The Role of the Hospital in Medieval England: Gift-Giving and the Spiritual Economy (review)

English hospitals were centers of caring rather than curing well into the eighteenth century. There is little evidence of medical practitioners at any medieval English hospital; the medicine offered was that of the soul not of the body. One should therefore expect a study of the role of the hospital in medieval England to say little about the history of medicine and much more about the history of piety. There have been several studies of poor relief and charity in regions of medieval England in the past two decades, many of them making use of the concept—anthropological in origin—of gift exchange: Donors enriched religious foundations in return for spiritual gifts such as intercessory prayer, confraternity, burial, and hospitality. It is on this gift-giving in its wider religious context—the spiritual economy— that Sweetinburgh focuses in this book.

After a short introduction that briefly establishes the methodological approach, the first chapter provides a survey of hospitals in medieval England, describing the foundation and patronage of the four main types of hospital: almshouses, leper houses, pilgrim hostels, and houses for the poor. Hospitals in Wiltshire and Warwickshire are used as case studies. The second chapter similarly surveys the hospitals of medieval Kent, the area of primary interest in this study, identifying two key regions for hospital foundation: Canterbury and the Cinque Ports in East Kent; and locations along Watling Street in North Kent between London and Faversham. The third and fourth chapters focus on the hospitals of the first region, especially those of Dover and Sandwich. These last two chapters form by far the most original half of the book, providing insight into patterns of patronage across the centuries in very particular urban contexts. The book ends with a conclusion that mostly summarizes the chapters.

Sweetinburgh's book is not really about the role of the hospital in medieval England but about the role played by hospitals in a very specific part of Kent. One gets the impression that the relatively limited evidence available has led to the inclusion of unnecessary padding. Are the hospitals of land-bound Warwickshire and Wiltshire really comparable with those of important channel ports? Although Sweetinburgh explains in the introduction that the Victoria County History series has influenced study of medieval English hospitals with variable results, she remains deeply bound to a county-based analysis. There were a number of ways the original research in this work could have been presented more usefully. First, ideas touched on in the introduction could have been explored more critically throughout. The concept of gift-giving that underpins the book is glossed over in a couple of paragraphs. Second, historical debates about piety and the decline or transformation of charitable giving in the late Middle Ages are mentioned in the introduction but not discussed further. It is not clear where Sweetinburgh stands in these debates because she does not return to them in the conclusion. Her copious footnotes indicate that she has read many works dealing with these topics, but she uses their data more than she engages with their arguments. This book could have been made far more interesting by using some of the examples in the notes to illustrate arguments more effectively. More discussion of the sources and greater use of other kinds of sources—for example, archaeological, liturgical, and literary— would also have provided much more context for changing patterns of medieval piety and charitable giving. It is not entirely clear whether Sweetinburgh really understands some aspects of medieval religion, because she scarcely mentions Purgatory; yet belief in Purgatory helps explain the whole spiritual economy. Also, more than once she refers anachronistically to the Vatican in the context of the twelfth- and thirteenth-century papacy.

Despite these problems, the third and fourth chapters of this book are indeed detailed studies of pious behavior in Dover and Sandwich that deserve some attention. Probably one of the most fascinating insights...