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- Author: Sally Mayall Brasher x
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Most people would agree that the hospital functions as one of the 'first duties of an organized society' as a public service for those members of the community who are in need. In the thirteenth century, hospitals represented a nexus of exchange between church officials, the community, the needy, and the pious or ambitious individual. This book presents a survey that offers an overview of the role of the hospital in affairs of the urban community, suggesting how changes within that community were reflected in the activities of the hospital. It locates the rise of the hospital movement in northern Italy within the context of the changing religious, social, and political environment of the city-states. The book introduces the hospital's central function in the distribution and administration of charity. It illustrates how the hospital and other charitable organizations played a role in the appropriation of power and influence by urban citizens. A comprehensive investigation of twelfth and thirteenth century hospitals' foundational charters follows. The book then delves into a detailed description of the physical plant of the hospital, the daily life of individuals, and rules and statutes followed by its members. It considers the social composition of donors, workers, and recipients of hospital services. Jurisdictional disputes among the city leaders, the community, individual religious orders, ecclesiastical authorities, and larger political forces. Finally, the book explores the process of consolidation and bureaucratization of hospitals in the fifteenth century and the emergence of state control over social services.
This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book provides a comprehensive examination of the foundation, administration, and evolution of the medieval hospital in northern Italy between the twelfth and fifteenth centuries. It describes the rise of the hospital movement in northern Italy within the context of the changing religious, social, and political environment of the city-states. The book also provides an analysis of the groups and individuals who administered the hospitals and their affiliations with other larger religious and community entities. It traces the jurisdictional disputes among the city leaders, the community, individual religious orders, ecclesiastical authorities, and larger political forces. The book explores the process of consolidation and bureaucratization of hospitals in the fifteenth century and the emergence of state control over social services.
The hospital movement in Europe arose out of a tradition of charity and religious life that originated in the earliest days of Christianity. The extensive, fast paced, urbanization of the high Middle Ages, nowhere more pronounced than in Italy, challenged the earlier ecclesiastical model of charity. The establishment of new forms of community created novel social, economic, and political relationships that tested the traditional authority of both the secular and ecclesiastical hierarchies. Some scholars have viewed the rise of lay religious and semi-religious movements throughout medieval Europe as a result of theological reform and ecclesiastical leadership. At their most basic level, charitable institutions, such as the hospital, gave immediate relief to those who were in need, fulfilling a primary service to the urban community. Charity was a dual mechanism; it served to alleviate the poverty of others and the sinfulness of the self.
This chapter explores the foundation of various individual hospitals. It considers the physical location of the facilities, the identity of the founders, and the motivation of those founders, along with a discussion of the communal context and jurisdictional structures under which they originally operated. There is a plethora of notarial documentation from cities in the Lombard region that gives evidence for the foundation of hospitals in the area. While hospitals were located throughout the medieval city, early charters suggest that a common feature of many was their location near the gates of the city, and often along major roads. The frequent reference to roads and gates in the documentation of hospital foundations has led some scholars to conclude that the primary purpose of the hospital was simply as a hostel for poorer pilgrims and travellers.
This chapter examines the operational structure of hospitals, including jurisdictional oversight, management, and operations of these organizations. While the ecclesiastical powers continually attempted to maintain a supervisory or proprietary role over the hospitals, the lay or semi-lay leaders who were attached to each individual institution had a great deal of power over day-to-day issues. Properties controlled by hospitals were not insignificant, and control over these assets would have been a major interest of the church leaders, the city and the communities. In addition to the major responsibility of caring for poor and ill patients and community members, hospital administrators also managed the resources and income accumulated by the hospital. In addition to the canons, confraternities, consortia, and other lay and semi-religious groups also took part in the administration of hospitals.
As much of the documentation for various medieval hospitals is fragmentary and obscure, it is difficult to reach broad conclusions regarding the administrative model, physical composition, or daily life of a hospital over the entire course of its existence. However, the author does have ample documentation for a few hospitals that must serve anecdotally to illustrate the internal life of these communities. It is possible to ascertain some information regarding the social status and living conditions of lay staff of the hospital community from inventories such as the one for Ospedale Rodolfo Tanzi and as oblation ceremonies and testamentary bequests. On those occasions when the church officials did intercede in the affairs of the hospital, the outcome was often the imposition or reinforcement of a 'rule' or statute of operation.
This chapter examines the jurisdictional disputes which reflect the transition in hospital governance from the lay initiative of individuals founders, through the assertion of ecclesiastical oversight and finally to oversight by an increasingly centralized communal government. Often, evidence of how external political strife adversely affected charitable institutions is illustrated through the jurisdictional disputes in which the communities became involved. Relations between Ospedale Rodolfo Tanzi, the bishop of Parma, and the city of Parma, illustrate how frustrated citizenry increasingly organized in response to the political meddling of ecclesiastical and imperial powers in civic life. A crisis in the administration of the Italian hospital occurred in the early to mid-fourteenth century and mirrored the general crisis of the age. The endemic conflict between and within cities, and with the institutional church and imperial powers, resulted in a politicization of all civic organizations, but in particular of the administration of the hospital.
The construction of Ospedale Maggiore was the culmination of reform efforts. In 1399, Duke Gian Galeazzo Visconti pursued the aim of reform by unifying and consolidating hospitals under civic authority, and based his plans on the process of unification already underway in Siena. The Black Death of 1348-1355 placed unprecedented pressure on all institutions but most specifically on hospitals, which were ill equipped to handle such a massive crisis. While the plague crisis and perception of increased poverty predicated an immediate communal response, reform efforts which included unification and centralization of hospitals were also implemented in reaction to mismanagement and jurisdictional disputes. Larger more centralized communal organizations replaced the smaller traditional confraternities and consortia that had been crucial players in the earlier era of foundation and administration of hospitals.
The hospital movement of the thirteenth through fifteenth centuries in northern Italy provides a lens through which to view the transformation of political power, religious life, and the social agency of urban citizens of the region. Traditional definitions of poverty and need, as well as suggestions of a Christian's responsibility to such need, no longer satisfied city-dwellers who saw a much greater demand and variety of suffering in their community than ever before. Communal need and institutional neglect led to the emergence of the medieval hospital as a widespread institutional phenomenon that served as a nexus of charitable activity, religious life, political access and social mobility. In the fourteenth century, multiple crises led to a further challenge to the ability of the laity to continue their control of hospital leadership.