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Saturday, June 4, 2016

The Ideal Medieval Hospital: St. John of Jerusalem

The Ideal Medieval Hospital: St. John of Jerusalem

While most medieval medical treatment was administered at home, hospitals were not unknown in the Middle Ages. Part-shelter, part-medical centre, medieval hospitals were meant to provide free care for the needy under the strict supervision of a religious order, and the way that they were run would not be unfamiliar to us. Let’s take five minutes to look at what may be the most famous hospital of the Middle Ages: The Hospital of St. John of Jerusalem (all quotes are from the great compilation Medieval Medicine: A Reader).


The Jerusalem Hospital was run by the religious Order of the Hospital of St. John, nicknamed “The Hospitallers” for obvious reasons. Like the Templars, the Hospitallers were one of the orders that sprang up in the Middle East to support the pilgrims and crusaders in the Holy Land as Christians attempted to conquer it. Formally established in the early 12th century, this order still exists today as the Knights of Malta.
Funded by donations from European Christians, The Jerusalem Hospital was staffed by salaried medical practitioners, including doctors (who did morning and evening rounds), surgeons, phlebotomists (bloodletters), and attending brethren (pp.474-477), all required to live by a strict code of chastity, obedience, and poverty, as were other members of religious orders. Believing that they were subservient to the poor and ill, who they had a duty to treat as kindly as they would Christ, the brethren were to give everything they had to aid their patients – even their horses (p.477) and beds. An anonymous cleric who had visited The Jerusalem Hospital wrote of the brethren’s devotion:
It has happened on a number of occasions that when the space … proves insufficient for the multitude of the suffering, the dormitory of the brethren is taken over by the sick and the brethren themselves sleep on the floor. (p.475)
“Hospitality” was the core of their work and paramount to their service, which is the very reason the building was called “hospital” instead of “medical centre”.
Religion, including Christ-like devotion to the poor and suffering, was not only an inseparable part of the hospital’s underlying philosophy, but also its everyday operations. For example, people were given the sacraments when they were admitted (p.463) as a first step in the healing process, and spiritual tending throughout their stay. Though religion was also at the heart of the conflict in the Holy Land, the Hospitallers did not turn away Muslims or Jews who came to them in need of care. The anonymous cleric says,
the sick are gathered together in this House out of every nation, every social condition, and both sexes, so that by the mercy of the Lord the number of lords increase in proportion to the multitude of languages. Indeed, knowing well that the Lord invites all to salvation and wishes none to perish [Ezek.18:32], men of pagan religion find mercy within this holy House if they flock thither, and even Jews. (p.474)
Doubtless, those patients who were not Christian found themselves being spiritually “tended” even as their bodies were being treated, which probably would not have made recovery especially relaxing for them. Still, they were not turned away even in this time of huge religious unrest, which testifies to the way in which the Hospitallers understood their mission of service: everyone should have the opportunity to be rested and healed (and also converted).

Not only did the Hospitallers not turn away patients, but they also actively went out and sought them. As the cleric recounts,
if the vital energies of the sick poor are so exhausted that they cannot go to the Hospital of St. John by their own efforts, they are charitably sought out within the city, and humbly transported by the Hospital servitors. (p.474).
In addition, wounded soldiers were brought to the hospital from their field tents, “transported on camels, horses, mules, and donkeys” (p.477). Only lepers were excluded from the hospital’s care.
In his report on the Jerusalem Hospital, the anonymous cleric criticizes wealthy people who pretended to be poor in order to stay in the hospital. What made it a tempting place to stay was the care with which the staff treated their patients, which extended all the way down to free, comfy bedclothes and slippers. The cleric writes of “feather cushions” which are plumped by attendants, “white linen sheets”,  and “fleecy blankets”, as well as a cloak and goat-skin slippers for trips to the outhouse (p.475). In a time in which wealthy travelers new to the Holy Land would have needed savvy in order to keep their own possessions clean and safe, the hospital would have seemed a tempting place to stay, once you got past the sticky moral problem of lying to a religious house.

Not all medieval hospitals would have lived up to the high standards of The Hospital of St. John of Jerusalem, but this gives you a general picture of what the medieval hospital aspired to be. You can read more about hospitals and other fascinating medical practices in Faith Wallis’ excellent Medieval Medicine: A Reader. If you’re intrigued by medieval hospitals, you may also be interested in the recent facial reconstructions of hospital patients in Edinburgh, Scotland. To find out more about the current form and mission of the Hospitallers, you can check out their homepage.