Book Review

The English Hospital, 1070–1570

N Engl J Med 1996; 334:127-128January 11, 1996

Article

The English Hospital, 1070–1570
By Nicholas Orme and Margaret Webster. 308 pp., illustrated. new Haven, Conn., Yale University Press, 1995. $45. ISBN: 0-300-06058-0

Professor Orme of the department of history at Exeter University and his associate Margaret Webster provide an inclusive, scholarly account of the hospitals of England in the clerically dominated centuries before the Reformation. At that historic watershed, just as the mighty abbeys and monasteries fell before Henry VIII, Defender of the Faith, so too the large number of hospitals in England, 585 or more, of which a few approached the monasteries in size and social position, found themselves under devastating attack.

In the Middle Ages hospitals were religious houses with varying degrees of clerical direction. The word “hospital” was derived from the Latin hospes, meaning both host and guest. A hospital was a place that practiced hospitality. In one mode, hospitality meant ministering to the needs of travelers, often those on pilgrimages, and in one unusual setting — St. Giles in the Fields — prisoners on the way to the gallows. Of equal importance to the care of travelers was the total care of the poor, especially those who were ill or disabled. In a separate category, hospitals were given over to the housing and treatment of lepers, of whom there were a surprisingly large number in medieval England. Regulations governing who should found a hospital, for what purpose, and with what organizational structure were more honored in the breach than in the observance. Hospitals were related to the prosperity of towns and were suburban in a medieval sense, isolated and poorly policed. Though ostensibly administered by clergy, this was often in name only and, as was later proved in the Reformation, a point of weakness.

The authors have organized their studies systematically in well-defined chapters. For example, chapter 3 deals with the function of the hospital, emphasizing worship as much as care, with cure a very low priority. Doctors and surgeons were rarely involved, and education and learning were relatively unimportant. Chapter 4 emphasizes the lack of organizational uniformity, though the rule of St. Augustine predominated. By 1300 most of the heads of hospitals were well paid. Women, rarely in leadership positions, were most commonly engaged as “sisters” similar to nuns. In the matter of resources, fund-raising for hospitals had a remarkably modern tone, but also included indulgences, sold with a certain amount of discretion. One chapter describes the inmates. Diversity was again the rule, with hospitals for Moslems, Jewish converts, the mentally retarded, the blind, those who were crippled, single mothers, young women who “had done amiss,” and so forth. There is no mention of cancer or tuberculosis.

The authors devote an appropriate amount of space to descriptions of leprosy, or what passed for leprosy, which was endemic in Britain in the period under consideration. Their account of the black Death of the mid-14th century is relatively low-key, though the plague was an important prelude to the secularization of the hospitals and the crises of the Reformation. The latter reflected, of course, the troubled times of the Tudor succession, which led to the decimation of the religious houses and the now secular hospitals, to the royal advantage. There is an excellent account of Henry VII's special project, the Savoy Hospital in London, now the site of the justly famous Hotel Savoy.

The final third of the book is devoted to a descriptive catalogue of the hospitals of southwest England — Cornwall, Devon, and particularly Exeter. Necessarily repetitive of the all-England part of the book, it should be of immense interest and value to serious scholars.

Taken altogether the book is generously and crisply illustrated, packed with detail, and superbly documented and indexed. Though directed toward scholars, it will reward the serious general reader with highlights such as the poem by Robert Copland, The Highway to the Spitalhouse, published in London in about 1530. Only two copies survive of this vivid recreation of pre-Reformation times. It should improve one's regard for the modern hospital.

J. Gordon Scannell, M.D.
Massachusetts General Hospital, Boston, MA 02114