Charity and Welfare: Hospitals and the Poor in Medieval Catalonia (review)

Potential readers should know that this book’s title is a more accurate guide to its contents than is its subtitle: hospitals are only one form that the caritative impulse took in medieval society, along with the distribution of food, clothing, and money to the needy, all of which are considered here. And the book does more, too, than simply consider medieval Catalonia, although certainly that is its focus: Professor Brodman regularly relates his account to other medieval societies—sometimes so that he can fill in gaps in his own material, sometimes in order to depict the Catalan world as either normal or distinctive.

The picture Brodman draws is one of changes over the period from the late eleventh to the fifteenth century. These include an increasing insistence on distinguishing between the deserving and undeserving poor, and the emergence of social policies favoring assistance to the former, so that, to a certain degree, charity began to turn into welfare; the transition from private to ecclesiastical or municipal control; the move from clerical to lay administration of services to the needy, and the replacement of voluntary by municipal funding; and the evolution of “hospitals” from shelters for pilgrims and the poor into institutions sometimes offering care to specific groups (e.g., orphans) and providing medical attention to the sick—by the end of the period, some of them were very large in size, and were typically operated by salaried staff. As Brodman presents these changes, they are all simply tendencies, not sharply demarcated transitions, and he is unwilling to agree with historians like Agustín Rubio Vela and Miri Rubin who he thinks interpret them as indicators of a new “secularization” of assistance; for him, charitable and pragmatic motives continued to intermingle in late medieval practices.

Readers of the Bulletin are likely to be most interested in Charity and Welfare’s discussion of medieval hospitals in Catalonia and elsewhere. The term is bound to be a misleading one in application to the Middle Ages, because for us today it is automatically associated with medical services, and Professor Brodman is careful to insist that before 1300 or so it should instead be understood to mean a public shelter open to those needing lodging—travelers, and the poor or homeless. In Catalonia such foundations can be traced back to at least the tenth century, and by the thirteenth century they existed in every Catalan community of any importance, from Barcelona and Girona to Vic and Manresa. The sick might of course be housed in such a shelter, but only because they needed housing, not because they were sick, and no medical care was provided to them. To be sure, separate shelters had been operated outside towns for the growing number of lepers since the mid-twelfth century, beginning in Barcelona and Girona, but here too only maintenance was provided, not medical treatment.

It was not before the middle of the fourteenth century that Catalan hospitals—apparently first of all in Tortosa—suddenly started to contract with physicians and other medical personnel to attend the sick poor residing there. The medicalization of the hospital had begun here as elsewhere in Europe (but only begun: the fifteenth-century institution might still make provision for the merely poor as well as for the ill). Brodman explains this transformation by saying that it depended on the professionalization of the health occupations that immediately preceded it (pp. 86, 98), but his argument is little more than post hoc, propter hoc, and I find it somewhat unsatisfying; might not both these phenomena be consequences of medieval Europe’s emerging conviction that medical care was of real benefit to those treated? If so, the introduction of medical personnel into the hospitals would only reinforce his larger argument, that late medieval charity was not merely a matter of enlightened selfishness, but one of genuine concern for the poor.