Abstract
The decline of the Roman Empire signaled many changes for Western Europe, including the evolution of the early medieval hospital. Prior to the early Middle Ages, hospitals and healthcare were the responsibility of governments and private individuals. A lack of stabilizing forces c. 500 CE obliged others to provide healthcare. Christians, and especially monasteries, took up the reins; the concern that Christians had for those less fortunate merged with the Roman notion of Amor civicus , love for one’s city. The end of the early Middle Ages witnessed a major change as new concepts of healthcare, from Byzantium, and medical treatises, especially from the Islamic world, made their way into Italy, setting the stage for an explosion of lay hospitals in the next two hundred years.
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Notes
- 1.
Brown, Through the Eye of a Needle, 63.
- 2.
Brown, Through the Eye of a Needle, 64.
- 3.
Men and women, lay and religious alike, contributed to the growing tradition— Amor civicus was not limited to church figures alone. While some early hospitals were available to the masses, those who wished to receive care at home relied on women. For example, even early in the history of Christian healthcare, “the Roman aristocrat Fabiola, praised by Jerome, showed her Christian devotion by founding a hospital and nursing in it.” See Gillian Clark, Women in Late Antiquity: Pagan and Christian Life-Styles (Oxford: Clarendon Press, 1993), 68.
- 4.
Victor of Vita, History of the Persecution of the Province of Africa, “The Charity of Deogratias, Bishop of Carthage, to the Captives Brought from Rome by the Vandals,” 1.24–6 in Readings in Late Antiquity: A Sourcebook, ed. Michael Maas (New York: Routledge, 2000), 311–312.
- 5.
“Episcopal organization of charitable institutions,” 12.10, Lives of the Holy Fathers of Merida, 5.3 in Pagans and Christians in Late Antiquity: A Sourcebook, ed. A. D. Lee (New York: Routledge Press, 2000), 225–226.
- 6.
Ibid.
- 7.
This term is borrowed from Peter Brown. See Peter Brown, The Making of Late Antiquity (Cambridge: Harvard University Press, 1978), especially chapter 3.
- 8.
Crislip, From Monastery to Hospital, 39. “Early monastic leaders obsessed over sickness and health. A deep concern with illness runs through all early monastic literature, the lives, rules, instructions, and homilies.” It should be noted that at the monastic hospital, the main concern was for the soul, yet, patients were given basic treatments, including those most employed by the earliest of peoples: cleaning, bandaging, and plastering/setting bones. Herbal remedies were provided and prayers, or invocations to Christ, were said. For herbal remedies, see, for example, the works of Matthew Platearius, Circa instans. Matthew was the chief authority on pharmaceutical ingredients, or material medica. His work survives in hundreds of extant copies in Latin and many other translated into a variety of European languages. Matthew Platearus, Circa instans, in Medieval Italy: Texts in Translation, 316–321.
- 9.
Crislip, From Monastery to Hospital, 39.
- 10.
Crislip, From Monastery to Hospital, 3.
- 11.
Crislip, From Monastery to Hospital, 8.
- 12.
Crislip, From Monastery to Hospital, 8. Crislip further notes that “the health care system stands among the defining characteristics of Christian monasticism, in evidence from the very beginnings of monastic social organization in the early fourth century. It attracted the notice of contemporary commentators and monastic theorists alike. Its breadth of treatments, its organizational scope, and its guarantee of compassionate care throughout the life cycle set monastic health care in stark contrast with the healing affording in nonmonastic society.” Crislip, From Monastery to Hospital, 9.
- 13.
Crislip, From Monastery to Hospital, 99.
- 14.
Crislip, From Monastery to Hospital, 100.
- 15.
Crislip, From Monastery to Hospital, 32. For more on Coptic Medicine, see Martin Krause, “Papyri Coptic Medical,” CE, 1886–1888. For more on Ancient Egyptian medicine, see Nunn, Ancient Egyptian Medicine.
- 16.
Crislip, From Monastery to Hospital, 10.
- 17.
Crislip, From Monastery to Hospital, 102.
- 18.
Crislip, From Monastery to Hospital, 11.
- 19.
Crislip, From Monastery to Hospital, 101–102.
- 20.
Crislip, From Monastery to Hospital, 14.
- 21.
Pachomian Komonia, Vol. 1: The Life of Saint Pachomius and His Disciples, trans. Armaund Veilleux (Kalamazoo: Cistercian Publications, 1980), 29.
- 22.
Crislip, From Monastery to Hospital, 39.
- 23.
Crislip, From Monastery to Hospital, 41.
- 24.
Crislip, From Monastery to Hospital, 103.
- 25.
See Sozomen 6.34; Firmus of Caesarea, Ep. 43 (SC 340). While there is some debate as to if this was indeed the first hospital, it is clear that this is the first hospital for which significant evidence survives. See Crislip, From Monastery to Hospital, 103.
- 26.
Ep. 150, tr. Deferrari, alt. in Andrew T. Crislip, From Monastery to Hospital, 190.
- 27.
Crislip, From Monastery to Hospital, 104.
- 28.
Crislip, From Monastery to Hospital, 105–106.
- 29.
Crislip, From Monastery to Hospital, 118.
- 30.
Ibid.
- 31.
Crislip, From Monastery to Hospital, 140.
- 32.
It should be noted that while the Benedictine Rule was most widely used and followed in early Western Christendom, most hospitals and associations of men and women in hospitals later followed the Augustinian Rule. The Augustinian Rule does not provide the detail that Benedict’s Rule does on caring for the sick, but the Augustinian Rule emphasizes cleanliness and requests that, when needed, a doctor should be consulted. The Augustinian Rule also allows a sick brother to have whatever from the pantry that is seen as necessary for his recovery. See The Rule of Saint Augustine , “Chapter Five: The Care of Community Goods and Treatment of the Sick,” Robert Russell trans., from Luc Verheijen, La regle de saint Augustin, Etudes Augustiniennes (Paris, 1967).
- 33.
See also Benedict, The Holy Rule of St. Benedict, trans. Reverend Boniface Verheyen (1949), accessed 17 May 2017 at http://www.kansasmonks.org/RuleOfStBenedict.html#ch4. For more on Benedictianism, see Marilyn Dunn, The Emergence of Monasticism: From the Desert Fathers to the Early Middle Ages (Oxford: Blackwell Publishing, 2003), 111–137.
- 34.
Matthew 25:36, NSV.
- 35.
Matthew 25:40, NSV. See also Benedict, The Holy Rule of St. Benedict, trans. Reverend Boniface Verheyen (1949), accessed 17 May 2017 at http://www.kansasmonks.org/RuleOfStBenedict.html#ch36.
- 36.
Benedict, The Holy Rule of St. Benedict.
- 37.
Ibid.
- 38.
Ibid.
- 39.
Ibid.
- 40.
Ibid.
- 41.
Ibid.
- 42.
Ibid.
- 43.
Ibid.
- 44.
Thompson and Goldin, The Hospital: A Social and Architectural History, 11.
- 45.
Thompson and Goldin, The Hospital: A Social and Architectural History, 15.
- 46.
Thompson and Goldin, The Hospital: A Social and Architectural History, 11.
- 47.
Patrick J. Geary, Living with the Dead in the Middle Ages (Ithaca: Cornell University Press, 1994), 77. Regarding earlier works on gift-giving in the early Middle Ages, see Georges Duby, “Taking, Giving and Consecrating,” in The Early Growth of the European Economy, trans. Howard B. Clarke (Ithaca, NY, 1974), 48–57; Marcel Mauss, The Gift: Forms and Functions of Exchange in Archaic Societies, trans. Ian Cunnison (New York, 1967).
- 48.
The uniqueness of the church, charity, and endowments led to the idea of the municipal hospital within the context of the city. This is key later when we discuss land endowments to the hospital of Saint John. The endowments were a type of piety.
- 49.
Georges Goyau, “Councils of Orléans,” The Catholic Encyclopedia, Vol. 11 (New York: Robert Appleton Company, 1911), accessed 8 September 2008 at http://www.newadvent.org/cathen/11318a.htm.
- 50.
For more on Clovis II’s charters, see Barbara H. Rosenwein, Emotional Communities in the Early Middle Ages (Ithaca: Cornell University Press, 2006), 146.
- 51.
The charter, as noted by Rosenwein, uses the terms timor and amor, going back to the ideas of love for one’s city. See Rosenwein, Emotional Communities, 146.
- 52.
The Hôtel-Dieu of Paris remains the oldest hospital in Paris up to this day, as well as the oldest hospital still in operation worldwide.
- 53.
While 1220 is a fairly firm date, others have suggested that the Hôtel-Dieu may have received the statutes as early as 1217 or as late as 1221. See below for more information.
- 54.
Rome Across Time and Space: Cultural Transmission and the Exchange of Ideas, c. 500–1400, eds. Claudia Bolgia, Roasmond McKitterick, and John Osborne (Cambridge: Cambridge University Press, 2011), 236.
- 55.
By and large, some of the most sophisticated medical practices and treatises were those of the Greco-Arabic tradition. This includes the work of Ibn Rushd, or Averroes (1120–1198 CE), a physician in Moorish Spain, Al-Razi, or Rhazes (865–924 CE), a Persian physician, chemist and alchemist and Hakim Ibn Sina, or Avicenna. Avicenna wrote The Canon of Medicine. Later, Avicenna’s works, as well as those of other scholars, were transmitted into the West through Muslim Spain and via the Crusades. Avicenna’s Canon was used widely in European medical schools. National Library of Medicine, “Islamic Culture and the Medical Arts: Hospitals,” accessed 10 August 2016, https://www.nlm.nih.gov/exhibition/islamic_medical/islamic_12.html.
- 56.
Miller, The Birth of the Hospital in the Byzantine Empire, xi. I have chosen to focus on Miller’s Introduction to the 1997 edition of his texts as an overview of Byzantine hospitals, as the introduction succinctly presents his arguments in a fashion that is useful for summary. Miller also answers some of the questions raised by the critics of the first edition and posits new questions for ongoing research, both of which are relevant to this work.
- 57.
Miller, The Birth of the Hospital in the Byzantine Empire, xi.
- 58.
Ibid.
- 59.
Miller, The Birth of the Hospital in the Byzantine Empire, xii.
- 60.
While Miller presents this argument here for Byzantine hospitals, I will present a similar argument for Western hospitals in the later chapters.
- 61.
The most prominent of the Byzantine hospitals was that of the Pantokrator Xenon. Critics of Miller have argued that his work on Byzantine healthcare has relied too much on this particular institution, whereas the other xenones might not have exemplified hospital care as the Pantokrator did. Most maintain that the Pantokrator Xenon was unique. Miller combats these ideas with an argument that finds parallels in the West. There exist sources that talk about the Pantokrator Xenon as ideal, but not the exemplar among the hospitals of Byzantium (see, for example, the vita of Empress Eirene—Vita imperatoris Irenes in Robert Volk, Gesundheitswesen und Woltätigkeit im Spiegel der byzantinischedn Klostertypika. Miscellanea Byzantina Monacensia, 28. Munich: Institut für Byzantinisik, neugriechische Philologie, und byzantinische Kunstgeschichte der Universität Müchen, 1983, 191). This is similar to Jacques de Vitry’s account of hospitals in the West. Miller also shows that the Pantokrator Xenon was indeed not unique, and there were hospitals that both copied and outdid it. For more on Miller’s view of the Pantokrator Xenon, see Miller, The Birth of the Hospital in the Byzantine Empire, 12–29.
- 62.
For more on Greek monastic rules, see Robert Volk, Gesundheitswesen und Woltätigkeit im Spiegel der byzantinischedn Klostertypika. Miscellanea Byzantina Monacensia, 28. Munich: Institut für Byzantinisik, neugriechische Philologie, und byzantinische Kunstgeschichte der Universität Müchen, 1983.
- 63.
Miller, The Birth of the Hospital in the Byzantine Empire, xiii. For more on the Pantokrator Typikon, see Paul Gautier, “Le typikon du Christ Sauveur Pantocrator,” REB 32 (1974), 1–145. The rules are incredibly similar to those of the hospitals of the West during the high Middle Ages, addressing the habits of the brothers, election of the superior, care for sick brothers, occupations within the hospital ward, etc. We do know, for example and in comparison, that the Hotel-Dieu of Paris paid its physicians to treat the patients. We know this from the hospital statutes, and we can assume from this that most places did something similar. Paris had in-house doctors who served the patients: “donec sanitati restituatur” while the physicians at the hospital of Saint John could only be called in particular instances. This was probably due to the major difference in size. Statuta domus Dei Pariensis, Cap. 21, accessed 17 November 2017, http://rosenwelten.de/stud_hist/editionen/paris.html.
- 64.
Miller, The Birth of the Hospital in the Byzantine Empire, xv.
- 65.
Timothy S. Miller, The Birth of the Hospital in the Byzantine Empire, xvi.
- 66.
Timothy S. Miller, The Birth of the Hospital in the Byzantine Empire, xvii. See specifically, the writings of Nicholas of Cusa (1401–1464) who met a Turk who was described as supermus praeerat hospitalibus. This suggests that there was even a transference of efforts from the Byzantines to the Muslims. See Miller Timothy S. Miller, The Birth of the Hospital in the Byzantine Empire, xvii–xviii.
- 67.
Timothy S. Miller, The Birth of the Hospital in the Byzantine Empire, xvii. This evidence comes to us from Philotheos Kokkinos, the Patriarch of Constantinople from 1354 to 1355.
- 68.
Timothy S. Miller, The Birth of the Hospital in the Byzantine Empire, xviii. There is evidence of wealth patrons and even the poor and sick who later come back to donate to the hospitals.
- 69.
The Vita Notgeri episcope Leodiensis is a poem from the period of the invasions in which the author of the poem assigns the role of the protection of the poor to the bishop. Legislation from the ninth and tenth centuries also insists on the bishop in this role. See Pierre de Spiegeler, Les Hôpitaux et l’Assistance à Liège (Xe-Xve Siècles): Aspects Institutionnels et Sociaux (Paris: Sociéte d’Edition “Les Belles Lettres,” 1987), 39.
- 70.
Medieval Italy: Texts in Translation, eds. Katherine L. Jansen, Joanna Drell, and Frances Andrews (Philadelphia: University of Pennsylvania Press, 2009), 311.
- 71.
Medieval Italy: Texts in Translation, 323.
- 72.
For more on Constantine, see Peter the Deacon, “Biography of Constantine the African,” in Medieval Italy: Texts in Translation, 312–314.
- 73.
See, for example, the works of Matthew Platearius, Circa instans. Matthew was the chief authority on pharmaceutical ingredients, or material medica. His work survives in hundreds of extant copies in Latin and many other translated into a variety of European languages. Matthew Platearus, Circa instans, in Medieval Italy: Texts in Translation, 316–321.
- 74.
The pig was believed to be “similar in their internal structures, in regard to the position of the internal organs none were found so similar [to humans] as pigs.” Matthew Platearus, Circa instans, in Medieval Italy: Texts in Translation, 321. Most of what was known was through Galen, as identified above.
- 75.
Copho (attributed), “Anatomy of the Pig,” in Medieval Italy: Texts in Translation, 322.
- 76.
Copho (attributed), “Anatomy of the Pig,” in Medieval Italy: Texts in Translation, 322–323.
- 77.
Medieval Italy: Texts in Translation, 323. Some women did receive medical license, which, as indicated by Jansen, Drell, and Andrews, came through practice.
- 78.
Trota (?), “Obstetrical Excerpts from the Salernitan Compendium,” in Medieval Italy: Texts in Translation, 314–315.
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Ziegler, T.A. (2018). Early Medieval Charitable Institutions and Hospitals, c. 500–1000 CE. In: Medieval Healthcare and the Rise of Charitable Institutions. The New Middle Ages. Palgrave Pivot, Cham. https://doi.org/10.1007/978-3-030-02056-9_3
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