Jerusalem’s Hospital of St. John: A model medieval hospital

Guenter Risse has provided, in his Mending Bodies, Saving Souls, a fascinating account of the Hospital of St. John in Jerusalem during the crusader years.

The Hospital reflected and elaborated on the values found in the earlier monastic history of Christian hospitals. Here are some glimpses, prefaced by a brief timeline of Jerusalem’s history:

Timeline of Jerusalem (clipped from Wikipedia):

Late Roman period

Arab control

Crusader period

Ayyubid period

During the Crusader period, Jerusalem was under Christian (Western) control for 88 years. Now, Risse’s account of the Hospital of St. John:

137        “Near the western entrance to Jerusalem stood the Tower of David, and as our pilgrims walked eagerly toward the Holy Sepulcher, they could not help but admire the large complex across the street occupied by the hospital of the Knights of St. John the Baptist, an internationally famous hostel. The complex was located to the south of the church of the Holy Sepulcher, occupying the western part of an area now known as the Muristan, site of a ruined Byzantine monastery. The initial convent had been built atop the old structure, with a hospice for the poor and the pilgrims located immediately to the north. Initially, this hospital had been just another monastic infirmary like the one at St. Gall, with a number of heated rooms, a kitchen, and an adjoining garden or lawn for the recreation of the sick. Its eventual expansion created an imposing building 230 feet long and 120 feet wide, with 18-foot arches and even higher ceilings, a structure admired by many visitors for its great beauty.”

137        “A contemporary description by John of Würzburg, a German priest and pilgrim, confirms this impression: ‘Next to the Church of the Holy Sepulcher, on the opposite side towards the south, is a beautiful church erected in honor of St. John the Baptist,’ he wrote. ‘The hospital is next to it, in which in various houses a great crowd of sick people is collected, some of them men and some women. They are cared for and every day fed at vast expense. When I was present, I learned from the servants that their whole number amounted to two thousand. Between night and day there were sometimes more than fifty corpses carried out, but again and again there were new people admitted.’”

138        “This German visitor also tells us that . . . [t]he establishment was equipped with baths, rooms for bloodletting and shaving, and several kitchens, and was even provided with animal pens. Wrote John of Würzburg: ‘The house feeds so many individuals outside and within, and it gives so huge an amount of alms to poor people, either those who come to the door, or those who remain outside, that certainly the total expenses can in no way be counted, even by the managers and dispensers of this house.’ . . . Theoderic in his book observed that ‘going through the palace we could in no way udge the number of people who lay there, but we saw a thousand beds. No king nor tyrant would be powerful enough to maintain daily the great number fed in this house.’”

The “prehistory” of the hospital of St. John in Jerusalem:

138        “Before the first century, the city already had a tradition of sponsoring Jewish hospices, and that tradition was eventually taken on by Christians to house and serve their own pilgrims who began flocking to Jerusalem, especially after the legalization of Christianity within the Roman Empire. In the centuries that followed, Jerusalem became an important destination point for travelers who visited the various holy places, reading aloud passages from the Scriptures in their respective locations. This reenactment of the dramatic events in the life of Christ—imitatio Christi—eventually became the ceremonial of the stations of the cross. . . . It was a truly mystical experience to be at the very site of the Lord’s final sufferings and to visit the empty tomb, the visible testimony of His resurrection.”

[a couple of pages ensue on the Muslim rule, including:]

138-9     “In 638, Jerusalem fell into Arab hands,. . . . The fall of Jerusalem and the subsequent conquest of all the coastlands of North Africa by the year 700 profoundly shocked all Christian countries. Still, the ruling caliphate of the Ommayad dynasty, with its capital in Damascus, accepted religious minorities, ensured freedom of worship, and encouraged a tolerant atti-[139]tude toward the vanquished. . . . in Jerusalem, orthodox Christians continued to outnumber Moslems in an atmosphere of prosperity and tranquility. . . .”

139        “The initial trickle of pilgrims became a raging flood after the tenth century as belief spread in the West that pilgrimage possessed a definite spiritual value and that visitors to the shrines would be granted special indulgences.”

140        In the run-up to the capture of Jerusalem by the First Crusaders, there had been “setbacks” to the Christian presence in Jerusalem and the ability of Christian pilgrims to visit the Holy City, as “roads were infested with bandits and local lords extracted further tolls, thus reducing the pilgrim flow from the West.”

Then in 1099 the Crusaders retook Jerusalem, initiating the period of 88 years of Christian control in that city.

140        “During the eleventh century, the steady increase in European pilgrims and merchants and their plight in an alien land had prompted the Amalfian[1] sponsors of the St. Mary of the Latins monastery to also build and administer a hospice dedicated to St. John the Baptist. This institution, presumably founded around the year 1080 and staffed by Benedictine monks, was to be reserved for ‘Latins, Italians, and Lombards,’ according to a later papal bull. Working under the direction of the abbot of St. Mary’s, Brother Gerard—probably an Amalfian layman—was appointed administrator. Like similar monastic hostels in Europe, its mission was to provide shelter and security for local and traveling Christians. The brothers servicing this xenodochium or nosocomium, modeled after other Syrian guesthouses, called themselves ‘the poor brethren of the Hospital of St. John.’ They pledged to help the poor and receive needy pilgrims with the aid of alms collected from Amalfian merchants.”

140        “Before the triumphal entry into Jerusalem of the forces of the First Crusade, Brother Gerard was accused by the Turkish rulers of Palestine of hoarding money as well as helping the crusaders. Although arrested and tortured by Jerusalm’s Islamic defenders, Gerard was saved by the prompt arrival of the Europeans, and he quickly took advantage of his position by persuading the new Frankish rulers to contribute to the endowment of his institution. Indeed, Godfrey of Bouillon granted some landed estates and city properties to Gerard and his brotherhood, thus allowing for a substantial expansion of charitable operations at the hostel. Among those selected for care at the hospice were knights and soldiers wounded in the siege of the city. These activities mirrored contemporary Christian hospitality and charity prevalent in all of Europe and Byzantium.”

[There followed more successes and donations that enriched the hospital, 140-1]

141        “In fact, Gerard and his hospice received a foundation charter from Pope Paschal II issued on February 15, 1113, in a bull creating the new St. John Order of the Hospital and placing the institution under papal protection. It also allowed the Hospitaller brothers to elect their own master and stipulated that all property and income provided to the establishment would be used for the benefit of pilgrims and the poor.” In the following years, other great benefits accrued to the hospital, including “exemption from the payment of tithes.”

141        Raymond du Puy changes Hospitallers’ statutes in the 1150s:

“Following Gerard’s death in 1120, the Hospitallers elected Raymond du Puy as his successor. Whereas Gerard’s institutional rules may have been Benedictine in origin and geared toward an independent monastic community in a city governed by Moslems, the new political and social circumstances created by the First Crusade demanded a total reconstruction of the hospital’s mission. Foremost among the reforms was an official shift in attitude toward the sick admitted to the hospital. While traditionally all monastic hostels had stressed the dignity of any fellow Christian, article 16 of Raymond du Puy’s new statutes written during the 1150s went further: subordination of the staff to the wishes of the sick. Entitled ‘How Our Lords the Sick Should Be Received and Served,’ the rule stated that ‘in that obedience in which the master and the chapter of the hospital shall permit an hospital to exist when the sick man shall come there, let him be received thus: let him partake of the Holy Sacrament, first having confessed his sins to the priest, and afterwards let him be carried to bed, and there as if he were a Lord.’”

141        “Under such a system, the caregiving Hospitallers—nominally their vassals—were ethically bound to provide faithful service regardless of the risk and expense.”

The order of Hospitallers became rich and powerful (141ff), even gaining a military role (e.g. protecting pilgrims from bandits—see 143, bottom)

144        “As brethren-in-arms, most Hospitallers identified themselves as ‘soldiers of Jesus Christ’ subject to the king of Jerusalem. Their organization now codified an aristocratic form of government with three levels of membership. First-class members or knights belonged to the young European gentry. They pledged to defend the faith and administer the vast estates willed by grateful patients and admiring rulers. The second class was composed of clergymen and brothers entirely devoted to spiritual matters and the physical care of the sick. Both groups wore black robes adorned with the eight-pointed white cross on the chest. . . .”

144-5     “The Augustinian regula [monastic rule] promoted by Raymond [Du Puy] demanded that the hospital staff—including the knights—be bound by the three customary monastic vows of chastity, obedience, and poverty. After the fall of Jerusalem, a new sisterhood game to work at the hospital to care for female patients. . . . [145] Third-class members of the Hospitallers consisted of serving lay brothers and sisters who carried out the necessary menial hospital tasks of cooking, washing, and cleaning.”

145        “From the start, Brother Gerard had decreed that physicians could be provided for the sick brethren. Later, Raymond’s rules also favored the addition of physicians to the staff. . . . [Papal bulls supporting the Hospitallers] confirmed the full-time employment of four lay medici (physicians0 and four chirurgici (surgeons). The practitioners had to live on the premises and take an oath of allegiance to their feudal superiors, the Hospitallers, although they had a higher status than brothers and were allowed to dine at the knights’ table. Additionally des Moulins’ [Roger de Moulins was Grand Master of the Knights Hospitaller from 1177 to his death in 1187] rules called for ‘physicians who have the care of the sick and who make syrups for the sick,’ a reference to pharmaceutical compounding. These statutes indicated an even greater degree of medicalization than had previously existed. . . . The institution . . . officially shifted its admission priorities from simply housing needy pilgrims to solely selecting those who were clearly sick. The approval of Rogers’ statutes by Pope Lucius that same year ratified the greater role of medical care in the institution: ‘it is decreed with the assent of the brethren that for the sick in the Hospital of Jerusalem there should be engaged for wise doctors who are qualified to examine urine [mainstay of medical diagnosis through much of the Middle Ages—see images in other sources] and to diagnose different diseases and are able to administer appropriate medicines.’”

145        “Unquestionably, the statutes of the Hospitallers reflected a trend toward more professional medical treatment, which can also be observed in contemporary Byzantine xenones and Islamic bimaristans. These regulations reflectded the continued availability of medical knowledge and personnel in Palestine and Syria. Whether under Byzantine or Moslem rule, Antioch, Tripoli, and Jerusalem remained centers of Greek learning, including medicine. It can be argued that one of the reasons for the medicalization of the Hospital of St. John during the 12th century was the presence of both Christian and Moslem physicians. . . . St. John’s also owed much to earlier Islamic hospitals that had flourished in the Near East since the eight century. By contrast, Frankish healers were rare.”

Characteristics of the care at the Hospital of St. John

146        When they first arrived, “after confession and reception of Holy Communion [they were] escorted to a bed.” Most beds “accommodated two or three individuals.”

146        “Since new arrivals usually surrendered their own clothing—it was cleaned and mended, to be returned at the time of discharge—they slept naked. However, regulations requested that each sick person ‘should have a cloak of sheepskin, caps of wool and boots for going to and coming from the latrines.’”

146        “Pregnant pilgrims seeking shelter for their deliveries could expect ‘little cradles for the babies born in the House, so that they may lay separate and that the baby in its own bed may not be in danger from the restlessness of its mother.’ Many unwed mothers were married in the hospital; others simply abandoned their offspring in the wards, to be cared for by the nursing brothers and sisters.”

146        Religious rituals surrounding care didn’t stop with the Eucharist upon admission. “Benedictine rules emphasized the spiritual welfare of the feeble and sick, with masses and communion celebrated early each morning before a candle-lit altar by the prior dressed in colorful vestments. Frequent prayers during the day, especially Our Fathers and Hail Marys, were part of the routine. At the end of the day, the last religious act was another set of prayers and then each inmate was sprinkled with holy water. ‘You, Our Lords the Sick1,’ demanded the Hospitaller on call, ‘pray for y ourselves and for all Christians who are ill in the world, that Our Lord will give them health. Our Lords the Sick!, pray for all members of the hospital fraternity and all other members as well as all men and Christian women who provide charity in the holy house of the hospital, so that the Lord will give them a good death.’” Note the emphasis here on “dying well,” so prevalent especially in late medieval culture.

146-7     Nursing gained prominence and prestige with “the growing status of the Hospitaller order, with some aristocratic members perhaps participating in personal caring activities,” though “knights were not involved in routine chores.” For those duties, “the 1181 regulations demanded that ‘in every ward and place of the hospital nine servants should be kept at their [patients’] service, who should wash their feet gently and change their sheets, and make their beds, and administer to the weak nec-[147]essary and strengthening food, and do their duty devotedly and obey in all things for the sick.’ A female staff washed clothes and bed linens.”

147        “All patients had to be fed before the caring personnel could eat, another gesture of humility and subservience. Raymond’s eighth rule dictated that ‘the sick and feeble are exempted from the common dietary rules,’ an important directive that freed them from the usual fasting routines prevailing in all monastic institutions.”

147        “Rest and nourishment in this institution during the Lenten season and participation in its routine ceremonies, with their formality and pomp, could only have strengthened patients’ faith in the redemptive quality of their sufferings.”

147-8     “For those . . . who would not recover, preparations [148] were made to surround them with caregivers and friends and thus ease their final dying moments.” [Again the emphasis on “dying well.”]

[1] People from the southern Italian Republic of Amalfi, Italy, who took away the trade monopoly in the Mediterranea from the Arabs and founded in the 10th Century mercantile bases in the Middle East.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s