Rotha Mary Clay

“No more brethren or sisters shall be admitted than are necessary to serve the infirm and to keep the goods of the house.” (St. John’s, Nottingham.)

THE hospital family varied widely in size and in the arrangement of its component parts, but this chapter, like the preceding, is concerned chiefly with the type of institution which had a definite organization. The establishments for infected persons will first be considered.

(i) THE LEPER HOUSEHOLD

(a) The Master.—“The guidance of souls is the art of arts,” says St. Gregory: particularly difficult is the guidance of souls in ailing bodies. Lanfranc realized that men of special gifts should be selected for the care of his Harbledown lepers. He not only arranged to supply all they might need on account of the nature of their illness, but appointed men to fulfil this work “of whose skill, gentleness and patience no one could have any doubt.” The Oxford statutes ordained that the master be “a compassionate priest of good life and conversation, who shall reside personally and shall celebrate mass daily, humbly and devoutly.” He was required to visit the infirm, to console them as far as possible, and confer upon them the Sacraments of the Church.88 The priest p144 serving lepers was permitted to dispense rites which did not pertain to other unbeneficed clergy; thus the Bishop of London commanded the lepers’ chaplain at Ilford to hear their confessions, to absolve the contrite, to administer the Eucharist and Extreme Unction. The ideal man to fill the unpleasant post of lepers’ guardian as pictured in foundation deeds and statutes was hard to find: men of the type of St. Hugh and Father Damien—separated indeed by seven centuries, but alike in devotion—are rare. Two Archbishops of Canterbury witness to the scarcity in a deed referring to Harbledown (1371, 1402). After stating that clergy are required to celebrate the divine offices in St. Nicholas’ Church, the document declares:—

“It may be at present, and very likely will be in future, difficult to find suitable stipendiary priests who shall be willing to have intercourse in this way with the poor people, especially as some of these poor are infected with leprosy; and this hospital was founded especially for sick persons of this sort.”

The master might himself be a leper. An inquisition of 1223 showed that at St. Leonard’s, Lancaster, it had formerly been customary for the brethren to elect one of the lepers as master.89 In 1342 the prior of St. Bartholomew’s, Rochester, was a leper. The regulations at Ilford provided for a leper-master and secular master, but those of Dover merely said that the master may be a leper. Although the law offered privileges to communities governed by a leper-warden (see p. 196), it does not appear to have been a common custom to appoint one. In hospitals dependent upon a monastery, some monk was selected to superintend the lazar-house.

(b) The Staff.—It has been said that leper-hospitals p145 were “heavily staffed with ecclesiastics.” There were indeed three at Lincoln, Ilford and Bolton to minister to ten or twelve men, but they conducted the temporal as well as spiritual affairs of the society. At Bolton, for example, the priests had to administer the manor which was held by the hospital. It was more usual to have only one chaplain in a household of thirteen. This was a favourite number, the figure being regarded with reverence as suggestive of the sacred band of Christ and His Apostles: “for thirteen is a convent as I guess,” writes Chaucer. There were to be at Sherburn “five convents of lepers, that is of the number of sixty-five at the least”; five priests ministered to them, of whom one acted as confessor, and used also to visit the bedridden and read the Gospel of the day to them.

The collection of alms also fell upon the staff, for as it was said at Bridport “lepers cannot ask and gather for themselves.” The procurator or proctor therefore transacted their business. It was ordained at St. Bartholomew’s, Oxford, that the clerk serving in the chapel should collect alms and rents and act as proctor. The staff sometimes included other untainted persons. Two healthy brethren at this Oxford leper-house were to be skilled agricultural labourers, able also to make enclosures and cover houses.

(c) Attendants.—Domestic and farm service was also done by paid attendants. There were female-servants in the Sherburn leper-house, who undertook laundry and other work, and one old woman cared for the bedridden.

(d) Leper Inmates.—Among the larger asylums, the approximate accommodation was as follows:—Harbledown 100, Sherburn 65, St. Giles’, London 40, St. Nicholas’, p146 York 40, Thanington near Canterbury 25, Dover 20, Plymouth 20, Bodmin 19, Winchester 18. There were 13 beds at Carlisle, Exeter, Gloucester, Reading, etc. In some towns there were several small hospitals. Numbers were of course liable to fluctuation, and often apply to a company of infected and healthy persons, as at St. Nicholas’, York. “They used to have, and ought to have, forty brethren and sisters, as well lepers as others; now they have thirty-two only.” (1285.) By an inquisition taken in 1291, it was reported that a former master had admitted thirty-six, of whom four were received pro Deo because they were lepers, but the rest for money. The king commanded that henceforth none should be received without special mandate, inasmuch as the funds scarcely sufficed for the multitude already maintained. The same abuse is noticeable a century earlier, for in 1164 Pope Alexander III forbade the patrons of St. James’, Thanington, to admit into the sisterhood any who were not infected, for healthy women had been importunately begging admission.90 It was complained in 1321, that St. Bartholomew’s, Oxford, was occupied by healthy and sturdy men; and that at St. Leonard’s, Lancaster, there were six whole and three lepers (1323). Both were originally intended solely for the diseased, the inmates of St. Leonard’s being called by Henry III “our lepers of Lancaster.”

It has been represented, as a proof that isolation was non-existent, that lepers and untainted persons lived a common life, eating and sleeping together. This was evidently not the case. The sheriff of Lincoln received orders that at Holy Innocents’ “the chaplains and brethren are to reside in one house, the lepers by p147 themselves and the sisters by themselves.”91 The statutes at Ilford and Dover give similar directions. The priests at Sherburn slept apart in a chamber adjoining the church, but the Harbledown staff lacked such accommodation until in 1371 it was ordained that they should henceforth dwell in a clergy-house—“a home separate from the sick persons and near to them.”

When both sexes were admitted, they lived apart, a woman with the title of prioress being selected to rule the female community. Some houses were set apart for women, e.g. Alkmonton, Thanington, Bristol (St. Mary Magdalene), Newbury (St. Mary Magdalene), Bury (St. Petronilla), Woodstock, Clattercot, Hungerford, Arundel, Westminster, whilst one left behind it the name of “Maiden” Bradley. It sometimes happened that a married couple contracted the disease. A clerk smitten with leprosy and his wife with the same infirmity were seeking admission to St. Margaret’s, Huntingdon, in 1327. By the Ilford statutes, no married man was admitted unless his wife also vowed chastity. On no account was a married person received at Dover without the consent of the party remaining in seculo, and then only upon similar conditions. In this connection a passing reference may be made to the marriage laws. Although by the laws of the Franks leprosy was a valid reason for p148 divorce, later Norman laws considered separation unjustifiable; this latter was the attitude of the Church, which is given fully in the Appendix to the Lateran Council of 1179.92 Yet the pathos of the leper’s lot is suggested by the declaration of Amicia, a woman of Kent in 1254—that in truth at one time she had a certain Robert for husband, but that now he had long been a leper and betook himself to a certain religious house, to wit, the leper-hospital at Romney.93

For many reasons the leper-household was most difficult to control: it is small wonder that abuses crept in. Men forcibly banished were naturally loth to submit to rigorous discipline. They were persons who would never have dreamed of the religious life save by pressure of circumstances; moreover, the nature of their infirmity caused them to suffer from bodily lassitude, irritability and a mental depression bordering upon insanity; in the life of St. Francis is a description of his ministry to a leper so froward, impious, abusive and ungrateful that every one thought him possessed by an evil spirit. London lepers were evidently not less refractory. From early days the city selected two men as keepers and overseers at St. Giles’, the Loke and Hackney; these officials, who were accustomed to visit the lazar-houses daily and to chastise offenders, were granted exemption from inquests, summonses, etc., on account of this “their meritorious labour, their unpleasant and onerous occupation.” (1389.) The London edict of 1346 confirms the undoubted fact that lepers are specially tempted to a loose life. Banished from the restraining influences of home and public opinion, they p149 were found in haunts of vice. The master of the lazar-house had no means of enforcing control. If the leper escaped and fell into evil habits none could prevent it: indeed, this did but ensure the liberty he craved, for the ultimate punishment of inmates was expulsion.

(ii) THE HOUSEHOLD OF THE INFIRMARY AND ALMSHOUSE

(a) The Master or Warden, who was also known as prior, custos, keeper or rector, was usually a priest, but occasionally a layman. One of the early masters of St. Mark’s, Bristol, was a knight, Henry de Gaunt, whose mailed effigy remains in the chapel. Crown hospitals were often served by chaplains and clerks, but the appointment of “king’s servants,” yeomen or knights, is noticeable during the fourteenth century.

It is rarely recorded that the custodian of the sick was a physician, but the absence of the title medicus in no way proves that he and his helpers were ignorant of medicine. In early days, indeed, it was only the clergy, religious or secular, who were trained in the faculty, and the master and his assistants must have acquired a certain intimacy with disease; they would have a knowledge of the herbals, of the system of letting blood, and other simple remedies. An important medical work, Breviarium BartholomÆi, was written late in the fourteenth century by John Mirfield of St. Bartholomew’s, Smithfield. He acknowledges that it is a compilation for the benefit of those who could not afford to buy the treatises whence it was derived; but he adds that part had been personally communicated to him and was supported by the experience of others. The fine manuscript copy in Pembroke p150 College, Oxford, includes a list of medical ingredients, herbs, etc.94

In some instances the warden is described as a physician. When the chaplain of St. John’s, Bridport, was incapacitated, Master John de Brideport, physician, was deputed to act for him (1265). The Duke of Lancaster presented his foreign doctor, Pascal de Bononja, to the Preston hospital (1355). “Louis the physician,” who held St. Nicholas’, Pontefract (1399–1401), may be identified with Louis Recouchez, king’s physician, who was then appointed to the hospital at Westminster. It is possible that visiting doctors and barber-surgeons attended hospitals. In an inventory of Elsyng Spital a debt of xxxvijs. ijd. was due to Robert the leech, and of xs. to Geoffrey the barber. One of the inquiries at the Dissolution of religious houses was:—“Whether the maister of the house doo use his brethren charitably when they be syke and diseased; and whether, in tyme of their sykenes, he doo procure unto them physicions.”

The duties—and temptations—of a warden are suggested by the “Articles of Inquisition touching the Savoy” (1535). Not only was inquiry made whether the master visited the poor at least twice a week, and the sick twice daily, but also:—

“Whether he be mercifull, beningne and louyng to the poore; and not skoymys [squeamish] or lothesome to uisite theym or to be among theym.

“Whether he or his ministers by his sufferance do take in suche as they reken moste clene of the poore, and repell theym that they reken most sore or deseased, for auoydyng of their owne lothesomenes or contagion.” p151

The qualifications and duties of the head of an almshouse are defined in the minute regulations of fifteenth-century founders. The master of Ewelme must be an able and well-disposed person in body and soul, one who could counsel and exhort the poor men to their comfort and salvation. He had to conduct frequent services, and was warned to omit none—not even “for plesaunce of lorde or lady”—save “if he be let by sekenesse or prechyng of the worde of God, or by visitacion of Fadyre and modir.” The master of God’s House, Exeter, might not be absent more than once or twice a year, his recess never exceeding three weeks and three days. At Wells, a chaplain of commendable life, manners and learning was sought—one “circumspect and expert in spiritual and temporal things, and free from all infamous vice.” The ale-house and hunting were forbidden to the warden of Heytesbury, as well as “inhonest playes, as of the Dees, cartes or of the hande-ball.” He must never be absent at night, nor for long by day, although it was lawful for recreation to walk a mile or two at certain times. He had, indeed, little leisure, for he conducted certain services both in the chapel and parish church, and kept school, besides ruling the almshouse.

The model master did not exist only in the imagination of founders, although he occurred rarely. Among good men who are not forgotten where they fulfilled their duty, mention must be made of John de Campeden, warden and benefactor of St. Cross. His friend William of Wykeham placed him in charge of that despoiled and dilapidated institution. He ruled wisely and spent large sums upon restoration. After a faithful stewardship of twenty-eight years, his death occurred in 1410. His memorial brass p152 retains its place before the altar. The brasses of several wardens are also preserved at Greatham.

(b) The Staff: Brethren and Sisters.—These offices became in some cases mere honorary posts; there was no salary attached to them, but officials were supplied with food and clothing. The sisterships at St. Katharine’s-near-the-Tower used to be given by the queen to her ladies. Of the eight sisters at St. Leonard’s, York, some were workers (see p. 154), but others lived apart from the rest in a place built for them near the hospital, and were mere pensioners enjoying provision of food, clothing, fuel and bedding. Unprotected women were often glad to relinquish some little property by arrangement, and be settled for life. “Brothers” might be priests, monks or lay-brethren. The staff of St. John’s, Oxford, consisted of three Augustinian chaplains—one being elected master—with six lay-brethren and six sisters. At Lechlade two brothers distinguished for kindness and courtesy were selected to exercise hospitality with charity and cheerfulness, and to watch over the sick.95 Of thirteen brethren at Kepier, six were chaplains, and the rest acted as steward, keeper of the tannery, miller, etc. The brethren of St. John’s, Ely, were forbidden to play with dice, or to be present at such play, but were to give themselves to contemplation and study of Scripture, one or two being deputed to wait upon the infirm. Each lettered brother of St. Leonard’s, York, was directed to study at his desk in the cloister two or three times a day.

The “proctor” was the financial agent of the community. He held an important post, and had occasionally an official seal. It was sometimes his duty to deliver a p153 charity-sermon—“to preach and to collect alms.” When the traffic in indulgences began, the proctor became a “pardoner.” (See p. 189.) Spurious agents abounded, for the post was lucrative. A man was arrested as feigning himself proctor of St. Thomas’, Canterbury; another was convicted of receiving money, beasts, legacies and goods ostensibly for that house.96 The collector received gifts in kind, and the following appeal was put forward by St. John’s, Canterbury:—“if any one wishes to give ... ring, brooch, gold, silver, cows, heifer, sheep, lamb or calf, let him send and deliver it to our proctor.” Sister Mariana Swetman was licensed to collect alms on behalf of that hospital (1465), an interesting instance of a woman virtually holding the office of proctor.

Ministering women have long laboured in our infirmaries for the benefit of the sick, carrying on their works of mercy side by side with men. “The lay sisters shall observe what we have above ordained to be observed by the brethren, as far as befits their sex,” decreed Archbishop Gray for St. John’s, Nottingham (1241). One of the men, corresponding to the monastic infirmarer, was responsible for the sick ward; thus a brother of Northallerton held the office of procurator infirmorum in lectulis, whilst two sisters watched by the sick, especially at night, and a third attended to household affairs. At Bridgwater, women “not of gentle birth but still fit for the purpose” assisted in nursing; they lodged in a chamber adjoining the infirmary and were to be always careful and ready both by night p154 and day to help the sick and to minister to them in all things.

The work of women among the sick developed further during the fifteenth century; they evidently took a prominent part in the management of the larger infirmaries. A lady, corresponding perhaps to the matron of to-day, was in authority at York. By a will of 1416, money was bequeathed for distribution among the helpers and inmates of St. Leonard’s at the discretion of Alice materfamilias. Long before (1276) the officers had included not only a brother called Gamel de Firmaria, but a sister named Ann medica;97 and in 1385 the principal sister was known as Matilda la hus-wyf.98 In some institutions there were already distinct ranks among nursing women. The pious poet Gower remembers in his will (1408) the staff and patients of four London hospitals; he leaves sums of money not only to the master and priests of St. Thomas’, Southwark, but “to every sister professed” and “to each of them who is a nurse of the sick.”

Woman’s sphere in hospital life was confined to work by the bedside and domestic duties. Occasionally they were found to undertake what was not fitting. The prior of Christchurch, Canterbury, made a visitation of the daughter-hospital of St. James, Thanington, after which he issued a deed of reformation (1414). A curious clause occurs in these statutes:—

“We command that no one of the sisters ... or any other woman soever while divine service is being celebrated in the chapel should stand or sit in any way round or near the altars or should presume to serve the priests celebrating the p155 divine offices or saying the canonical hours, since, according to the first foundation of the said hospital its chaplains or priests ought to have a clerk who ought to officiate in the aforesaid matters.”

In addition to regular brethren and sisters, there were under-officials. The staff of the larger institutions included clerks in minor orders, who assisted in worship and work. In almshouses where there was no resident master, a trustworthy inmate held a semi-official post. Thus at Donnington there were thirteen pensioners, and “one at their head to be called God’s minister of the poor house.” When the “tutor” at Croydon went out of doors, he ordained “oon of his fellawes moost sadde [serious] and wise to occupy his occupacion for him till he come ageyne.”

(c) Attendants, etc. Serving men and women were employed to wait upon the infirm and upon the staff. Lanfranc ordered that the poor of St. John’s, Canterbury, should have careful servants and guardians, lest they should need anything. When the poll-tax was levied in Oxford (1380), there were twelve servants, artisans and farm-labourers working at St. John’s. In the immense establishment at York there were sixteen male and female servants, besides a host of other stipendiaries—two or three cooks, bakers, brewers, smiths and carters, a ferrywoman, twelve boatmen, etc. Working-class officials called the “man harbenger” and “woman harbenger” were employed to attend to beggars passing the night at St. John’s, Sandwich. At the Maison Dieu, Dover, two women made the beds, served the poor and washed their clothes. The position of the female attendant in an almshouse is well described by the name p156 “sister-huswiff” used at Heytesbury. The ideal woman to hold the post is pictured in the statutes of Higham Ferrers; of good name and fame, quiet and honest, no brawler or chider, she should be “glad to please every poor man to her power.” She had minute directions as to housekeeping and other duties which would fill the day, and in illness she must visit the patients at night. The keeper of the five married couples at Ford’s hospital, Coventry, was required “to see them clean kept in their persons and houses, and for dressing their meats, washing of them, and ministering all things necessary to them.”

(d) The Sick and Infirm.—Having described the officials, it will be well to form some idea of the number of the infirm to whom they ministered. The largest establishment of this kind was St. Leonard’s, York; and at Easter 1370, there were 224 sick and poor in the infirmary, besides 23 children in the orphanage. About the same time there were 100 brothers and sisters at St. John’s, Canterbury. A large number of patients were cared for in the London hospitals of St. Bartholomew, St. Thomas and St. Mary. St. Giles’, Norwich, accommodated 30 poor besides 13 aged chaplains, and 40 persons were maintained at Greatham. The majority of permanent homes were smaller, thirteen beds being a usual number. Many hospitals were obliged to reduce the number of patients as the revenues diminished. In the year 1333, St. Bartholomew’s, Gloucester, supported 90 sick, lame, halt and blind; but two centuries later Leland notes that it once maintained 52, but now only 32.

Of pilgrim, patient and pensioner, little can be recorded. Temporary inmates came and went, receiving refreshment and relief according to their needs. Some of the resident p157 poor were chronic invalids, but others were not too infirm to help themselves and assist others.

The frequent attendance at prayers certainly gave the almsfolk constant occupation, and they were required to be busy at worship or work. The poor men of Croydon were charged “to occupy themsilf in praying and in beding, in hering honest talking, or in labours with there bodies and hands.” Inmates at Ewelme must be restful and peaceable, attending to prayer, reading or work; their outdoor employment was to “kepe clene the closter and the quadrate abowte the welle fro wedis and all odyr unclennesse.” (Pl. XVII.) It was directed at Higham Ferrers that in springtime each poor man should help to dig and dress the garden, or if absent, give the dressers a penny a day. In the same way, at Sandwich, an inmate’s allowance was stopped if he failed to render such service as he could. Those brothers at Ewelme who were “holer in body, strenger and mightier” were commanded to “fauer and soccour and diligently minister to them that be seke and febill in all behofull tyme.