THE LIBRARY OF IBERIAN RESOURCES ONLINE
CHARITY AND WELFARE:
HOSPITALS AND THE POOR IN MEDIEVAL CATALONIA
JAMES WILLIAM BRODMAN
Preface
Hospitals, in the Middle Ages, were broadly conceived as institutions that received pilgrims and travelers, cared for the sick, and tended to individuals designated by society as being poor. In recent years, such institutions have begun to attract the attention of historians. Some scholars have come upon hospitals incidentally; these include those who study marginality and marginal groups, since the latter were frequently clients of hospitals and caritative institutions. Others have become interested in various examples of laic or nonclerical associations, such as confraternities, parish institutions, and municipal councils, and have subsequently discovered and addressed the assistance such organizations rendered to the poor. More directly tied to hospitals are the efforts of those who examine the origins and character of medical practice because this includes consideration of the settings within which the healing arts were actually practiced. In addition, among the historians of religion and the medieval Church, an interest in the Gregorian reform movement has been broadened to include a study of the various new orders, among which are caritative groups that operated and staffed hospitals. These scholars have been joined by local historians, whose analysis of urban archives has brought to light various types of civic institutions, which include hospitals and other institutions of municipal charity. Finally, contemporary society's debate over issues like welfare reform, care of children and the elderly, and the universality of health care has sparked an interest in the medieval response to these same subjects.
The first modern studies of European hospitals and charitable provision date from the late nineteenth century and, as in most history of this age, the attention was focused on the formation and development of institutions. (1) By the mid-twentieth century, some scholars began to consider the social context of medieval benevolence by exploring the legal framework within which charity was distributed.(2) Since 1970, there has been an explosion of interest in the subject along two principal lines of investigation. One thread of inquiry has centered on the study of particular urban societies and groups. This has produced illuminating studies of hospitals and charity for Italian communes like Venice, Genoa, and Florence, for the [x] English communities of York and Cambridge, and for Brussels and other urban centers of the Low Countries. (3) Social historians, on the other hand, have concentrated their attention on both ends of the social spectrum. Michel Mollat and his associates, such as Bronislaw Geremek, have introduced the subject of poverty and painted a picture of how the underclass fared in the world of medieval France. (4) Philippe Ariès, Shulamith Shahar, and others have addressed the nurturing of children, and John Boswell the phenomenon of their abandonment. (5) Prostitutes, lepers, slaves, and the aged have each found their historians. (6) Other scholars have tackled the issues of gender, social minorities, and power elites.(7) While much of this is peripheral to the study of hospitals per se, each of these topics deals in important ways with the methods, motives, and means of medieval caritative assistance.
Within Iberia, the modern study of hospitals, charity, and poor relief also began in the later nineteenth century, when Fermín Hernández Iglesias published a history of hospitals and Manuel de Bofarull a study of confraternities. In the decade before the outbreak of the Spanish Civil War, their interest was continued principally by the Catalan historians Joseph Maria Roca, Luis Batlle Prats, and César Martinell, whose focus remained chiefly institutional.(8) In 1944, as Spain was recovering from its recent conflict, and within the context of the Franco dictatorship, the Franciscan Pere Sanahuja and Antonio Rumeu de Armas both published histories of charity. The former focused on a single locality, Lleida, while the latter emphasized the national, or pan-Hispanic character of medieval assistance.(9) Both reflected the ethos of the era by emphasizing the religious and institutional aspects of medieval giving. Historians like José Tolivar Faes and Robert I. Burns, S.J., wrote in the 1960s about hospitals in Asturias and Valencia, (10) but general interest in the subject was not manifested until the convocation of a large conference at Lisbon in 1972.
The Lisbon Conference gathered historians from throughout Iberia who for the first time addressed a broad array of questions relating to poverty and relief in the Middle Ages. Michel Mollat, whose own studies of the subject at the University of Paris dated from 1962, was invited to deliver the keynote address. Twenty-seven ponencías followed. Given the locale of the conference, almost half of the presentations concerned Portugal; six dealt with Catalan subjects; another five were situated within the Crown of Castile; and three dealt with pan-Iberian topics. The poor in law and literature, institutions of charity, and the role of monarchs were among the topics addressed.(11) The impact of this assembly is evident from the flood of [xi] scholarship that followed in its wake. Within Castile in the 1980s, Luis Martínez García published several studies of hospitals at Burgos, and other scholars wrote of Valladolid, Alicante, and Córdoba. In 1986, Carmen López Alonso published an Iberian version of Mollat's general study of poverty and assistance.(12) But the primary focus of the new scholarship has been in eastern Spain, a region associated with the medieval Crown of Aragon, and especially Catalonia.
Several Catalan scholars, participants in the Lisbon conference and colleagues in the Department of Medieval History at the University of Barcelona, launched in 1975 an investigation of charitable institutions and their assistance to the poor of medieval Catalonia. This resulted in the publication of a collection of studies, La pobreza y la asistencia a los pobres en la Cataluña medieval.(13) Barcelona was the primary focus of this effort, which produced profiles of several of the city's medieval hospitals, studies of cathedral and parish charities, and a preliminary analysis of charitable bequests. The decade that followed led to major studies of hospitals and poor relief in Urgell, Girona, and Lleida within Catalonia, as well as to those of Valencia and Majorca. Although the initial focus of most of these publications was institutional, by the late 1980s scholars became more topical by turning to such subjects as food, gender, children, and class.
Much of the work to date has been of a provisional nature; typically, hospitals have been addressed only as part of a larger analysis of Catalan urban life in the later Middle Ages or else have been treated as isolated phenomena.(14) Archival collections that survive, particularly for hospitals and other charities from the fourteenth and fifteenth centuries, have not yet been systematically explored and only now are beginning to attract the attention of researchers. Towns like Tortosa, Tarragona, and Vic have yet to find their historians. The neighboring Kingdom of Aragon has attracted even less attention, and in the realms of Valencia and Majorca only the eponymous capital cities have received any significant study. Yet, despite these lacunae, this is an opportune time for a broad synthesis. Enough has been accomplished to reveal the broad outlines of Catalan charity, but the published research is diffuse, often difficult to access, and little known outside of Catalonia itself. This is unfortunate because eastern Spain belonged to the same Mediterranean world as the Italian city-states, which have by contrast received considerable attention from the outside world. The result has been a degree of distortion that attributes to Italian institutions a primacy and uniqueness that may not always be warranted. Consequently, the addition of Catalonia and eastern Spain to the map of medieval [xii] charitable provision will broaden the context and thus give us a truer picture of its genesis, character, and evolution.
This study, then, is motivated by several purposes. First of all, it seeks to be synoptic by placing the disparate studies produced over the past quarter century and earlier into a broad and comparative structure that will enable us to understand the general contours of the development of organized charity and public policy toward the poor within Catalonia and in other regions of the Crown of Aragon. This will create an analytic framework for those who choose to pursue new research on Catalan themes and will permit Catalan material to be incorporated into an understanding of the European context of hospital development.
This work is, second, contextual, because it seeks to relate local developments to the mental and physical worlds shared by other European communities. Consequently, the institutions and practices of Catalonia will be compared with those of neighboring regions, like Castile and Languedoc, and also with the more distant societies of northern Europe and Italy. This broader perspective will assist in our understanding of the dynamic of hospital expansion and help us to understand the interplay of geography, ideology, and local institutions in the formation of a policy of assistance toward the poor.
Finally, questions of care inevitably raise issues of public policy because they involve the transfer of resources from one segment of the community to another. Just as contemporary society struggles with questions of welfare reform, managed health care, and assistance to the elderly, people of the Middle Ages had to make decisions about whom they wished to help, and for what reason(s). Their solutions were no easier than those of modern legislators. Natural catastrophes, demographics, societal resources, ideologies, and social prejudice each had a role to play. In formulating their responses, however, medieval authorities came to place great importance on the distinction between charity, that is, aid given gratuitously and indiscriminately to others, and welfare, which is assistance targeted toward certain groups for particular, desired ends. The emergence of a philosophy of welfare, moreover, implied the creation of criteria meant to distinguish the worthy and unworthy from among the great mass of the poor. Such concepts are only slowly returning to the contemporary debate over the reform of welfare. An understanding of the medieval context within which such ideas of charity, welfare, and the right to assistance were originally developed might bring a measure of perspective and sensitivity to the modern discussion.
[xiii] This study will begin with a general consideration of poverty, because it was the essential condition that established a need for care and which provided a moral and practical justification for the assistance to be rendered to any individual. Chapter 1 will thus examine the notions of voluntary and involuntary poverty and the emergence of a separate and identifiable class of paupers who were deserving of society's assistance. Essential to our understanding of these ideas are the distinctions that developed after 1100 between the deserving and undeserving poor and between public motives based on ideas of charity and those proceeding from an intention to preserve a particular social order (welfare).
Chapters 2 and 3 define the basic modes of assistance toward the poor as the provision of food and shelter and establish the basic caritative infrastructure that was developed in Catalonia and elsewhere within the Crown of Aragon from the eleventh to the fifteenth century. Care is taken to sort out the sometimes vexing problems of chronology in the foundation of the various almshouses and shelters. A second question is one of initiative and how the patterns of institutional foundation and patronage change between the twelfth and fourteenth centuries.
Chapter 4 looks inside the hospital -- at its governance, personnel and patients, and the physical configuration of its space -- in order to estimate the kind of care it was able to offer the needy. Also discussed is the transition from smaller institutions of the twelfth and thirteenth centuries to the larger general hospitals of the fifteenth century, a development in which Catalonia played a particularly important role.
Chapters 5 and 6 consider particular dimensions of care. Chapter 5 examines the emergence of shelters that specialized in the care of certain groups (for example, lepers and the insane), and then, with the emergence of medical practice, how many hospitals began to include medical assistance as part of the routine of care. Chapter 6 discusses how society regarded women and children who lived at its margins, the ways in which they were provided with assistance, and how this was meant to aid their reintegration into society.
Chapter 7 uses the question of public motivation to draw together the various themes of poor relief. After establishing the model for the development of Catalan hospitals in a comparative perspective, it turns to the issues of public policy and practice toward the poor. The discussion takes issue with Carmen López Alonso, Agustín Rubio Vela, and others who have argued that a fundamental shift took place in the fourteenth century from assistance predicated upon religious values to one based on secular ideals. The [xiv] reality, in fact, is more complex and nuanced and demonstrates that medieval assistance to the poor grew out of and depended on an interplay of motives and objectives. It combined elements of charity and welfare, the religious and the secular, and church and state.
The polyglot nature of the Crown of Aragon complicates decisions about how the names of persons and places should be rendered in the text. The town, for example, can be correctly identified in Castilian as Lérida or in Catalan as Lleida. The count-king who ruled between 1213 and 1276 can be Jaime I, Jaume I, or James I. There are no fixed conventions for deciding these matters, but the following rules govern decisions of orthography in this work. The names of persons and places, for the most part, are rendered in the native language. Because the setting for this study is Catalonia, Valencia, and Majorca, Catalan usage predominates. Consequently, monarchs are identified by their Catalan-Valencian names and numbers, not by their Aragonese designation. Thus, the Catalan count Pere II is also Pedro III of Aragon, Pere III is Pedro IV, Alfons II is Alfonso III, Alfons III is Alfonso IV, and so on. English equivalents are avoided as being even more ambiguous. Variants of some names are employed in bibliographical citations if the language of the work quoted is not Catalan. In some instances, however, when the English equivalent of a name is the better known and there is no ambiguity, it is employed. Thus, Catalonia is preferred to Catalunya, Florence to Firenze, and Ferdinand II to either Ferran or Fernando.
The same general system of money that was common in much of medieval Europe, based upon the Carolingian ratio of one pound (libra) to twenty sous (solidi), to two hundred forty pennies or diners (denarii), was used in the Crown of Aragon. The measure of value for each of these units varied from place to place; Barcelona, Valencia, Jaca and Majorca each had its own independent coinage. The current study, however, is not intended to be statistical, and thus minor variations in the exchange among these currencies have been ignored. In addition to pounds, sous and diners, other coins occasionally appear. The morabetin was worth between seven and nine sous; the maravedí about nine diners; the florin between eleven and seventeen sous; and the mazmodin around three and a half sous.
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This study of hospitals has taken me over a decade to complete. During this time, I received assistance from several sources. I would like to acknowledge my debt here and express to each individual my gratitude and [xv] appreciation. The University of Central Arkansas was generous in its allotment of time and resources for this study, and the interlibrary loan staff of Torreyson Library was indispensable in finding articles from obscure journals. The Centre d'Estudis Medievals de Catalunya in Barcelona and its director, Maria Teresa Ferrer i Mallol, must be thanked for bibliographic assistance and for the use of an excellent collection of Catalan periodicals and monographs. The American Academy of Research Historians of Medieval Spain, the Society for Spanish and Portuguese Historical Studies, the North American Catalan Association, the Mid-American Medieval Association, and the Texas Medieval Association each provided opportunities for me to present and test sections of this study. I am particularly grateful to those whose reading of the manuscript provided both keen insights and practical advice. These include Charles Julian Bishko, who, a quarter-century after the completion of my doctoral work at the University of Virginia, remains a valued and trusted mentor, Gregory J. W. Urwin, my colleague at the University of Central Arkansas, and Teofilo F. Ruiz of Brooklyn College and Princeton. I also must acknowledge a debt to Giles Constable for introducing me many years ago to the theme of charity in the Middle Ages, and to my colleagues in AARHMS who encouraged my studies over the years: Rev. Robert I. Burns, S.J., Joseph O'Callaghan, James F. Powers, Bernard Reilly, and Jill Webster. Larry J. Simon of Western Michigan University graciously provided the cover illustration, and Jill Webster and Pilar Salmeron, an archivist at Barcelona's Hospital de Santa Creu i Sant Pau, helped to establish its provenance. A graduate student at the University of Central Arkansas, Rebecca Prestwood, diligently helped me to sort out the notes. I am grateful for the financial support given to this project by the Program for Cultural Cooperation between Spain's Ministry of Education and Culture and United States Universities. At the University of Pennsylvania Press, Jerome E. Singerman, Humanities Editor, and Ruth M. Karras, editor of The Middle Ages Series, helped me through the review process, and Ellen Friskett and Mindy Brown through the various phases of production. All errors are, of course, mine. My children, James and Meg, tolerated my long hours on their computer. A special thanks is owed to my wife, Marian Masiuk Brodman, who through a patient reading of the several versions of the manuscript, always provided sound advice and needed encouragement.
Notes for the Preface
1. These early works include: for England, Rotha Mary Clay, The Mediaeval Hospitals of England (1909; reprint ed., New York, 1966); for Spain, Fermin Hernández Iglesias, La beneficencia en España , 2 vols. (Madrid, 1876), and Manuel de Bofarull y Sartario, Gremios y cofradias de la antigua Corona de Aragón, Colección de documentos inéditos del Archivo General de la Corona de Aragón, vols. 40-41 (Barcelona, 1876-1910); for France, Statuts d'Hôtels-Dieu et de Léproseries. Recueil de textes du XIIe au XIV e siècle, ed. Léon LeGrand (Paris, 1901).
2. See, for example, Jean Imbert, Les hôpitaux en droit canonique (Paris, 1947); and Brian Tierney, Medieval Poor Law: A Sketch of Canonical Theory and Its Application in England (Berkeley and Los Angeles, 1959).
3. See Paul Bonenfant, "Hôpitaux et bienfaisance publique dans les anciens Pays-Bas des origines à la fin du XVIIIe siècle," in Annales de la Société Belge d'Histoire des Hôpitaux , 3 (1965): 1-195.
4. Mollat's work was first published in France as Les pauvres au moyen âge (Paris, 1978), and in English translation as: The Poor in the Middle Ages: An essay in Social History, trans. Arthur Goldhammer (New Haven, Conn., 1986). See also Études sur l'histoire de la pauvreté, ed. Michel Mollat, 2 vols. (Paris, 1974). For Geremek, see Les marginaux parisiens aux XIVe et XVe siècles (Paris, 1976), published in English as The Margins of Society in Late Medieval Paris, trans. Jean Birrell (Cambridge, 1987); and Poverty: A History, trans. Agnieszka Kolakowska (Oxford, 1994).
5. Philippe Ariès, Centuries of Childhood: A Social History of Family Life, trans. Robert Baldick (New York, 1962); Shulamith Shahar, Childhood in the Middle Ages (London, 1990); and John Boswell, The Kindness of Strangers: The Abandonment of Children in Western Europe from Late Antiquity to the Renaissance (New York, 1988).
6. For example, see Leah Otis, Prostitution in Medieval Society: The History of an Urban Institution in Languedoc (Chicago, 1985); Françoise Bériac, Histoire des lépreux au Moyen Âge, une société d'exclus (Paris, 1988); Aging and the Aged in Medieval Europe: Selected Papers from the Annual Conference for Medieval Studies, University of Toronto, Held 25-26 February and 11-12 November 1983, ed. Michael M. Sheehan, C.S.B. (Toronto, n.d.); and Charles Verlinden, L'esclavage dans l'Europe médiévale, 2 vols. (Bruges, 1955-77).
7. See, for example, Violència i marginació en la societat medieval, Vol. 1 of Revista d'història medieval (Valencia, 1990); Danielle Jacquart and Claude Thomasset, Sexuality and Medicine in the Middle Ages, trans. Matthew Adamson (Princeton, N.J., 1988); Women and Work in Preindustrial Europe, ed. Barbara A. Hanawalt (Bloomington, Ind., 1986); and R. I. Moore, The Formation of a Persecuting Society: Power and Deviance in Western Europe, 950-1250 (Oxford, 1987).
8. Luis Batlle Prats, "Inventari dels Bens de l'Hospital de la Seu de Girona," Estudis Universaris Catalans 19 (1934): 58-80; César Martinell, "Els hospitals medievals catalans," Pratica medicina (1935): 109-32; Joseph Maria Roca, L'hospital migeval de Sant Macià (Barcelona, 1926).
9. Pedro Sanahuja, O.F.M., Historia de la beneficencia en Lérida (Lérida, 1944); Antonio Rumeu de Armas, Historia de la previsión social en España: Cofradías, gremios, hermandades, montepíos (Madrid, 1944).
10. J. Tolivar Faes, Hospitales de leprosos en Asturias durante las edades media y moderna (Oviedo, 1966); Robert I. Burns, S.J., "Los hospitales del reino de Valencia en el siglo XIII," Anuario de estudios medievales 2 (1965): 135-54.
11. The proceedings are published as A pobreza e a assistência aos pobres na península ibérica durante a idade média. Actas das 1.as jornadas luso-espanholas de história medieval. Lisboa, 25-30 de Setembro de 1972. 2 vols. (Lisbon, 1973) (hereafter cited as A pobreza).
12. See Luis Martínez García, La asistencia a los pobres en Burgos en la baja edad media (Burgos, 1981) and El Hospital del Rey de Burgos: un señorío medieval en la expansion y en la crisis (siglos XIII y XIV) (Burgos, 1986). See also Adeline Rucquoi, "Hospitalisation et charité à Valladolid," in Les sociétés urbaines en France méridionale et en Péninsule Ibérique au Moyen Âge. Actes du Colloque de Pau, 21-23 Septembre 1988 (Paris, 1991), 393-408; Rafael Martínez San Pedro, Historia de los hospitales en Alicante (Alicante, 1974); Antonio García del Moral, El Hospital Mayor de San Sebastian de Córdoba: Cinco Siglos de Asistencia Médico-sanitaria Institucional (1363-1816) (Córdoba, 1984); Carmen López Alonso, La pobreza en la España medieval (Madrid, 1986).
13. La pobreza y la asistencia a los pobres en la Cataluña medieval , ed. Manuel Riu, 2 vols. (Barcelona, 1980-82) (hereafter cited as La pobreza). For a discussion of the project, see 1: 7-16.
14. See, for example, Carme Batlle i Gallart, La Seu d'Urgell medieval: La ciutat i els seus habitants (Barcelona, 1985) and Christian Guilleré, Girona al segle XIV, trans. Núria Mañé, 2 vols. (Barcelona, 1993-94).