. From their origin as guesthouses for pilgrims and almshouses for the indigent, medieval hospitals offered custodial care rather than therapy. The sick poor received special attention when monastic infirmaries were extended beyond the cloister in early Benedictine communities (Fleury, Centula) and until the heyday of Cluny. French hospitals long retained a religious character in their moral and economic dependence on charity as well as in their staffing and administration. A gradual secularization occurred, however, first with the building of the nonmonastic “Hôtel-Dieu,” typically near the gate of such new towns as Troyes or Provins. The number of these foundations increased dramatically after 1100 thanks to the inspiration of the Hospitalers of St. John, seigneurial largesse, and bourgeois initiative. The development of universities opened the door to professional medical assistance with visits by doctors and their students and, apparently, the occasional performance of surgery: this was the case for the hospital of Saint-Esprit in Montpellier, recommended by the pope as a model for all Christendom. By the 15th century, many institutions passed under royal or municipal control and were governed by lay committees. The best-preserved example of this type is the Hôtel-Dieu of Beaune, built between 1443 and 1459 by Nicolas Rolin, chancellor of Burgundy.
If the modern “health-care facility” is focused on the operating room, the heart of the medieval hospice was the sick ward, or salle. The great hall was over 300 feet long in the Hôtel-Dieu of Paris and in the one founded at Tonnerre by Marguerite, the wife of Charles of Anjou.
While benefactors could claim private quarters, most residents were lodged communally. Two often shared one bed, particularly in the smaller dormitories; curtains would screen each bed in the larger, draftier, and more crowded wards. Some hospitals had isolation wings for contagious patients, the disruptive insane, or children; others, like Saint-Jacques of Valenciennes, turned away incurable patients. Special foundations sheltered lepers, the mentally ill, the old, or, as in the case of the hospice “des Quinze-Vingts” erected by Louis IX in Paris, the blind. In many instances, care and conditions declined from the late Middle Ages on, with the aging of early foundations, the fading of charitable impulses, the overcrowding in epidemics and wars, and—paradoxically—the transition to official control.
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Mundy, John H. “Hospitals and Leprosaries in Twelfth- and Thirteenth-Century Toulouse.” In Essays on Medieval Life and Thought Presented in Honor of Austin P.Evans, ed. John H.Mundy and R.W.Emery. New York: Columbia University Press, 1955.
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