Tudor Health Reform: The Politics of Health Reform from a Medieval Perspective

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Is the NHS medieval? Is this an insulting claim to make? Insulting to modern hospitals or those of the Middle Ages?

Professor William Ayliffe considers modern health reform from the perspective of Tudor medical practice. He provides an overview of some of London's most important mediveval hospitals, including St Bartholomew's, St Thomas' and St Mary's Bethlem, and compares our own healthcare systems with those of the Tudors, in terms of cleanliness, dignity to patients and even hospital architecture.

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22 June 2011   Tudor Health Reform   Brief Notes of the Lecture   Professor William Ayliffe     “NHS hospitals are medieval”. Well perhaps Victorian but not the clean places of refuge with good food and nursing care.   What was a medieval hospital?   Hospital: “hospes, stranger/guest”   Originally many founded to receive travelers/pilgrims not necessarily sick   Dole   Care of elderly/infirm.   Medieval institutions called hospitals regarded themselves as houses of religion domus dei (maisondieu). “A building or group of buildings which housed an institution providing spiritual and medical care” 1100 in E&W 35 London Impressive institutions, often amongst largest buildings of city   The distinction between hospitals and religious houses blurred.   Care for poor and travelers responsibility of all monasteries and religious houses and also great lay houses as in Saxon times.   St John’s Cambridge: that sick and weak people should be admitted kindly and mercifully, except for pregnant women, lepers, the wounded, cripples and the insane.’   Other hospitals provided for pregnant, lepers, cripples or insane.   Often hospitals referred to as chapels or colleges. Three hospitals attended chapter meetings so for Augustinians were on a par with monasteries:   St. Mary within cripplegate St. Mary without Bishopsgate Maiden Bradley Types of hospitals   Hospitals were founded by royalty, church, corporations (monastic and military orders, guilds, fraternities), or individuals   Many types of medieval hospitals   Hospitale simplex: Provided (limited) nursing and religious care. These frequently followed the rule of Augustine, were monastic and presided over by a master and staffed by lay-brothers (and sisters in mixed hospitals)   Almonaries:at gates and infirmaries within monasteries   Hospitale(Eng. spital, spital house, spittle for beggars)   Domus dei (Eng. Measondue)   Domus elemosinarie (Eng. almshouse)   Lazar houses, Lock Hospitals   For poor or specific groups: (Conversii, Blind, Priests).   “There are in and about the City of London certain Houses called Colleges, not so much designed for Learning, as for the common and comfortable living together of such as are Aged, poor or decayed by Sickness or Misfortunes, and are mere Foundations of Charity JS”   The First Hospitals in England   Lanfranc Benedictine Abbot of St. Stephen’s Caen became Archbishop of Canterbury 1070-1089. Rebuilt Saxon cathedral to the same design as the abbey church in Caen.   “he constructed a house of stone and added habitacula for different needs along with a courtyard. The main buildings were divided into one part for 30 men oppressed by various kinds of infirmities and the other for 30 women in a bad state of health (Later dedicated to St. John)   On the other side of the street he constructed a church for generously endowed canons to live and minister to the inmates (Priory of St Gregory which by 1170 became a separate Augustinian priory).   Also built wooden houses outside the west gate for lepers (St Nicholas Harbledown). They obtained donations from pilgrims for seeing a slipper worn by St. Thos Becket. The site is now an almshouse.   His colleague Gundalf similarly rebuilt Rochester and founded St. Bartholomew’s Hospital. The Gilbert Scott-restored chapel remains.   Functions of Medieval Hospitals   1. Worship    Centered on the 7 daily services divine office. In addition masses were also held. Later on Chantry priests. Relics and images of value.   Chapels to St John the Baptist (for houses of infirm), St. Mary Magdalene, especially leper houses (sister of Lazarus) Bartholomew flayed alive skin complaints, Giles, patron of cripples, lepers and nursing mothers; Leonard, nursing mothers. Anthony, James, Lawrence and Nicholas also associated with plague, travel or disease.   The staff were expected to participate actively in religious rites. The inmates passively, by being adjacent to the chapel.   The general public could also attend and some chapels acted as parish churches, St Barts the less. Roles in religious calenders St. Mary without Bishopsgate chief preaching site at Easter   2. Charity to poor sick and travelers   Provision of alms at the gate (Still practiced at Winchester)   St Giles in the Fields drink for condemned   Short term hospitality: Care if sick until they recovered or died.   Limited medical care. One of the sisters at York was a medica, John Mirfield a cleric of St Barts wrote Breviarum Bartholomei in 1380. Medical care was expensive and therefore mostly delivered by amateurs.    John of Arderne, one of the leading surgeons of the mid-fourteenth century, who warned his colleagues to be "warre of scarse askyngis, ffor ouer scarse askyngis setteth at not both the markette and the thing".   Richard II's physician, John Middleton, was retained at an annual fee of one hundred marks. William Bradwardyne surgeon on 1394 Irish expedition, submitted a bill for £66. 13s. 6d. Just for medicine and travelling expenses.   Elsing Spital 1448 mentions 37s2d due to Robert the leach and 10s to Geoffrey the Barber. The mercer Jon Don bequeathed £25 to a surgeon Thos Thornton to enable him to continue for 5 years to cure the poor sore and sick in St Barts, St Mary without Bishopsgate and St. Thos Southwark.   In his daily besynes and comfort of the poure, sore and seke peple lakkyng helpe and money to pay for their lechecraft in London   3. Education and Learning   Larger houses possessed small libraries   By 13th century  some involved in the education of boys. Initially offering poor scholars food.   Then board and provision of education.   Lucrative. Some Hospitals restricted resources to inmates to fund school. Others gave up being hospices altogether.   St Barts, St Katherine’s and St Anthony’s became famous schools (Sir Thos More, John Whitgift). School fights with St. Pauls who called the Poor St. Anthony’s boys Tantony Pigs.   Foundation of London  Hospitals   Bishops responsible for the poor. They and monasteries founded hospitals.   Except the smallest hospitals, were staffed and headed by clergy, their chapels under episcopal jurisdiction. Until Savoy.   Often transient.   Two hospitals for the poor at Brentford.   1393: St. Mary, St. Anne, and St. Louis. Newly-built in 1393, a chapel and two houses with bedding and other necessaries for poor travelers.   1446: Hospital of Virgin Mary and nine orders of holy angels. John Somerset, royal physician and Chancellor of Exchequer.   1416: Ancient spital house at Tottenham, mentioned in 1416 and 1484, but then disappears from record.   Before the black death (1349) only one large hospital inside walls: St Thos Acon   Later foundations by City were mostly almshouses (ie respectable, uniformed, forbidden to beg).   Revolting diseases still marginalised into extramural foundations   Pre-reformation Health Reform   The first independent free standing organisations occur after the conquest   London: well provided with hospitals   London 35+ (incl 10 for lepers) York 35 Bristol 16 Norwich 15 Exeter 10 Canterbury 9 Some became extinct :   Ran out of Money: poorly endowed,   Ran out of patients: specific cause no longer relevant Jewish convert, leprosy)   Ran out of Staff: Black death and loss of staff   Some suppressed:   Henry V Alien Priory Act   Henry VIII: Closure of Monasteries   Edward VI: Suppression of Fraternaties   St. Bartholomew’s Hospital   The priory of St Bartholomew’s was the most important of the city of London Monasteries.   Raherecourtier. After the white ship disaster 1120 he went on pilgrimage to Rome where he fell ill. Vowed he would found a hospital.   1123: Priory and hospital were founded together Augustin Canons. The rights of the former over the latter were controversial and argued continually until King John declared these as acts against the crown. However they were able to elect their own master but not allowed to erect an alter or have an image of St. Bartholomew.   The endowments were not enough and other sources of income were needed.   Royal help, oak trees for fuel, excuse from taxes.   1325: Chantry chapels.   1423: repaired by Whittington   1453: church by Lady Clinton   1464: the king pardoned certain unauthorized grants to the house in consideration of the relief given there "to poor pilgrims, soldiers, sailors and others of all nations".   Guest house, orphanage and school   Special facilities for the unmarried mother, who was allocated "mete and drynke of the placys coste and full honestely gydyd and kept" for some weeks after giving birth.   Child cared for until weaned   if mother died, infant full board and education at the hospital's expense.   The brethren also rescued babies from Newgate prison; also received free tuition.   Poor and orphaned children formed the nucleus of a school which achieved such good results that it soon began to attract fee-paying pupils from outside.   1260, the widow of Walter de Chaure, gave the hospital her husband's houses in Smithfield to finance the education of her two sons. Dissolution   Petition by Gresham.   Reconstituted in 1544   Hospital was given to the city in 1547   1548 there were three surgeons, with salaries of 18s. each, appointed to be in daily attendance on the sick   The first superintendent of the hospital was Thomas Vicary, serjeant-surgeon to Henry VIII   Next 300 yrs an alderman of London elected president of St. Bartholomew's Hospital.   1667 had relieved 1,383 sick and admitted 196.   The cost of the work in 1730 was defrayed by public subscription, Dr. Radcliffe £500 a year for the improvement of the general diet, and £100 a year to buy linen.   Little remains of the original hospital   St. Thomas’ Southwark   Monastery of St. Mary Overy, [pious virgin daughter proprietor of Thames Ferry] (f.1106 by Bish Giffard) contained building for the use of the sick and poor maintained by bretheren and sisters. 1173 re-dedicated to St.Thos.   1212: monastery damaged by fire “Behold at Southwalk an ancient spital built of old to entertain the poor has been entirely reduced to ashes” Petr de Rupibus (des Roches) Bishop of Winchester.   1215Refounded by Bishop, new site east side of Borough High Street, where the water was pure and the air healthy (ubi aqua est uberior et aer est sanior).   New hospital was also dedicated to St. Thomas the Matyr. Property of the church of Winchester and free from St. Mary’s. The former bretheren and sisters then transferred, not allowed to rebuild the old hospital.   1369: Joan, the widow of Robert Fuwyth, conspired with her lover to assault and rob her former husband, then lived in adultery at St Thomas's Hospital. Joan claimed, somewhat implausibly, to have been abducted without her consent and to have escaped from the hospital at the first opportunity   C15th: Whittington donation: for Thomas Spital ... an ospytalyte, New chamber with 8 beds for young women that had done amiss, all things that happened in that chamber to remain a secret.   1540the hospital was surrendered to the king. Revenue £309, 40beds   Cult of St Thomas   Canterbury Cathedral: North Aisle, Trinity Chapel:   Eilward of Westoning,field worker, owed a denarius by his neighbour Fulk. The debt is denied so they go off to the local alehouse to discuss the matter “as is the English custom”.   Eilward leaves him in the pub and goes to Fulk’s house, takes a whetstone and ditcher’s gloves. He is captured and the objects only being worth a nummus, Fulk adds extra bits around his neck.   Remanded in custody at Bedford.   After failing trial by water, he is sentenced to blinding and castration (membrasecta).   Praying to St. Thomas, the saint appears to him paints the sign of the cross with his crook. The membra swell so Eilward's sight is restored. Exposing his restored manhood and giving alms.   Miracles took place in 1171-3, recorded Prior Benedict and glaziers 1213-20.   Unusual miracle: appearance of St. Thos not imbibing of blood and water which was part of the cult.   1166: Assize of Clarendon, Henry II, required "anyone, who shall be found, on the oath of the aforesaid [a jury], to be accused or notoriously suspect of having been a robber or murderer or thief, or a receiver of them be taken and put to the ordeal of water   St Mary’s without Bishopgate   1197: The 3rd Augustinian Hospital. F. Walter Brown & wife Rose, for care of sick. Endowed with adjacent lands and 100s rent. Domus Dei et Beatae Virginis   Prior, 12 Austin canons religious duties, 5 Lay brothers and 7 sisters for the care of the sick poor 180 well furnished beds.   Ran into financial difficulties, lax discipline, scandal (visiting the houses of Alice la Faleyse & Maltida who lived within the precinct).   The Bishop of London dismissed the prior appointed the sub prior of St Barts. deposed prior was given a room near the infirmary, a double allowance of bread, ale and food, 40s/year and allowance for his servant (a gallon of beer, a loaf of black bread a dish from the kitchen and a companion was assigned to him). 1277, Bishop of London gave a spring at Stepney, permitted the brethren to divert it by underground pipes to the hospital infirmary for "the recreation, refreshment and profit of the poor. Things improved until the black death.   Offered semi-permanent accommodation, often to widows or women whose husbands abroad.  July 1383, the prior sued Sir Robert Aleyn £19 incurred by his wife as a boarder.   1391: The pope granted indulgence to those who visited on great festivals and crowds came.   1543: Suppressed. Church in a bad way. Revenue £504, 180 beds   Good work had been done and Gresham petitioned for it to continue under the rule of the Mayor. (It had been founded and endowed by London citizens). Refused and 1540 granted to Richard Moryson.   St Mary within Cripplegate   1331: Founded by William Elsing a Mercer. On his own land in the parish of St Alphage and St Mary Aldermanbury (Church rebuilt in Fulton USA).   Elsingspital, for 100 inmates (initially 32 then 60). Blind beggars, particularly blind or paralysed priests preferred. "My very bowels are torn with compassion (viscera mea gravius torquentur) for those priests who are left poverty-stricken and wretched because of blindness or paralysis   Religious duties responsibility of 5 dedicated secular priests. Warden annual accounts; complete suit of the same colour (not to exceed 30s) given every year. Regulation for services in the chapel and visits to the sick in the hospital.   1337:Elsing worried about the seculars wandering about the city petitioned for them to be replaced with regular Canons. 5 Austin Canons and a prior elected with the assent of the Dean and Chapter of St. Paul’s.   1438: In debt because of enlarging the church.   The priors lodgings into a house which burned down xmas eve 1541. On the site was built Sion   College.   Main aisle demolished after reformation rest converted to parish church of St. Alphage. The lodgings for the poor turned into stables.   Domus Conversorum   1232: Founded Henry III in New St. (Chancery Lane)   For converted Jews. 700 marks a year plus land and houses.   It quickly became large, 150 robes were given out at Christmas 1255. The accommodation was inadequate and new building began in 1265. Poor administration funded by deodands (Jewish poll tax) est. 16,000 Jews in England.   1290: Expulsion. No new converts would lead to  natural; avoided by Edward III placed children of the converted and foreign converts.   1344 -only eight inmates   1371- Only two.   The house was annexed to the mastership of the rolls in 1377   Pensions were still awarded as late as 1700s   1717 Demolished for a new house for the master of the rolls.   The Savoy   1505: Henry VII; site of Savoy Palace; the most magnificent mansion in England, John of Gaunt; totally destroyed in the peasant revolt 1381.   "there be fewe or noon such commune Hospitalls within this our Reame, and that for lack of them, infinite nombre of pouer nedie people miserably dailly die, no man putting hande of helpe or remedie."   The king bequeathed 10,000 marks.   Master, 4 chaplains and 26 staff to accommodate 100 poor men every night.   Santa Maria Nuova, Florence. Dormitory; cruciform structure with cubicles in the north and south transepts.   First Hospital to have attending Medical Staff.   "honest men" skilled in, respectively, medicine and surgery, whose duty was to visit the sick each morning and afternoon when necessary.   Hospitaller and vice matron stood at the door to receive the poor, who proceeded to the chapel to pray for the founder. Hot baths, delousing ovens for clothes, freshly laundered dressing gowns bearing the Tudor livery   All except the sick departed the next day.   1553: dissolved, re-founded by Q. Mary using her maids of honour. Military Hospital Civil War and the Dutch war.   The office of master became a sinecure. William III commission outlived its usefulness. Closed in 1702.   St Katherine’s by the Tower   Ancient Hospital (or College) East of the Tower of London.   1148: Matilda, commemorate loss of infant sons, Stephen and Eustace, Eleanor (wife of Edward I), gift of manors. Endowments increased by Phillipa, (wife of Edward III).   Establishment: Master, 3 brethren, 3 sisters, a Bedes-woman and six poor clerks for the good Education of Children. Sisters of the Chapter had equality with the brothers.   Master bound to give Twelve poor Men every Day 12d. From the 16th of November [which is the Deposition of Edmund Archbishop] till the Day of St. Edmund, [King and Martyr, 20th Nov] and also a Thousand half Pence to a Thousand poor Men that Day, being the Day K. Henry III. Died.   There is a very fair Church belonging to this Hospital, where Prayers are daily said   1273: gave up general nursing; new charter as an almshouse for eighteen Bedeswomen and six poor scholars.   C15th. musical reputation equal to that of St. Paul’s   Reformation; spared under the protection of The Queen Mother. Its establishment was given a Protestant form   1825: Church pulled down to make way for the docks. Interesting Gothic building, exclusive of the choir, 69’ long, 60’ broad. Gothic altar, and stalls, of 1340–69, was curiously carved with grotesque, fanciful monsters.   St Thomas of Acon   1191: Capture of Acre, Richard I and Philip II of France. William, Chaplain to Dean of St. Pauls, formed bretheren of military Order of The Hospitallers of St Thomas of Canterbury at Acre.   Purpose: Tending to the sick and wounded, burying Christians fallen in the Holy Land and raising ransom captives. Militarized by Peter of Roche, Bishop of Winchester, during the Fifth Crusade 1217-1221   1248: Cheapsideconventual church f. Thomas Fitz Theobald de Helles, Wife, Agnes was the sister of the murdered archbishop. St. Mary and St. Thomas of Canterbury   1279:One of the brothers ran away and had be captured whilst celebrating mass in St Clement Danes.   1291: Fall of Acre. Priory moved to Cyprus erected the beautiful St. Nicholas church. 1327 chantries neglected poor.   1360: abandoned military role & rule of the Teutonic Knights, adopting that of the Augustinians charitable work and running grammar school. Custody entrusted to Mayor and City. Subsequently many bequests   1383:Rebuilding of the large and beautiful church   C14th  the order died out - the last Knight of St. Thomas Frater Richard de Tickhill given his habit by the preceptor of Cyprus, Frater Hugh de Curteys in 1357 at the church of St. Nicholas of the English at Nicosia.   1538:House surrendered. Gresham’s petition that the work in aid of the poor and sick might continue under the City Corporation was ignored.   Buildings acquired by Mercers (Becket’s father Gilbert a Mercer). Destroyed in the fire of London.   St Mary’s Bethlem   1247: f. by Simon Fitzmary, sheriff made over his lands nr St. Botolph, to Godfrey bishop of Bethlehem. Priory of canons brothers and sisters Order of St. Mary of Bethlehem. Duty to pray for founder and receive bishop. Badge to be worn: 5 ray red star inclosing blue circle.   Master (became sinecure) porter his wife and 9 inmates.   1346: Corporation of London protection   1375: becomes a Royal Hospital under the alien houses act.   Deputy Warden deprived the inmates of food, fuel, so that he could equip a school for fee-paying boys.   1403: visitation by king’s clerks: Already an asylum, 6 lunatics and 3 sick persons. Supported by collections 2 boxes, gifts, relatives of the inmates, fees (a merchant from Exeter paid 12d a week whilst sick). general fee 6s. 8d. per quarter reductions for long-term patients 2yrs. Abuse by the porter Peter Tavener, stealing, selling of ale, selling of beds £40.   1450: referred to as Bedlam   C16th: 31 patients in space for 24. Noise was hideous “more able to drive a man that hath his wits rather out of them”   1547: rescued by the Lord Mayor and citizens Henry VIII grants a charter for the hospital for the insane. Government of hospital passed to City of London.   1560: Q Elizabeth "Sume be straught from there wyttes, thuse be kepte and mayntend in the Hospital of our Ladye of Beddelem untyle God caule them to his marcy or to ther wyttes agayne."   1675: a new hospital built on land granted by the city at Moorfields.   Pilgrimage hospitals & daughter houses   Pilgrimage to Jerusalem increasingly difficult and dangerous.   Santiago also. “This is a barbarous race unlike all other races in customs and in character full of malice, swarthy in colour, evil of face, depraved, perverse, perfidious, libidinous, drunken..for a mere nummus a Navarrese or Basque will kill a Frenchman. (James Brodman Charity & religion in medieval Europe)  778 defeated Charlagmane’s rear army killing Roland.   Many hostels in Southwestern France and the Pyrenees, extensions of monastic hospitality.   C12th three of these gave rise to minor hospitaller orders:   Hospital of Aubrac: 1120 founded by pilgrim Adalard who had been beaten up and left for dead in a snowstorm. 100 brothers wearing blue cross. Included 20 lay brothers four of whom were knights.   Santa Cristina de Somport: c1100-1115. Served route from Bearn to Saragossa. Fed and sheltered pilgrims. Also had knights but were led by clergy not soldiers.   Canons Regular of St. Mary Roncesvalles: 1132 by King Alfonso I of Aragon and Bishop of Pamplona. Dependency of cathedral chapter. 72 members only 10 were Canons. “Open to all, sick and well, not only Catholics but also pagans, Jews, heretics and vagabonds…. women and men took it upon themselves to minister, doing so with great charity”.   Large complexes, church, residence, hospital and guest house for the rich.   St Mary’s Rouncival   1231: Wm Marischal, Earl of Pembroke: Funds and endows Augustinian Hospital and gardens of St. Mary Rouncival in the Strand in village of Charing Cross.   Dependency of St. Mary’s Roncesvalles Navarre. Military order, Prior Knights and Bretheren to defend the pass, lodge and feed pilgrims, tend the sick and bury the dead. Accepted modified Augustinian rule in 1137. Hospital prosperous until the Black Death then the French wars.   1379: Chapel and lands seized by King.   1382: Nicholas Slake, a king’s clerk appointed warden of Hospital (following notorious embezzlement by pardoners). Mentioned in Chaucer. Canons of Augustinian hospitals served as their own pardoners. Not a layman. Free to repentant sinners xch for alms   Almshouse measured 80 feet by 23 feet, and contained at least nine beds, Records of payments "for lynyng' of ix coverletts for the Almes beddes.” for "naylles for to mend iii beddes in the Almonse house"; for "threde for turnyng' and mendyng' of the sheitts"; for straw "for the Almes beddes,”. The allowance per patient was 1d. a day for the cost of food and of any medical aid. Few patients spent more than three or four days in the almshouse, and against many of their names is the entry "died”.   Occasionally extra comforts were provided for the almshouse by gift or bequest, Kateryn Phillips will,1504 "buryed in the Chappell of our Lady of Runcedevale" and bequeathed "to the hospitall' of our Lady aforsaid a fedderbed, a peyr of shets, a bolster, a pair of blanketts, a coverlet."   A variety of pea was developed in its gardens, pisum maius. Grown as a soup pea until 1855.   Suppressed under alien houses act by Hen V. Re-edified by Ed IV. Taken over by King Henry VIII and dismantled. Henry Howard built Northampton house on the site.   St John of Jerusalem   1023: Amalfi merchants established hospital in Jerusalem, on site of Charlemagne’s destroyed by Caliph el-Hakim. Dependent on Benedictine monastery of Santa Maria Latina; ward for each sex. After crusader capture 1099 attached to Holy Sepulchre. Brother Gerard’s Hospital became famous. In 1113 becomes the Order of the Hospital of St. John of Jerusalem, nursing the sick and poor. Plans for subsidiary hostels in West. Eventually 44 commanderies in England, after templar suppression.   c1144: Lord Jordan Briset f. Nunnery & Priory in ten acres of Clerkenwell, 1st prior Neapolitan, 4th English. Allowance of 1d/day for brothers 20s for Prior. Some pensioners preferred treatment. Flagons of ale, loaves of bread, meat even during lent etc. Wayfarers could claim for 3 days, sickness allowed admittance to the infirmary.   1187-1798: military side prominent to secure pilgrim routes. Increase wealth (97,000 florins/yr 1478) allows health-care functions despite massive military spending. Swearing in: White cloth, candle: free from vows, inc marriage ‘slave to our lords the sick poor’. Poverty, Chastity, Obedience. Compulsion to serve in East. After 1248 red in battle.   1381: Destroyed peasants revolt. Unpopular prior Sir Rob. Hales, Treasurer in Rich II minority, beheaded, treasures burnt.   1450: Jack Cades revolt 1450 Kent properties sacked “The first thing we do, let's kill all the lawyers.” (Henry VI Part2).   1540: Prior Weston pension £1,000/yr but died on day of dissolution rest beheaded. Possessions of the Commentaries transferred to crown.   Unique hipped bell tower (1484), gilt, enameled, and was blown up by Protector Somerset in 1548 to use as quarry for his palace in Strand.   1536: Priory of Kilburn nuns expelled (retains name St. John’s Wood).   Other Alien Houses   St. Anthony’s   1095:lay society formed by Gaston of Valloire in thanks for his son, to care for victims of St Anthony’s Fire (ergotism). Vin sacré touched the bones, from Egypt, of the uneducated founder of monastisism. Housed in Saint-Antoine-l'Abbaye, Benedictine Priory. Uniform of black with blue Tau. Antagonism; reorganised by Boniface VIII as St Augustine canons 1297. Benedictines moved to Montmajour.  International organisation, network of 200 hospitals.   Care for ergotism, then later pilgrims.   Pardoners had come to England as early as 1218 (Henry III protection)   1254: London branch of Brothers of St. Anthony of Vienne founded for a master, 2 priests a schoolmaster and 12 poor men. A former synagogue granted by Henry III confirmed by Pope Alexander V.   1291:hospital nr St. Benet Fink not in Jewry. Did the brothers or the Jews move? Henry III order 1252 that there should be no synagogues except where they existed in the reign of John.   Property worth 8s/yr so dependent on alms. Pardoners sanctioned by pope. St Anth claimed unfit pigs which had a bell fitted by the proctor and set free, responsibility of citizens to feed them.  “Follows me like a Tantony”. Images of St Anthony being accompanied by a pig.  C16th representation of the saint in the Catherine Room, No.2 Canons’ Cloister, Windsor   During French wars cut off from mother house. Rich II would not allow pope Clements’s candidate and put his own (Macclesfield).   1414: Came into Kings Possession under Alien Priories Act. By that time 12 infirm old men.   St. Anthony’s becomes a school   1441: John Carpenter, master, future bishop of Worcester, St. Benet Fink for the maintenance of a grammar school. Thos More, John Whitgift tradition of polyphonic singing   1475: Edward IV gives St George’s Chapel the hospital and advowson (right to appoint). By 1563 the religious foundation was largely brought to an end. 1565: Almsmen given 1s each and turned out by Johnson a schoolmaster who became prebendary of Windsor.   1550:Royal Charter Edward VI: freedom of worship. Protestants escaping religious wars in France needed somewhere to worship. Church in Threadneedle Street, (formerly gropecunt lane), leased to the French Protestant community in London during Elizabeth I’s reign. Queen still appoints Pastor.   ‘the church called St Anthonies Chappell now commonly called the French Church for the use of people to resorte thither to their divine service’   Burned in Fire, rebuilt 1669!   St Benet’s pre-Fire church was rectangular. After the Fire, the City appropriated the northwest corner of the church for widening Threadneedle Street. This left an irregular site on which to build, which Wren addressed by rebuilding St. Benet’s in the shape of a decagon. Demolished 1844. Sale of furnishings raised £15/5s   Leprosy   1070-1150: 68 hospitals are founded, half of these for lepers.   Ring of 10 leprasoriums on main roads of London, sited to be impossible to avoid them. Erasmus “Upon the lefte hand of the way is an almes howse from them runnyth owt as sone as they here a horseman commynge and offereth hym the over lether of a shoo in a glasse lyke a precyouse stone” (a relic of St Thos)   Enfield, Hammersmith, Highgate (1473), Holborn (St. Giles's), Kingsland, Mile End. St James and Knightsbridge in Westminster, Southwark, Bermondsey.   1549:administration transferred to Bart’s who appointed surgeons as masters (Guiders) £4/day plus 4d/d for each inmate’s food. Not to beg within 3 miles of city.   1280: Kingsland Leper (lock) Hospital (Loques=rag) SW of junction of Kingsland Rd with Dalston Lane. Run by Guides, maintained by bequests.   1549: dependency of St Barts.1633 a case of venereal disease; became majority of patients by the mid C18th along with ague, diarrhoea, dropsy, fever and jaundice. 1668 six wards women only. (Men sent to Lock, Southwark).  Closed 1760   C12thSouthwark: Royal foundation: joint dedication of St. Mary and St. Leonard. the Loke or Lazar-house stood in Kent Street, west side by first milestone from London bridge. 1487; John Pope will for repair and maintenance.   1473: Wm Pole a leper founds Hospital of St. Anthony Highgate Hill, on land given by EdIV facing Whittington stone.1650 the premises, covering two roods and worth £9 a year, consisted of a timber building with a tiled roof, containing a hall, a kitchen, three small rooms on the ground floor, and five small rooms above, and an orchard and garden.   1500:Hammersmith leper hospital, Ravenscourt Park mentioned in will of Joan Frowyk. 4d to every leper to pray for her soul. 1623 payments cease.   1559:Last cases of leprosy in London.   Leper Hospitals   Hospital of St. James the less for Leperous Sisters   Hospital founded before 1189 for 14 leprous women, and 8 brethren, first documented during the 12th century. The brothers and sisters were in separate houses, and followed the Austin rule. It was demolished in 1531 for the construction of St James's Palace, consisting of two Hides of Land, with the Appurtenances, in the Parish of St. Margaret in Westminster, and founded by the Citizens of London, before the Time of any Man's Memory, for fourteen Sisters, Maidens, that were leperous, living chastely and honestly.      Joined by eight Brethren to minister Divine Service.           After this also, sundry devout Men of London gave to these Hospital four Hides of Land in the Field of Westminster; and in Hendon, Calcote, and Hampstead, eight Acres of Land and Wood. King Edward I confirmed those Gifts, and granted a Fair, to be kept on the Eve of St. James, the Day, the Morrow, and four Days following.   This Hospital was surrendered to VIII; the Sisters allowed Pensions for the Term of their Lives,   and the King built there a goodly Manor, annexing thereunto a Park, closed about with a Wall of Brick, now called St. James's Park, John Strype’s survey.   St Giles In the fields   1101:Pulchram satis et magnificam. founded for 40 lepers by Queen Matilda (wife of Henry I, granddaughter of Edmund Ironside (d.1016), married son of the Conqueror and thus unite the Saxon and Norman lines. Also Duncan murdered by Macbeth and mother of Wm d. White Ship 1120) .   Being a leper house, St. Giles was built in the fields which surrounded old London. The hospital was supported by the Crown and administered by the City for its first two hundred years; in fact, it was named a royal free chapel.   1299: Edward I, it was administered by the Military and Hospitaller Order of Saint Lazarus, one of the chivalric orders to survive the era of the Crusades.   C14th: turbulent one for the hospital, with frequent accusations from the City authorities that the members of the Order of Saint Lazarus, known as Lazar brothers, put the affairs of the monastery ahead of caring for the lepers. Pts evicted for monks   St. Giles was a chapel attached to the leper's hospital and it was the custom for prisoners passing the chapel door on their way to execution to be given a 'parting cup' of a bowl of ale as an act of charity. 1453 gallows moved to Tyburn. The custom continued after the chapel became a parish church in 1547.   1402:9 lepers   1535:14 paupers.   Lesser and transient houses   St Giles without Cripplegate: “An hospital of the French Order” (Tanner). In Whitecross Street at the time of Edward I, and that it was suppressed by Henry V, who founded in its place a brotherhood for the relief of the poor.   St Paul’s Hospice1190:Henry de Northampton, canon of St. Paul’s, founded hospital within precincts. Tithes of St. Pancreas & Kentish town given by Dean and Chapter.   Alexander le Ferim: Hospice for poor. Given to St. Anth 1268.   La Reole Hospice: Granted to St. Stephens College Westminster 1369.   Jesus Commons: A number of priests lived together in a house left to them in Dowgate Ward. It survived the changes of Edward VI to become extinct from loss of numbers in Elizabeth’s reign.   Grocers Almshouse: Founded 1429 by Thomas Knolles and other Grocers for the relief of seven "aged poore Almes people"   Hospital without Aldersgate, a Cell to the House of Cluny, suppressed by King Henry V.   Hospital of Holy Trinity Aldgate: f. Matilda of Bolougne.   House near Charing Cross for "Distraught and lunatic people” kept in a "stone house” until the late C14th, moved to St Mary's Bethlehem   St Augustine’s Pappy   1430: Wm Oliver, Wm Barneby & John Stafford found Hospital for poor impotent priests and bretheren of the Papey.   1442: 3 chaplains found the fraternity of St. Charity and St. John the Evangelist near the Church of St. Augustine in the Wall.   1451: Mayor Gregory: Pappy Chyrche in the Walle be twyne Algate and Beuysse Markes. And hyt ys a grete fraternyte of prestys and of othyr seqular men. And there ben founde of almys certayne prestys, both blynde and lame, that be empotent."   Chapel and churchyard of St. Augustine Papy, formerly a parish church.   Master, 2 wardens elected every year by the brothers. No member of the fraternity of 60 poor priests could be elected. They were given shelter, food and wood and an allowance of 6-8d/day.   Cleanliness: a married couple was engaged to keep the house clean and attend to the laundry.   Suppression of the fraternities by Edward VI   Whittington’s Hospital   1424: Founded by executers of Richard Whittington for 13 poor persons. Citizens of London, preferably Mercers or ministers of Whittington College who could no longer fulfill their duties.   Founders of Whittington's almshouse refused admission of those "infecte with lepre or eny suche other sikenesse intollerable”   A house was built to the east of the St. Michael paternoster, next to the dwelling of the chaplains of Whittington College.   Separate apartments but communal meals.   Daily attendance at "matyns, masse, evensong, complen and other houres of holy Chirche",   The almsmen had to pray for the souls of Whittington and his wife Alice and after high mass assemble around the tomb and recite De Profundis. Psalm 130 used in liturgical prayers for the faithful departed. In sorrow the psalmist cries to God, asking for mercy.   The college was dissolved by Henry VIII but the house of charity survived the reformation and almshouses exist in East Grinstead.   Milborne’s Almshouses   1524: by Sir John Milbourn built on land bought from the Crossed Friars. 13 poor men and their wives if married, members of the Drapers Company.  They had to go to the conventual church every day to pray for the founder and his family. Recite at eight o'clock every morning the psalm de profundis and a paternoster, ave, and creed, with the appropriate collect for the salvation of their patron.  Remained on original site till 1862 then moved to Tottenham.   Health Reform is constantly required   1348-9: Hospitals declined after the Black Death. Leper hospitals lacked lepers.   Others lacked funds.   1395: Lollards (12 conclusions) suggested abolition of chantries and nationalisation of the endowments to found new alms houses for the sick.   1414: House of Commons hospitals “now for the most part decayed.” MPs accused those responsible of diverting hospital income to other uses, leaving the needy to die in misery.   % hospital income spent on the clergy had risen at the expense of the poor. St Mark Bristol founded as an almonry to feed 100 of the poor a day, with a single chaplain to pray for the founder's soul.   C15th had become a house of Augustinian canons feeding only 27 poor.   Some  foundations had become sinecures for clerics who appropriated all the income.   Complaints about the abuse of poor relief by "sturdy beggars” profession of indigence.   St Leonard York imposed levy of a thrave from every ploughland in the diocese: revolt 1469. feeding the rich not the poor marched on York. The revolt  suppressed, Edward IV abolished the levy   1479:Merchant’s bequest of 126. 8s. 4d. to the "poure  excluded "the commyn beggeres going aboute all the daie light and lying in [hospitals] the nyght tyme”   Reform and dissolution   The London of Edward III was a city of palaces, that of Queen Elizabeth a city of ruins.   The Black Death severely affected hospitals. St James in Westminster the master and all brothers and sisters except one, William de Weston, died. By 1353 there were no inmates.   Hospital incomes fell, wages and incomes rose. It was impossible to maintain large numbers of bretheren.   Purchase of corrodies, individual was assured of board and lodging for life upon payment of a specific sum of money. Diverted resources from needy.   Condemned in 1316 visitation of Barts by Bishop London, & 1387 by Bishop Winchester about St Thos.   Shift of work to the essentials (clergy) who started to take increasing share of the wealth. Some ceased to exist, often following amalgamation with a church; others declined to free chapels, or were amalgamated. Others, St Ants became schools. St John’s in Cambridge became an academic college.   New foundations almshouses these survived the reformation.   Separate rooms not dorms, less communal except for chapel, named after founders.   Gresham, surgeons of St Bart’s Vicary, Sir John Ayliffe   The poor after dissolution   1545: Lamentacyon of a Christian agaynst the Cytye of London " London, beyng one of the flowers of the vvorlde, as touchinge worldlye riches, hath so manye, yea innumerable of poore people forced to go from dore to dore, and to syt openly in the stretes a beggynge, and many ...lye in their howses in most greuous paynes, and dye for lacke of ayde of the riche.I thinke in my judgement, under heaven is not so lytle prouision made for the pore as in London, of so riche a Cytie.”   1546: A Supplication of the Poore Commons: Poor "now in more penurye then euer they were." Once they had scraps, now they have nothing."Then had they hospitals, and almeshouses to be lodged in, but nowe they lye and storue in the stretes. Then was their number great, but nowe much greater."   Refounding of Royal Hospitals by Henry VIII   Provides £500 for St Barts, as long as city provides same amount.   St. Bartholomew's of Gloucester was restored to the corporation by Elizabeth on condition that forty poor people, a physician and a surgeon, were there maintained   1592-3: County treasurers were appointed to distribute the product of a rate to be levied by the justices for the relief of poor soldiers and sailors. The treasurers were responsible for the building and maintenance of hospitals for the aged, impotent, lame and blind   1597:the Poor Law Act empowered church wardens and overseers of the poor to build hospitals on waste lands, the funds to be raised by the taxation of every inhabitant of lands.   1600’s pest houses   1722: Poor Law: Building of Hospitals and work houses   1834:Unions took over many workhouse hospitals. These were usually combined institutions-workhouses with sick wards.   Medieval Medicine mainly outside hospitals   Separation of surgery from medicine, 1215 4th Lateran Council, forbade physicians (most of whom where clergy) from performing surgical procedures, as contact with blood or body fluids was viewed as contaminating to men of the church. Surgery was relegated to guilds   Exceptions eg Theodoric Borgognoni cleric in major orders, at the papal court 1240.   1377: John of Arderne De cura oculorum, compilation of other people's views, much of it being taken from Lanfranc. C15th English   Increasing interest in diagnosis and treatment:   1250: Gilbertus Anglicus, Compendium medicine “cataract consists of a collection of humours between the tunics”   Renaissance   Time of religious wars. Rising neo-platonism and Augustinian philosophy. Reality a mixture of matter (corrupt) and spirit (good). The human body was unique, a micro-version of the cosmos and therefore influenced astrologically. Mars correlated with bravery, fortitutude. Its correlate on earth is iron/ore. Red and the strongest metal. So if you have anaemia-lassitude-not enough Martian influence.   Phillip von Hohenheim (Paracelcus) (1493-1541) treats you with iron and you get better. Fleeting rash of syphilis, Rx with Mercury.   John Freke 1688-1756   The first ophthalmic surgeon in Great Britain son of a surgeon b. London 1688. Apprenticed to Mr. Blundell, whose daughterhe married.   1726, he was made assistant-surgeon to St. Bartholomew'sHospital, and the same year was made curator of the museum whenit was started. This museum was in a single room under the "cuttingward," and among other things it contained the stones whichsurgeons had removed, which previously had been placed in thecounting room when patients paid their bills.   In 1727, he was put in charge of the blind patients, and the governors passeda resolution:   Through a tender regard for the deplorable state of blind people,the Governors think it proper to appoint Mr. John Freke, oneof the assistant surgeons of this House, to couch and take careof the diseases of the eyes of such poor persons   The four stages of cruelty Hogarth 1751. Tom Nero begins by torturing animals then is hanged for murder. The skeletons in the niches: James Field notorious pugilist and James MacClaine gentleman highwayman recently hanged. It takes place at the newly formed Surgeons Company under Freke.   Thank you   Patients and colleagues.    Prof Carole Rawcliffe   History of St Bartholomew’s Norman Moore   Cartulary of St Bartholomew’s   Wellcome Foundation   Nicholas Orme The English Hospital, Yale University Press 1995   Victoria County History   St. Bartholomew’s Archive, St.Thos. Archive   Guildhall Archive   The story of England’s Hospitals Courtney Dainton London Museum Press 1961   History of Britain’s Hospitals: Barry Carruthers, Book Guild Sussex 2005   Kings Court galleries Fulham SW6   Clay, R M, 1909, The medieval hospitals of England. London. Methuen   Walking London's Medical History Nick Black       ©Professor William Ayliffe, 2011 

This event was on Wed, 22 Jun 2011

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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