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CHARITY AND WELFARE:
HOSPITALS AND THE POOR IN MEDIEVAL CATALONIA

JAMES WILLIAM BRODMAN

[47] The hospitals that emerged in Catalonia and elsewhere in Europe in the centuries after 1000 grew out of a myriad of institutional and individual benefactions and were thus highly decentralized in character. Relatively few hospitals, in Catalonia or elsewhere, were connected to external institutions, such as religious orders, or operated according to any standard norms of governance. The majority were, as we have seen, independent foundations over which individual patrons often asserted various proprietal rights. In addition, most were of such modest size that the typical Catalan town was able to accommodate several hospitals and shelters of various sorts. What were the consequences of this institutional fragmentation? In order to answer this question, we must first investigate the personnel of the Catalan hospital, examine the motives and the character of their service, and sketch the physical space of the typical institution. A study of their administration reveals complaints in the fourteenth century that some hospitallers abused their autonomy, which led Church and municipal authorities to claim rights of supervision and oversight. In the fifteenth century, limitations of size, problems of governance, and economic disorders caused many of these small medieval institutions to be dissolved and consolidated into larger general hospitals.

Patronage and the Medieval Hospital

Virtually all Catalan hospitals were founded and endowed by individual or corporate benefactors who thereby claimed rights of patronage over their future administration. This power included the authority to appoint present and future administrators, to conduct visitations, to set rules of behavior, and to determine the types of individuals whom the hospital would assist. Illustrative of such a patron is Joan Colom, who established an [48] eponymous hospital, En Colom, in Barcelona circa 1229. Even though Joan was an important officer in the cathedral chapter, he did not entrust this new foundation to the bishop or to his fellow canons; instead he turned to a trusted kinsman, Berenguer de Plan, to be both administrator of his hospital and the guardian of his two nephews and a "natural" son, Bernat. Significantly, Berenguer continued to govern even after En Colom had been consolidated with the capitular hospital in 1236.⁽¹⁾ In another example, the layman Pere Desvilar served as director of his own hospital in Barcelona, and then passed the responsibility on to his son. Pere, however, recognized the limitations of familial governance because in 1308 he directed that, once his family had relinquished control, the hospital would then pass into the jurisdiction of Barcelona's Consell de Cent. ⁽²⁾

The case of the Hospital of Llobera at Solsona illustrates how difficult it was for a founding family to maintain its patronage over a hospital for more than one or two generations. This institution was established in 1411 by the will of Francesca, the daughter of a prosperous local merchant. Francesca nominated as its administrators three of her relatives, who were merchants in Barcelona. Future heads were also to be chosen from within the family, but by the local Dominican prior and the abbot of the Augustinian monastery. Subsequently in 1446 these two ecclesiastics nominated three younger kinsmen to take up the task, but unlike those of the earlier generation, they no longer wished to accept the responsibility. Thus, in 1447, the relatives hired a canon of Urgell, Bartomeu Travesset, to serve as rector.⁽³⁾ Given difficulties such as these, many heirs, like those of Bertran de Seva of Granollers, simply relinquished their rights over a hospital to others, usually to the bishop or chapter, but also to municipal councils, religious orders, and confraternities.⁽⁴⁾

Long before the fifteenth century, therefore, most hospitals had come under some sort of external control. At first, this governance tended to be ecclesiastical, with the bishop and chapter being especially important; in the fourteenth century, town councils also assumed supervisory functions over hospitals.⁽⁵⁾ As we have seen, virtually every episcopal town had its cathedral hospice; other shelters, if they were ecclesiastical in character, were also often subject to the bishop's oversight. In some instances, this authority was granted by the founding family to the bishop, and in others it fell by default. Even when the bishop lacked any formal powers, he still would claim the right to monitor how hospitals took care of the poor and to audit their accounts.⁽⁶⁾

Some, like Agustín Rubio Vela who has studied the hospitals in [49] fourteenth-century Valencia, argue that the appearance of municipal supervision of hospitals is a sign of their gradual secularization. Most Valencian institutions founded in the thirteenth century, he observes, were entrusted to various religious orders, while only two of seven fourteenth-century foundations had an ecclesiastical administration.⁽⁷⁾ Although Rubio Vela sees this as a significant paradigmatic shift, hospitals at the end of the Middle Ages continued to exhibit patterns of mixed and even shared governance. Girona's New Hospital, for instance, was a laic foundation of the early thirteenth century that had come under municipal control; nonetheless, it possessed a chapel and priest and was placed under the invocation of Santa Caterina. Even greater integration of religious and secular authority can be seen in such fifteenth-century institutions as Barcelona's Hospital of Santa Creu, which was established in 1401 through the merger of six older hospitals. Governance was entrusted to a board of directors, two of whose members were selected by the bishop and his chapter, and two by Barcelona's municipal government, the Consell de Cent. ⁽⁸⁾

In addition to the indifference of later generations, the need for some sort of financial oversight and assistance precipitated external interventions. Reacting to complaints of malfeasance, Pope Clement V, in his decretal of 1311, Quia contingit, established a measure of episcopal control over most hospitals in Europe by requiring that hospital administrators render an annual financial accounting to the local bishop and by empowering the bishop to correct any abuses that would thereby be uncovered. ⁽⁹⁾ Problems of this sort, including a failure to attend properly to the poor, caused the bishop of Barcelona in 1326 to relieve the rector of the leper hospital of Sant Llàtzer, who had been jointly named by the bishop and the Plegamans family. The rector's administrative functions were then turned over to a new officer appointed by the bishop alone. ⁽¹⁰⁾ Similarly, in 1341 the municipal council and bishop of Valencia appointed a joint committee to investigate charges that the city's hospitals were turning away the sick, and in 1346 the council, now acting alone, sent two men to each hospital to see whether "sick and miserable persons were being received and housed and provided with the necessities" by the various hospitaller administrators.⁽¹¹⁾ Finally, it is clear that financial irregularities were a major reason that authorities in Barcelona promulgated an elaborate set of ordinances for the Hospital de la Santa Creu in 1417, some sixteen years after its foundation. Not only did the prologue of this document complain about fraud, malfeasance, and a general confusion, but the ordinances also elaborated a complex scheme that mandated regular audits of everything from alms to supplies and bed linen.⁽¹²⁾

Rectors

[50] Presumably, the individual whom the bishop, chapter, and/or municipal council would select to direct a hospital was a trusted and reputable member of the community. Various factors came into play in the making of this appointment: kinship, friendship, and even money. In 1278, for example, Bishop Arnau of Barcelona agreed to appoint a priest named Bernat Ferrer as administrator of the Hospital of Sant Macià, after Bernat had promised to give the hospital all of his property. This was a substantial endowment that included eight vineyards and personal property worth thirteen hundred sous. This was not a case of Bernat adopting the status of a religious, taking a vow of poverty as either a frater or donat, and entering some sort of community life. Instead, the new administrator was given a life's interest in his income and property, and thus his style and standard of living would seem not to have changed. Yet because this concession would ultimately benefit the hospital, the bishop tells us, Bernat was given his commission.⁽¹³⁾ But there could be other considerations as well. For example, there is the case of Nadal, a convicted killer who was taken out of prison in 1348, in the middle of the plague, to tend the over eighty patients languishing in the hospital of the poor in the Minorcan town of Ciutadella. Evidently the regular attendants were already dead, and no volunteer could be found to work among the sick in the hospital. Under Nadal's solicitous care, however, some of the patients survived the plague. In 1349, as a reward, the municipal council of Ciutadella appointed Nadal as permanent administrator, and King Pere absolved him of his past crimes.⁽¹⁴⁾

The day-to-day operation of hospitals, nonetheless, fell to various administrators, usually called rectors, who were charged with the governance of the institution and the protection of its interests. Some served for life, while others were appointed for a fixed term.⁽¹⁵⁾ Pere Desvilar, the founder of the Hospital of Sant Macià in Barcelona, demanded that all its future administrators swear to serve the poor, never to alienate its property but seek to expand it, and to preserve all its rights. ⁽¹⁶⁾ The letter of appointment that Berenguer de Molendinis received in 1347 as administrator of the Hospital of En Colom of Barcelona obligated him to render annual accounts and seek episcopal confirmation for any appointments to the hospital staff.⁽¹⁷⁾ Bishop Ponç de Gualba's reform of the leper house at Barcelona in 1326 stipulated that the new administrator would collect offerings and alms, insure that donors of property renounce in writing all their rights to the property, make an annual accounting of all income before any official named by [51] the bishop, and supervise all the hospital's leaseholds. The accounts of Girona's Pia Almoina suggest that after the plague a deliberate market strategy was developed that allowed the institution to purchase and stockpile grain when the price was lowest; one would assume that everywhere similar decisions were also the responsibility of the rector. ⁽¹⁸⁾

In some instances, there could be more than one administrator. In smaller hospitals, like Girona's Hospital Nou, the functions were often performed by a married couple, although technically the husband held the title of comendador, while his wife was a mere donata. In large institutions, there would have been a hierarchy of officials. At Barcelona's Hospital of Santa Creu, for example, there were four nonresident overseers, chosen for two-year terms, who represented the hospital's patrons, the municipal council and the bishop. Next in the hierarchy was a resident official, the president, who appointed all subordinate staff, and under him were the prior and infirmarian, who actually supervised the spiritual and material well-being of patients. ⁽¹⁹⁾

Maintaining discipline among inmates and patients was an important component in the establishment of strong leadership within the hospital. In 1334, for example, the municipal council at Valencia explicitly placed the lepers of the Hospital of Sant Llàtzer under the regla e disciplina of the proctor, stipulating that he could impose penalties as harsh as confinement for any transgression of the rules.⁽²⁰⁾ A collapse of discipline, on the other hand, led the municipal council of Lleida in 1412 to petition the papacy to replace the rector of an orphanage that operated under the care of the Antonines.⁽²¹⁾ Santa Creu's ordinances compelled each member of the staff to take a solemn oath to obey the administration and the ordinances. Singled out as particular behavioral problems were swearing, fighting, and rumoring; in addition, there was an evident concern that hospitallers might misappropriate food, medicine, linen, supplies, and alms. To control these illicit behaviors, the ordinances established regular procedures for accountability and placed in the hands of the administrators the power to withhold salaries, to impose fines, and to inflict corporal punishment.⁽²²⁾

If they were clerics, rectors also had priestly obligations toward both inmates and the hospital's financial benefactors. In 1210, for example, Pere de Granollers, a priest of Barcelona's cathedral, left his bed, bedding, and various rental properties to the cathedral's shelter on the condition that its proctor celebrate an anniversary mass on his behalf in the cathedral.⁽²³⁾ Evidently such duties could become burdensome. In 1363, this led the rector of the Old Hospital at Girona, who was obliged to say anniversary masses for [52] hree priests of the diocese, to employ other clergy to serve the spiritual needs of those in the hospital. The temptation to do so must have been strong because the income from such anniversaries amounted to sixty sous, while the cost of substitute clergy was only seven sous. ⁽²⁴⁾ Indeed, the conflict between these two allegiances, to benefactors and to inmates, was one of the reasons Bishop Ponç de Gualba intervened in the affairs of the leper hospital of Sant Llàtzer at Barcelona in 1326. A benefactor, Ramon de Plegamans, had in 1218 established a beneficed priest to serve the chapel; for the balance of the century, this prebend was held by the rector of the hospital. The bishop, in 1326, as the result of a visitation, concluded that this priest's obligations to the benefactor's family left him little time to attend to the spiritual needs of the resident lepers. Consequently, the bishop established and endowed with an income worth twenty-five pounds a year, a second chaplaincy whose sole function was to serve the lepers. At the same time, presumably because his duties to the Plegamans family detracted from his ability to serve as administrator, the chaplain was also relieved of these functions, which were then turned over to a lay appointee of the bishop and chapter.⁽²⁵⁾ In Valencia, conversely, the ability of an administrator to "provide the sacraments during the day as well at night" motivated the jurats of Valencia in 1400 to name as head of the leprosarium of Sant Llàtzer the priest, Matheu Agramunt, to replace Pere Roig, a notary who had grown too old to serve. Presumably, in this instance, the difficulty of procuring clergy for dying lepers outweighed other considerations. ⁽²⁶⁾

There are other instances of expanding bureaucracy. In 1375 the jurats of Valencia divided the office of En Claper's administrator among three appointees: a hospitaller (and his wife) to supervise care for the sick, a proctor to manage the endowment, and an administrator. The administrator, now a personage of high estate who was appointed for life, no longer resided at the hospital. Instead he served more as the hospital's patron or protector. Santa Creu in Barcelona, had an entire staff of clergy. A prior, in addition to his responsibilities for the other clergy, the liturgy, and the preaching of "notable sermons," prayed for confraters and other benefactors at his daily mass in the chapel, visited the inmates, and recorded all instances of child abandonment. A rector administered the sacraments to inmates, and four other priests assisted the prior and rector in their duties. ⁽²⁷⁾

Ostensibly, in all of these instances, the decision to create one or more chaplains as distinct officials reflected the increasing complexity of the hospital, presumably rendering the duties of administration, consolation, and commemoration too onerous for a single individual. Rubio Vela, in addition, argues that the separation of religious and administrative functions [53] was a by-product of the secularization of hospitals in the fourteenth century. The office of administrator, he believes, was no longer regarded by many incumbents as a religious vocation, but was seen as a secular office that required specific skills.⁽²⁸⁾

The economic status of hospitaller administrators varied immensely. Some, one suspects, were only marginally better off than the poor they assisted. For example, Bonanat d'Arques, administrator of the New Hospital of Urgell in the fourteenth century, had to sell off his blanket to buy wheat. ⁽²⁹⁾ Not nearly so desperate was the administrator at Sant Llàtzer in Barcelona whose salary was fixed in 1326 at fifty sous (increased in 1343 to one hundred sous), plus bread, wine, and a daily stipend of two diners for food. This was not a princely sum at all, in light of the fact that other employees were paid nearly as much, nor atypical, because in 1347 Berenguer de Molendinis, administrator of En Colom, was paid the same amount.⁽³⁰⁾ But the priest Bernat Domenge, named administrator of the Hospital of Bonesvalls in 1349, and the rector of the almoina of Barcelona received three hundred sous each, and the rector of Lleida's almoina four hundres sous; still higher were the stipends of Antoni dez Clapers and Berenguer de Plan. The former, as hospitaller-administrator of the hospital established by his forebear, Bernat, in Valencia, was paid a salary of one thousand sous. The latter was the kinsman whom Joan Colom had named as procurator of his hospital. Berenguer, along with several of Colom's relatives, were housed in the deceased canon's house, and had rights of usufruct to a large assortment of the hospital's original endowment.⁽³¹⁾ His successors, like Berenguer de Molendinis, who lacked any tie of relationship to the founder, did not fare nearly as well. Nonetheless, some hospitaller leaders were surprisingly prosperous, as an inventory of Girona's Old Hospital, done in 1362 upon the death of its hospitaller, Berenguer Verdaguer, demonstrates. Berenguer's quarters were well-furnished with a bed, chest, armoire, chair, stool, and storage closet. Among his personal effects were a saddle, sword, silver reliquary, a large supply of clothing that included sixteen overcoats, a gold altar cloth, two silver cups, a library of some twenty-five paper and parchment books, about two hundred sous in cash, and an account book showing receivables of over fourteen hundred sous. Interestingly enough, Berenguer's intellectual interests ran toward the theological; his library contained only one book of medicine and this seems to have been a legacy from a previous incumbent. The inventory also shows that rectors were responsible for the hospital's accounts and property records, since a chest containing these documents was found in Berenguer's room.⁽³²⁾

Hospital Personnel

[54] Jacques de Vitry, in his Historia occidentalis, tells us that hospitals were served by communities of men and women, who "lived according to the Rule of Saint Augustine, without property of their own, and in common under obedience to a single superior, and, having accepted the habit of the regular life, promised perpetual continence to the Lord." ⁽³³⁾ But, in reality, the hospitalarii, the fratres et sorores , who served the poor, conformed to no fixed pattern. Some were religious, either in the formal sense of being subject to an established regula , or else in the practice of some form of community life. Other institutions were served by a mixed group, that might include those under some form of dedication, like donats, but also retainers who served for a salary, who themselves might have been reared in the house as foundling, or who were even slaves.⁽³⁴⁾

The clearest examples of religious communities are found in hospitals affiliated with the Antonines, the Trinitarians, Mercedarians, or with the Orders of the Holy Spirit, Roncesvalles, and Saint John. While greatly outnumbered by locally controlled institutions, these collectively represented a significant number of hospitals, and perhaps more importantly were models of organization and practice for local institutions.⁽³⁵⁾ For example, the Rule of the Hospitallers of Saint John, which evolved between 1125 and 1153, exerted a degree of influence over other orders and hospitals. The Order of the Holy Spirit, as a case in point, derived approximately a third of its statutes from the Hospitaller Rule.⁽³⁶⁾ Developed initially between 1204 and 1208, over time this rule grew into an elaborate code of 105 capitula that dealt with matters of governance, conduct, religious observance, and recruitment. The serving brothers and sisters were subject to the authority of an externally appointed superior, were bound by the vows of poverty, chastity, and obedience, and were compelled to follow a specific dietary, liturgical, and disciplinary routine. These impositions gave a shape and rhythm to their daily existence that would set them apart from hospitallers who served for pay. But even within religious communities, however, there were nuances of observance. In addition to serving brothers and sisters, who were bound by the rule, there were also lay affiliates, or oblates, who shared in the community's life but who were not fully bound by its discipline.⁽³⁷⁾

Some hospitals not affiliated with an order also possessed the semblance of a religious life, although Carme Batlle argues that such observance in Catalonia had disappeared by the fourteenth century. ⁽³⁸⁾ These independent communities generally saw themselves as Augustinian ( ordo s. [55] Augustini ); that is, they professed some version of the Rule of Saint Augustine, which in the twelfth century had come to be adopted by most nonmonastic religious communities.⁽³⁹⁾ An example of this would be the hospice for the poor and sick established by Ramon in 1156 upon his election as prior of a group of Augustinian canons at Organyà, a town in the Segre valley twenty-seven kilometers south of Urgell. A brother canon, Joan, was placed in charge, and the small establishment was endowed with a portion of the chapter's own resources. ⁽⁴⁰⁾ This was similar to the regime at the English Hospital of Saint Leonard's in York, where the staff consisted of thirteen chaplain-brothers who lived under the Augustinian Rule.⁽⁴¹⁾ However, because this Rule was no more than an outline, or prologue, derived from Augustine's 211th letter, there was in fact a diversity of custom that grew out of local experiences and circumstances. For the larger orders, these usages began to coalesce in the twelfth century; those of independent houses, however, did not emerge until the beginning of the thirteenth century. In France, for example, statutes for municipal hospitals began to appear around 1200, first at Angers, then at Montdidier (1207), Paris (1220) and Cambrai (1220). Indeed, church councils held at Paris (1212) and at Rouen (1214), under the presidency of the papal legate Robert de Courson, attempted to impose such norms of conduct on all those who served in hospitals and leprosaria. As a consequence, by the end of the thirteenth century, most important Maisons-Dieu in France had written statutes.⁽⁴²⁾

Another version of religious observance would be found in communities of Beguins, individuals who imitated Franciscan spirituality but who did not always follow the order's spiritual direction. In the first third of the fourteenth century such a community was established in Valencia, by a layman named Ramon Guillem Català, to operate a hospital for the sick, variously entitled the Hospital de Santa Maria or Hospital de Jesuchrist or Hospital de Beguins. The founder, presumably himself a Beguin, manifested the movement's suspicion of ecclesiastical authority by placing the hospital under the dominion of Valencia's municipal council and by explicitly declaring that neither the bishop or any other ecclesiastical person could interfere in its administration. Eventually, a dozen or so sick people were attended by a religious community, homes de penitència, led initially by a frare, Jacme Just. While strictly speaking they did not follow the Third Rule of Saint Francis, their regimen, influenced by the writings of Arnau de Vilanova and Ramon Llull, reflected mendicant spirituality. Indeed there is evidence that, in addition to sheltering the sick poor, the house of Valencia [56] welcomed itinerant preachers as they passed through the city. Because they sheltered religious noncomformists alongside the traditional needy, Beguin hospitals were not a widespread phenomena.⁽⁴³⁾

For most of Iberia, however, religious customs were less articulated. For example, there was no written rule until 1535 for the community that served the Hospital del Rey in Burgos. ⁽⁴⁴⁾ The Aragonese hospital at Somport and the more ephemeral Order of Santa Cristina associated with it have left no written constitutions even though Innocent III in 1216 had explicitly recognized the community as Augustinian. ⁽⁴⁵⁾ At Lleida, the hospital established circa 1150 by Guillem Nicolau and his wife was served by a small religious community for which no written customs are known.⁽⁴⁶⁾ Thus, in many hospitals the norm seems to have been an unwritten practice. Why? The hospitals were small; there is no known conciliar mandate, as in France, for formal constitutions; perhaps, as Batlle suggests, many municipal and even episcopal hospitals were served by salaried personnel. One of the few examples of written constitutions that we do have are those that emanated from the eponymous hospital established by the Barcelonan layman Bernat Marcús, in the late twelfth century. Its rector, appointed by the bishop of Barcelona until 1339, supervised a small community of fratres et sorores that in 1306 consisted of only three members. In 1307, after a pastoral visit made by Bishop Ponç de Gualba, the community adopted a rule entitled: Constitutiones fratrum et sororum hospitalis Bernardi Marcucii. Because this hospital was in desperate condition and would be sold off in 1339 to the city, however, the appearance of a written customs in 1307 was more a sign of decadence than strength, perhaps a vain attempt on the part of the bishop to breathe new life into a dying congregation. ⁽⁴⁷⁾

Most Catalan hospitals, however, were not served by any sort of formal religious community. The Hospital of En Colom in 1306-9, for example, numbered among its staff an assortment of personages: a rector, two chaplains, two laysisters or donatas, four female servants, who tended to the sick, three alms collectors who begged bread, two gardeners, and five wet nurses. The staff of the nearby hospital of Bernat Marcús, while smaller, reflects the same diversity; in 1306 there was a rector, one serving brother and two sisters, and several hired maids.⁽⁴⁸⁾ Barcelona's leper hospital in the fourteenth century had on its resident staff an administrator, several priests, a serving sister, a female porter, several messengers, and a male slave; in addition, the hospital paid salaries to nonresident alms collectors (baciners) and "informers" who seem to have been neighbors delegated to keep the bishop apprised of the hospital's situation.⁽⁴⁹⁾ At the beginning of the [57] fifteenth century, Barcelona's Hospital of Santa Creu had a large staff of administrators and attendants, all of whom were salaried. Valencia's Hospital of En Clapers also had a staff of mostly hired retainers: a male hospitaller, his wife, and two female and one male servant, but occasionally the records show one of these serving for no pay. Staff at the nearby Hospital de la Reyna included an administrator, a proctor, a resident concierge, medical personnel, and attendants.

The ratio between inmates and staff, where it can be determined, was surprisingly small: one to seven at the Hospital of En Colom; one to five at Sant Llàtzer; and one to three at the Hospital de la Reyna. ⁽⁵⁰⁾ But this did not translate into intensive care for patients since the majority of the staff was charged with other tasks, such as serving the chapel, collecting alms, and tending to the garden, building, and the endowment. This can be seen in the 1388/89 budget for Valencia's Hospital of En Clapers, where salaries for those who tended to the sick consumed only 3.8 percent of the total, about the same amount that was paid to the single collector of the hospital's rents, and less than the 6.6 percent paid to various priests. The only exception involved the care of infants, because in the same budget wet nurses received 18 percent of the total, which after food (47 percent) was the largest item.⁽⁵¹⁾ Thus, in modern terms, each of these shelters seems to have borne a large overhead, both because such institutions were responsible for their own financial support, but also because they were used to house poor relations, dependents, and students.

Donats

Of particular interest among hospitaller personnel are the donats, whose relationship to the hospital was quite complex in its combination of personal and religious motivation. ⁽⁵²⁾ Typically, a donat or donata conferred all or most of his/her personal property upon the institution, and promised to serve it for life. The hospital, in return, promised full support and lifelong care. The founder of a hospital, for example, could become a donat, like Roger de Uncastillo, a resident of Huesca and seemingly a widower, who built a bridge over the Rio Guatizalema and with it a hospice to shelter the poor. In 1199, he relinquished control of the hospital to the bishop of Huesca, but the bishop in turn recognized "Brother" Roger as its rector, and obligating him to provide a chaplain to attend to the hospital's religious needs. In a somewhat different vein, Huesca's bishop in 1196 conferred a [58] hospital already in his domain on Salvador Pescador and two brothers and their wives, so that in return for material support they would serve the poor there. In this instance, Salvador lacks the appellation "brother," but he and the others may still have been donats since there is no compensation mentioned beyond their personal sustenance. ⁽⁵³⁾ Much the same situation prevailed in Lleida where Guillem Nicolau and Falerna, his wife, presided over their hospice with the assistance of a small community of lay brothers.⁽⁵⁴⁾ Individuals could become donats in a variety of ways. Most directly, one could enter into a contractual relationship with a hospital, in which one would exchange service for support. An example is the contract signed on June 7, 1336, by Bernat Albió with the Hospital of Sant Joan in Reus. Bernat, a resident of Reus, offered himself "to the service of God and of his poor" and granted his "person as a donat of the hospital of Reus," promising the town councilors and the hospital administrator to serve the poor there for his whole life and to procure the alms, rents, and legacies that belong to the hospital. Furthermore, he granted the hospital thirty Barcelonan pounds, in return for which he was to be given food, drink, clothing, and whatever else he was accustomed to have. If future administrators wished to terminate this arrangement, then Bernat was to have his money returned; but if Bernat decided to leave of his own volition, then he was not owed any refund. A similar arrangement, but one involving a married couple, Bernat Vidal and his wife Ramona, was signed with Reus in 1323. ⁽⁵⁵⁾

The practice was also common in Barcelona. For example, Pere Desvilar, in endowing his hospital, required that support be provided for his maid, Maria; En Colom's administrator, Berenguer de Plan, guaranteed support to two nieces, Sancha and Borracia, Bernat, who was probably his son, and to Bernat's mother. We can assume that the women lived as donatas, especially Sancha and Borracia because they were guaranteed transfer to a house of religion should their places ever be eliminated. In Lleida, a charter of 1220 contains the names of three ministers of the Hospital of Sant Martí -- Pere Rubio and his wife Maria, and Ermesenda de Canals, who seem to have been donats of the house. In 1288, Pere Portolés, evidently an elderly man, became a donat of the same hospital in return for a payment of a hundred and fifty sous, but one wonders whether Pere was merely purchasing nursing home care rather than embarking upon a career of service.⁽⁵⁶⁾ In Vic, the hospitals of Sant Jaume and Santa Trinitat were served by communities of donats. The Rule of the Order of the Holy Spirit hints that serving sisters, at least, were recruited from among the orphans and other young girls reared within its hospitals.⁽⁵⁷⁾

[59] Thus, the institution of the donat was multifaceted. On the one hand, it provided a vehicle for those who wished to live a quasi-religious life of service, without vows and outside the confines of a formally established religious community. But, in some instances, it is scarcely distinguishable from a corody, a type of medieval annuity that had nothing to do with service to the poor. Instead it was a vehicle for the elderly who lacked the support of a spouse and/or children to guarantee for themselves a modicum of care and perhaps spiritual comfort in return for a fixed payment. ⁽⁵⁸⁾ Unlike other regions of the continent where shelters specifically for the elderly began to appear in the late Middle Ages, Iberia and Catalonia do not seem to have had such institutions. Thus, the elderly here are to be found dispersed throughout the hospitaller population as long-term residents (donats or corodians), or in the shorter term as malalts (invalids), or as indigents about to die. The Iberian evidence permits no insight into the age at which the elderly would enter such a shelter or the length of their stay. Patricia Cullum's study of Saint Leonard's in England, however, suggests that those who purchased places did so before the onset of serious disability, and that on average their care lasted about eight years for a man and ten for a woman. ⁽⁵⁹⁾

Nurses

Because surviving documents generally concern matters of finance, property, or governance, there is little information about the tasks performed by the men and women who served the poor in hospitals. The linkage of names and titles, however, does suggest that such tasks were assigned according to gender. Administrators, alms collectors, and medical practitioners, for example, were generally, although not exclusively, male. Those who tended to the ordinary needs of inmates, on the other hand, were generally female. The Rule of the Hospitaller Order of the Holy Spirit, for example, specifically assigned to sisters the tasks of washing the sick and their bedding, but for the sake of modesty spared the sisters from performing similar duties for the serving brothers. Nonetheless, the rule makes clear that sisters were dependents of and subject to the order's male leadership. ⁽⁶⁰⁾ Women at the English Hospital of Saint Leonard (York), according to a visitation held in 1364, also acted as nurses, tending to the sick, feeding and washing them, and alerting the priest if any needed confession or the last rites. ⁽⁶¹⁾ Valencia's Hospital of En Clapers in 1375 had a male hospitaller, Rodrigo Serrano, who directed the other servants and oversaw the distribution of food and [60] drink; his wife took charge of female patients. Under this couple served two other women and a man, all of humble estate. The man purchased and transported combustibles to the hospital, did some gardening, and washed the male patients, while the women tended to female patients, did the laundry, made bread and prepared the meals. ⁽⁶²⁾ While no narratives of hospital life have survived, Jacques de Vitry describes the life of medieval hospital attendants as a kind of living martyrdom:

For the sake of Christ, however, they endure such an overwhelmingly pervasive foulness of the sick and illnesses of almost intolerable stench, taking upon themselves such violence because I believe that no other kind of penance can be compared to this holy and precious martyrdom in the eyes of God. Therefore those pieces of squalid excrement, upon which, like a fertilizer, their souls stumble in order to bring forth fruit, the Lord will change into precious stones, and the odor of the stench will become sweet.⁽⁶³⁾

Other Members of the Staff

In addition to donats, the familia of the medieval hospital included individuals who served in a variety of capacities. Among them were the acaptadores (or baciners, or bacinadores ), the alms collectors who stood at church doors on Sundays and feasts and at other likely spots in town during the rest of the week. ⁽⁶⁴⁾ These were regulated by the bishop through the issuance of licenses. The three baciners who served the Hospital of En Colom, for example, wandered the streets of Barcelona six days a week to beg bread and on Sundays took up their station at the entrances to churches. Those of Sant Macià even brought abandoned children with them to arouse the pity of the faithful; on Good Fridays, they asked for mattresses and bedding. In the mid-fourteenth century the vicar general wrote to all the rectors, vicars, and chaplains in the diocese to remind them that these almoners had the right to collect alms inside or outside of churches whenever they wished. ⁽⁶⁵⁾ At Barcelona's Santa Creu, the collectors were under the supervision of the infirmarian, to whom they were to deliver their proceeds each afternoon. Indeed, the rivalry among competing collectors produced the inevitable litigation. For example, in 1409, the Antonines of Lleida, claiming an exclusive right gained from King Pere III to seek alms in the streets of the city while ringing bells, obtained an injunction from King Martí that demanded that members of the Order of the Holy Spirit silence their hand bells. ⁽⁶⁶⁾

Because hospitals depended on the charity of others, the collection of funds was important. At large institutions like Santa Creu, collecting [61] money became quite complex and spawned additional personnel. In addition to the donations collected by almoners or deposited in boxes placed in Barcelona's churches, gifts of clothing, money, or other goods might be given to any staff member, who was obligated to turn them in within twenty-four hours. Legacies were an important source of revenue, but it was difficult for the hospital to discover the existence of such gifts, or to enforce them once the testator died. As one remedy to the problem, the hospital's reebedor, or receiver of accounts, was obligated to visit each notary in Barcelona at least once a month, in order to examine the notarial manuals for the records of new bequests and wills currently being executed. In 1401, the year of its foundation, King Martí had also entrusted to Santa Creu the property of those who had neither a will nor children; in order to claim these goods the reebedor presumably also had to maintain contact with parish priests.⁽⁶⁷⁾

Besides almoners, the receiver and the administrators already discussed, the ordinances of Santa Creu list a wide variety of other employees. In charge of patient care were the infirmarian, two women who served as his assistants in wards that served women and children, a woman in charge of bed linen, a baker, a person in charge of beverages (boteller), a pantryman, a storage room supervisor, a transporter, a cook, a barber, several other physicians and barbers on call, an apothecary, and an unspecified number of attendants who served meals and cared for patients. The clergy included the prior, rector, and four other priests. The physical plant was entrusted to the porter, who maintained regular visiting hours, and a janitor in charge of maintenance. Administrators were assisted by a scribe or secretary, a purchasing agent, and an auditor of accounts. In the mid-sixteenth century, this amounted to a staff of thirty-one.⁽⁶⁸⁾

At the other end of the spectrum, but probably not all that unusual in smaller establishments, was the Hospital of Sant Llàtzer in Valencia where inmates, while under the direction of a municipally appointed proctor, seem to have fended for themselves. A brief series of statutes issued in 1334 mention no staff, apart from the administrator. The inmates, female and male, are advised to select the dish that they wish to eat each day, implying that its preparation was their own responsibility. ⁽⁶⁹⁾

Hospital Space

While early hospitals and shelters were located in or near the cathedral cloister, later constructions tended to be located elsewhere. During the [62] twelfth and thirteenth centuries, the cost of land and access to clients seem to have guided the choice of locale more than any fear of contagion. Thus, several of Lleida's early shelters, such as the Hospitals of Guillem Nicolau on the flood-prone banks of the Segre and Pere Moliner next to the municipal slaughterhouse, were sited on otherwise undesirable plots. Bernat Marcús placed his pilgrim shelter near the northern exit road from Barcelona; and other twelfth-century hospitals here were placed across the Ramblas in a still undeveloped area whose poor drainage rendered it unhealthy. At Valencia, several hospitals were clustered in the outlying suburb of Sant Julià. The fear of contagion could be an issue with leprosaria, which in northern French towns like Bourges, Paris, and Limoges were usually positioned downwind, on the north or east side of town. The leprosaria of Barcelona and Valencia, on the other hand, were established outside of the walls, but intermingled with other types of hospitals. The outbreak of the Black Death and its demographic catastrophe finally coalesced attitudes on the subject of quarantine; thereafter hospitals as a matter of course were relegated to peripheral areas. For example, the petition of the confraternity of Sant Jaume to King Pere III in 1377 to establish a new hospital in central Valencia was denied on the grounds that the locale was too populated; the monarch instead suggested a site on the edge of town. ⁽⁷⁰⁾

Medieval hospitals were generally small, consisting of a handful of wards or rooms with only a dozen or so beds.⁽⁷¹⁾ It has been estimated, for example, that the entire city of Valencia in the fourteenth century, with its ten hospitals, had space for only forty-five to eighty sick people. Here, during the fifteenth century, an important hospital like La Reyna housed on average of 12.8 inmates. The largest, En Clapers, could shelter thirty-four, but rarely did so. Between 1384 and 1395, its average daily inmate population ranged from a low of 8 to a maximum of 18.4.⁽⁷²⁾ In Catalonia, before the fifteenth century, few could match in size the eighty-seven beds available at the Hospital del Rey in Burgos, and none came close to the great Hospital of Saint John in Jerusalem, or to Saint Leonard's in the English town of York, which could accommodate several hundred. No other town could match Paris, which had over a thousand beds for resident paupers and as many others for transients and pilgrims. ⁽⁷³⁾ Instead, Catalan hospices rarely held more than a score of beds, and of these more were set aside for men than for women.⁽⁷⁴⁾ For example, the hospital founded by the noble Ramon de Montros in his village outside of Lleida in 1324 had only seven beds, which with accompanying linen cost seventy sous each; at Urgell, the New Hospital had but five beds; and Vic's Hospital de la Santa Creu contained [63] twelve beds. ⁽⁷⁵⁾ At Barcelona, in 1306, the Hospital of En Marcús had a total population of nineteen persons, staff and inmates together; in 1307, the Hospital of En Colom housed ten sick, four abandoned children near the age of five, and eight children being nursed.⁽⁷⁶⁾ Santa Eulàlia, despite a capacity of thirty, served just six inmates in 1305.⁽⁷⁷⁾ The Hospital of Sant Macià circa 1400, as one of Barcelona's larger hospitals, counted twenty-two beds for men and another six for women. ⁽⁷⁸⁾

With time medieval hospitals grew in size and function. The earliest were mere shelters that provided little else than a secure place in which to sleep. An example of this would be the small hospital established by the canonical community of Organyà in 1156. Here the poor and sick had the benefit of a space right at the entrance to the Church of Santa Maria and within the church in the chapel of Sant Joan. Any further care was of a symbolic and ritualistic nature. For example, guests in the shelter were fed a meal of bread, wine, and meat only on four important days of the year: two that inaugurated seasons of penance (the first Sunday of Advent and Septuagesima Sunday) and the two most important feasts of the liturgical calendar, Christmas and Easter.⁽⁷⁹⁾ Later hospitals, particularly those in urban locales, not only sheltered larger numbers, but also afforded them various forms of extended care. The best evidence that we have for the size, configuration, and functioning of these shelters comes from a scattering of inventories that have been made of their contents. The four such examples to be examined here run the gamut from the larger to the smaller, and include representatives of those in a variety of town settings.⁽⁸⁰⁾ The impression is that none of the buildings was grand, but consisted rather of a warren of small rooms contained in one or two stories.

Of the four, the Old Hospital at Girona was the largest, with ten rooms and a porch. There were two sleeping rooms, one with eighteen beds for men and another with seven beds for women. In addition, there was a kitchen, with other rooms for making bread, storage, milling grain, and storing wine, a chapel, a sitting room, and private rooms for the hospitaller and female attendants. Sant Macià in Barcelona had nine rooms, five of which were dormitories that had the capacity for housing thirty men and six women, but this seems to include its permanent personnel. In addition, it had a kitchen, storage hall, and two dining rooms. The Hospital of Pere Desvilar in Barcelona had two small dormitories, each with six beds, and one with two smaller beds, probably for children. At Reus, there is no breakdown by room, but the inventory shows accommodations for nineteen and a modest amount of kitchen equipment. While we do not know the [64] size of the beds, or whether they accommodated more than a single patient, the inventories show that each bed was equipped with a mattress, a pair of sheets, a cushion, a blanket (or two), and, less frequently, a coverlet. ⁽⁸¹⁾

The inventories also give details about other facilities. At Girona, the kitchen was well-equipped and provisioned and must certainly have provided its clients with food and drink; Sant Macià, with a larger population, had two upstairs dining rooms but far less in terms of cooking space or equipment. Reus, with but one cauldron and fireplace iron, and Pere Desvilar, with its paella pan and fireplace iron (and despite the good intentions of a founder who had mandated an ample menu), were even less prepared to provide meals. Thus, there must have been considerable variation in the regularity and amounts of food served the poor. The impression is that space was cramped, because extra beds and mattresses were placed in every nook and cranny. Girona had four mattresses in the sitting room and another in the storage room; Sant Macià had an extra bed in each of the dining rooms and in the kitchen, although some of these beds may have belonged to the staff. At Girona, the attendant's room contained one bed; but surely more helpers were needed to do the cleaning and cooking. At Sant Macià where no separate accommodation for the staff is mentioned, the bedding provided in the dining halls and kitchen appears to have been of somewhat better quality. Of the four hospitals, religious services were possible only at the Old Hospital of Girona, which had a chapel equipped with various hangings, crosses, altar cloths, vestments, and liturgical books. Presumably the other hospitals followed the custom of En Clapers in Valencia, which was to pay the rector of the local parish a fixed annual fee to provide inmates with the sacraments (communion and confession) and burial.⁽⁸²⁾ Girona and Reus both had axes for cutting wood and swords for protection; Reus also had a pair of hoes for a garden, which Rubio Vela argues was an essential adjunct of every medieval hospital.⁽⁸³⁾

The Patient Population

While most, if not all, medieval hospitals were dedicated to the service of the poor, the tendency to differentiate among classes of the poor is evident by the fourteenth century. There were those whose condition, age, or status required services beyond mere asylum; some hospitals were reserved for specific classes of individuals, like aged fishermen, impoverished priests, or abandoned children. Valencia's Hospital of En Clapers served the sick, but not lepers, the mentally disturbed, or the merely hungry, all of whom were [64] refused admission.⁽⁸⁴⁾ A distinction was made between the deserving and undeserving poor, motivated by a fear that society's charity might be abused by the lazy and shiftless. Thus, the limosnero at the Hospital del Rey in Burgos was admonished to admit only genuine pilgrims and the true poor, and his colleague at the nearbly Hospital de Santa María la Real was forbidden to admit knaves, scoundrels, vagabonds, and vile women. By statute, the Hospital of Jesucristo in Córdoba could not admit those who begged at the town gates or at the entrances to its churches.⁽⁸⁵⁾ On the other hand, some shelters, even in the fourteenth century, targeted the dispossessed. During the 1370s, several citizens of Valencia, assisted in 1377 with a municipal grant of two hundred sous, provided a house near the portal of N'Avinyó for the destitute who had fled from famine in Castile. Data from Barcelona's large general hospital of Santa Creu indicates that in the fifteenth century a majority of patients were transients, not only from the peninsular realms but also from all around the Mediterranean (France, Naples, Genoa, Greece, and even Rhodes).⁽⁸⁶⁾

There were other criteria that could influence admission to hospitals and shelters. There is the distinction, studied by Patricia Cullum at medieval York, between those who were able to pay for their care and those whose poverty forced them to rely on the resources of the house, in English usage, a cremett versus a corodian. The institution of the corody has not been adequately studied in Iberia, although Robert I. Burns has noted it in his survey of Valencian institutions. Here the monastery of Sant Vicent, alternately monastic and Mercedarian, was required to maintain twenty corodians, nominated by the king from among his household and familiars, as a type of crown pensioner. What Burns describes, however, is a somewhat different institution, since at Sant Vicent neither the pensioner nor the crown, at least directly, handed over any cash; the expense was charged against the monastery's endowment. Hospitals, generally less well endowed than this royal monastery, could not afford such largesse and thus, insofar as we can see, demanded payments from those seeking lifetime care.⁽⁸⁷⁾

Another factor influencing the admission policy is similar to the phenomenon at Sant Vicent, namely the reservation by the founder or by an important patron of the right to nominate the holders of a certain number of places in the hospital. We have already seen this at work in the hospitals of Barcelona, where Pere Desvilar in 1311 reserved four spots in his eponymous hospital for his own kinsmen.⁽⁸⁸⁾ The canon Pere Desvilar, in endowing the Hospital of Sant Macià, gave one place to his maid, Maria; Berenguer de Plan, as administrator of the Hospital of En Colom, provided for his two nieces, son, and mistress. ⁽⁸⁹⁾ Some founders, however, like Bernat [66] dez Clapers in Valencia, gave administrators no instruction at all concerning admissions and left these decisions entirely in their hands. In these circumstances, the primary factors used in granting entrance would be the number of beds available and the availability of economic resources.⁽⁹⁰⁾

The nature and duration of services afforded the poor naturally varied with the type of institution. Many monasteries, for example, like the Cistercian monastery at Poblet, provided just hospitality, but in separate facilities for rich and poor guests.⁽⁹¹⁾ At pilgrim hospices, stays were expected to be of short duration, and at the smaller and poor hospices meals were provided only on special occasions. In Burgos, for example, the Hospital del Emperador limited accommodations to one or two nights, except in case of illness or inclement weather. Guests were given bed, charcoal and firewood for cooking, but no food, except on Fridays and the days of Lent. The larger and better endowed Hospital del Rey was more generous. Those who came in the morning were given a meal; evening arrivals got bed and board; the sick received better food and a bed for the duration of their illness.⁽⁹²⁾ Only the sick could stay beyond the night. The Pyrenean hospital at Roncesvalles also limited hospitality to one night for travelers but up to three nights for genuine pilgrims.⁽⁹³⁾

Within Catalonia, this same sort of discrimination is evident. The Hospital of Girona would provide shelter to the poor for up to three days but denied admission to "lunatics," the "wicked," or the type of vagrant who merely wandered from hospice to hospice. Sick people would be accepted, presumably for longer terms, but, to protect itself from excessive burdens, the hospital acknowledged an obligation to serve only the inhabitants of the castle of Palagret, where the hospital held lands and whose people were thus its responsibility. Completely excluded, for lack of proper facilities, were abandoned infants. But older children like Joan Bartholomeu of Esterria, near Banyoles, were helped. Joan's father was a poor widower, presumably unable to care for his son. Thus the hospital accepted Joan into its care, promising him sustenance, food, shoes, and all his needs. ⁽⁹⁴⁾

Inmate populations evidently fluctuated a great deal in size, if statistics for the Hospital of En Clapers in Valencia are at all typical. During the last quarter of the fourteenth century, the patient load was highest during the plague at the beginning of April 1375 when twenty-eight were housed. But in October 1384 the daily average had fallen to 4.8 inmates, slightly smaller than the hospital's staff of five. In 1394-95, because of an improvement in income, the average had risen to 18.4, still far below the hospital's nominal capacity of thirty-four.⁽⁹⁵⁾

[67] It is difficult to profile the exact character of the inmate population of medieval hospitals because hospitallers, except in the cases of abandoned infants, were generally not required to keep a record of admissions. The prologue to the ordinances developed in 1417 for Barcelona's new Hospital of Santa Creu contains this description of a hospital's population: "poor men and women, the crippled, paralytics, the mentally disturbed, the wounded, and others suffering from diverse human miseries."⁽⁹⁶⁾ As for earlier hospitals, what we know of medieval patients can only be derived from snippets of anecdotal information. For example, the record of deaths at Valencia's En Clapers in 1374-75 lists an infant, a youth, as well as an old woman, demonstrating a diversity of age. But here inmates were always Christians, never Muslims or Jews despite their significant representation within Valencia's population. Most patients were from the city itself, while some were residents of the realm and a few were foreigners. Despite the mention of a squire, a merchant, and a young fisherman, indications of social status are rare; most inmates were undoubtedly humble. At Barcelona's Santa Creu, on the other hand, where a larger number of patients were outsiders, records reveal a variety of professions: priests, pilgrims, tailors, farmers, fishermen, students, laborers, and, in 1481, even an Italian physician. ⁽⁹⁷⁾

Among Catalan hospitals predating Santa Creu is the hospital of En Colom in Barcelona, which had the charge to serve pilgrims, vagabonds, and the poor, individuals who would likely be transients. Yet in 1307 its inmate population also contained those whose stays must have been extended -- ten sick people, four abandoned children around the age of five, and eight children still being nursed.⁽⁹⁸⁾ Some hospitals, as we have seen, also housed corodians like Bernarda, whose father, Ramon Cadena, had paid the New Hospital of Urgell three hundred sous in 1290 to care for his daughter from his death until hers. ⁽⁹⁹⁾ The Hospital of Sant Macià in Barcelona was perhaps typical in the diversity of its clientele, which included those of diverse station who came to the hospital to die -- the slave woman Margarita Baciners, a woman from the village of Llobregat named Na Bacona, an unnamed Beguin. For these the hospital had to provide care until their death, but the seriousness of their illnesses is indicated by the brevity of the stays-- three days for Na Bacona and eight for the slave Margarita. Sant Macià then became responsible for the cost of their burial shroud and service, for which special collections seem to have been taken up. Statistics from Barcelona's Hospital of Santa Creu in the late fifteenth century show forty-nine percent of all patients admitted were terminal, [68] confirming the anecdotal evidence from Sant Macià.⁽¹⁰⁰⁾ Sant Macià also provided shelter for travelers and/or pilgrims who had fallen ill. In one instance, two individuals too ill to beg their own alms in the city were fed and sheltered for six days at a cost of two sous. In 1390, shelter was given here and at other hospitals in Barcelona to the casualties of the battle of Bascara, at which Catalan forces led by Bernard de Cabrera had halted an invasion by the count of Armagnac. There were also infants like the child of four or five months who was found at the hospital's door on Monday morning, August 30, 1389. This child was given to a woman named Alfonsa who nursed it until its death in October. While most such abandoned children were similarly given out to wet nurses, some were housed at least temporarily at the hospital when a wet nurse was on staff or when goat's milk was available. In 1386, for example, the administrator, Guillem Rossell, rented a slave to serve as a wet nurse for seven months. Finally, Sant Macià dispensed charity to those who were not inmates, giving, for example, two sous to Eulalia to purchase medicine for her child. ⁽¹⁰¹⁾

If hospitals were "sacred" and protected places within the medieval town, with certain of their personnel protected by canon law, did inmates also benefit from any form of special immunity? The only indication that this was so is a charter of King Jaume II, dated October 31, 1314, that exempted the patients of En Clapers in Valencia from any action resulting from a crime, debt, reprisal, or any other cause.⁽¹⁰²⁾ Other charters generally privileged only hospitallers. Staff members at Barcelona's Santa Creu, for example, were granted various safeguards ( guidatica) by the king in the early fifteenth century, including the right to carry otherwise prohibited weapons.⁽¹⁰³⁾

The General Hospital

The end of the medieval era also marks a profound change in the character of hospitaller services. Too small to provide much beyond shelter and custodial services, and with endowments that, because of the economic crisis of the later fourteenth century, had diminished in real value, many of the small hospitals were consolidated into larger, general municipal institutions. In addition to the inadequacy of funds, the usual justifications for reform -- improper diversion of funds, dishonest administrators, lack of adequate supervision -- are uniformly cited as motivating factors. Brian Pullan believes that preaching by Observant Franciscans, who feared that the poor suffered from fraud and corruption within the older institutions, was [69]  important in encouraging the development of general hospitals. ⁽¹⁰⁴⁾ For the most part, the initiative to reorganize hospitaller institutions in order to improve their efficiency would come from secular authorities, principally municipal councils and other local authorities, who had become the patrons of last resort. The exception to the pattern is England where Henry V in 1414 proposed a general reformation of hospitals; but his motives were different -- the diversion of "wasted" monies into the royal treasury. ⁽¹⁰⁵⁾ In Italy, general hospitals were founded in Brescia (1447) and Milan (1448) and in Venetian towns like Bergamo (1457). In France, the parlement of Toulouse reformed the hospitaller structure in 1505, establishing five major institutions to treat specific problems like syphilis, orphans, and pilgrims.⁽¹⁰⁶⁾ In Portugal, Prince Duarte in 1430 requested and in 1437, as king, received the assent of Pope Eugenius IV to consolidate various small hospices throughout his kingdom. Subsequently, general hospitals were established in Lisbon and Coimbra. Within the Crown of Castile, general hospitals came later. The first was established only in 1499, when Queen Isabel and her husband Ferdinand endowed the Hospital del los Reyes Católicos in the pilgrim town of Santiago de Compostela. With its separate wards for men and women and for rich and poor, this institution became a model for later hospitals in Castile: Toledo (1504), Granada (1511) and Seville (1546).

This movement of consolidation came much earlier to the Aragonese Crown than to the other regions of Iberia and seems even to have foreshadowed developments in Italy. Within Crown lands, the first Aragonese general hospital, Nuestra Señora de la Gracia, was established in Saragossa in 1425 and another was founded in Majorca in 1456-58. In Valencia, municipal authorities in 1409 created the Hospital de Ignoscents, Folls e Orats for abandoned children and the mentally disturbed and in 1495 a general hospital. ⁽¹⁰⁷⁾ Within Catalonia, consolidation is seen in Lleida in 1453 when six of the medieval hospitals were joined together to form the Hospital General de Santa Maria.⁽¹⁰⁸⁾ Around the same time, the municipal and capitular hospitals of Urgell were joined in response to the economic difficulties of the era. ⁽¹⁰⁹⁾ In 1464, the city and cathedral hospitals at Tarragona were merged and, later in the century, Archbishop Pere d'Urrea of Tarragona, acting in response to the wishes of King Ferdinand II, merged other hospitals throughout his archdiocese.⁽¹¹⁰⁾

Barcelona's consolidation was the earliest of all. On February 1, 1401, the Consell de Cent appointed a civil commission to study the condition of the city's hospitals; Bishop Joan Ermengol of Barcelona and the chapter subsequently did the same. On March 15, the two commissions agreed to consolidate the hospitals of En Marcús and Pere Desvilar, both of which [70] were under municipal administration, with the capitular hospitals of En Colom and Sant Macià into the Hospital of Santa Creu, to be governed by a board composed of two citizens and two canons. On June 27, the leprosarium of Sant Llàtzer was added, and on July 23 the prior of Santa Eulàlia del Camp petitioned that the small hospital there also be included because "it does nothing useful." Subsequently and because the consolidation involved the alienation of church property, the approval of the Avignonese pope, Benedict XIII, was sought and received. The newly constructed Hospital of Santa Creu was dedicated to the service of the infirm poor and others who were accustomed to being sheltered in the city's hospitals. It endured as a medical facility until 1926, after which its functions were assumed by a new Hospital de Santa Creu i Sant Paul in the Eixample district. One of its last patients was the famed Catalan architect Antoni Gaudí, who died there on June 7, 1926. Today the medieval structure serves as the Biblioteca de Catalunya. ⁽¹¹¹⁾

The fifteenth-century structure, begun by the architect Guillem Abrill, is the largest example in Catalonia of the monumental style of hospital architecture, characterized by large halls surmounted by a beamed roof supported on diafragmes arches. Its chapel, however, utilized the nave of the older Hospital of En Colom. A painting of 1410 shows that the first of the great halls, ten by sixty meters in size, and half of another had been completed. Records in 1457 speak of five wards, including one for women. A second ward for women was built in 1472, and additional space was added at the end of the century. An inventory of 1564 indicates that Santa Creu had a capacity of between 120 and 200 patients.⁽¹¹²⁾

The actual operation of Santa Creu is described at great length in ordinances that were promulgated in 1417, which are reflective of the hospital's first decade of operation. Most valuable for our purposes here is their outline of routine patient care. While its size and resources certainly enabled Santa Creu to provide more comprehensive treatment to inmates than its smaller counterparts, its customs seem typical of late medieval usage. A lengthy section of ordinances deals with the reception of patients, a duty performed by the infirmarian. According to our earliest statistics, from 1473-1491, Santa Creu during this period admitted an average of 264.5 patients each year, 191.8 male and 72.8 female. According to the ordinances, each one of these, after having his feet washed and "thoroughly cleansed," was to be provided with a bed and a meal. Then the rector, who as the hospital's chaplain had charge of the religious needs of patients, would arrive for confession, and perhaps communion and last rites. Meanwhile, the infirmarian was to summon medical personnel and [71] then see that prescribed food and medicine were properly delivered. At some convenient time, the infirmarian and hospital scribe were required to interview the patient formally and ask "with gentle words" his name and geographical origins, compile an inventory of his money, clothing, personal and real property, and debts, and request the name of the individual to be notified in case of death. The emphasis on money and property was designed to protect the patient as much as to benefit the hospital. After verifying the accuracy of the patient's inventory, his property was to be kept safe, and returned in its entirety should the individual live. There is no indication that the cost of care would in any way be deducted from this amount. If, on the other hand, the patient died, then the hospital claimed all of his property and rights. In addition, clothing would be collected, cleaned, and sold off for the hospital's benefit. All of this indicates that inmates were indeed poor, that whatever money they carried would be meager in amount, and that residual property, if any, would not likely be claimed by heirs.⁽¹¹³⁾

The routine care outlined is one of bed rest, with a therapy of food and medicine. The condition of the patients was to be regularly checked by various personnel. The prior, in five daily visits, was to give spiritual consolation and summon the rector should the patient require confession and the late rites. The infirmarian was to make seven daily rounds to check on the quality of the food, patient hygiene, and the administration of medicine. In addition, barbers and physicians under retainer were to make morning and afternoon rounds, during which they were to provide medical care and report terminal cases to the prior so that the appropriate sacraments could be administered. There were separate wards for men, women, and children, each with its chief attendant and subordinates. Dinner was served at midday; attendants provided medicine and refreshments at other hours and cleaned up after patients. For those patients who did not die, the hospital realized the risks of premature discharge. The infirmarian was instructed not to release any patient until the cure was complete. To do otherwise, the ordinances argued, would make little financial sense because the person would undoubtedly relapse, be readmitted, and cost the hospital for additional care. The only exception to this rule was the case in which an individual would discharge himself by signing a release absolving the hospital of any future responsibility for his care and treatment.⁽¹¹⁴⁾

The specialization and diversity of purpose that mark the evolution of the hospital in medieval Catalonia parallel an internal development as well. [72] Just as these hospitals grew in number and size, their internal governance became more complex, as we have seen in this elaboration of the administrators, nurses and functionaries who staffed the hospital. With regard to institutions like the donat and the corody, or the effort of ecclesiastical and municipal authorities to exercise a measure of oversight, the experience of Catalonia is reflective of the rest of Europe. Eastern Spain, however, stands apart in other respects. For the most part, its caritative institutions were smaller than those found in larger urban areas, like Paris or northern Italy, or in even more rural areas like Burgos that lay astride major pilgrimage routes. Despite their modest proportions, however, Catalan establishments were at the forefront of institutional development, pioneering the concept of the general hospital. For reasons that remain to be studied, however, Catalan hospitals lacked some of the religious character of their French counterparts. Few were operated by formally, or informally, organized communities of religious; certainly by the fourteenth century, salaried staffs, which must have increased operating expenses, had become the norm throughout Catalonia and the Crown of Aragon. Finally, it is perplexing, in light of the relatively few number of available beds, that so many hospitals should have operated below their capacity. We have seen a number of instances in which financial hardships caused administrators to limit admissions, but such efforts also brought public rebuke from authorities. Attempts were also made to bar vagrants, the insane, and other undesirables from free bed and board. Nonetheless, given the level of poverty and disease during these centuries, it is hard to believe that there would be any lack of demand for these unoccupied beds. Perhaps this tells us that medieval communities had far lower expectations of public assistance than modern societies and that, for most, family and friends functioned as the principal providers of shelter and care in times of need.

Notes for Chapter Four

1. Batlle, L'assistència, 36-37.

2. Ibid., 50-51. A similar situation prevailed at Valencia where Bernat dez Clapers entrusted the task of nominating the administrator and chaplains of his eponymous hospital, after the death of his executors, to the jurats of Valencia (Rubio Vela, Pobreza, enfermedad y asistencia, 107-8).

3. Coll Julià, "Documentación notarial," 2:287-89.

4. In the instance of Bertran's heirs, control of his hospital, which had been established circa 1325, was transferred to the town council (Danon, Visió històrica, 17).

5. For a discussion of this at Toulouse, see Mundy, "Charity and Social Work in Toulouse," 240-46; see also Rosen, "Historical Sociology," 12. Of the more than twenty hospitals and hospices identified in the Kingdom of Valencia circa 1300, all but Valencia City's leprosarium fell under some sort of ecclesiastical control; the fourteenth century was characterized by municipal and laic initiatives. See Luis García Ballester, La medicina a la València medieval: Medicina i societat en un país medieval mediterrani (Valencia, 1988), 111-12. An example of a mixed regime would be that of Valencia's Hospital of Sant Vicent, operated by Cistercian monks under royal patronage, but subject after 1370 to visitations by delegates of the municipal council. The city council itself directed only the leprosarium in 1300, but by 1400 had added three other institutions. One of these was the Hospital of En Clapers, whose administrator was appointed by the jurats and who had to render account to the council twice a year. Furthermore, the founder requested, but did not require, the jurats to check once a week that the sick were being properly cared for. See Rubio Vela, Pobreza, enfermedad y asistencia, 51-52, 54, 108-10.

6. In Barcelona, by the fourteenth century, the power of appointment was in fact exercised by the bishop's vicar general, as a document of January 8, 1349, naming Bernat Domenge as administrator of the Hospital of Santa Maria de Bonesvalls (Cervelló) makes clear (Gyug, Diocese of Barcelona , 241, n. 576).

7. Rubio Vela, Pobreza, enfermedad y asistencia, 39-43. Philip Gavitt, in his study of Florentine hospitals, essentially comes to a similar conclusion, but places the shift from a religious to a secular emphasis in the late fourteenth century. He notes, for example, that testators now turned to guilds or the commune to realize their charitable objectives, not to churchmen. See his Charity and Children in Renaissance Florence: The Ospedale degli Innocenti, 1410-1536 (Ann Arbor, Mich., 1990), 18.

8. The administrators, as they were called, were chosen for two-year terms on the feast of the Holy Cross in May, with one cleric and one citizen chosen each year. See Danon, Visió històrica, 21-22. Ordinacions del Hospital General de la Santa Creu de Barcelona (any MCCCCXVII), Copiades textualment del manuscrit original y prologodes (hereafter Ordinacions ), ed. Joseph María Roca (Barcelona, 1920), viii; for Girona, see Guilleré, Girona al segle XIV, 1:165. Such sharing of authority was not unique to Catalonia. At Amiens, in the fifteenth century, the master of the Hôtel-Dieu was elected by the town council and then installed by the bishop (Rosen, "Historical Sociology," 14). On the broader issue of lay versus clerical influence over charity, see Andrew Barnes's critique of the secularist thesis: "Poor Relief and Brotherhood," Journal of Social History 24 (1991): 603-11.

9. Rosen, "Historical Sociology," 13; Tierney, Medieval Poor Law, 86.

10. Pérez Santamaría, "San Lázaro," 1:83-90.

11. Rubio Vela, Pobreza, enfermedad y asistencia, 51; 169-70, n. 7.

12. The racional or auditor was to review all accounts every six months. Those found guilty of any impropriety would be liable for any damage done, through the garnishment of their salary, and subject to any other penalty, corporal punishment, or fine levied by the administrators. Ordinacions , vi-vii, xxxvii, xlv.

13. "Nos, itaque, Arnaldus, Dei gratia episcopus Barchinone, et capitulum eiusdem, attendentes laudabilem propositum et pie devotionis affectum tui dicti Bernardi Ferrarii comendamus tibi predictum hospitale." Batlle and Casas, "Caritat privada," 1:176-78, no. 6.

14. Amada López de Meneses, "Documentos acerca de la peste negra en los dominios de la Corona de Aragón," Estudios de la edad media de la Corona de Aragón 6 (1956): 354-55, no. 75 (June 15, 1349).

15. At Toulouse, minister was the preferred term, but gubernator and infirmus were also used (Mundy, "Charity at Toulouse," 239). At Aix-en-Provence, commander was the title of choice in the thirteenth century (Jean Pourrière, Les Hôpitaux d'Aix-en-Provence au Moyen Âge: XIII^e, XIV^e et XV^e siècles (Aix-en-Provence, 1969), 89). A municipal ordinance at Valencia in 1319 mandated that the rector of the municipal leper house serve for two years, while King Alfons III in 1333 gave Miquel Sánchez del Coro a lifetime appointment to the nearby Hospital de la Reyna (Rubio Vela, Pobreza, enfermedad y asistencia, 163-65, nos. 1-2). At Girona's Hospital Nou, commanders served indeterminate but lengthy terms. Bonanat Nadal and his wife served, for example, from 1319 to 1331 (Guilleré, Girona al segle XIV, 1:166).

16. Batlle, L'assistència, 47.

17. J. N. Hillgarth and Guilio Silano, The Register NOTULE COMMUNIUM 14 of the Diocese of Barcelona (1345-1348) (Toronto, 1983), 184, no. 498; see a similar document in Gyug, Diocese of Barcelona, 241 n. 576 (January 8, 1349).

18. Pérez Santamaría, "San Lázaro," 1:84; Guilleré, Girona al segle XIV, 1:292.

19. Guilleré, Girona al segle XIV, 1:166; Ordinacions , viii-xviii.

20. Rubio Vela, Pobreza, enfermedad y asistencia, 165.

21. Complaints the rector's regime was ineffective date from 1384 (Tarragó, Noves Aportacions, 25-26).

22. Ordinacions, xli-xlv.

23. Batlle, L'assistènica, 28-29.

24. Batlle Prats, "Inventari dels Bens," 79-80.

25. The new chaplain was obligated to say mass daily for the lepers, hear their confessions, administer to them the other sacraments, bury them in the hospital cemetery, and serve as deputy to the lay administrator (Pérez Santamaría, "San Lázaro," 1:86-87, 90).

26. Rubio Vela, Pobreza, enfermedad y asistencia, 192-93, n. 24.

27. The Hospital's confraternity was confirmed by King Martí in 1405. See Ordinacions, x-xii; Danon, Visió històrica , 158.

28. Rubio Vela, Pobreza, enfermedad y asistencia, 112-5. A similar division of responsibility is noted at Valencia's Hospital de la Reyna by the fifteenth century. Batlle, L'assistència, 67-9;

29. Batlle, Urgell medieval, 126-33.

30. For example, Na Camp, a female attendant in 1300 and 1301 was paid a salary of sixty-five and seventy sous, plus articles of clothing. In 1379, Na Alamanda, the porter, received eighty sous, while two of the bread collectors were paid one hundred ten sous, and a third, who had additional duties, was given a hundred twenty sous. See Pérez Santamaría, "San Lázaro," 1:85, 104-5. Hillgarth and Silano, Register, 184, no. 498; Sanahuja, Beneficencia en Lérida, 75.

31. Batlle, L'assistència, 38; Rubio Vela, Pobreza, enfermedad y asistencia, 111; Gyug, Diocese of Barcelona, 241-42 n. 577; Baucells, "Pia Almoina," 104.

32. Batlle Prats, "Inventari dels Bens," 68-76.

33. See his Historia occidentalis, cap. 29, 147.

34. In the Italian municipal hospital of Brescia in the 16th century, for example, many members of the staff had been children of the house, including the goatherd and the porters. See Brian Pullan, "Orphans and foundlings in early modern Europe," in Poverty and Charity, 3:23.

35. The Order of the Holy Spirit, for example, is estimated to have had fourteen establishments throughout Iberia in the thirteenth century, growing to thirty during the next two centuries. See B. Rano, "Ospitalieri di Santo Spirito," Dizionario degli istituti de perfezione (hereafter, DIP ), 6:1005. In the thirteenth century, the Trinitarians had perhaps ten hospitals in Iberia, of which three were in Catalonia (Lleida, Tortosa, and Anglesola) and another in Valencia city. See James W. Brodman, "The Trinitarian and Mercedarian Orders: A Study in Religious Redemptionism in the Thirteenth Century," ( Ph.D.dissertation, University of Virginia, 1974), 211-29. Mercedarian hospitals, really hospices for recently ransomed captives, were found in Catalonia (Barcelona, Montblanc), Aragon (Saragossa, Sarrión, Huesca, Teruel), Valencia (Valencia City, Denia), the Balearics (Palma de Mallorca), and Occitania (Maleville). See James William Brodman, Ransoming Captives in Crusader Spain: The Order of Merced on the Christian-Islamic Frontier (Philadelphia, 1986), 12, 21, 25, 27-28, 30, 35-36, 78. Franciscans were bequeathed funds to operate hospitals in Barcelona and Valencia, although they actually did so only in the latter. They also briefly operated a leprosarium in Tàrrega. See Webster, Els Menorets, 94-96, 109.

36. Léon LeGrand, "Les Maisons-Dieu: Leurs Statuts au XIII^e siècle," Revue des questions historiques 60 (1896): 104; Miller, "Knights of Saint John," 720.

37. A short version of a rule is contained in Innocent III's grant of June 19, 1204 (PL 215:377-80). The articulated code is found in "Regula ordinis S. Spiritus de Saxia," PL 217:1138-56. See also P. L. Hug, "Order of the Holy Spirit," in New Catholic Encyclopedia, 7:103-4; Rano, "Santo Spirito," DIP 6:1002.

38. Batlle, L'assistència, 41.

39. For a discussion of the Augustinian Rule in the context of hospitaller communities, see Miller, "Knights of Saint John," 715-16; and Statuts d'Hôtels-Dieu , vi-viii.

40. Marquès, "Fundació d'un hospital a Organyà," 7-8.

41. In addition to the chaplain-brothers, there were, in the visitation of 1364, eight sisters who cared for the sick and poor, a number of lay brothers (who in the fifteenth century were replaced with maidservants), four secular chaplains to serve the church and chapels, and a host of lay servants who served as cooks, brewers, laundresses, and so on. Cullum, Cremetts and Corrodies , 7.

42. Specifically, members of these communities were to take vows of poverty, chastity, and obedience to the bishop, wear a religious habit, move on to another place if their numbers exceeded the population of the poor to be assisted, use donated goods for the poor, not for themselves; married couples who enterrd the community were thenceforth to lead chaste lives in religious habits. Statuts d'Hôtels-Dieu, xi-xii, xxiii. See also Miller, "Knights of Saint John," 720-22.

43. For example, the administrator of the hospital, frare Jacme Just, was accused of heresy in 1353. Agustín Rubio Vela and Mateu Rodrigo Lizondo, "Els beguins de València en el segle XIV. La seua casa-hospital i els seus llibres," Miscel.lànea Sanchis Guarner 1 (Valencia, 1984): 330-34.

44. Martínez García, Hospital del Rey, 60-61.

45. Durán, Hospital de Somport, 60-61, 86-90.

46. Tarragó, Lérida, 22-24.

47. Batlle, L'assistència, 58.

48. The Hospital of En Marcús, at the same time, had a rector, a donat, and two donatas (Pifarré, "Dos visitas," 2:84-89.

49. Pérez Santamaría, "San Lázaro," 105-7.

50. Pifarré, "Dos visitas," 2:85-86; Pérez, Santamaría, "San Lázaro," 1:104-13; Gallent Marco, "Hospital de la Reyna," 81-82. At Saint Leonard's in medieval York, the ratio was in the range of five or six to one, but since only eight actually served the inmates, the real ratio was closer to twenty-six to one. See Cullum, Cremetts and Corrodies , 8. At En Clapers in 1388, a female servant, Na Dolça, served the sick for no pay (Rubio Vela, Pobreza, enfermedad y asistencia, 118).

51. Rubio Vela, Pobreza, enfermedad y asistencia, 102. This evidence is corroborated by the experience of Burgos's Hospitals del Rey and San Lucas where the cost of patient care did not exceed fifteen percent of the budget (Martínez García, "Asistencia material," 356).

52. For a discussion of donats and the confusion between them and serving brothers/sisters and other inmates, see Mundy, "Charity and Social Work in Toulouse," 267-70. In Florence, where wives were often twenty years older than their husbands, widowed women were known to take religious vows at some sort of charitable institution where, in return for their estates, the hospital would guarantee them employment and care. At the fifteenth-century foundling hospital, such women were known as commessi; similar contracts are extant for single men and married couples (Gavitt, Charity and Children , 115-16).

53. Antonio Durán Gudiol, Colección diplomática de la catedral de Huesca (Saragossa, 1965-69), 2:533-34, no. 560; 497-98, no. 519.

54. Tarragó, Lérida, 22-24.

55. Vilaseca, Hospitales medievals de Reus, 31-32, 64.

56. Pere's two sons, daughter-in-law, and nephew assented to the arrangement, probably by way of relinquishing their claim to the amount being given Sant Martí (Tarragó, Noves aportacions, 14-15). For a discussion of corodies, that is, contracts that exchanged property for care, support, and burial, see Mundy, "Charity and Social Work in Toulouse," 258-265. For Joan Colom, see Batlle, L'assistència, 36.

57. Ollich, "Les entitats eclesiastiques de Vic," 97; Junyent, Vic, 87-88. Cap. 76 states that such girls would have the choice of service, under the three vows of religion, in which instance they would receive support for life, or else they could choose marriage. "Regula ordinis S. Spiritus," PL 217: 1151.

58. In the fourteenth and fifteen centuries, elderly who had children frequently joined their households. On average, Russell's studies suggest that between 1275 and 1450 the elderly represented between 8.5 and 12.5 percent of the population (Josiah C. Russell, "How Many of the Population Were Aged?" in Aging and the Aged, 124-25). On the institution of the corodies, see Cullum, Cremetts and Corrodies, 8-10, 20-28; on its practice in Florence, see Gavitt, Charity and Children, 116.

59. Sankt Nicholaus Spital (1458) in Kues of Germany's Mosel region housed thirty-three men over the age of fifty; Saint Jan's Hospital in Bruges provided rooms for pensioners who had property to give the hospital; but pilgrim hospices like Saint Jacques in Valenciennes specifically excluded the old. Luke Demaitre, "The Care and Extension of Old Age in Medieval Medicine," in Aging and the Aged, 13. All in all, the terminology used to describe the inhabitants of hospitals is imprecise. Cullum's study of Saint Leonards of York, for instance, describes a wide variety of status: serving sisters who tended the poor; corodians and livery-holders who paid for varying levels of care; and livery and corody holders who wore the habitum sororis, who for a price were able to dress as the serving sisters and who may or may not have worked alongside them. Furthermore, corodies were priced at a level to enable the hospital to support the inmate for about a decade (Cullum, Cremetts and Corrodies, 21, 26-27).

60. For example, female superiors were appointed by the male master. Discipline also displayed a gender bias. Errant sisters were to be punished severely and, if necessary, denounced to the pope and turned over to civil authority. Brothers, however, were to be given several chances at reform, being subject to escalating penalties of prayer, defrocking, and imprisonment, but with the proviso that repentance would bring forgiveness ("Regula ordinis S. Spiritus," PL, 217: 1146, 1148-49, 1151, 1154, caps. 42, 62, 67, 80, 99).

61. Cullum, Cremetts and Corrodies, 15.

62. Rubio Vela, Pobreza, enfermedad y asistencia, 118-19.

63. See his Historia occidentalis, 148, cap. 29.

64. The baciners who worked for Barcelona's leper hospital, for example, begged at several of the city's churches on Sundays and on major feasts, but on minor feasts went to only one location. Pérez Santamaría, "San Lázaro," 94. López Alonso, Pobreza en la España medieval, 466. In general, the custom at Barcelona was to permit alms-seekers of all sorts access to churches on Sundays and feasts, except for those feasts specifically designated for the cathedral building fund, when only collectors from the see could make their appeal. See privileges extended in this regard to the Orders of Roncesvalles, the Holy Spirit and Saint Anthony (Gyug, Diocese of Barcelona, 331-32, n. 878; 337, n. 893; 344, n. 913).

65. Batlle, L'assistència, 42; Utterback, Pastoral Care , 114-15; Roca, Sant Macià, 6-7.

66. Tarragó, Noves aportacions, 28-29; Ordinacions, xvii.

67. Ordinacions, xxvi, xlii; Danon, Visió històrica , 157. On Majorca, caritative institutions evidently relied on the diligence of executors for the reception of pious legacies. During the plague years, however, when these legacies became difficult to collect, due both to the death of executors and the sudden impoverishment of the testator, the bishop attempted to appoint two priests to claim such gifts until restrained by royal intervention. López, "Documentos acerca de la peste negra," 369-70, no. 87 (January 19, 1350).

68. Ordinacions, ix-xl; Danon, Visió històrica , 57-58.

69. Rubio Vela, Pobreza, enfermedad y asistencia, 165.

70. Ibid., 36, 77-8.

71. Bed counts, however, are not always a reliable method for estimating capacity. While hospitals like Valencia's Hospital de la Reyna permitted only one inmate per bed, others allowed as many as two or three in a bed. Gallent Marco, "Hospital de la Reyna," 82.

72. Or, 15 to 23 places per 10,000 of population (García Ballester, Medicina a la València, 110). See also Gallent Marco, "Hospital de la Reyna," 82. In contrast, modern authorities recommend just for medical care upwards of 100 to 120 beds per 10,000 of population: Aragó, Hospitals a Catalunya, 45. Rubio Vela, Pobreza, enfermedad y asistencia , 87, 132.

73. Burgos's other major hospitals, those of the Emperador, with twelve beds, and that of Santa María la Real with eighteen spaces, more closely approximated Catalan conditions (Martínez, "Asistencia material," 351-52). At Toulouse, in 1256, the Hospital of Saint-Raymond had fifty-six beds, a size matched by only two of the other thirteen hospitals in the city (Mundy, "Charity and Social Work in Toulouse," 253). By contrast, contemporary estimates, doubtlessly exaggerated, of the patient population at the Hospital of Saint John in Jerusalem range from one to two thousand (Miller, "Knights of Saint John," 719). Saint Leonard's had a population of some two hundred inmates, making it a large hospital for England. By contrast, Saint John the Baptist, Canterbury, supported sixty, and Saint Cross, Winchester, only thirteen (Cullum, Cremetts and Corrodies, 2). In Paris, the principal hospital, the Hôtel-Dieu at Notre Dame, had 279 beds that could accommodate up to three patients each, and a lying-in room with 24 beds, but in the fifteenth century the average population was far below capacity, perhaps four hundred to five hundred persons at a time (Geremek, Margins of Society, 175-76). Florence in the fifteenth century had thirty-three hospitals, of which six housed fewer than ten inmates, seven had space for up to twenty, another could accommodate up to thirty, two others up to forty, one up to fifty, and five more than fifty. The largest were Santa Maria Nuova with 230 beds, and the foundling hospital of the Innocenti which could house as many as 700 (Henderson, Piety and Charity, 375-77).

74. At the Hospital del Rey at Burgos, for example, the hostel for women contained eight beds, while that for men had twenty-nine, that of the Emperador had three for women and nine for men, and of the original ten beds at Santa María la Real all were designated for males (Martínez, "Asistencia material," 350-52). In Catalonia, the Hospital of Sant Joan at Reus had fifteen beds for men and only four for women (Vilaseca, Hospitales medievals de Reus , 55-58).

75. Tarragó, Noves aportacions, 33; Batlle, Urgell medieval , 126-32, 157; Junyent, Vic, 124.

76. Pifarré, "Dos visitas," 2:83-89.

77. Batlle and Casas, "Caritat privada," 1:141-44.

78. Roca, Sant Macià, 4-12.

79. Marquès, "Fundació d'un hospital a Organyà," 8.

80. These descriptions seem fairly typical and may be compared with that of Valencia's En Clapers, which was located in a central building, with a front porch for the inmates, and a central atrium off of which were located separate wards, with eighteen beds for men and sixteen for women, a chapel, kitchen, servants' quarters, administrator's room, dispensary, and loft. The central patio contained the hospital's water source, and a cypress tree. Rubio Vela, Pobreza, enfermedad y asistencia, 85-89.

81. In contrast, the Knights of Saint John, by their statutes of 1182 promised each patient not only bedding, but also a coverlet, a cap and cloak, and slippers (Miller, "Knights of Saint John," 731).

82. The rector of Sant Llorenç received one hundred sous per year for his services, or about half of what was budgeted for physician care (Rubio Vela, Pobreza, enfermedad y asistencia, 127).

83. Batlle Prats, "Inventari dels Bens," 65-76; Ordinacions, lxxviii, lxxxiii-lxxxv; Vilaseca, Hospitales medievals de Reus, 55. Desvilar, in his will, directed that each inmate be fed daily with a ration of bread, wine, meat/cheese/eggs/fish, and accompaniments. The absence of an elaborate kitchen suggests either a failure to carry out these wishes, or perhaps just the simplicity of the preparation (Batlle, L'assistència, 51). Rubio Vela has published an inventory of the Hospital of En Clapers in Valencia that was taken in 1384, in which he also notes the presence of gardening tools. See his Pobreza, enfermedad y asistencia, 80-1; 187-91, n. 23.

84. Hospitals like En Clapers, however, would distribute alms to the needy, with which they could buy food (Rubio Vela, Pobreza, enfermedad y asistencia , 136).

85. López Alonso, Pobreza en la España medieval, 429-31.

86. Rubio Vela, Pobreza, enfermedad y asistencia, 37-38, 176; Danon, Visió històrica, 78.

87. Saint Leonard's in York had both types of corodians, those who purchased their place and those who received their place through crown appointment. See Cullum, Cremetts and Corrodies, 8-10, 22-3; and Burns, Crusader Kingdom, 1:285-89.

88. Batlle and Casas, "Caritat privada," 1:135-37, 178-80, no.7; Batlle, L'assistència, 51.

89. Batlle, L'assistència, 36.

90. Rubio Vela, Pobreza, enfermedad y asistencia, 129.

91. López Alonso, Pobreza en la España medieval, 415, 423-24.

92. A ration of bread was provided on Fridays, and a small meal of bread, fish, beans, and vegetables during Lent. Santa María la Real, another pilgrim hospice, also provided no food, but did dispense over fifty pairs of shoes to guests as replacements for worn-out footwear; during Lent, in addition, thirteen poor (five fewer than the number of available beds) were fed (Martínez, "Asistencia material," 351-52). Rodrigo Ximénez de Rada gives this contemporary account of the services provided by the Hospital del Rey: "And he [King Alfonso VIII of Castile] constructed buildings and houses for a hospital . . . which he enriched with so much wealth that at all hours of the day necessities were administered to all pilgrims, and no sufferer was turned away. Through a marvelous [system], beds were constantly made ready for all wishing to spend the night. Also for the sick, even [those] close to death, everything necessary to restore them to pristine health was used by the hands of merciful men and women." See his De rebus Hispaniae , bk. 7, caps. 13-14, 173-74.

93. López Alonso, Pobreza en la España medieval, 415.

94. Batlle Prats, "Inventari dels Bens," 78-79.

95. Rubio Vela, Pobreza, enfermedad y asistencia, 132.

96. Ordinacions, v.

97. Rubio Vela, Pobreza, enfermedad y asistencia, 133-34; Danon, Visió històrica, 78.

98. Pifarré, "Dos visitas," 2:87.

99. Batlle, Urgell medieval, 125-33.

100. Burying the dead was especially crucial during times of plague. In May 1375, the Hospital de la Reyna in Valencia was given by the municipal council a special allotment of thirty pounds for the purchase of burial shrouds (Rubio Vela, Pobreza, enfermedad y asistencia, 52). During the period 1473-91, Santa Creu admitted 5,027 patients, of whom 2,459 died (Danon, Visió històrica, 82).

101. Roca, Sant Macià, 8-9, 25-29.

102. Rubio Vela, Pobreza, enfermedad y asistencia, 133-34.

103. Danon, Visió històrica, 158.

104. For example, at Valencia in the late fourteenth century the initial twenty pound endowment of the Hospital de la Reyna had fallen below the minimum necessary to keep its doors open, and the leper hospital of Sant Llàtzer in 1380 was said to be in "great need and misery" because of "the high prices of the things necessary for the sick" (Rubio Vela, Pobreza, enfermedad y asistencia, 71-2). In England, many rural hospitals, whose income was derived chiefly from land, disappeared after 1350, following the collapse of land values. See Miri Rubin, "Imagining Medieval Hospitals: Considerations on the Cultural Meanings of Institutional Change," in Medicine and Charity before the Welfare State (London, 1991), 20. On the complaints against older hospitals, see Pullan, Renaissance Venice, 204; and his "Support and Redeem," 5: 190.

105. The Hospital of Bernat Marcús, on the verge of bankruptcy in 1339, was turned over to Barcelona's council, and in Valencia the Hospital de la Reyna for the same reason became a municipal responsibility in 1379. While remaining independent, the Trinitarian hospital of Sant Guillem began to receive periodic subsidies toward its operating expenses from the municipal council. Assumption of responsibility for hospitals could also provide some advantage to municipal councils. Rubio Vela, for example, has discovered that at Valencia several hospitals were compelled by the council to invest in municipal bonds at below market rates in order to enable the city to pay off higher cost obligations. Similar studies have not been done for Barcelona, but parochial alms funds at parishes like Santa Maria del Pi and Sant Just did invest in municipal bonds. See Rubio Vela, Pobreza en el Valencia , 52-9, 63-4, 72-3; Batlle, L'assistència, 52-59. For England, see Clay, Mediaeval Hospitals, 212, 229.

106. Mundy, "Charity and Social Work in Toulouse," 278 n; Gavitt, Charity and Children, 11; Pullan, Renaissance Venice, 203-7; Pullan, "Support and Redeem," 5:191-92.

107. López Alonso, Pobreza en la España medieval, 450, 455-57; Antonio Contreras Mas and Ramón Rosselló, La asistencia publica a los leprosos en Mallorca (Majorca, 1990), 42; García Ballester, Medicina a la València, 111-12. In the Italian regions of Tuscany and Lombardy, the tendency to establish large general hospitals also dates from the late fourteenth century. Some, like those of Santa Maria Nuova in Florence and Santa Maria della Scala of Siena, were reorganizations of much older institutions, while others in Brescia (1447) and Milan (1448) were new establishments (Gavitt, Charity and Children , 10-11).

108. Lara and Trenchs, "Hospital de Pedro Moliner," 59.

109. The merged hospital closed for a decade in 1452, and the building was turned into a town hall. Efforts to construct a new edifice were delayed until 1460 due to difficulty in raising money. The new building opened in 1462. Batlle, Urgell medieval, 149-55.

110. For example, in Tarragona the city hospital was merged with that of Santa Tecla, and in Montblanc Santa Magdalena acquired the assets of the Hospital of Sant Bartolomeu. Adell i Gisbert, "Montblanc," 246.

111. López Alonso, Pobreza en la España medieval, 455-56; Danon, Visió històrica, 21-22; 145-155.

112. Santa Creu's architectural style contrasted with a more domestic style typical of crowded urban neighborhoods, in which small rooms were constructed around a small, central patio. The monumental style was more typically found in less built-up areas (Adell i Gisbert, "Montblanc," 243-44). The inventory of Santa Creu from 1564 contains about 126 beds and 211 mattresses. For a general description of Santa Creu, see Danon, Visió històrica , 23-35; 88-9.

113. Danon, Visió històrica, 82; Ordinacions, xiii-xv.

114. Ordinacions, xi, xvi, xx-xxi, xxxii-xxxiii.