book provides a nuanced and compassionate interpretation of government policies in practice, going beyond traditional oppositions between rich and poor, by recreating the personal reactions and survival strategies of people and families at all levels of society.

Wider significance

Each age faces the challenge of new diseases from cholera to AIDS and Ebola, but plague remains the paradigm against which reactions to epidemics are often judged. This book, while focussing on seventeenth-century Florence, examines the Tuscan capital within a wider Italian and European context to assess the real impact of policies on the city, the neighbourhood, street and family. Writing in a vivid and approachable way, Surviving Plague in the Early Modern City unearths the forgotten stories of doctors and administrators struggling to cope with the sick and dying, and the reality of living in a time of plague through the personal diaries of the literate, and the personal testimony of the poor, in court cases.

Official Reactions

Many histories of public health concentrate on chronicling government policies, whereas here equal emphasis is placed on the lived experience. Underpinning this narrative is a vivid recreation of the stories and experiences of individuals who endured and survived the epidemic. Contemporary political and medical rhetoric often blamed disproportionately the lower levels of society as the spreaders and even cause of plague, but official measures are examined to establish their real impact on the whole population. These included the cordon sanitaire along the frontiers of the Tuscan state; sanitary surveys of the living conditions of the poor; inspection and locking up of infected houses. A range of treatments are examined from the plague doctor’s prescribing of the ‘miraculous’ drug of Theriac to the surgeons’ lancing of buboes to the complex recipes devised by empirics.

Façade of the Church of S. Miniato al Monte, the Benedictine abbey, which became the main Lazaretto in Florence. (Photo by John Henderson)

Lazaretti or Isolation Hospitals

Lazaretti, vast crowded isolation hospitals, served to distinguish many Italian cities from their northern European counterparts. Some cities built new structures, but many took over existing buildings, as in the case of Florence, where the beautiful Romanesque convent and church of San Miniato al Monte on the hill overlooking Florence to the south of the river Arno became the city’s major Lazaretto. Together with the other Lazaretti around the city, San Miniato housed and treated over 10,000 people during the epidemic of 1630 to 1631, but did, as was claimed at the time, they lead to a reduction in mortality? or simply provide a convenient way for the poor to be enclosed?

Pieter van Halen, ‘The Plague of the Philistines at Ashdod’ (1661), (Wellcome Collection. CC BY)

Religion

Religious strategies also form an important theme of this book, reflecting contemporary belief in the necessity to placate divine ire at the sins of Mankind, through prayers and public masses. But elaborate processions with holy relics were an integral part of the ceremonial response. How far did this lead to conflict with the health board officers given the perceived threat of the spread of disease when large numbers collected together?  The plague in Florence also led to the commissioning of major works of art and architecture from the Medici Grand-ducal family to the more and less affluent, as they paid for chapels, altarpieces, and silver and wax votive offerings. This truly inter-disciplinary study examines the representation of local saints, such as Saint Antoninus, as well as popular votive saints, such as St. Sebastian and San Rocco, in relation to their depiction in other parts of Italy.

Individual Experience and Survival Strategies

Florence Under Siege seeks above all to look behind the optimistic gloss of official printed accounts to examine individual experiences. It recreates the often moving and tragic narratives of the individuals who ran isolation hospitals, the doctors who treated plague victims, and the ordinary men and women left bereft and confused by the sickness and death of family members.

Anon (Orazio Colombo), ‘Punishment and Execution of Untori or Plague-spreaders in Milan’ (1630), after the engraving by ‘Bassano’ or ‘Francesco Vallato’ (Wellcome Collection. CCBY)

Plague on Trial

Analysis of the large corpus of contemporary court records provides fascinating evidence of the numerous survival strategies through which individuals coped with the very real fear generated by a city under siege from an invisible enemy and how they attempted to side-step regulations in order to preserve their possessions and their normal way of life. Examination of detailed trials reveals not just the extraordinary variety of ‘crimes’, but also reveals greater compassion than suggested by the draconian punishments prescribed in law and thus helps to break down the traditional picture of the opposition of rich and poor, the governors and governed.

Reviews of Florence Under Siege by Professor John Henderson

Henderson offers a holistic account of plague in seventeenth-century Florence and reaches important new conclusions about the impact and effectiveness of public health measures. The fine detail of the story makes for a brilliant realisation of devastation, resistance and survival.
Vanessa Harding author of ‘The Dead and the Living in Paris and London, 1500-1670’.

In this vivid account, Henderson brings to life the fearful experiences of Florentines as they prepared, dealt with, and lived through an early modern public health crisis … Essential reading.
Brian Maxson, author of ‘The Humanist World of Renaissance Florence’.

With a keen attention to gender, power and social networks, Henderson traces a vivid picture of resilience and survival through the complex interplay of plague and piety’.
Giulia Calvi, author of ‘Histories of a Plague Year.

Henderson draws on a striking range of sources to present a human-scale fresco. He shows how townspeople, eager to save their souls as much as their skin, strove to cope and survive each in their own way … Re-sets our understanding of what plague meant at every level of early modern society to those caught up in it.
Colin Jones, co-author of ‘The Medical World of Early Modern France’.

Chapter outline:

1. Plague and Public Health in Italy and Europe Plague and Italy’s Reputation in Europe Historians and Plague in Italy Plague in Florence: Themes and Sources

Part I, Florence Under Siege: Coping with Plague

2. The Invasion of Plague in Early Modern Italy Plague approaches Florence:

• Border Controls and cordons sanitaires
• Plague on the Outskirts of Florence, Summer 1630
• Plague Mortality in the City, 1630–1

3. Medicine, the Environment and the Poor Doctors and Diagnosis: ‘A certain sickness with suspicion of contagion’

• Preventive Measures and the Environment
• ‘Filth is the mother of corruption’: The Sanitary Survey, August 1630
• Marginalisation of the Poor: ‘It was not the time to make the body of the city worse with such malign humours, the most inclined towards putrefaction’
• Poverty and Charity: The Growth of ‘misery, necessity and sickness’

4.  Plague and Public Health: Treating the Body of the City and the Body of the Poor

• Official Reactions in August Public Health and Prevention
• The Control of Plague Doctors and Medicine: Treating the Body of the Poor

5. Fighting the Plague

• The Spread and Impact of Plague
• Coping with Death
• Quarantine and the City
• Quarantine and the Countryside

Part II, Religion, Isolation and Survival

6. Religion in the Time of Plague

• The Plague Approaches: The Church and Preventive Measures Plague at its Height and the Practice of Religion
• Celebrating with Sant’Antonino: The Plague Relents
• Plague, Religion and the Grand-Ducal Court: The Cult of Domenica da Paradiso
• Religion and Quarantine: ‘Providing for the health of the soul is more important than [providing for the health] of the body’
• SS. Annunziata and Plague
• The Madonna dell’ Impruneta and the Return of Plague, 1633

7. Lazaretti and Isolation: ‘More feared than death itself’?

• First Experiments and the Hospital of Messer Bonifazio
• The New Isolation and Quarantine Centres Lazaretti: Form and Function
• ‘The medicines in this period play an important role’
• Spiritual Medicine
• Assessing Patient Mortality: ‘More feared than death itself’?
• Life, Death and Serving the Poor Sick: ‘I desire that you pray God for me, because I am suffering under the heaviest of crosses’
• Life in the Lazaretti: The Perspective of the Staff

8. Surviving Plague

• Plague and the Law
• Punishment and Enforcement
• Prosecution: General Categories
• Prosecuting the Popolo

Epilogue: The Return and End of Plague, 1632–3

Book Discount

You can get a substantial discount (£9.00) on the recommended retail price of £30 by using this form (PDF) to order your copy of Florence Under Siege.

John Henderson is Professor of Italian Renaissance History in the Department of History, Classics and Archaeology, Birkbeck, University of London, and Emeritus Fellow of Wolfson College, University of Cambridge. He has published a wide range of books and articles on the social, religious, and medical history of medieval and renaissance Tuscany. Major books include: Piety and Charity in Late Medieval Florence (Clarendon Press, 1994; Italian trans., 1998); Christianity and the Renaissance. Image and Religious Imagination in the Quattrocento, ed. with T.V. Verdon (Syracuse UP, 1990); Poor Women and Children in the European Past, ed. with R. Wall (Routledge, 1994); The Great Pox. The French Disease in Renaissance Europe, with J. Arrizabalaga and R. French (Yale UP, 1997); The Renaissance Hospital. Healing the Body and Healing the Soul (Yale UP, 2006; German trans., 2007; Italian trans., 2016); Plague and the City, ed. with L. Engelmann and C. Lynteris (Routledge, 2018); and Florence Under Siege. Surviving Plague in an Early Modern City (Yale UP, 2019).

The VIII Abrils de l’Hospital – INHH’s 12^th International Conference took place in Barcelona between the 24 and 25 of April. The Conference saw the participation of more than twenty scholars from a broad array of academic, cultural and institutional backgrounds, who presented papers on the interaction of hospitals and traveling. The topic, that gave its name to the conference, was approached from different, yet coherent, perspectives: from medieval pilgrimage routes, Christian or not, to 20^th century medical tourism. This self-conscious attempt at diversity that was not only temporal, but also geographical, with study-cases centred on the Mediterranean, Northern Europe, Southern Africa, the United States or India, to name a few, besides those concerned with the transmission and circulation of models in wider contexts. Methodological concerns were also addressed, emphasizing the importance of network analysis and the potentialities of new digital technologies in the study of hospitals.

Both the paper presentations and the ensuing discussion proofed to be stimulating and fruitful, and, we hope, laid the foundations of something that goes beyond the conference itself.