Medieval Hospitals of London

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This lecture looks at the birth of hospitals in London in the Medieval period. Considered are such questions as how hospitals came out of - and at one point competed with - the church, what they offered, who they offered it to, and to what (suprisingly high) standard they offered their health care.

Part of the Safeguarding London's Health, Monday's at One lecture series. Other lectures in this series are:    
   The Origins of the NHS, by Professor Virginia Berridge 
   London's Hospitals Today, by Geoffrey Rivett
   The Future of London's Hospitals, by Dr Patricia Oakley

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William Ayliffe


Medieval Hospitals of London

We are going to see during the Medieval period that although the era was nothing like our own, it is very tempting to draw very many similes between that period and ours.  We must be cautious when we do it, however, but nevertheless, we will see in future lectures how very similar certain issues are. 

Before I talk about the situation in London, I would like to talk about what exactly a medieval hospital was, how they were founded and what occurred in the country.  Once I have done that, then I am going to talk about the London hospitals before addressing what happened in the falling apart of the situation and then, finally, the dissolution.

A medieval hospital was either a single building or a group of buildings which was there to provide spiritual care.  It sounds a little strange but actually medicine was rather down on the list of things that a hospital had to do.  The word 'hospital' derives from hospes, a stranger or guest, and this comes from the medieval tradition of travellers being given food and lodging at monasteries on their way to various shrines throughout Europe and even into the Middle East.  These travellers may not necessarily have been sick, but by the time they had been on the roads of England and Europe, they certainly were likely to be sick and some of them required more than just an overnight stay.  It is rather difficult to throw out somebody who is half-dead onto the street and say "You've had your overnight", and so more and more beds were required to accommodate these people within the hospitals.  These were attached to the monasteries, so the monasteries got rather fed up of this and wanted to found some places outside the monastery walls, not within, because their hospitals inside the monastery walls were for their own monks and their own people.  This was really the start of when particular buildings started to be founded. 

An example of such institutions include ones founded by the knights for lepers, forming one of the great foundations down in the South of France, only to be destroyed just after the Napoleonic Wars.  There is also the Maison Dieu in Ospring on the way to Kent.  Maison Dieu is the Anglo-Norman for the "House of God" or "Domus Dei".  This is where travellers on their way to the Continent would stay overnight and, again, it was mainly for spiritual care. There was a chapel and it was absolutely essential that you attended chapel, but you would be fed, you would be watered, you would be given a bed for the night, and then you were on your way to Dover and then on to the Continent.  Just behind this early hospital at Ospring remains the remains of the most complete archaeological remains we have of any medieval hospital, and we will come to that later.

Travelling and alms were a part of English culture.  It has been a part of English culture in the great Saxon times, and even lay houses used to provide beer and bread to travellers as they were going through the country.  But, as well as this, the ecclesiastical role cannot be underestimated.  Three hospitals - St Mary's within Cripplegate, St Mary's at Bishopsgate, and Maiden Bradley, the non-London hospital - used to attend the main chapter meetings of the Augustinian order.  They were regarded in exactly the same way as the great monasteries were regarded.  There was no difference between this function of a hospital and a monastic function, and that is quite different from how we view hospitals today.  These were religious organisations that accidentally would look after you if you were sick.  Their main function was to look after the spiritual care, and if you happened to be too sick to go home, you stayed in and you became a sick lay member of that community until you died.  Their other job of course was to bury you.

The distinction between hospitals and religious houses was therefore a matter of degree rather than of kind, and looking back through medieval literature, it is very difficult for historians to tell what was a hospital.  Sometimes they are described as a chapel; sometimes they are described as a college. It is only later archaeological evidence comes out, and some of this has been done quite recently, particularly in Bristol, with the Lord Mayor's Chapel which turns out to have been the main body of the hospital in Bristol. 

There were many types of hospitals, as we have mentioned before.  They could be founded by a number of people: the king, church corporations and not necessarily monastic, the great military orders (of which St Thomas Acon, was the great example in London and was the largest one in the early medieval period).  St Mary Bethlem was founded by the military order before it mutated into a specialist hospital for lunatics.  So there were many types.  Some provided care - these were called 'hospitale simplex'; others provided religious care.  They nearly all followed the rule of Augustine because this allowed the monks time to look after the sick.  Many of the other orders were too busy praying and doing other religious duties to have any time at all to look after the sick, which explains why Augustinian canons were the most common type of people involved in this process.  They nearly always had a master, and we will see later that that master did not necessarily have to live on site, and that created many of the problems.  They were staffed by lay brothers, and often sisters in a mixed hospital such as St Bart's.  For the poor, there were specific groups. There were lepers, the conversei, who were the converted Jews, and blind priests.  There were several other functions as well: they were also communities of clergy and lay people; they had fraternities present; they acted as churches for the local population; they had chapels; they had a caring role; and also an educational role. 

The words in English are quite interesting - "hospitali" mutated into "Spital" or "Spital House" or "Spittal" with a double "t", which was particularly a house for beggars in the later medieval period, the derogation that it was slightly lower class.  The Domus Dei, in English, as we mentioned before; the Maison Dieu; and the Domus elemosinarie, which mutated into the English "almshouse", the one in the City of London being the first to actually put those two words together in English.

We have mentioned that there were several functions.  Worship was extremely important.  There would have been prayer at the one end led by a priest and in the aisles would be where the patients are housed.  This is a very typical pattern.  Most medieval hospitals of any size at all, twelve and above, conformed to this pattern.  To you or me, looking at such a building now, we would think it was a church: it looks like a church; it smells like a church; it acts like a church.  If we had wandered into it in the medieval period, we would have thought it was a church as well, apart from being littered with these poor sick people on either side of the aisles.  Church services were held according to the seven daily service, plus extras.  There was a lot of church going on in this.  There were also masses.  Later on, in the 1300s, chantry priests were added to the equation, and they were singing and chanting away there too.  So perhaps it is best for us to imagine it as something like a few sick people littering a church. 

Furthermore, many people visited these buildings because they held relics and several images of great value.  There were many instances of hospitals actually having fights with their local church over issues relating to the local congregation being in some sense 'stolen' by the hospital.  St Bartholomew's being a very good example of this, as they had a fight with the priory which eventually ended up going to the King, where it was forbidden for the hospital to have any relic or any image of St Bartholomew in it, because it was taking away the money from the main church down the road.  Many hospitals had to have permission to even build a steeple, such as in Norwich.

Chapels were dedicated to a very few number of saints.  In the great panoply of Catholic saints, few names come up.  The St Mary Magdalene, particularly for leper houses; she was the sister of Lazarus, who had leprosy, and that was why.  Bartholomew was flayed alive, so he had a skin problem which mirrored what a lot of people suffered from in the day.  Some of these may well have been pre-Renaissance syphilis and there are some bones in the Museum of London that actually fairly clearly do have syphilis that came from St Mary's within Cripplegate.  This means that we are quite certain that this disease, or some form of endemic or perhaps venereal syphilis, existed in medieval Europe pre-Columbus.  Giles was a patron of cripples, lepers and nursing mothers.  Leonard was the patron saint of nursing mothers.  Anthony, James, Lawrence, and Nicholas were all associated either with travel or some particular disease.  These are the names of all of the hospitals, really until quite late.  One or two exceptions include Holy Cross, relating to the crusades.  It is only in the later medieval period that newer names come in, just before the dissolution.

The staff were expected to participate in all the religious services, praying to the local saint, attending the seven rites, in addition to attending the masses.  This meant that they only had a bit of time in between to look after the sick and this, again, is why they had to be Augustinians.

The general public could also attend and many of these chapels were parish churches - for example, St Thomas' in Southwark. 

They also had roles in religious calendars.  St Mary's at Bishopgate was the chief preaching site at Easter time.  Therefore everybody went there at Easter.  The reason you went there was you got special dispensation from the Pope and you got a few days off in hell.

So we now come to the charity provision; provision of alms at the gate.  If you rang at the bell, you were expected to be given bread and beer.  This is still practised at Winchester, but I am not sure how poor you have to be to do this and I have not tried it myself, although if you do go there, it is still a functioning hospital, or hospice now, with a wonderful courtyard in its medieval buildings, so it is really one of those wonderful things that just occur in England that are just quite amazing.  St Giles-in-the-Fields was quite an interesting one, just over the road from where we are now.  It was here that people coming past from Newgate Prison to be hanged in Tyburn were given a drink at the gates of the hospital.  This could get quite a riotous event at the time because the beer was quite strong.  They were not given the small ale; they were given a real proper drink so that they would behave themselves properly on the gallows.  There would be quite a crowd gathering round at these events, and it became quite an occurrence, until it was dissolved, unfortunately.

There was also short-term hospitality that we mentioned earlier.  You had to look after the sick, you could not just chuck them out, and you had to bury them if they died in your hospital.  There was also care of the long-term sick - lepers, the insane and suchlike.  This happened not just in London.  Often it is said that Bedlam was the only hospital concerned with it.  In fact, it turns out that that is not true, and more recent research has shown that colleges were converted to look after the insane in Cambridge and in York as well.

Unfortunately medical care was mostly by amateurs.  One of the sisters at York, for example, was a medica, not a medicum or a medic, but a medica.  John Mirfield of course, the famous one at Bart's, wrote theBreviarum Bartholomei in 1380.  This book was important because it was the first one written in the Western world that included the new learning from the Arabic scholars.  Elsing Spital, a bit later on, mentions that there was 37 shillings and tuppence due to Robert the Leech - Robert the Leech was a blood letter, and bloodletting was still one of the main ways of dealing with many sicknesses; ten shillings to Geoffrey the barber, so he was not quite as important, or he did not do as much work; and then this enormous sum given by one of the mercers, with an intriguing name, who bequeathed 25 pounds to Thomas Thornton to enable him to cure the poor, the sore and the sick at Bart's at St Mary's in Bishopsgate, and St Thomas'.    As an aside, my ancestor, just 20 years later, was a surgeon at St Bartholomew's Hospital.

Then, finally, one of the functions of a medieval hospital was education and learning.  As we will see later, many of the London hospitals, later in their evolution, developed grammar schools and they became important places.  Part of the reason why they had this educational element was that one of their functions was to look after pregnant women who had either got pregnant accidentally or whose husbands had died accidentally, both of which was a bad thing in the medieval period.  When those children grew up there may have been no further way for them to have sustenance, particularly if the mother was poor, so they were taken on, if they were boys in particular, by the hospitals to function as choristers.  They then needed an education, so they provided grammar schools.  So St Anthony's Hospital and St Bartholomew's Hospital in London, became great centres of education, not just for the choral tradition but also in grammar.  We have examples of Latin grammar books present in the hospital libraries.  The only purpose of this was to instruct the children, and perhaps new novice monks and the lay brethren, but that would be less likely.

Medieval hospitals were a lot more common than we used to believe.  There was an exponential growth of hospitals, particularly founded straight after the Norman Conquest.  Many foundations continued to be founded each year, and then you see there was a sudden dip that occurred about the time of the Black Death.  That was when hospitals went into decline and new numbers of them were not being formed.  There were amalgamations of existing hospitals, so their numbers plateau at about 500.  That is an awful lot of hospitals for a very small population, but most of these hospitals were very small.  Very few had over 100 beds - only St Leonard's in York, St Bart's, St Mary's within Cripplegate, the Savoy later on, are the very few examples over 100-bedded. Most hospitals were founded for the biblical number of twelve.  So there were many, many small hospitals looking after the local population, with local care.  This may have some interest to future talks in this series because it looks as if we may be going to some sort of system that is similar to this.

The total number of hospitals in some of the cities was quite enormous.  London had 35, including the nine for lepers; York had 35; Bristol, 16; Norwich, 15; Exeter, 10; Canterbury, 9.  Take these numbers with caution.  They are being interpreted all the time, and in fact, we have stopped collecting numbers of hospitals, because we do not really know what a hospital is.  Is a hospital building called a hospice that has one priest and one poor sick blind priest who he is looking after?  It certainly was in the medieval period, but it would be difficult for us to justify a hospital for one person now, even with the Darzi reforms.

The first hospitals in England, as we mentioned, were founded a long time ago, straight after the Norman Conquest, and what is astonishing is they still exist to this day.  The first three hospitals exist, which is really quite amazing. 

Lanfranc was the Benedictine abbot at St Stephen's in Caen.  He was invited over to England to become Archbishop of Canterbury.  He rebuilt the ruin of the Saxon cathedral, to exactly the same design, to within the inch of the abbey church in Caen and he even used the same stone.  He then put in different buildings around and then founded the hospital outside the city gates.  The main buildings were divided into one part for thirty men and the other part for women, a mixed hospital, but separated.  This is perhaps another thing the NHS could learn: you do not have mixed sex wards; they are not a good idea.  The Normans knew that and everybody knew it in the medieval period.  In fact, if you go through the archives of these old hospitals, many of the problems were actually of monks and nuns and various others males and females 'mixing' in their various houses, and it was one of the reasons that several disciplinarian issues were taken against them.

This particular hospital was subsequently later dedicated to St John, and still exists and still has people in it.  You can visit it with permission.  Of major interest in this hospital are the main dorm still exists, although it lacks a roof, and we are hoping English Heritage, which has now taken on responsibility for this, is going to get on to this.  It is in real need of protection as it is only built out of flint and ragstone.  They also have the fine accolade of having the the oldest toilets in England, which were apparently in continuous use for 900 years.

Lanfranc then built another hospital, the one for lepers, outside.  This was at St Nicholas Harbledown, and we will hear a little bit more about this hospital later on.  Leprosy was a big issue during this period.  There was a biblical indictment that you had to separate lepers from the rest of the population.  They used to harangue people on the way into town particularly to see this slipper worn by Thomas Becket, and people were so frightened they would go in and see the slipper, pay the money and get out.  There was no escape from these lepers because the way through Harbledown is the only way in to Canterbury from London.  As soon as the lepers in the hospital heard a horse coming, they would come out with their bells.  People used to moan about this, but it used to make them a good income.

Lanfranc's colleague was called Gundalf, who similarly rebuilt Rochester, and also founded St Bartholomew's Hospital.  You will hear that name several times outside London of course, as you will the name of St Mary's, which was used five or six times in London in the medieval period.  But Gundalf's St Bartholomew's hospital still remains.  Gilbert Scott heavily restored it, but you can just see the medieval remnants of that original hospital chapel in Rochester.

Now we are at the stage where we can talk about the London hospitals.  We can talk about why they were founded and perhaps the first reason was the fear of leprosy.  In 1070 to 1150, 68 hospitals were founded.  Over half of these were for lepers.  There is a ring of leper hospitals around London that goes from Hammersmith to Tottenham round and then south of the river, to the Locke Hospital, which we do not know the site of but we think was rather near where St Thomas' is today.  This brought about more of what I mentioned to you before, when people would complain about the lepers coming out to him and basically threatening him that they were going to do some horrible.

The second reason for founding hospitals in London was biblical: to feed the hungry and clothe the naked, from St Mark's gospel.  Bishops were responsible for the poor.  They and their monasteries often founded the early hospitals.  We can actually see that the only hospital of any size inside the city of any size was St Thomas Acon, the military hospital.  All the other larger hospitals are outside, and there is a reason why they are outside: it is because poor people are rather smelly.  They are also rather dirty and they have lice, and you do not want them mixing with the general population, so what you did was to ship them out to St Bartholomew's Hospital or to the various other hospitals that encircled London.  You could encourage them to go there because they were going to get free food, free boarding, and if they are sick and they have to stay there some time, even some money to keep them going - several pence a day.

After the Black Death, things changed.  Many small hospitals start to be set up within the walls, and we are going to come onto those.  These now are regulated by the City of London.  You wear a uniform.  You get the uniform changed at several intervals in the year, at Christmas, at Easter, and it has to cost less than forty shillings, or thirty shillings in some instances.  They have baths; they are washed. 

The thing I really object to is when people come to England and they say that the modern NHS is medieval.  They are totally wrong!  It might be Victorian, but it is not medieval!  Medieval hospitals were really clean.  You could go in there and you could eat your dinner off the floor. The first thing that happened to you when you rang the doorbell in the medieval hospital was that you went to chapel.  The next stop was the bath, and the nuns took the clothes off your back, boiled them, and baked them in the ovens.  You then went into clean sheets overnight.  So they were fantastically clean, and you were well looked after.  You did not have old people starving to death because the lay brethren and the sisters came round and fed you.  So the hospitals of today may unfortunately bare resemblances to Victorian hospitals, but certainly not Medieval ones.  It was by their exemplary stance on cleanliness that many revolting diseases were marginalised.

I am going to specifically go through the major London hospitals in order because there will be some of you who have got your favourite hospital.  But if I miss out one of them, please forgive me, but I think I have done most of the ones that people know about.

The Priory of St Bart's was the most important of all the monasteries. It was one of the most important monasteries in Europe. It was founded in 1123, as a monastic church for St Augustinian canons at the same time at the hospital.  There is this wonderful story of Ray, who was the courtier here. He had this wonderful time with wine, women and song.  Then sometime after the White Ship disaster, in which the next king of England was drowned, he realised the atmosphere had changed at court.  So he suddenly decided this might be a good idea not to be a jester and a joker and a womaniser and a drinker.  So be became religious, which was a good idea, especially in that period, and he went on a pilgrimage to Rome.  Unfortunately, he fell ill, probably got malaria, and when he was in Rome he noticed the Hospital of St Bartholomew on the other side, which had been founded by the Romans, but it was nothing like any of these hospitals.  That was the place you sent slaves who were sick, and slaves who were sick had things like typhus.  They were really dangerous, so you put them on an island in the Tiber and basically let them get on with it.  It was more like a penal colony in the French West Indies than what we would consider a hospital was today, but nevertheless, it was better than the alternative and the name "Bartholomew" stuck, so he had this image of St Bartholomew who was telling him that he had to found a hospital and a priory on his return to England, which he did.

We mentioned before that churches and hospitals next to each other could often have fights, because they are fighting for limited funds.  This is because if you have got a particular person coming down to visit your chapel or your chantry or your bit of stained glass, they are going to give you a certain amount of money and they therefore may not have any left over to give to the church next door.  So hospitals were deliberately forbidden from having many of these issues there and it was very difficult for them to erect towers or have a decent church. 

We can see in the pre-Fire maps the position of St Bartholomew's, number 102, with a square tower - the same square tower, by the way, that still exists today.  This is after the medieval building by Dick Whittington.  Then there was the cathedral, the priory church, on the other side, with a beautiful rounded apse, which still remains to this day and still has the Norman stonework inside.  It is really one of the most astonishing buildings in London.

However, as we mentioned before, the original endowments were not enough and these hospitals were always poor.  They were given royal help - four oak trees a year for fuel, which was very significant, and they were excused from taxes.  In 1325, they were allowed to put chantry chapels in.  Chantry chapels was the great way of making money because you then have people who are paid by someone outside the hospital to sing for the dead and you were paid to do that, so the more chantry chapels you had, the better.  We mentioned the hospital was repaired and then the church in 1453, and most of the stonework that remains in the only bit of the medieval hospital is what you can still see today.  Very little of the original chapel remains, but if we look carefully, we can see some of the original stonework at the base of the tower, and it looks very much like Lanfranc's stonework, from which it is contemporaneous with and it is built out of very similar stone.  So one has to presume that there are some remnants of the medieval hospital left, and furthermore, inside the church, there is a brass from the period.

It survived thanks to Gresham, as this lecture is thanks to Gresham, and it was given to the City in 1547.  The reason why it survived is quite an interesting story, and we will come onto that at the very end.  It continued its work through the years so that, in 1667, it had relieved 1,380 sick outpatients and admitted 196.  It was clearly a very busy place.  Like St Anthony's down the road, it was well loved by the local population.  It was also the least corrupt of all the monastic foundations.  There were one or two examples of individual corruption, but not on a mass scale.

The other great rival of Bart's is St Thomas' in Southwark.  It originates from the monastery of St Mary Overie, which got its name because it was over the river, and before the bridge was built, they were responsible for the ferries, and then after the bridge was built, they were responsible for the chapels and restoring the bridge.  The hospital was founded for the use of the sick and the poor and it was maintained by the Augustinian brethren and sisters.  It was destroyed by fire in 1213.  Nothing remained except the chapel of the hospital, which was then subsequently used by the monks and the nuns whilst they were rebuilding the church.  The Bishop of Winchester, Peter De Roche, came along and did not like this arrangement at all, so rebuilt another hospital on the Southwark side, but the other side of the bridge approach, which became the new St Thomas' Hospital, and he dedicated this to St Thomas the Martyr.  This is not the original St Thomas' Hospital. It now owes no allegiance to St Mary's whatsoever; it owes allegiance to Winchester as it was built on Winchester ground.  In fact, those of you who go down to this part of the world can still see the remnants, with a beautiful rose window, of the Bishop of Winchester's original palace which was down here.  Then there was some sort of dilly-dallying going on, and there was some sort of deal struck so that the monks and sisters who used to look after the sick were then transferred to this hospital.  The regular monastic canons could then stay in the new rebuilt one, which eventually went on to become Southwark Cathedral.  In 1540, the hospital was surrendered to the King, and then subsequently, the whole thing was demolished in the 1800s, just after Guy's was built, and shifted over to St Thomas' now, opposite the Houses of Parliament.  This was an extremely fortuitous site, and it may be spared the suppression which is being done by the new Government, rather along the lines of the 1140 and further suppressions.

Many other important hospitals were present in London.  We are only beginning to realise how important some of them were.  There was a wonderful excavation done by the Museum of London at St Mary's without Bishopsgate.  It was under a prior and twelve Austin canons.  They had lay brothers and sisters and 180 beds - this is an enormous hospital!  Only St Leonard's in York could compare with this.  It ran into financial difficulties, as often was the case, and lacked discipline.  The monks were visiting the houses of Alice de la Felaze and Matilda, who, interestingly, lived within the premises of the hospital, which was kind of handy, but somebody put two and two together and worked out it did not make tuppence and there was a lot of trouble over that and they were dismissed.  The Bishop of London then dismissed the prior and he appointed the sub-prior of St Bartholomew's.  The reason they did that was that everybody trusted St Bartholomew's.  They trusted it right the way through history.  Henry VIII trusted St Bartholomew's, and in fact, he endowed some money to it.  The deposed prior, however, was not just sacked; he was treated rather like the head of some corporation in the City of London today.  He was given a room near the infirmary, a double allowance of bread, ale and fuel, forty shillings a year, and an allowance for his servant, who was given the astonishing amount of a gallon of beer, a loaf of black bread and a dish from the kitchen a day, and he also had a companion assigned to him.  This is really living it very well by medieval standards.

Things continued to improve until the Black Death, when things went into decline, as along with many other hospitals.  It was so bad that the Pope himself granted an indulgence to anyone who visited the hospital, and great festivals.  I mentioned to you before about Easter, which explains why this was one of the great places people went to because you got an indulgence if you went along to listen to the suppressions.  And then it was suppressed. By that stage, the church was in a bad way.

The original hospital unfortunately fell down, but some good work had been done by this hospital, and Gresham again petitioned for it to continue, and actually, it had been founded by London citizens. It was nothing to do with the church.  But it was refused, and Henry gave it to Richard Morrison.  We want to watch this story, by the way, because many hospitals are about to be suppressed now.  Many of those hospitals were founded by local corporations, such as the good burghers of Croydon, who founded their local hospital by subscriptions.  It is a question which should be asked of the Government, as to where these proceedings will when it is closed down in a few year's time. However, those proceedings do not belong to the NHS because the original people who founded those hospitals were not compensated when the hospitals were taken over by the NHS, unlike Henry, who did compensate the owners and put them on pensions.  So there is an interesting legal story that if any of you could think about and want to save a local hospital by giving the Government a headache.

There is another St Mary within Cripplegate.  This one was founded in 1331 by William Elsing and is sometimes known as Elsing's Hospital.  He was a mercer of London, and it was founded for blind beggars, as opposed to blind priests.  Blindness seems to have been a big thing coming around London and it seems to have been a particular thing that really upset people because they founded so many hospitals for them.  William Elsing founded the hospital on his own land, in the parish of Alphage and St Mary.  The remains of the church of St Alphage still exist on London Wall.  However, the other church that was on the other side of London Wall was destroyed in the Great Fire, rebuilt, then destroyed again in the Blitz, and subsequently rebuilt in Fulton in the United States of America to celebrate Winston Churchill, who gave his Fulton speech there in Missouri, and that church now still survives there. 

Blind or paralysed priests were to be referred.  So here we come back to the blind priests.  It seems that there was something priests were doing that was making them go blind - something they were doing or eating was making priests go blind at a faster rate than the general population. 

The governance and performance of religious duties was the responsibility of five secular priests on this occasion.  One of them was the warden - this is the first time we used the word 'custos', the Norman French word.  We will come across that word with St Thomas' later on.  They had strict rules, such as them not being allowed to hold any other preferment and they had to write regular accounts.  This was because people were worried about hospitals now.  Hospitals were potentially worth a fortune, and land and plate and things of value were being sold off by corrupt wardens, money was not going to the poor in the hospital, and there are many instances later where there were no sick people in the hospital - there was the porter who took all the money and was living like a lord.  So people were getting very concerned about this sort of thing and that is why very strict regulations started to come into place here.  They also had regulation for services in the chapel, and they also had to visit the sick in the hospital.  This is very interesting.  This tells us a lot about what the other hospitals were not doing! 

So Elsing was worried about the priests because they were now secular, as I told you, and they were wandering round London drinking, gambling, and visiting whorehouses.  He got really upset about this, so he petitioned the City and wanted them replaced with regular canons, and this is what eventually happened to the Dean and Chapter of St Paul, replaced them with five Austin canons.  Still, by just 100 years later, it was terribly in debt, possibly because they enlarged the church.  We know they enlarged the church here because after the main bit of the church had been pulled down, the tiny little bit that was left was able to serve as the parish church, rather like St Bart's the Great.  The little tiny bit of that church that was left is still the largest parish church in London, which gives you an idea of what was lost during the Reformation, and we may allude to that if we have time at the end.

The Domus Conversorum is a very interesting place, and there are two stories about the Jews in London that are very important at this time.  He founded it in Chancery Lane, just outside the walls, just down the road from Barnard's Inn Hall, where we are now.  It was for converted Jews. He gave them 700 marks a year plus land and houses. The winds were blowing for the Jews in Europe, and 150 of them decided it was a good idea to convert, and this was considered quite a good thing at the time.  However, it was the minority of Jews in England as there were 16,000 Jews in England then.  Only a tiny fraction actually took the bread.  Again, as we said, they were given robes at Christmas, so we know how many there were.  There was new accommodation and building.  Matthew Paris' drawing of this still survives.  Then the natural extinction of the house looks set to occur, because they began to expel the Jews in 1290, so there are no more Jews to convert, so the Jews who are there are going to die, so the house should then cease to exist.  However, what they did was then put the children of the converted Jews to keep it going, and the other thing they did was accept foreign converts.  It is quite interesting: England, almost uniquely, after the suppression and expulsion of the Jews, which it more or less had to do, still allowed Jews to come back in, and there was quite a good Jewish immigration into England, and then subsequently again Cromwell confirmed this.  The house was eventually annexed to the Master of the Rolls in 1377 and then was destroyed for the new house of the Master of the Rolls, and the Master of the Rolls was also the master of this hospital, and interestingly, in 1716, the last petition for alms from this endowment came from some converted Jew who appealed. We do not know whether he was given it or not, but I suspect not.

Then there are the alien houses.  Their name means that they were founded by a group of religious people who were not based in England.  The most important of these was St Anthony's Hospital, which was founded by the broths of St Anthony of Vienne.  Again, it only housed twelve men, which is interesting as it was a very important hospital but very few inmates.  Hospitals were not about looking after sick people.  They were about after doing good for the Lord, and if you looked after one sick person, you had done your duty and you could get into heaven; twelve, was quite a nice number; but more than twelve and it starts to get expensive, and hospitals of more than twelve keep on recurringly running into monetary problems.  This hospital was formed on a synagogue.  We originally did not know where this hospital was because later accounts put the hospital in St Benet Fink and this is far away from Drury, so they think the brothers may have moved.  However, there is another thing: in 1252, there was an order that no synagogues should exist in London except where they had existed under the reign of John.  So the synagogues outside there were closed down and so this was actually vacant property from a synagogue on which they were able to build.  The property was worth about eight shillings a year, which is nothing, so they were entirely dependent on alms. 

The interesting way of their alms was for St Anthony's claimed the unfit scrawny pigs from Smithfield Market that were too scrawny to even be bothered to kill - previously they just knocked them on the head and thrown them into the ditch.  But when St Anthony's claimed the pigs, they had their ears slit and a bell was put around them and they were set free to go through the City of London.  It was then your duty if you saw one of these pigs to feed it.  Because of this, these pigs grew to enormous sizes, and they used to follow people round.  They were semi-domesticated, they would go into their houses, they would follow them into church - they could not get rid of the damn things.  They became very fit, and then they were killed and then they were worth a fortune.  In fact, there was a saying that someone who was bothering you would follow you round like a Tantony.  Well, a Tantony was a St Anthony's pig.

During the French Wars, it was cut off from its mother house, so it lost its ability to achieve new blood and new priests , and so it lost money.  It came into the King's possession under the Alien Priories Act, and then eventually it was appropriated to St Benet Fink for the maintenance of a grammar school, as we mentioned before, taking on one of the other functions of a medieval hospital.  Then, eventually, it was appropriated to the College of St George's Windsor, and one of their corrupt members gave the almsmen a shilling each and chucked them out onto the road, taking over the property for his own purposes.  This is after the dissolution of the monasteries.

St Thomas of Acon was the only large hospital in the City of London until the Black Death.  Acon is the anglicised version of Acre.  St Thomas the Martyr, who is Thomas à Becket, had a group of knights, after the fall of Acre in the Holy Land, who took on holy vows and became Knights Hospitallers.  It is one of the hospital orders like the Templars and the various other ones.  The reason why the hospital was founded here in Cheapside is that it was founded on land that was owned by Thomas Becket's family.  Agnes, who was married to the founder, Thomas Fitztheobold, was actually the sister of Thomas à Becket, the murdered Archbishop.  The military order then founded the hospital.  They also founded one in Acre, which was for burying the dead and looking after wounded Christian knights, and also to raise funds for ransoms from the Saracens. 

In 1248, the conventional church was begun in London.  There are a couple of interesting stories when you go through these records.  One of the brothers ran away, he hated it so much, and so eventually they had to go and capture him.  He was celebrating mass on St Clement Danes along with his mate, and they actually kidnapped him and took forced him to go back and be a brethren in the hospital.  This tells us that they must have had a particularly austere regime there - probably not much bread, wine, and obviously no brothel incorporated within the hospital as in some of the others that we have seen.

In 1383 there was a rebuilding of this church, which was reputed to be one of the most beautiful in London.  Then it was surrendered in 1538.  Gresham petitioned that its good work in aid of the poor and sick might continue under the City Corporation but it was refused.  The buildings were acquired by the mercers and then subsequently destroyed in the Fire of London.

St Mary's Rouncival was another alien house, founded in 1223 by St Mary's Rouncesvalles.  It was originally a military order, and their job was to defend pilgrims on the way to Spain from the Pass, with force if necessary.  They also looked after them and fed them.  Then they changed from being military to a modified Augustinian rule in 1123.  The hospital in London was very prosperous until the Black Death and the French Wars, again cutting it off from its mother house in Navarre.  The chapels and land were then seized by the King under the Aliens Act, and the King appointed his own clerk to be the surgeon.  This hospital, by the way, is mentioned in Chaucer through the character of the pardoner: "With him there rode a gentle pardoner of Rouncival, his friend and compeer."  His job was to collect pardons for the hospital, and later on in the story, he indeed starts harassing his fellow travellers for money.

St Mary Bethlem has come down to us, famously.  The hospital still exists and is now part of the Maudsley, down in Croydon.  It originally was founded just outside the City walls but was subsequently moved.  It was never very large.  The master was a sinecure - i.e. he took the money and did not actually live in the hospital.  There was a porter, his wife, and nine inmates.  Visited in 1403 by the King, it had six lunatics and three sick persons, showing it was already specialising in the cure of the mentally ill.  It got its money by collection boxes that were walked around the City of London.  There was much abuse. The porter, who basically ran the show, was found stealing and selling ales.  He sold off all the beds in the hospital so that the sick people had to sleep on the floor and were chained to the walls.  It was just hell, and, indeed, one of our words for hell is bedlam, and this was the reason why.  By the Sixteenth Century, they had crowded in 31 patients into a space that was barely fit for 24.  The noise was hideous, the crying of these poor people, and it was said it was enough to drive a sane man mad, so it is not surprising that the mad were mad.  Eventually, Henry VIII granted a charter for it, so it was one of the few medieval hospitals to survive through to the modern day.  It moved to Moorfields, and then subsequently out to where the Imperial War Museum is, and then subsequently again out to its lands in Croydon. 

Before we close, I will mention a couple of specialist hospitals with rather nice names, the first of which is St Augustine's Pappey: three chaplains and a fraternity.  We mentioned that this was one of the ways hospitals could be founded.  They founded a chapel and churchyard in what was formerly a parish church.  Sixty poor priests were housed in its hall, with communal living, communal eating and communal praying.  But it was suppressed by Edward VI when he suppressed all the others.

Whittington's Hospital is important for the City of London.  It was founded here right in the heart of the City, in 1424, by the executors of Richard Whittington, for thirteen poor persons.  That is another biblical number that was allowed as well.  All hospitals had a biblical number, but any number can be a biblical number, from one to three to twelve to thirteen, or any multiple of it!  It was preferred for mercers or ministers of Whittington College - this was a collegiate church - who could no longer fulfil their duties.  It was built to the east of St Michael Paternoster, next to the dwelling of the chaplains of Whittington College.  There were separate apartments but they had communal meals, so we are starting to evolve more into a modern type of hospital.  The almsmen though had to pray for the souls of Whittington and his wife, and they had to assemble round the tomb and recite De Profundis.  It was dissolved by Henry VIII but, as a charity, it survived the Reformation, and almshouses in this name still exist down in East Grinstead.

Milborne's almshouse also show a similar story.  They were built slightly later but, again, nothing remains of these original medieval almshouses.  This was for thirteen poor men and their wives - interesting that number keeps on coming up with almshouses time and time again - but this time they are allowed their wives in, which actually brings it up to 26 if they were all married.  This time, they had to be members of the Drapers' Company.  They also had to go to the church every day to pray for the founder and his family, and this remained on its original site till 1862. 

And now, to close up, we will talk about the large hospitals founded at a later date, just before the Dissolution.  The Savoy was probably the great one as it was a very important hospital.  The long nave that was over 100 feet long in the east/west axis, even longer in the other axis.  It was bequeathed with a lot of money, they were bequeathed with good clothes, they had a blue uniform they had to wear.  You were allowed in, but you were then chucked out after one night only, unless you were sick.  This one night only rule was very important as the hospital was for an enormous number of people - 100 people could come in here.  It was then dissolved in 1553.  It was re-founded by Henry's daughter Mary, and used her maids of honour to actually provide the bedding and the beds.  It was then used as a military hospital in the Civil War, and again by Charles in the Dutch War.  Interestingly, St Bartholomew's Hospital was used as a military hospital in both of those, and again in the First World War.  Then the office of master became a sinicure and the hospital was bound to fail, and the commissioner for Henry VIII said it had outlived its usefulness - i.e. it had all the endowments, but it had no patients - so it was then closed in 1702.  It was just down the road from where the Savoy Hotel is today.

There were also many lesser houses.  It depends how many hospitals you want to count, but the important ones included such hospitals as St Giles.  All we know of this hospital is that stood on Whitecross Street, and that it was suppressed as an alien house and closed down by Henry V. 

St John of Jerusalem, just up the road here in Clarkenwell, was a part of the priory for Knights Hospitaller.  The gate of St John's still survives and can be visited today.  This was more of a guesthouse, and did not even represent what we would call a hospital.  Even if you were a medieval person, you would not regard this as a true hospital.  It was really for people moving about in hospital, meaning hospitaller business, throughout England and Europe.  Also there was the La Reole Hospice which was founded at St Stephen's College in 1369 and closed down.  Jesus Commons, again, was a community of priests that lived together in a house that was left to them.  It survived the suppression of the fraternities by Edward VI, but it became extinct because they ran out of priests.  It was not a good idea to commend yourself, being a priest.

So we have spoken about the Reform and Dissolution.  Some of the hospitals survived to look after the poor in their original form.  A part of this system did not actually go out of fashion in England, and when I went to Manchester Royal Eye Hospital for one year to do my anatomy, I had to, apart from Anatomy, go down to do Casualty, and it was still as it had been in the past.  They had two great big Victorian doors, outwith which the population of Manchester remained.  The doors were then opened, and as many people who could come in and be seen were seen, and the doors were then closed.  You then, as a junior doctor, worked through all of the people who were there until you were finished, which might take you to six or seven in the evening, and then you went home, and the next day, the same thing happened, and the people came in.  It is really quite an astonishing thing.  You learnt your trade because you had see about 120 patients in a day.  But it is probably not an ideal way to run things.

The Black Death affected many hospitals, and this is the reason why many of the early medieval ones closed. If you have only got twelve people and five brethren and one master, you do not need to kill off many before you have got a hospital that is not functional anymore.  Some of the large hospitals survived.  In St James' in Westminster, everyone died except William of Westin.  There were no inmates, no one left.  Can you imagine being the only person present in your hospital?  Hospital incomes fell, but wages and incomes of everybody else went up, so it got expensive to maintain things and it was impossible to maintain large numbers of brethren.  There was a shift of work to the essentials, i.e. the clergy, so less sick were looked after in these hospitals.  Paradoxically, they became more like churches and less like hospitals, which was to their eventual problem a hundred years later.  Some ceased to exist altogether or they were amalgamated.  Some, like St John's in Cambridge or Magdalen College in Oxford became colleges of the University proper, and some parts of the original hospital still exist in those buildings and can be visited if you ask them.

Reform was needed.  The Lollards of course did the twelve Conclusions.  One of those was about hospitals. They suggested the abolition of chantries and the nationalisation of the endowments to form new almshouses for the sick, and that is precisely what happened, even though they did not take this on.  Newer hospitals were founded as almshouses for looking after the sick and they became less church orientated.  The tendency for these new foundations was that they would survive the Reformation, so the ones founded after this period survived.  The ones that did not and did not reform and became chantry chapels or became college chapels, collegiate chapels, were all destroyed and none of which survive.  There is one chantry chapel still in existence, in Leicestershire, but it is not still in use and a very beautiful building it is too.

So the London of Edward III was a city of palaces, but the London of Queen Elizabeth was a city of ruins.  There were ruins everywhere - all down the west side of the City of London, down the walls, contiguous with each other, were beautiful medieval buildings of the great monasteries and hospitals that went down from Bart's, and you had the ones in Cheapside, further down on the wall on the outside eventually ending up in Blackfriars.  You had the Whitefriars, the Greyfriars.  There were some beautiful churches.  St Thomas Acon we mentioned, one of the most beautiful churches in the whole of Europe.  Now, nothing remains, not even a stone.  One thing remains, however, and that is an effigy they found buried of Christ, and that is present at the front of the Mercers' Chapel.  If any of you are lucky enough to go there, you will see the original medieval and you will get an idea of the quality of what was lost. 

When they did the exhibition of gothic and art for England 18 months ago at Victoria & Albert Museum, one of the saddest things was when you walked out through the buildings, through the rooms in V&A - they had about maybe five or six rooms slightly larger than this hall we are now stood in, all filled with some artefacts but not much.  As you left, they said that this is all that remained of this period.  That is all that remains of the art, and this is not enough to furnish one small chapel, like Bart's, for one Sunday service.  The rest of it was destroyed, completely and utterly, and when the English destroy something, they really know how to do it!  When they destroyed the Palace of Savoy, which was owned by John of Gaunt, they destroyed everything, including the jewels.  They hammered them down with hammers until they were dust so no one could use them.  No one was allowed to take it.  This was not larceny.  This was a deliberate act against wealth, an accumulation of wealth by rich people, which they did not agree with.  One person tried to smuggle a silver cup out in his pocket and he was hanged on the spot when they caught him.  The purpose of this destruction was to make a point - he did not want to say, "We, the peasants, are greedy robbers, Your Majesty"; he wanted to say, "We, the peasants, are reformers of your new country, which is going to be better."

We are now at the end of my talk and I would like to briefly thank Professor Carol Rawcliffe, who is the world expert on this topic, who has helped me in many ways and spoken to me at length and emailed me.  I should also point you towards the several references on my Power Point presentation that are commonly available.

Thank you very much.



©William Ayliffe, Gresham College, 7 April 2008

This event was on Mon, 07 Apr 2008

professor william ayliffe

Professor William Ayliffe FRCS PhD

Professor of Physic

Professor William Ayliffe is Emeritus Professor of Physic at Gresham College and a Consultant Ophthalmologist at the Lister Hospital in London.  As well as being...

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