Medieval monasteries as incubators of the modern hospital - part V
How the "charitable revolution" started the de-monasticization of healthcare
In the years after the St. John hospital in Jerusalem was founded (the 12th century - a first renaissance in which the university and its “scholastics” rose to prominence), a new theology of sickness sprang up: “Like monks, martyrs, saints, and finally apostles, the sick could function as mediators between God and His people. Their intercessional prayers on behalf of patrons and caregivers were believed to be valuable.”[1]
This was an important development, as during that century, in a more urban and more economically stable and flourishing Europe, more and more hospitals were founded by wealthy lay donors. And that was a good thing – the “charitable revolution” of the 12th century – because by the 11th c., monasteries were nearing the end of their hospitaling. The culprit? Economic change:
“For almost 1,000 years, almshouses and hospitals had been organized and run in accordance with highly successful monastic models of prayer and work. Now, in the face of rapid population growth and urbanization, these establishments became inadequate purveyors of traditional charitable assistance. An increasingly urban economy based on commerce that demanded markets, contracts, and currency loans rapidly became the instrument and measure of work. Just at the time their own incomes started to decline, the monasteries’ almonries were overwhelmed by the growing influx of needy individuals, a reflection of new and more complex social and economic conditions affecting the European population.”[2]
The de-monasticization of healthcare, however, did not mean its secularization – at least as we moderns use the term “secular.” Rather, as the scholastics labored in the university to give ethics (as all of theology) a new, more rational basis, 12th-century laypeople, spurred by a newly robust theology that stressed how merciful acts could contribute to one’s salvation, joined en masse in what scholars have called a “charitable revolution.”
During this time, the Matthew 25 parable of the sheep and the goats jumped the fence from church and monastery to the highways and byways. This staple of the preaching friars rapidly became an important motivator of lay charitable activity, in the form of the “Seven Corporal Acts of Mercy.” These comprised the six from Matt 25:31 – 46: feeding the hungry, giving drink to the thirsty, clothing the naked, visiting and ransoming the captive (prisoners), sheltering the homeless, and “visiting” the sick—plus “burying the dead,” from the Book of Tobit. Most catechisms and devotional guides joined the chorus, stereotyping these actions as “the Jesus things to do.”
As thousands of refugees crammed the burgeoning cities, and the clergy and monks struggled mightily against the dramatic rise in poverty that had started in the 11th century, they began to invite laypeople into the holy task of succoring the sick and poor. Thousands of confraternities—lay “clubs” dedicated to charity, mutual support, and Christian devotion—sprang up on the landscape, along with lay penitential groups that also performed charitable acts. This new movement amounted to the creation of a public social safety net in European cities, as care for others’ physical needs increasingly came to be seen as the Christian duty of all people. Popes even issued “plenary indulgences”—time off of purgatory—for visiting the sick.
Initially the new lay institutions – leper houses, hospitals, hostels—operated alongside monastic and parish-based houses. By the 1300s, however, lay organizations increasingly replaced church-led ones.[3]
“Charity,” which today usually means giving money to a good cause, was a key theological term in this period – in Latin: Caritas. Quite simply, it meant self-giving love—agape—directed first and most importantly toward God, and then (as a result) at one’s neighbor. For medieval Christians, its special objects were “those within society who were regarded as vulnerable, degraded, or in serious material need.”[4]
For the early and medieval church, alms—money given to the poor—had been only one part of the real meaning of charity. Hospitals had slowly become “the concrete expression, in bricks and mortar, of Christ’s teaching on charity.”[5] Now laypeople flocked to this concrete expression of Christ’s teaching: lords, nights, and townspeople founded hospitals, left bequests to them in their wills, and worked in them. England boasted only 68 hospitals in 1150, but 252 in 1200, 389 by 1250, and close to 500 by 1300. By the time the Black Death devastated that nation in 1348, it had reached a peak of 541 hospitals.[6]
Many of these new hospitals were small, but all were “predicated in some way on the seven works of mercy.” Some were leper houses, some served a wider (and often poor) constituency, and some dedicated themselves exclusively to the succor of the poor.[7] Historian Adam Davis studied 13th-century wills in Flanders and found that a full 85% of them included some kind of charitable giving, on behalf of “lepers, hospitals, widows, the ransoming of captives,” with almost half leaving money to at least one hospital. One wealthy Parisian merchant couple “not only founded a hospital for poor widows, but left testamentary bequests to lepers, the blind, students who were without support, those suffering from ergotism [a fungus-caused illness marked by convulsions and gangrene], the poor who had fallen on hard times, hospices for the sick, poor girls who wished to marry, orphans, and prisoners.” [Adam J. Davis, “Hospitals, Charity, and the Culture of Compassion in the Twelfth and Thirteenth Centuries,” Approaches to Poverty in Medieval Europe Complexities, Contradictions, Transformations, c. 1100–1500, ed. Sharon Farmer (Brepols, 2016), 23-45]
[1] Risse, 106.
[2] Risse, 107.
[3] Risse, 109.
[4] James William Brodman, Charity and Religion in Medieval Europe (CUA Press, 2009), 2.
[5] Carole Rawcilffe, Medicine for the Soul: The Life, death and resurrection of an English medieval hospital, St Giles’s, Norwich, c. 1249-1550 (Stroud: Sutton, 1999), 5.
[6] Nicholas Orme & Margaret Webster, The English Hospital: 1070 – 1570, 35.
[7] Sheila Sweetinburgh, The Role of the Hospital in Medieval England: Gift-giving and the Spiritual Economy (Four Courts Press, 2004), 21-22.