Charity and Religion in Medieval Europe

2. A Cascade of Hospitals

2 A Cascade of Hospitals The High Middle Ages gave birth to the ancestor of the modern hospital. While, for much of this period, the term hospital is to be understood by its root meaning—that is, as a place of shelter rather than a locus of care—every town and many villages and rural locales came to possess one or more of these institutions . The initiative for their foundation can be attributed to no single segment of medieval society, for we can count among their benefactors, bishops, cathedral chapters , monasteries and religious orders, and pious laypeople , as well as religious, professional, and municipal associations . As shelters, hospitals were meant to house, first of all, pilgrims and travelers, but as institutions grew more numerous and complex, they also began to serve orphans, the aged, those who suffered from chronic diseases such as leprosy and ergotism, the victims of famine and unemployment , and eventually the insane and those stricken with the plague. Compared to modern or even early modern institutions, these medieval houses of charity were small and were tied more to their local community than to any larger entity. Many were served by men and women 45 46  a cascade of hospitals who lived as consecrated religious, although there were also those who worked for pay. So pervasive and diverse was the hospitaller phenomenon in the Middle Ages that it almost defies generalization. Medieval hospitals, even those that fell under secular governance, had a religious character.1 Undoubtedly this is due to their early association with bishops and monasteries. In most regions, the first known hospitals and almshouses were tied to cathedrals, and frequently these grew into the largest and most important local institutions that provided relief to the poor. When the episcopal foundation was eventually augmented by others of different patronage that may have targeted special categories of the needy, such as “the deserving poor,” it was this original institution that often continued to serve as the charity of last resort. Furthermore, even hospitals that fell outside of direct ecclesiastical governance often remained subject to some form of episcopal oversight and regulation. Here our purpose is not to essay a general history of hospitals but to examine their religious character. There are several explanations for the prominence of episcopal charity in the history of western welfare. As we have seen in chapter 1, the most basic is rooted in the biblical imperative to feed the hungry and clothe the naked. Prior to legalization and subsequent imperial patronage in the fourth century, the patristic Church, under its bishops and deacons, accepted a responsibility toward widows, orphans, and others unable to provide for their own basic needs. Late imperial bishops, such as Augustine of Hippo and Ambrose of Milan, enunciated this obligation in their writings. For example, the former says: “The things of which we have charge do not belong to us but to the poor.” After the collapse of the Roman imperial infrastructure in the West after the fifth century, episcopal sees and monasteries remained as almost the sole institutional support for those on the margins of society . Even with the appearance of new secular institutions at the advent of the second millennium, the urban character of the episcopal office placed bishops and cathedral chapters in a key position to observe 1. For example, King Alfonso X of Castile in his Las Siete Partidas, a large mid-thirteenth century compendium of law, states that hospitals are religious because “the acts and works of piety” are performed in them. Las Siete Partidas, 1.12.2, p. 169. a cascade of hospitals 47 the consequences of municipal revival in the eleventh and twelfth centuries : the migration of peasants displaced from the countryside, the weakening of the extended family and its social safety net, the cyclic nature of an emerging capitalist economy, the expansion of commercial and religious travel (pilgrimage), and the magnetic attraction of towns in times of famine. Thus, this period of social and demographic gestation gave rise to classes who came to be considered poor in the modern sense, that is, lacking the material support enjoyed by their peers through dint of circumstance, not choice. Coincidently, within the Church, the clergy itself was undergoing an ideological and structural reform that made it more attuned to the material needs of society . Finally, secular, municipal institutions were too immature before 1200 or 1300 to challenge, supplant, or augment episcopal initiatives...