The Knights of Saint John and The Hospitals of The Latin West

The Knights of Saint John and the Hospitals of the Latin West
Author(s): Timothy S. Miller

Source: Speculum , Oct., 1978, Vol. 53, No. 4 (Oct., 1978), pp. 709-733
Published by: The University of Chicago Press on behalf of the Medieval Academy of
America
Stable URL: https://www.jstor.org/stable/2849782
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THE KNIGHTS OF SAINT JOHN
AND THE HOSPITALS OF THE LATIN WEST
BY TIMOTHY S. MILLER
THE Knights of Saint John, founded after the conquest of Jerusalem (1099),
were renowned in Europe as Christian soldiers. They were, however, equally
famous for their charities, especially for their great Hospital in Jerusalem.
As modern scholarship has demonstrated, the Knights' Hospital influenced
many new institutions in the cities of the high Middle Ages and encouraged
the development of organized centers to treat the ill.'
Scholars have maintained that the Knights of Saint John, known also as
the Hospitallers, were the first Latin Christians to organize a hospital for the
sick, and they assert that the roots of the new institution are to be found
either in Islamic society or in Byzantium.2 In this study I propose to examine
the Hospitallers and their infirmary in more detail, concentrating on two
important questions. First, to what extent was the Knights' Hospital in
Jerusalem indeed something new to Latin Christians, and to what extent was
it a natural outgrowth of native European movements? Second, what impact
did Byzantium and the Islamic world have on the Hospitallers' house of the
sick? While exploring these questions I shall also emphasize the role of
demographic pressures and disease in stimulating hospital development.3
1. THE HOSPITALS OF THE WEST
The Knights' Hospital in Jerusalem was not entirely without precedent in

Western Europe. From the sixth through the ninth century there were a
number of institutions in the West that treated the sick, although the ter-
minology used in the sources does not always distinguish clearly between
hospitals and other houses of charity.
I L. Le Grand, Statuts d'Hotels-Dieu et de Leproseries (Paris, 1901), and "Les Maisons-Dieu, leur
statuts au XIIIe siecle," Revue des questions historiques 60 (1896), 95-134, emphasize the impor-
tance of the Knights of Saint John in the development of hospitals in France. G. Schreiber,
"Byzantinisches und abendlandisches Hospital," Gemeinschaften des Mittelalters (Regensberg:
Munster, 1948), p. 22, also attributes an important role in hospital development in the West to
the Knights. J. Riley-Smith, The Knights of St. John in Jerusalem and Cyprus [1050-1310] (London,
1967), the most recent political history of the order, mentions the influence of the Hospital in
Jerusalem on medical care only in passing.
2 Riley-Smith, The Knights, p. 335, proposes both possibilities, though the Arab world is seen
as the more likely inspiration. See also E. Wickerheimer, "Organisation et legislation sanitaires
au royaume franc de Jerusalem (1099-1291)," Archives internationales d'Histoire des Sciences 4
(1951), 699.
3 William McNeill, Plagues and Peoples (New York, 1976), pp. 59-63, deals in general with the
phenomenon of urbanization and diseases. C. Probst, "Das Hospitalwesen im hohen und spaten
Mittelalter und die geistliche und gesellschaftliche Stellung des Kranken," Sudhoffs Archiv:
Zeitschrtft fur Wissenschaftsgeschichte 50 (1966), 246, emphasizes the importance of population
increase and population concentration during the twelfth century in the development of
hospitals.
709

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710 The Knights of Saint John
Before 800 Latin documents used the Greek word xenodochium to describe
houses of public charity. Thereafter, the Latin word hospital was common,
though writers still frequently employed the Greek term.4 Both xenodochium
and hospital refer to travelers' inns.5 Since wayfarers often fell ill on thei
journeys both because of the hardships of medieval travel and because of the
new diseases encountered from place to place, inns had to provide care for
the ill. Some of these inns, as we shall see, evolved into houses only for the
sick, while others remained simple hospices with some casual care for travel-
ers stricken by disease, but the terms hospital and xenodochium were used for
both institutions.6 Though the Greek East developed a distinctive word,
nosokomeion, for hospitals dedicated to the sick, the Latin West continued to
use the more general terms. Because of this confusion in terminology one
must be careful to determine when medieval sources are describing a simple
hospice and when they are referring to what we shall call a true hospital, i.e.,
an institution which focuses attention primarily on curing the diseased by
providing a strict regimen, medicine, and physicians.
The Latin documents from the Merovingian and Carolingian periods
frequently mention hospices. These were often built next to monasteries or
in the surviving Roman towns of Italy and southern Gaul. Upon closer
examination, however, very few of these xenodochia seem to have operated as
true hospitals. Though the hospice founded by King Childebert in Laon
during the sixth century was designed to serve pilgrims and to provide care
(cura) for the sick, there is no reference to a disciplined regimen for the
patients, to hospital wards, or to the activities of a physician.7 Adalhard of
Corbie established a similar xenodochium in the eighth century.8 His hospice,
like most of those in Gaul, resembled the xenodochium in ninth-century Or-
leans, which Theodulf, the Carolingian bishop and poet, described in a short
poem, "Here let the tired receive support, the languishing medicine, and the
sorrowful joy."9
Two hospices in Merovingian Gaul, however, seem surely to have
functioned as true hospitals, one established by Bishop Praeiectus of Au-
vergne in Clermont during the seventh century and the other by an uniden-
tified bishop about the same time in Poitou. Both were small institutions,
housing twenty patients in Clermont and twelve in Poitou.10 In connection
4G. E. Gask and J. Todd, "The Origins of Hospitals" in Science, Medicine, and History: E
the Evolution of Scientific Thought and Medical Practice Written in Honour of Charles Singer
Underwood (London, 1953), p. 130, and n. 24.
5 Concerning Greek terms see P. Koukoules, Byzantinon Bios kai Politismos (Athens, 1
2:141; concerning the Latin term hospital see Du Cange, Glossarium Mediae et Infimae Latin
s.v.
6 L. C. MacKinney, Early Medieval Medicine with Special Reference to France and Chartres (Balti-
more, 1937), pp. 176-77.
7MGH Conc 1:105.
8 MGH SS 2:530.
9 MGH Poet 1:554. See also the analysis of the various kinds of early medieval hospitals in
MacKinney, Medieval Medicine, pp. 176-77.
10 MGH SSrerMerov 5:235; Diplonzata, Chartae, Epistolae, leges, aliaque instrumenta ad res
Gallo-Francicas spectantia, ed. J. M. Pardessus (Paris, 1849), 2:239.

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The Knights of Saint John 711
with these two hospitals one ought to recall Henri Pirenne's thesis regarding
Merovingian Gaul. Throughout this period Syrians, Greeks, and Jews from
the Greek East inhabited many towns of Gaul both in permanent settlements
and in temporary merchant quarters." Describing the foundation of the
Clermont hospital, the Passio Praeiecti episcopi states that Bishop Praeiectus
organized the xenodochium "following the customs of the orientals."'2 The
Latin text here seems to mean that the bishop was observing Eastern practice
in using his own property rather than church funds to finance the hospice.
The text, however, could also refer to the specialized medical nature of the
institution, a characteristic not common in Frankish hospices. Whatever the
meaning, the passage indicates that Praeiectus was in contact with Eastern
traditions, most likely through the oriental merchants, men who were famil-
iar with the many true hospitals in the Eastern Empire and who could have
advised Praeiectus in ordering his establishment.
Two other xenodochia of the West seem to have been true hospitals, one in
Visigothic Spain, founded by Bishop Masona of Merida (573-606), and the
other operating in Rome during the seventh and eighth centuries.13 Both of
these cities were in close contact with the Greek East. At Merida many of the
bishops were Greeks and trade with Byzantium was brisk; at Rome men
from the eastern Mediterranean were often elected to the papacy, and Greek
monasteries were numerous.'4
Outside of these four examples the xenodochia of the West do not appear
to have been true hospitals. Certainly the hospices attached to Benedictine
monasteries were not for the treatment of the ill; they were designed only to
house travelers. Although St. Benedict's Rule einphasized that Christ had
commanded his followers to care for all the sick, in practice it established an
infirmary limited to sick monks.15 Thus, the plans for the great ninth-
century monastery of St. Gall included a large, well-equipped hospital for
the monks but provided as a public xenodochium a mere guest house, separate
from the cloister.16
The true hospitals of the early Middle Ages all seem to be associated with
the East, with cities where religious or commercial contact with Byzantium
was alive. As the West moved away from Byzantium under the Carolingians,
the urban xenodochia declined. Moreover, as the Roman legal concepts of
H. Pirenne, Mohammed and Charlemagne (New York, 1939), pp. 79-96.

12 MGH SSrerMerov 5:235: "(Praeiectus) xenodochium quoque in propriis rebus, orien-
talium more secutus, in loco qui Columbarius dicitur, fabricare curavit." See also MacKinney,
Medieval Medicine, pp. 176-77.
13 Concerning Merida, Paul the Deacon, De vita patrum emeritensium, MPL 80:139. See also
Luis Vazquez de Parga, Las Peregrinaciones a Santiago de Compostela (Madrid, 1948), 1:449-51.
Concerning Rome, Liber diurnus Romanorum pontificum, ed. Hans Foerster (Bern, 1958), p. 124;
for the date of the Liber diurnus, see pp. 21-36.
14 Fr. Dvornik, Les Legendes de Constantine et de Methode vues de Byzance (Prague, 1933), pp.
285-91, discusses in detail the extent of Greek monastic settlement in Rome. Paul the Deacon,
De vita patrum emeritensium, MPL 80:128-30, demonstrates Eastern contacts of the bishops of
Merida.
15Benedicti Regula, ed. R. Hanslik (Vienna, 1960), chap. 36, p. 95.
16 MacKinney, Medieval Medicine, p. 177.

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corporate rights and legal personhood fell victim to the German idea of
Eigenkirchen, hospices established by private owners often reverted to secular
use.'7 The xenodochia which managed to survive usually became the property
of monastic houses which had no interest in maintaining elaborate hospices.
Most abbeys considered the hospices of secondary importance and aban-
doned them whenever they became a financial burden.18 In twelfth-century
Germany records abound which reflect the dilapidated state of the old
hospice foundations of Carolingian and Ottonian times.19
Let us now turn from the early medieval West to Latin Christendom after
the mid-point of the eleventh century, i.e., to Europe after the beginning of
the urban revolution. We will consider, on the one hand, the demographic
trends developing in the West during this period which established the need
for true hospitals, and, on the other, the failure of native Western institu-
tions alone to meet this need, a failure which led the West to the Knights of
Saint John and their new hospitals.
In the eleventh century the population of Europe began to increase
rapidly. In England, where the records are best, experts estimate that the
number of inhabitants tripled between 1086 and 1346.20 Across the conti-
nent the population no doubt increased at a sirmilar rate, expanding arable
lands and swelling the ranks of the urban populace.21 As a result of growing
population and increased trade, European towns prospered, attracting ex-
cess agricultural workers inside their walls by offering the chance for new,
more profitable occupations.22 Since all newcomers could not find jobs,
suitable food, and adequate housing, many of them, having been lured to
the urban centers by the promise of wealth, languished in poverty, subject to
the many diseases rife in urban environments. Cities were far more open to
endemic diseases than were agricultural communities; until the nineteenth
century they were unable to replenish their own populations. Increased
person-to-person contact, sanitary problems caused by refuse and sewage,
contamination of the water supply, and an inferior diet compared to village
fare, brought illness to many town dwellers, and especially to the susceptible
immigrants whose relative isolation as peasants on the land had not provided
them with exposure to the variety of diseases endemic to towns.23 Thus
urban centers not only gainfully employed some of the excess population of
17 W. Schonfeld, "Die Xenodochien in Italien und Frankreich im fruhen Mittelalter,"

Zeitschrift der Savigny-Stiftungfiir Rechtsgeschichte 43, Kan. Abt. 12 (1922), 35-38.
18 S. Reicke, Das deutsche Spital und sein Recht im Mittelalter, 2 vols. (Stuttgart, 1932), 1:49.
19 Concerning Bonn see Reicke, Spital, 1:49; concerning Constance see the Vita Sancti Coun-
radi altera, MGH SS 4:444.
20 J. C. Russell, British Medieval Population (Albuquerque, New Mexico, 1948), est
the English population more than tripled between 1086 and 1346.
21 L. Genicot, "On the Evidence of Growth of Population in the West from the Eleventh to the
Thirteenth Century," in Change in Medieval Society, ed. S. L. Thrupp (New York, 1964), pp.
14-18.
22 M. Postan, "The Trade of Medieval Europe: The North," in The Cambridge Economic History
of Europe (Cambridge, 1966), 2:160-67.
23 McNeill, Plagues and Peoples, p. 67.

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the high Middle Ages, but they also acted as gruesome drains which debili-
tated or eliminated the biologically uninitiated.24 No sincere Christian could
have remained unmoved by the widespread disease in the bustling towns of
twelfth- and thirteenth-century Europe.
Robert of Arbrissel, one of the great religious activists of the high Middle
Ages and founder of the famous monastery at Fontevrault, was renowned
for his care of the poor and the sick.25 Bernard of Clairvaux warned the
wealthy bishops of Latin Europe to bear in mind the misery of the poor
crowding their episcopal towns.26 Finally, Radulf Ardens, an intellectual of the
early twelfth century, extolled the virtues of the poor and sick, comparing
them to the apostles, and warned the rich of their punishment if they failed to
relieve the sufferings of the unfortunate. Radulf portrayed the poor man of
his time as Lazarus, the character in Christ's parable who suffered both
poverty and disease. That Lazarus was linked with the poor throughout
Europe in the twelfth century indicates that disease was rampant among the
landless men streaming to the growing cities.27
The new conditions in the towns of Europe demanded many kinds of
public philanthropic services: simple hospices to shelter the wandering poor,
alms for the hungry inside the cities' walls, and some sort of medical care for
the ill. Throughout twelfth-century Western Europe the church was devot-
ing more attention to the physical problems of the poor, but a survey of the
major religious movements of the West reveals that they did not sponsor
true hospitals. Some ascetic movements avoided philanthropy almost com-
pletely, while other more worldly religious communities turned their atten-
tion to serious problems of the poor but fell short of developing true
hospitals on the scale needed to treat the sick of the new towns. Before the
Knights of Saint John organized their Hospital in Jerusalem, one can detect
surprisingly little development of public infirmaries in Latin Europe.
The old monastic houses of the West did not respond with any concrete
24 E. Patzelt, "Pauvrete et Maladies," in Poverta et Ricchezza nella Spiritualita dei Secoli XI e XII, 8
(Todi, 1969), 165-87, points out that references to the sick increase greatly in the sources
describing conditions of the eleventh and twelfth centuries, but she stresses the role of
epidemics in causing this increase. The high Middle Ages, however, was a period of great
population expansion which argues against widespread epidemic conditions during those years.
J. M. Bienvenu, "Pauvrete, miseres et charite en Anjou aux XIe et XIIe siecles," Le Moyen Age 82
(1966), 389-424, mentions natural disasters and resultant crop failures as an explanation for the
misery among some of the poor. A. M. Lazzarino Del Grosso, Societa e Potere nella Germania del
XII Secolo: Gerhoch di Reichersberg (Florence, 1974), pp. 166-67, n. 197, notices the frequent
references to the pauperes et infirmi in Gerhoch of Reichersberg's treatises and suggests that
many of these "infirm" had been disabled by war or suffered mutilation as a punishment. These
scholars fail to indicate that the health problems caused by urbanization and closer human
contact were significant. C. Probst, "Das Hospitalwesen," p. 246, does emphasize urbanization as
a cause of deteriorating health conditions among the poor of Western Europe.
25 Baudri de Bourgueil, Vita Roberti de Arbrissello, MPL 162:1055.
26 Bernard of Clairvaux, Tractatus de moribus et officio episcoporum, MPL 182:81
27 Homiliae Radulfi Ardentis, MPL 155:1963. Concerning Lazarus see E. Patzelt, "P
Maladies," p. 176, who melitions that beggars were called in Italy lazzaroni. See also Gerhoch of
Reichersberg, MPL 193:1070, who compares the poor of his time with Lazarus.

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program to relieve the suffering caused by rapid urbanization. Though the

great abbey at Cluny, one of the centers of Benedictine monasticism during
the eleventh and twelfth century, maintained two guest houses, neither of
these provided any special treatment for the ill.28 In the many Cluniac
monasteries and priories along the pilgrim routes to Corhpostela, the monks
did not offer any more to the traveler, sick or healthy, than they did at the
mother house.29 Peter the Venerable, abbot of Cluny (1 122-1156), omitted
any statement about care for the sick in his long exhortation on receiving
guests.30
By the late eleventh century Western monasticism, an institution increas-
ingly under attack from many quarters of society, reached a point of crisis.
Modern scholars have stressed that the holding of property and the osten-
tatious display of wealth by the old Benedictine abbeys were the grounds of
discontent voiced against the monks.3' The Cistercian reform was one solu-
tion to the problem of wealth, a movement creating abbeys humble in
appearance which collected no rents and which removed themselves still
farther from the entanglements of the world. As a consequence of their
contemplative nature, one would not expect to find the Cistercians promot-
ing true hospitals. The order's statutes of 1134 provided care only for sick
monks.32 Moreover, in 1157 the general chapter specifically forbade the
order's doctors to practice outside the monasteries or to treat laymen.33 This
contemplative attitude, reinforced by the remote locations of Cistercian
abbeys, prevented the order from developing public infirmaries.
Besides the Cistercian movement, there were, however, other attempts to
steer the religious life in new directions. Although Citeaux criticized the
older Benedictine abbeys for their worldliness, some communities of Augus-
tinian canons accused them of avoiding the world, of failing to heed Christ's
command to serve others. Because these communities were located in the
episcopal towns especially subject to the pressures of rapid population in-
crease, they first recognized the need for a more philanthropic Christianity.
As testimony to this new spirit stands a constitution for canons regular of
unknown provenance but dating surely from the late eleventh century. The
281 J. Evans, Monastic Life at Cluny [910-1157] (London, 1930), pp. 92-95. See also N.
Cluny under St. Hugh (Notre Dame, Indiana, 1968), pp. 65-66 and 88, who observes that donors
to the monastery often required that they be admitted as monks to the monastery whenever
they became ill or when they reached old age. Such clauses reveal that society needed a place for
its ill and infirm, but the lack of such facilities for laymen forced wealthier sufferers to become
monks in order to receive adequate treatment.
29 Vizquez de Parga, Las Peregrinaciones, 1:450-51.
30 The Letters of Peter the Venerable, ed. G. Constable (Cambridge, Mass., 1967), Letter 28, pp.
74-75.
31 Raoul Manselli, "Evangelismo e Povertt," in Poverta et Ricchezza, p. 25; J. Leclercq, "
Monastic Crisis," in Cluniac Monasticism in the Central Middle Ages (Hamden, Conn., 1971), pp.
219-28.
32 Statuta capitulorum generalium ordinis cisterciensis, ed. J.-M. Canivez, 8 vols. (Louvain, 1933),
1:30.
33 Ibid., p. 65.

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canons attacked the monks for their self-centered asceticism and extolled
their own community's activity in ministering to the spiritual and temporal
needs of men.34 Though these canons did not establish a true hospital, they
were aware that Christ expected his disciples to do more than seek a distant
refuge for the practice of personal asceticism.35
Among the new communities of canons in twelfth-century Europe, the
most organized movement was that of St. Norbert. He founded his first
house at Premontre outside Laon, prescribing an active, apostolic life for his
followers. These Premonstratensians, however, soon adopted the ascetic
spirit of the Cistercians and never became effective against the social and
religious problems of the towns. Nevertheless, the early years of St. Nor-
bert's order reveal a tension between the contemplative life and the active
apostolic vocation.36 Possibly as a consequence of their initial active orienta-
tion, the Premonstratensians included in their statutes of 1131-34 provisions
for a hostel reserved especially for the ill from outside the monastery.37
Though the Premonstratensians' move toward Cistercian ideals halted any
further development of this hospice, their concern for public medical care
indicates that reforming religious men in the West were beginning to ap-
preciate the need for true hospitals.
The Augustinian rule, which regulated the lives of clerical canons such as
the Premonstratensians, provided the framework for still another religious
movement of the twelfth century, the communities of lay brethren. These
seem to have developed first in Germany at the reforming abbey of Hirsau.
Under Abbot Wilhelm (1069-1091), some of the lay brothers or conversi of
Hirsau were organized as an independent community subordinate to the
abbey and were placed in charge of its hospice.38 Subsequently, such lay
brotherhoods spread across Germany and were in the words of the Chronicon
of Bernold, "in no way inferior to the monks."39 In 1121 the archbishop of
34 The constitutions of this community of Augustinian canons is published by J. Leclercq,

"Influence de Gregoire VII dans le reforme canoniale," Studi Gregoriani 6 (Rome, 1959-61),
199-223. For the sections criticizing monks and extolling the life of the canons, see chapter 51,
pp. 218-19. See also J. Leclercq, "The Monastic Crisis," pp. 223-24. Concerning the Augustin-
ian canons in general see K. Bosl, "Die Entwicklung des Augsburger Burgertums," Bayerische
Akademie der Wissenschaften, Philologisch-Historische Klasse, Sitzungsberichte 1969 (Munich, 1970),
22-23, who links the movement of Augustinian canons which began in the cities of Italy with
the new social-economic conditions of the late eleventh century. See also George Duby, "Les
Chanoines reguliers et la vie economique des XIe et XIIe siecles," in La Vita Commune del Clero
nei secoli XI e XII, 1 (Milan, 1962), 72-81. The new canonries were important in ministering to
the larger urban population and represented a break with the older cathedral chapters which
had inherited their structures from the rural aristocratic society of the Carolingian period.
35 Leclercq, "Gregoire VII," p. 218: "Ad discipulos autem quos dominus missit in messam
suam, quorum vicem canonici in eclesia tenent....
36 H. M. Colvin, The White Canons of England (Oxford, 1951), pp. 6-8.
37 Les Statuts de Premontre, ed. P1. F. Lefevre (Louvain, 1946), p. 60. In the thirteenth century
the canons also maintained a number of hospitals in England. See Colvin, White Canons, p. 143.
38 Reicke, Spital, 2:50.
39 MGH SS 5:452: "[laicil qui, etsi habitu nec clerici nec monachi videntur, nequaquam tamen
eis dispares in meritis fuisse creduntur."

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Salzburg assembled a group of lay brothers to whom he entrusted a hospice

he himself had renovated.40 Bishops and laymen followed this example,
founding throughout Germany new xenodochia completely free of monastic
control. Many of these hospices were old foundations which, having been
neglected by distant abbeys or worldly cathedral chapters, had decayed
during the Carolingian and Ottonian years.41 Now the lay brothers revived
them by elevating them to the central position of their religious lives.
France witnessed a parallel development. At Fontevrault Robert of Arbris-
sel established at the beginning of the twelfth century several hostels for the
poor and sick in which both male and female conversi served as part of the
religious life.42 In 1162 an independent house of lay brethren was minister-
ing to the poor in the town of Aubrac. The statutes which survive from that
community suggest that it had been established some years prior to 1i162.43
In England, too, hospices were entrusted to Augustinian lay brethren.
Archbishop Lanfranc erected a hostel just outside Canterbury in the late
eleventh century and installed lay canons as attendants.44 A foreigner named
Rahere founded the famous hospice of St. Bartholomew, Smithfield, near
London in 1123, when he gathered an Augustinian brotherhood and began
work on the dormitory building.45
Mindful again of the difficulty in medieval Latin terminology, one must
consider whether these new hospices were true hospitals.46 Neither Arch-
bishop Conrad at Salzburg (1123) nor the bishops of Hildesheim (1161)
and of Ulm (1183) mention the sick.47 At Hildesheim the charter states that
the increase in destitute persons in recent years had rendered the old
hospice obsolete, an observation indicating only that population pressures in
the countryside were pushing excess peasants into the cities and swelling the
number of paupers.48 Though these population pressures set the stage for
hospital development, there is no indication yet in these sources that the
renovated xenodochia in Germany were functioning as true hospitals. In
England the situation was similar. Most of the hospices reorganized under
Augustinian brothers were to shelter and feed the poor flowing into the
cities.49 Archbishop Lanfranc's hospice at Canterbury, however, was an ex-
ception, for it seems to have served primarily the diseased among the poor.50
40 Reicke, Spital, 1:56.

41 Ibid., p. 49.
42 Vita Roberti Arbrissello, MPL 162:1054-55.
43 Le Grand, Statuts, p. 16.
44 Monasticon Anglicanum, ed. William Dugdale, 6 vols. (London, 1830), 6, 2:615 [= Eadfmeri
Historia Novorum in Anglia, ed. M. Rule (London, 1884), p. 15].
45 J. C. Dickinson, The Origins of the Austin Canons and Their Introduction into England (London,
1950), pp. 121-22.
46 See above, p. 710.
47 For Salzburg see Reicke, Spital, 1:56; for Hildesheim, pp. 48-49; for Ulm, p. 58.
48 Ibid., p. 48: "quod . . . domus hospitalis aptis pauperum receptaculis omnino careret ac
debita ipsis situs et angustia loci denegaret."
49 The hospice reorganized after the Norman conquest in York was constructed "pauperibus
ad ipsam civitatem confluentibus." See Monasticon Anglicanum, 6, 2:608.
50 Ibid., p. 615.

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Many among the indigent fell ill because of unhealthy conditions in the
cities, as we observed earlier. Lanfranc's institution grew naturally out of
health problems which inflicted the paupers of his diocese. Granted the
widespread disease among Europe's poor in the twelfth century, it is surpris-
ing that the archbishop had no imitators. Even Fontevrault, which surely
treated the sick with special attention, did not operate a true hospital.51 The
statutes governing the brothers of the hospice in Aubrac do not once men-
tion infirmii but talk only of the poor guests of the house.52 During the
twelfth century, however, one important house of Augustinian canons began
to focus its charitable activities on the treatment of the sick, the xenodochium
or hospital in Jerusalem maintained by the Knights oi Saint John.
The Hospitallers were one of the new houses of lay brethren which
formed in Latin Christendom in the latter part of the eleventh century.
Gerard, the first superior of the brothers - they did not call themselves
knights until the end of the twelfth century - was a layman supervising a
xenodochium attached to a traditional Benedictine monastery, St. Mary's of
the Latins. The abbot of St. Mary's entrusted the large xenodochium of his
monastery to a lay brotherhood similar to the communities which were
taking over the care of hospices at Hirsau and throughout Germany.53 The
first statutes of the Jerusalem brotherhood, the Rule of Raymond du Puy,
were influenced by the regula of other Augustinian houses; by 1184-85 the
papacy classified the Hospitallers of Jerusalem among the Augustinian
communities.54 Thus, the Knights and their hospice were part of a
European-wide movement of lay brothers who were dedicated to maintain-
ing houses of public charity.
The hospice of the Hospitallers, however, was distinct from the other
xenodochia in the lands of Latin Europe in that it very early exhibited the
attributes of a true hospital. Though we have no one document which
describes in every detail how the twelfth-century Hospital of the Knights
functioned or what was its daily routine, still it is possible to collate passages
from the statutes of the order and from papal letters and pilgrim accounts to
obtain a fairly clear idea of what kind of house the Hospitallers maintained
in Jerusalem.
Gerard's brotherhood became prominent in the days following the
crusaders' conquest of Jerusalem (15 July 1099). The leader of the Christian
army, Godfrey of Bouillon, granted many estates to Gerard and his follow-
ers.55 Under the first king of Jerusalem, Baldwin (1 100-1 1 18), nobles of the
51 Vita Roberti Arbrissello, MPL 162:1055.

52 Le Grand, Statuts, pp. 16-21.
53 William of Tyre, Historia rerum in partibus transrnarinis gestarum, in Recueil des histo
croisades. Historiens occidentaux (Paris, 1884), 1:825-26, reflects a development very similar to the
hospices of Hirsau.
54 See Riley-Smith, Knights, pp. 46-48, for a discussion of the Rule of Raymond du Puy;
Letter of Pope Lucius III, Cartulaire general d'ordre des Hospitaliers de St.-Jean de Jrusalem
(1100-1310), ed. J. Delaville le Roulx, 4 vols. (Paris, 1894), l:cart. 690, p. 458 (cited hereafter
only by cartulary number and page).
55 Cart. 1, p. 1.

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kingdom gave large tracts of land to the Hospitallers; in Europe, too,

magnates like the count of Barcelona, Berengar III, endowed the order with
lands for support of the poor.56 In 1113 Pope Paschal granted a charter to
Gerard's congregation and offically recognized it as a corporation which was
to use its wealth to maintain pilgrims and paupers in the Hospital
(xenodochium). By 1131 the fame of the Hospital moved King Alfonso of
Aragon to bequeath it one-third of his realm.58 All these early documents
acknowledge an institution, usually called the Hospital, maintained by
Gerard and the members of his order for the aid of pilgrims and the poor.
These documents do not indicate that Gerard supervised a true hospital;
neither the papal documents nor the testaments of nobles describe care for
the sick. The first substantial evidence of an infirmary is found in the Rule,
issued under Raymond du Puy (1120-1160), Gerard's successor. This
document has not been precisely dated, but it was composed before 1153
and, by affirming customs already in use, reflects conditions as they had
been for some years.59 Most of the chapters in the Rule deal with the
disciplined life of the brothers; only a few concern charitable practices and
treatment of the sick. Stating clearly that the order's wealth is for the poor,
chapter six of the Rule taxes the far-flung estates one-third of their revenue
for the Hospital.60 Chapters one and two mention the brothers' duty to act as
servants of the poor, but only chapter sixteen describes services provided
exclusively for the sick.61 According to this chapter the Hospitallers must
greet the suffering man, have him confess his sins, and administer the
Eucharist. After ministering to his spiritual needs, the brothers ought to
carry him to bed and serve him as if he were their lord. The same chapter
requires on Sundays a procession with aspersion into the house of the sick
and also the reading of the Gospel there. Although the Rule confirms that
the Hospitallers' charities in Jerusalem included all forms of almsgiving, it
provides evidence that the house of the sick was a prior concern. After its
expenses had been met, the rest of the resources, collected from the order's
estates, were distributed as alms.62 Moreover, among the cartularies of the
order an official styled the custos Hospitalis infirmorum appears in 1155;
Pontius is the first to hold this office, followed in 1163 by a certain Piota.63
Such an office indicates an organized institution whose main duty was minis-
tering to the infirm.
The most detailed information on the Hospital during the twelfth century
is found in the Statutes of Roger des Moulins, master of the order from
56Cart. 20, p. 21; cart. 24, p. 25; cart. 33, p. 31.

57 Cart. 30, p. 29.
58 Cart. 95, p. 85. This charter is authentic, though it was later annulled. See Riley-Smith,
Knights, p. 44.
59 Riley-Smith, Knights, pp. 50-51.
60 Rule of Raymond du Puy (cited hereafter as Rule), chap. 6: cart. 70, p. 64.
61 Rule, chap. 2 and 3: cart. 70, p. 63; chap. 16: cart. 70, p. 67.
62 Rule, chap. 6: cart. 70, p. 64.
63 Cart. 237, p. 179; cart. 312, pp. 225-26.

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1177 to 1187. The general Chapter of 1182 probably approved these stat-
utes as a response to growing criticism of the order's military involvement, or
perhaps it employed them to correct abuses in the Hospital's administration
due to increased military expenses.64 As a result, the Statutes of 1182, as
opposed to the Rule of Raymond du Puy, deal almost exclusively with the
physical operation of the Hospital. Chapter four requires that the brothers
maintain four wise doctors to diagnose diseases and to prescribe medicine;
the following chapters regulate diet, sleeping arrangements, and clothing for
the patients. The brethren must also guard the sick day and night and
provide them with servants.65 A papal letter of 1184 mentions not only four
doctors but also four surgeons in the Hospital.66
In their brief descriptions the pilgrims of the late twelfth century have
added more information on the organization of the Hospital. John of
Wurzburg noted several rooms where a multitude of sick, both men and
women, were treated.67 Theodoricus, who visited Jerusalem in 1187, was
impressed by the size of the institution and the number of patients.68 He
estimated that more than 1,000 patients were there, while John of Wurzburg
put the number at 2,000. Though these figures are no doubt exaggerated,
they do reflect the Hospital's impressive size. Both pilgrims observed sepa-
rate rooms which probably served as wards.
The statutes of the order and the pilgrims' accounts leave no doubt that
the Hospital of St. John in Jerusalem provided true care for the ill, not mere
sustenance. It offered the services of doctors and surgeons, a specific diet,
and the medicines available to medieval physicians. Thus, the available
sources clearly suggest that by the second half of the twelfth century the
Knights' great house in Jerusalem had indeed become a true hospital.
Besides the main hospital in Jerusalem the Knights also maintained hos-
pices in the cities of the West. In a letter of 1113 Pope Paschal referred to
xenodochia and ptochia of the Knights in numerous towns of Italy and south-
ern France, but he gave no indication that regular care for the sick was
provided in these institutions.69 King Roger I of Sicily, however, specified in
1137 that the Knights treated the infirm in the houses of his kingdom.70
Moreover, in the Statutes of Roger des Moulins (1182), one paragraph refers
specifically to domus infirmorum in the priories outside Jerusalem and to the
commanders' responsibilities to serve the sick in these houses.7' In the thir-
teenth century the order's convent in Bremen had organized its resources to
64 Cart. 527, p. 360. Pope Alexander III sent this letter (1178-1180) to Master Roger des
Moulins, warning him not to neglect charities because of military involvement.
65 Statutes of Roger des Moulins (cited hereafter as Statutes): cart. 627, pp. 426-27.
66 Cart. 690, p. 458.
67 John of Wiirzburg, "Descriptio Terrae Sanctae," ed. T. Tobler in Descriptiones Terrae Sanctae
ex saeculo VIII, IX, XII, et XV (Leipzig, 1874), p. 159.
68 Theoderici Libellus de Locis Sanctis, ed. T. Tobler (St. Gall, 1865), p. 33.
69 Cart. 30, pp. 29-30.
70 Cart. 124, pp. 103-4.
71 Statutes: cart. 627, p. 426.

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aid the infirm.72 These examples indicate that the larger priories in the West
were also providing true hospital care. Though there are no statements that
these hospitals employed doctors, indirect testimony from the Statutes of the
Teutonic Knights suggests that they did.73 Thus, not only the great Hospital
in Jerusalem but also the smaller houses in Western Europe were function-
ing as true hospitals by the late twelfth century.
Toward the end of the twelfth century hospices other than those of the
Knights began to focus more care on the treatment of the sick. A certain
Guy organized a community of Augustinian brothers to administer a
xenodochium in the city of Montpellier. By 1204 these men were managing
hospices in Rome and other southern cities.74 The statutes of Guy's com-
munities along with the correspondence of Innocent III prove beyond a
doubt that these lay brothers were attending the sick in their hospices.75 Of
even greater significance, however, for the history of hospitals in the Latin
West was the close dependence of these statutes on the Rule of Raymond du
Puy. Over one third of the Statutes of Montpellier derived from the Rule of
Raymond du Puy, including the crucial section describing the reception of
the sick and the care they were to receive.76
In northern and central France independent hospice communities began
to commit their constitutions to writing about the same time that the hos-
pices of Montpellier were proliferating in southern France. The Hotel-Dieu
(hospice) in Angers, which published its rules about 1200, was the first of
these independent houses to include specific references to the diseased.
Although the heading of these statutes refers to the institution only as the
House of the Poor, chapters five, six, and seven outline specific duties which
the brothers must carry out in locating the ill inside the city, in bringing
them to the hospice, and in attending their spiritual and physical needs. The
Hotel-Dieu in Angers borrowed these regulations concerning the care of the
sick directly from the statutes of Montpellier, which, as discussed above,
were dependent on the Hospital of the Knights of Saint John.77
In 1207 the Hotel-Dieu of Montdidier prepared its own written regula-
tions, using the Rule of Raymond du Puy as the immediate archetype both
for the chapters dealing with the care of the sick and for those disciplining
72 Reicke, Spital, 2:41, n. 4.

73 Ibid., 2:46, points out that the statutes of the Teutonic Knights (1240) ordered the priors to
hire doctors whenever they were needed in the provincial infirmaries. The Teutonic Knights
were to function "ad exemplum Hospitalariorum in pauperibus et infirmis" (quoted from a Bull
of Innocent III by Le Grand, "Les Maisons-Dieu," p. 104). Thus it is likely that the practice
concerning hiring doctors for provincial infirmaries, described in the statutes of the Teutonic
Knights, came from the customs of the Hospitallers.
74 Innocentii III regesta, MPL 214:85; Regula ordinis Sancti Spiritus de Saxia, MPL 217: 1130-31.
75 Le Grand, "Les Maisons-Dieu," p. 105, observes that the only extant copy of statutes for the
house at Montpellier dates from the mid-thirteenth century. Nevertheless, he believes that this
later redaction reproduces the earlier code save for a few minor additions.
76 Ibid., pp. 105-6.
77 Le Grand, Statuts, pp. 21-33, esp. chap. 5, p. 23, and chap. 6, p. 24.

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the brothers in cases of violence or of concealed private property.78 These

statutes of Montdidier were borrowed by the hospices at Noyen (1218), at
Saint-Riquier (1233), at Beauvais (1246), at Rethel (1247), and at Montreuil-
sur-Mer (1250).79
When committing its rules to writing in 1217, the Hotel-Dieu at Paris also
borrowed the chapters regarding the reception and treatment of the sick
from the Rule of Raymond du Puy and even adopted several sections of the
Statutes of Roger des Moulins, the second body of Hospitaller legislation,
concerning night-time supervision and the provision of clothing for patients.
From Paris these regulations spread to other cities of northern France,
bringing with them the hospital discipline oi the Knights of Saint John.80
In Germany, too, the late twelfth century marks a dramatic change in the
orientation of hospices. When the Teutonic Knights became an independent
military order in c. 1190 they accepted the Hospitaller discipline for the care
of the sick. As one would expect, the Teutonic Knights multiplied their
holdings most rapidly in their German homeland and began to open new
hospitals in which the Hospitaller customs were followed.81 They also took
over many of the older hospices which had formerly been managed by
independent houses of lay brothers.82 Their statutes, issued in 1240, testify
that their hospitals maintained nursing sisters and male servants to minister
to the sick. Though resident doctors were not attached to the daughter
houses in Germany, the priors could hire physicians as conditions de-
manded. At their central house in the Holy Land, however, the Teutonic
Knights, following Hospitaller custom, supported resident physicians.83
Throughout Western Europe the late twelfth century witnessed a dynamic
increase in the number of hospices influenced by the Rule of Raymond du
Puy and the Statutes of Roger des Moulins. But again, one must examine
carefully these new foundations of the high Middle Ages to confirm their
functioning as true hospitals. Though the statutes of the hospice at Montpel-
lier do not mention physicians or special medicines, they require remedial
baths administered by the nursing sisters.84 More importantly, by stipulating
that the brothers should search the city streets once a week and carry back
the sick to the hospital, they demonstrate that this hospice was no longer a
travelers' inn or a simple poor house but was concentrating its efforts on
healing the sick. The hospice at Angers in northern France included the
same provisions.85
78 Ibid., introduction, p. xvi: "La regle de Montdidier ... reproduit non seulement le sens,
mais les termes memes d'article relatif aux malades dans les constitutions de Raimond du
Puis."
79 Ibid., introduction, pp. xiii-xiv.
80 Ibid., introduction, pp. xvi-xvii.
81 Le Grand, "Les Maisons-Dieu," pp. 103-4.
82 Reicke, Spital, 1:121,
83 Ibid., 2:46.
84 Regula ordinis S. Spiritus de Saxia, MPL 217:1145-46.
85 Le Grand, Statuts, p. 23, and n. 1.

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Though the documents of the Hotel-Dieu at Paris from the twelfth cen-
tury do not once refer to the treatment of patients, at the end of the century,
at the very time many of the urban hospices were adopting the regulations
of the Hospitallers, they begin to speak exclusively of the sick.86 In spite of
frequent allusions to an infirmary the Parisian statutes of the thirteenth
century make no provision for a resident doctor.87 The cartularies of the
community, however, testify that in 1221 a surgeon was treating the bed-
ridden in the infirmary and that in 1231 a doctor practiced in the hospital.88
On the other hand, these same sources do not record before the fourteenth
century resident doctors such as those of the Hospital in Jerusalem.89 Never-
theless, that a physician and a surgeon treated patients during the early
thirteenth century indicates that the Hotel-Dieu was by that time a true
hospital. Though a modest operation compared to the Hospital in
Jerusalem, it now concentrated on the treatment of the sick as its principal
goal. Moreover, Jacques de Vitry, a man trained in Paris and widely traveled
in the eastern Mediterranean, classified the Hotel-Dieu of Paris and a num-
ber of other new Western hospitals together with the Sampson xenon of
Constantinople, one of the many true hospitals of the Byzantine Empire.90
During the eleventh and twelfth centuries when Europe's growing popula-
tion, more mobile patterns, and urban centers began to spread disease
among the poorest class, the native institutions of Western Christianity
responded slowly. There are some notable exceptions. As we have seen,
Lanfranc founded a hospice at Canterbury which seems to have functioned
as a true hospital; at Fontevrault Robert of Arbrissel offered special charity
to the diseased. Finally, at Premontre the followers of St. Norbert treated
laymen who suffered from disease. Despite their earnest efforts to organize
true hospitals, these houses were not able to spur a massive movement to
tackle the problem of disease among the wandering poor of the new age.
The Hospital of the Knights in Jerusalem, on the other hand, was a great
edifice whose very size and whose location among the holy places helped to
fire the religious sensibilities of Western Europeans. Frederick Barbarossa
(1152-1190) praised the Hospital for its inestimable works of mercy and for
the practice of charity, which it demonstrated on an extraordinary scale.91 In
his exuberance Pope Celestine III (1191-1198) linked the Hospital with
Christ himself, maintaining that the Savior had left the edifice as a miracu-
lous gift for mankind and that the Virgin had rested there.92 Such apocry-
phal links between the Hospital and the persons of the New Testament
increased its prestige and gave it influence far exceeding the impact of other
86 E. Coyecque, L'Hotel-dieu de Paris au moyen age: Histoire et documents (Paris, 1891), p. 62 and
87 Le Grand, Statuts, pp. 43-53.
88 Coyecque, L'Hotel-Dieu, p. 100.
89 Ibid., p. 97.
90 Historia occidentalis of Jacques de Vitry, ed. J. F. Hinnebusch (Fribourg, 1972), pp. 149-5
91 Cart. 270, p. 203.
92 Cart. 911, pp. 577-78.

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Western institutions such as Lanfranc's house at Canterbury or the public

infirmary at Premontre. The Hospital thus inspired men of Latin Christen-
dom by providing a living model of Christian charity which religious com-
munities imitated throughout the towns of Western Europe.
2. THE HOSPITALS OF THE EAST AND THE ORIGINS

OF THE HOSPITAI IN JERUSALEM
We have seen that Western Europe greeted the Hospital as a novel institu-
tion. Let us now consider the Moslem and Byzantine influence on the
Hospitallers' infirmary. Though the Knights of Saint John were themselves
Westerners, their great house was in Jerusalem, a city subject to Byzantine
and Arab influences. In the Islamic lands and in the East Roman Empire
institutions had flourished for centuries which could well have affected the
Hospitallers in developing their infirmary.
In Byzantium true hospitals had been open most probably since the reign
of Constantius (337-361), although positive evidence does not appear until
the sixth century. During the fourth century a religious movement inspired
by Eustathius of Sabasteia developed a form of urban monasticism whose
adherents did not live as hermits or dwell in large cenobitic monasteries in
the countryside but rather formed smaller urban communities (synoikiai)
which took part in the life of the city.93 Among the institutions inspired by
Eustathius and his followers were charitable houses to serve the needs of the
urban poor. Eustathius influenced both Patriarch Macedonius (342-48,
350-60) in Constantinople and Basil the Great of Caesarea when they
established ecclesiastical institutions to relieve the suffering of the indigent.94
Since none of the fourth-century sources describes these houses for the poor
and sick in any detail, one cannot know whether they were definitely true
hospitals. Nevertheless, the sources clearly reveal that urban Christian
movements in the East had very soon recognized the need to provide care
for the sick and unfortunate in their midst.95 Eustathius of Sebasteia and
Macedonius of Constantinople, two of the prominent leaders in Christian
philanthropy, were both linked with heresy, and indeed the whole urban
monastic movement between 350 and 450 was a hotbed of resistance to
ecclesiastical authority, but Basil's acceptance of the charitable institutions
and John Chrysostom's successful efforts to incorporate them into the or-
thodox episcopal structure enshrined these agents of practical charity among
the hallowed traditions of Eastern Christianity.96
Among the philanthropic institutions of East Rome the xenon (xenodochion)
of Sampson is the first which the sources describe clearly as a true hospital.
93 G. Dagron, "Les moines et la ville," Traveaux et Memoires 4 (1970), 250-52.

94 Ibid., pp. 247-52; Regulae brevius tractatae, MPG 31:1184.
95 G. Dagron, Naissance d'une capitale (Paris, 1974), pp. 510-11; Ph. Koukoules, Bios kai
Politismos (Athens, 1948), 2:64-75.
96 Dagron, "Les moines et la ville," pp. 350-53. See also Dagron, Naissance, pp. 510-16, who
stresses the disruption the urban monks caused and examines the role of the Greek fathers in
trying to subdue them.

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Prokopios mentions its destruction in 532 and its restoration by Justinian

(52 7-565).97 The Miracles of Saint Artemios, a saint's life from the early seventh
century, supplements Prokopios's account with some interesting details. A
certain Stephen, a deacon of Sancta Sophia, suffering from an infection of
the groin, entrusted himself to the surgeons at the Sampson xenon. Though
he had a house and family in Constantinople, the surgeons committed him
to the xenon bed for three days for an operation.98 The Sampson xenon was
thus a true hospital with resident surgeons and beds for patients. Moreover,
though it is termed a xenon (Greek for hospital), it offered treatment to a
resident of Constantinople who was also a man of some substance. The
Sampson hospital was thus not an inn or a place offering simple care to the
poverty-stricken ill but was an institution for specialized medical treatment
which could not be performed in a home.
That true hospitals such as the Sampson were operating in sixth-century
Byzantium should not be surprising, if one remembers the demographic
patterns of the East Roman Empire. Constantinople was continually attract-
ing from the provinces men of all classes who came for ecclesiastical, com-
mercial, and governmental reasons. In such an entrepot immigrants as well
as old residents were constantly exposed to new microbes. Both endemic and
epidemic diseases created such an unhealthy environment that even the
wealthy had difficulty surviving for many generations.99 Faced with such
human misery the Constantinopolitan church developed an institution, the
xenon or nosokomeion, to alleviate the suffering. The Eastern church was
quickly able to organize some care for the sick since communities of urban
monks, the Eustathian synoikoi, were already dedicated to serving lay town
dwellers.100 In the Eustathian movement the monks themselves treated the
sick, but gradually a tradition developed that the monks were not to partici-
pate in the actual work of the public infirmary. Still, Eastern monasteries
continued actively to support true hospitals and many other public philan-
thropic institutions, while in the West the Benedictine abbeys seemed un-
comfortable serving laymen and frequently allowed even their simple hos-
pices to deteriorate. True hospitals ministered to the city populations
throughout the history of the Greek empire; some of the monastic typika
which outline in detail the functioning of these hospitals have survived. One
such typikon, drawn up by Emperor John II Komnenos (1 118-1143) to estab-
lish the imperial monastery of the Pantokrator, provides a detailed outline of
procedures in its public infirmary.101 In this hospital a staff of thirty-six served
thirty-eight male patients, while another eleven persons attended twelve
97 Prokopios, De aedificiis 1.2.14-17.

98Miraculae S. Artemii, ed. A. Papadopoulos-Kerameus, Varia Graeca Sacra (Petersbu
pp. 25-28.
99 R. Jenkins, "Social Life in the Byzantine Empire," in The Cambridge Medieval History (Cam-
bridge, 1967), 4, 2:87-88.
100 For a general discussion of nosokomeia see Koukoules, Bios, 2:141-47.
101 A new critical edition with introduction and index has been published by P. Gautier, "Le
Typikon du Christ Sauveur Pantocrator," Revue des Etudes Byzantines 32 (1974), 1-145.

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female sufferers. The staff included surgeons, chief doctors, simple physi-
cians, various grades of assistants, and manual servants. Moreover, the typi-
kon divided patients and staff into five specialized wards. The entire medical
complex was supervised by two administrators, one of whom, the oikonomos,
was perhaps a monk of the monastic community.102
The typikon of the Pantokrator demonstrates clearly that this institution
was a true hospital. Moreover, a seventh-century hagiographical text indi-
cates that the Pantokrator was not unique in Byzantium.103 There were
apparently numerous hospitals organized along the same lines as the Com-
nenian xenon of the twelfth century.104 Thus, from the sixth-century
Sampson xenon to the twelfth century when the Knights of Saint John
developed their medical services in Jerusalem, the East Roman Empire
possessed true hospitals which could well have provided an archetype for the
early Hospitallers.
In the Moslem lands of the eastern Mediterranean true hospitals had
opened their doors in the reign of Harun-al-Raschid (786-809), who estab-
lished in his capital city of Baghdad a bimaristan (Persian: house of the sick)
which bore his name.105 Harun was indirectly influenced by Byzantium in
organizing his hospital since Djibra'il b. Bakhtishu, the man -who advised him
on its organization and was its first director, was a Christian of the Nestorian
creed from the hospital of Djundaysabur in Khuzistan. Here Nestorians
fleeing Byzantine persecution in the fifth and sixth centuries had established
a true hospital with the support of the Sassanid dynasty.106 By the time of
Harun's reign, this hospital and attendant medical school had achieved fame
throughout Islam. Through its daughter institution, Harun's hospital in
Baghdad, it profoundly influenced all subsequent hospitals in the Moslem
East.107 During the tenth century new dynasties emerged in the Islamic
heartland, each-of which wished to establish a reputation for philanthropy
and pu-blic works. Constructing hospitals was one expression of a ruler's
concern for his subjects. Thus, the Buwayhid prince, Adud al-Dawlah,
opened the greatest of the Baghdad hospitals, the Adudi, where twenty-four
physicians supervised the diet of the patients and prescribed medicines.
Descriptions of the Adudi leave no doubt that it was a true hospital.108
102 Ibid., pp. 8-12.

103 Ibid., p. 9.
104 Miraculae S. Artemii 28-31 mentions archiatroi and hyperourgoi at the Christodoulos, tw
classes of physicians which appear also in the typikon of the Pantokrator. Moreover, the archiatroi
of the Christodoulos xenon worked in monthly shifts just as the physicians of the Pantokrator.
For a summary of the history of true hospitals in Byzantium see A. Philipsborn, "Der Fortschritt in
der Entwicklung des byzantinischen Krankenhauswesens," Byzantinische Zeitschrift 54 (1961), 338-
65.
105 S. Hamarneh, "Development of Hospitals in Islam," Journal of the History of Medicine and
Allied Sciences 17 (1962), 367-68.
106 Ibid., pp. 367-68; Encyclopedia of Islam (London, 1965), 2:1120.
107Encyclopedia of Islam (London, 1960), 1:1223.
108 Hamarneh, "Hospitals in Islam," pp. 369-70.

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From Baghdad true hospitals spread to other Moslem cities; one of the
most illustrious was built by the Turkish emir, Nur al-Din, in Damascus in
1156. Ibn Djubayr, the famous Spanish traveler of the late twelfth century,
left an account of the al-Nuri hospital's routine wherein he mentions daily
rounds conducted by the physicians and careful written records of pre-
scribed treatments.109
Besides the hospitals treated here, there were many other such institutions
in the Moslem world. They were widely dispersed and prominent in the
urban life of Islamic cities, so prominent that Ibn Djubayr ranked them
among the glories of Islam.110
Unlike the West, the Moslem lands included several huge cities where
endemic diseases flourished. Baghdad with a population of almost 1.5 mil-
lion was the largest, but even Damascus and Cairo were cities much larger
than the towns in Latin Europe.1"' Trade linked these great cities with one
another and with smaller urban centers, creating an environment conducive
to the spread of diseases. By supporting hospitals the caliphs and newer
princely clans attempted to gain popularity among the city masses whose
urban habitat constantly threatened them with sudden illnesses.-12 So, too, in
Constantinople and in the large Byzantine towns of Anatolia the sea
termini of overland caravan routes to India and the Far East - the Greeks
suffered from similar microbe attacks.113 Both the Byzantine emperors and
the orthodox church realized early in the empire's development that political
and doctrinal stability in urban centers required conspicuous support of
public charities, including care for the many who suffered from disease. 14
As a result of economic and urban conditions both Byzantium and Islam had
perforce organized caritative institutions, including true hospitals, on a scale
unknown to the agrarian West. In either society were institutions which
could have served as models for the Hospital in Jerusalem.
J. Riley-Smith, the most recent historian of the Knights of Saint John,
states that Arab medical centers most probably inspired the first Hospitallers,
suggesting as grounds for his supposition the Arabs' political domination of
Palestine. 15 Since 638 the Arabs had controlled Jerusalem. Even after the
crusaders had founded their Christian state in Jerusalem (1099), Moslem
cities such as Damascus were only a few kilometers from Christian ter-
ritories. Byzantine lands, on the other hand, lay far to the north of
109 Ibid., pp. 371-72.

110 Ibid., pp. 372.
"I1 Encyclopedia of Islam, 1:898-99. See also Middle Eastern Cities, ed. M. Lapidus (Berkeley,
1969), pp. 21-25.
112 Hamarneh, "Hospitals in Islam," pp. 38041.
113 Schreiber, "Hospital," pp. 23-24; concerning Anatolian cities, see Sp. Vryonis,
of Medieval Hellenism in Asia Minor and the Process of Islamization from the Eleventh t
Fifteenth Century (Los Angeles, 1971), pp. 6-42, esp. 17 and 40.
114 Schreiber, "Hospital," p. 26. See also Dagron, Naissance, pp. 509-11, for the early efforts
of the orthodox church in Constantinople to organize hospitals and other caritative institutions.
I" Riley-Smith, Knights, p. 335; Hans Prutz, Die geistlichen Ritterorden (Berlin, 1908), p., 39.

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Jerusalem by the eleventh century. A closer examination, however, of the

balance of power in medieval Palestine, combined with a careful study of the
Knights' origins, demonstrates that Byzantine xenones were the models for
the Hospital.
Before the Arab conquest of Jerusalem Byzantine monasteries and philan-
thropic institutions including true hospitals had operated in the Holy City.
During the fifth century Saint Theodosios opened two treatment centers
near Jerusalem, one for sick laymen and one for ailing monks.116 After the
Arabs took over Palestine, Byzantine Christian institutions declined, but they
did not disappear. From the seventh to the eleventh century orthodox
patriarchs continued to sit in the city. Besides the continual presence of an
organized church in the region, Palestine was subject to East Roman political
influence during certain periods of the Arab domination. In 969 the Byzan-
tine emperor Nikephoros Phokas (963-969) recaptured the Syrian city of
Antioch and thereby restored Byzantium to a position of power in the
Levant. Greek armies moved south into Palestine from their new base in
Syria, receiving envoys from many cities including Jerusalem.117 Though the
emperor John Tzimiskes (969-977) occupied Caesarea, only fifty kilometers
from Jerusalem, the Holy City itself never came under Byzantine political
control. Nevertheless, throughout much of the eleventh century the Greek
emperors played an important role in Jerusalem as the protectors of the
Christians there. When Constantine IX (1042-1055) undertook the recon-
struction of the Church of the Holy Sepulchre, Moslem and Christian con-
temporaries agreed that Christians were almost in control of Jerusalem; a
rumor circulated that the emperor himself was inside the city.118
Though Byzantine prestige in the Holy Land suffered severely with the
attacks of the Turks in the late eleventh century, it asserted itself again in
Palestine under the crusaders. Both King Baldwin III (1144-1163) and
Amalric I (1163-1174) had Greek wives; in 1159 King Baldwin and the
Latin prince of Antioch acknowledged as their overlord Emperor Manuel I
(1143-1180).119
Having considered the Byzantine influence in Palestine, let us outline now
the specific events and institutions which gave birth to the Knights of Saint
John and their Hospital. In the twelfth and thirteenth centuries two versions
of the Knights' origins circulated. The first was apocryphal, stressing a
biblical foundation and placing the Hospital in the midst of New Testament
events. The second traced its foundation to Amalfitan merchants who traded
regularly in Jerusalem during the eleventh century.120 This second account
116 Der Heilige Theodosios: Schriften des Theodoros und Kyrillos, ed. H. Usener (Leipzig, 1890), p.
41.
117 G. Ostrogorsky, A History of the Byzantine State (New Jersey, 1969), pp. 297-98; S. Runci-
man, A History of the Crusades (Cambridge, 1968), 1:31.
118 G. Schlumberger, L'Epopee byzantine (Paris, 1905), 3:23, 131, 203-4; Runciman, Cr
1:36-37.
119 Runciman, Crusades, 2:350; Ostrogorsky, Byzantine State, p. 386.
120 Riley-Smith, Knights, pp. 32-34.

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rests primarily on the Historia of William, archbishop of Tyre, a reliable

historian whose post as Chancellor of the Kingdom of Jerusalem brought
him close to the Knights. William's account, written between 1170 and 1182,
is supported by the south Italian chronicler, Amato of Monte Cassino, by a
bull of Paschal II, and by archeological evidence.121
Synthesizing these various sources, one obtains a coherent picture of the
Hospital's foundation. Sometime after the end of the Christian persecution
under the Egyptian caliph, al-Hakim (1014), Amalfitan merchants requested
permission to restore the old Latin monastery and -hospice of St. Mary. Once
the refurbishing was complete, they staffed the house with Italian Benedic-
tines who, in addition to their spiritual exercises, offered' shelter to Amal-
fitans conducting business in Jerusalem or visiting the Christian shrines.
These merchants also founded a convent of nuns to administer a hospice for
women. During the eleventh century the number of pilgrims and poor
travelers from the West continued to increase so that the Amalfitans decided
to build a third hospice and church for all poor travelers regardless of
origin. They entrusted this institution to lay brothers, the future Hospital-
lers, whose prior was appointed by the abbot of St. Mary's.122 Shortly after
the first crusade these brothers under their prior Gerard had organized true
hospital services in their hospice.
Though both Islamic and Byzantine infirmaries could have influenced the
brothers ih developing their xenodochium for the sick, the history of the
Hospital's foundation indicates a Byzantine rather than a Moslem archetype.
First, Amalfi, the city from which the founders of the Hospital hailed, had
closer ties with Byzahtium than any other Western community -with the
exception of Venice.123 Moreover, Amalfitans of the eleventh century were
in contact with orthodox monasticism, since they had founded in the reign
of John Tzimiskes (969-976) a monastery for their citizens on Mount Athos
and -a little later organized a religious house in Constantinople itself.124
Through this close relationship with Eastern religious houses they must
surely have learned of the Eastern monks' dedication to the maintenance of
hospitals. Second, a certain Mauro and his son Pantaleone, the chief con-
tributors to the Amalfitan religious houses in Jerusalem, were members of a
family with close ties -to the Eastern Empire.125 Mauro himself possessed a
palazzo in Constantinople; Pantaleone had received the title of consul
(hypatos) from Emperor Constantine X (1059-1067) as a reward for support-
ing the Byzantine government of southern Italy.126 He also gave gold doors,
121 Ibid., pp. 34-36; William of Tyre, Historia rerum in transmarinis gestarum, 1:822-26.
122 The chronology of the Amalfitan foundation is worked out by Riley-Smith, Knights, pp
34-35.
123J. H. Pryor, "The Origins of the Co-mmenda Contract," SPECULUM 52 (1977), 14 and 26.
124 A. G. Paspates, Byzantinai Meletai Tbpographikai kai Historikai (Constantinople, 1877), pp.
137-38.
125 Aime of Monte Cassino, L'ystoire de li Normant, ed. V. de Bartholomaeis, Fonti per la
d'Italia. Scrittori 76 (Rome, 1935), p. 342.
126 Ibid., p. 342; W. Heyd, Histoire du Commerce du Levant (Leipzig, 1936), 1:100-101.

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made in the workshops of Constantinople, to several churches of southern

Italy. 127
Third, the very church around which the Amalfitans constructed the
Hospital indicates a link with Byzantium. These merchants from Italy did
not build a totally new structure for the church and hospice outside the
monastery of St. Mary; they rather restored an ancient building which had
been ravaged by al-Hakim, the Egyptian caliph. The edifice they chose to
renovate had been dedicated originally to Saint John the Baptist by Byzan-
tines during the fifth century. The great orthodox patriarch of Alexandria,
John the Almoner, had restored the church about 626, confusing later
generations as to which John was the building's patron saint.128 A document
of the early ninth century is the last to refer to the church as active.129
Thereafter, one cannot determine whether it remained open as a Byzantine
shrine, but, since there were no major upheavals in Palestine until the
caliphate of al-Hakim, one would suspect that orthodox Christians continued
to use it.
The Georgian version of "The Capture of Jerusalem" by Antiochus
Strategos mentions a gerokomeion or hospital for the care of the aged attached
to this church of St. John in 614.130 A gerokomeion in the East Roman Empire
resembled a true hospital and included in its constitution rules concerning
medical care and diet.131 Though there is no evidence that this particular
gerokomeion survived the Persian and Arab conquests, it may be significant
that the Hospital was constructed about a Byzantine church which had
formerly been the chapel of a similar orthodox philanthropic institution.
The Amalfitan origins of the Hospital, the East Roman connections of the
Mauro family, and the Byzantine history of the Knights' conventual church
all demonstrate a close link between orthodox traditions and the new Latin
house in Jerusalem. But more important for our argument than these
specific indications of Byzantine influence is the Hospital's intensely Chris-
tian nature. It was, first, a religious house, staffed by lay conversi subject
originally to a Benedictine abbey and later to their own master. Second, its
brothers saw labor in its infirmary as the practice of Christian virtue and as
an integral part of the religious life. Finally, it incorporated prayer and
liturgy in the prescribed treatment of the ill.132
These specifically religious practices the Hospital shared with the xenones
of Byzantium. First, all orthodox houses were associated with monasteries or
127 Heyd, Commerce, 1: 102-3.

128 H. Vincent and F.-M. Abel, Jerusalem: Recherches de topographie, d'archeologie et d'histoire
(Paris, 1922), 2:645-46; Riley-Smith, Knights, pp. 34-35.
129 "Commemoratorum de casis dei vel monasteriis," in Itinera Hierosolymitana et descriptiones
Terrae Sanctae, ed. T. Tobler and A. Molinier (Geneva, 1880), p. 302.
130 Vincent and Abel, Jeirusalem, p. 645.
131 Koukoules, Bios, 2:168-70.
132 These three essential characteristics of the Hospital are apparent from the Rule: cart. 70,
pp. 62-68; and the Statutes: cart. 627, pp. 425-26. See also the letter of Pope Lucius III, cart.
634, p. 431.

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churches; from the Eustathian houses of the fourth century to the Panto-
krator of Comnenian Constantinople monastic communities administered the
true hospitals of the empire.133 Second, the typika outlining the routines in
Byzantine hospitals emphasized the religious aspects of serving the sick,
Christ's brothers, just as the Rule and Statutes of the Hospitallers did.'34
Finally, Byzantine hospital treatment required liturgy, confession, and
prayer. 135
The hospitals of Islam were, by contrast, not religious. Though pious

sentiments often moved the caliphs and princes to set up hospitals and to
endow them richly, their organization was secular.136 It is unlikely that the
secular infirmaries of the "infidel" Moslems could have inspired so
thoroughly a Christian institution as the Hospital.
If, indeed, the Hospital in Jerusalem inherited its customs from Byzanti
hospitals, one would expect to find concordances between the rules of
Raymond du Puy and Roger des Moulins on the one hand and the typika of
East Roman institutions on the other. The Hospital has most often been
compared with the Pantokrator and, surely, there are some similarities.137
The differences, however, between the institution in Jerusalem and the
Pantokrator are striking. The Constantinopolitan hospital maintained a large
staff of doctors, divided the patients into five specific wards, required medic-
inal baths, and prescribed many other routines which are not found at the
Hospital.'38 One must remember, however, that the Pantokrator was one of
the richest of infirmaries, located in Constantinople at the very center of
Byzantine society where it enjoyed imperial patronage and the support of a
well-organized medical profession. It represented the highest development
of the East Roman hospital tradition. If one compares the Hospital with a
more modest Byzantine institution, one obtains more favorable results. The
typikon of one such hospital survives from the monastery of Kosmosotira in
the provincial town of Ainos. There Isaak Komnenos, a younger son of
Emperor Alexios (1081-1118), founded a monastery and hospital circa
1152.139 The hospital was outside the monastery walls yet subject to the
133 For the monastic origins of philanthropic houses and hospitals in Byzantium see above, p.
723. For the monastic connections of the Sampson xenon see R. Janin, La Geographie Ecclesiastique
de l'Ernpire Byzantine, Pt. 1: La Siege de Constantinople et le Patriarchat Oecumninique, vol. 3: Les Eglises et
les rnonasteres (Paris, 1969), p. 562. Concerning the Pantokrator see Gautier, "Le Typikon du
Pantocrator," p. 29, 11. 22-31, 44.
34 "Le Typikon du Pantocrator," p. 87, 11. 985-89, 995; "Typikon du monastere de la
Kosmosotira," ed. L. Petit, Bulletin de l'Institut archeologique russe a Constantinople 13 (1908
135 "Le Typikon du Pantocrator," pp. 99, 11. 1154-61 concerning the liturgies, p. 89,
1002-5, concerning confessions.
136 Hamarneh, "Hospitals in Islam," pp. 379-80; Encyclopedia of Islam, 2:1120.
137 Schreiber, "Hospital," pp. 3-79; Riley-Smith, Knights, p. 335. Regarding confess
Typikon du Pantocrator," p. 89, 11. 1002-5, cf. Rule, chap. 16: cart. 70, p. 67. Regarding
liturgical candles "Le Typikon du Pantocrator," p. 93, 11. 1084-89, cf. Rule, chap. 3: cart. 70, p.
63.
138 "Le Typikon du Pantocrator," p. 82, 1. 904-p. 92, 1. 1074.
139 Koukoules, Bios, 2:145-46.

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hegoumen (abbot). Its rule provided specific instructions for beds, coverlets,
and clothing for the patients, specifically caps, shirts, and cloaks. The Stat-
utes of Roger des Moulins are parallel, allotting a bed, a coverlet, and a cap
with cloak and slippers to each patient.140 The number of servants assigned
to wait on the patients was very close in the two houses, eight at Kosmosotira
and nine at Jerusalem.141 Moreover, both hospitals included the liturgy
among the prescribed routines and required fitting burials for patients who
died while under treatment.142 Finally, unlike the Pantokrator, Kosmosotira
did not possess a highly specialized staff of physicians but only a single
doctor and an adequate supply of medicine, a requirement in the same
spirit as the Hospital's provisions for four wise doctors, knowledgeable in the
preparation of necessary medicines.143
Although the Statutes of Jerusalem resemble in many details the typikon of
Kosmosotira, this correspondence does not imply that the great Hospital of
the Knights borrowed its customs directly from the monastery at Ainos. It
indicates rather how the general practices in Byzantine xenones, practices
varying from institution to institution, formed the tradition which impressed
the early Hospitallers. Whether the Amalfitans drew up guidelines for their
hospital patterned on xenones which they had seen on Athos or in Constan-
tinople, or whether some house in Jerusalem, perhaps even the old geroko-
meion of St. John, was the exemplar is not clear, but that the hospital institu-
tions of Byzantium inspired the Amalfitan founders and the Hospitallers
who succeeded them seems certain.
The Hospitallers did not simply adopt the Byzantine xenones and their
orthodox institutions; they altered these traditions in important ways to
adapt them to the Latin Christian world. First, the Knights freed themselves
from any connection with their parent house of St. Mary's. Basil of Cap-
padocia and John Chrysostom had successfully incorporated the support of
charitable institutions into the fabric of Byzantine monasticism, but the
Benedictine tradition had not developed specialized public philanthropy.144
Though at first the Hospital of the Knights shared also the Byzantine xenon's
dependent status vis-'a-vis the monastery, it was essential for its further
development that it be independent of the Benedictine monastery.145 Some-
time during the confusion surrounding the crusaders' conquest of
Jerusalem, the Hospitallers liberated their community and the Hospital from
140 "Typikon de la Kosmosotira," p. 53; Statutes: cart. 627, p. 426.

142 "Typikon de la Kosmosotira," p. 55; Statutes: cart. 627, p. 426, and Rule, chap. 16: cart.
70, p. 67.
144Regulae Brevius Tractatae, MPG 31: 1184; Benedicti Regula, ed. R. Hanslik (Vienna, 1960),
chap. 36, p. 95, refers only to the care of sick monks. Concerning Benedictine neglect of hospices
see Reicke, Spital, 1:49.
145 Concerning the location of. the hospice with respect to the parent monastery see J
Wiirzburg, "Descriptio," pp. 159-60; cf. "Typikon de la Kosmosotira," p. 53. See also A. K.
Orlandos, Monasteriake Architecktonike (Athens, 1958), p. 76.

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the abbey of St. Mary. The brothers were now free of any tendency on the
part of the monks to assign monastic revenues to concerns other than the
proper maintenance of the Hospital. The Hospitallers thus provided the
West with a new order, controlling its own resources for the support of its
true hospitals, leaving Benedictine monasticism and its various reform
movements to their contemplative life.
The Knights of Saint John also made Byzantine hospital discipline avail-
able to the West by offering a Latin rendering of Greek infirmary customs.
The Statutes of Roger des Moulins (1182) are a Latin paraphrase of certain
clauses in Greek typika.146 The Knights, however, did more than simply
translate Byzantine regulations. The Rule of Raymond du Puy has no paral-
lel among Byzantine monastic documents. It regulated the community life of
lay brothers whose principal religious duty was service in the Hospital. The
typika of Byzantine monastic communities, in contrast, said almost noth
about the monks' hospital duties. The charter of the Pantokrator, for exam-
ple, did not once refer to the monks' labor in the xenon, while one clause
might have excluded them from such work.147 Though the resources of the
Pantokrator monastery were unquestionably committed to the maintenance
of the public infirmary, one has the impression that the hospital staff was
composed exclusively of laymen. The Kosmosotira typikon also lacks a chap-
ter indicating that the monks dedicated themselves in any special way to
hospital service. Again, this monastery had at all times to support the public
hospital, yet some of the actual workers might have been hired laymen.148 In
contrast, the Rule of Raymond du Puy opens with the statement that the
brothers' prime mission was to serve the poor sick, while the Statutes of
Roger des Moulins suggest that the brothers themselves waited on hospital
patients. 149
The Rule of Raymond du Puy also differs from any Byzantine document
by introducing the feudal notion of service to a lord. The brother Hospital-
lers were to regard the sick of the Hospital as their lords (domini) and show
them the faithful service of vassals.150 Moreover, through their propaganda
in the West the Knights emphasized the relationship of the feudal virtues to
service in the Hospital. In a letter to the Western prelates (1119-1124),
Raymond du Puy asserted that Hospitallers received the same heavenly
rewards for their labors on behalf of the sick as the knights who fought in
the crusade.151 In the same spirit donations for the maintenance of the order
47 "Typikon du Pantocrator," p. 63, 11. 559-61: KvnWt(uoV j?VtOt 7cpoacYlaiav Kai 8aat i6v
61aKOV16V 6L7atTOOa1 Tiv 94o06V Tq govfq 8laTpt3lv 0og6?g T6V iv jovax%v t1anto01TjaiTat....
148 "Typikon de la Kosmosotira," pp. 48-49: (Torg KdgVOuat) gn qp60togvou Tob 7rpo6UaT6To
xplgplioV K&V d1 ?axaTov 1 TP1 govfV KaTaVT1fjCYV dao86o0. .,, The physician was certainly
hired. See "Typikon de la Kosmosotira," p. 54.
149 Rule, chap. 1: cart. 70, p. 62; Statutes: cart. 627, p. 427.
150 Schreiber, "Hospital," pp. 32-33.
151 Cart. 46, p. 39: "quicumque autem in nostram fraternitatem intraverunt vel intrabu
sint securi de Domini misericordia quasi militant in Hierosolimis, et recipient . . . gloriam
coronam justicie."

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and its hospital could atone for the sins of the benefactors and their fami-
lies.152 By suggesting that men could win the rewards of virtue not only for
valor on the battlefield but also for devoted service on behalf of the sick, the
Knights were able to tap a rich source of popular piety among the knightly
class and fire enthusiasm for a form of charity which other Western religious
movements had neglected. The twelfth century saw a great surge in religious
devotion among the knights of the West, a piety which was expressed in
crusading zeal but which also turned to the corporal works of mercy. The
Hospitallers played an important role in channeling that zeal toward the
service of the sick.
It is doubtful that the Greek hospitals of Constantinople would have
found an enthusiastic reception in Latin Christendom without the funda-
mental adaptations wrought by the Knights of Saint John. As we observed
earlier, the Greek monasteries gave unwavering financial support to true
hospitals, but the monks themselves did not devote any special zeal to such
corporal works. Indeed, by the twelfth century most of the hospital services
seem to have been carried out by professional physicians and attendants. In
the West, however, where such a profession was lacking and where the
monasteries had not developed a strong tradition of supporting public
infirmaries, a new religious order dedicated exclusively to hospital work was
needed to establish and manage public infirmaries. The Hospitallers fulfilled
that role.
3. CONCLUSION
This study has demonstrated, first, that Western Europe during the early
Middle Ages did not develop true hospitals. Though there were a few public
infirmaries in cities of Merovingian Gaul and Lombard Italy, these were
associated with Easterners and were not promoted by native Western reli-
gious institutions. Thus, when the Knights' Hospital became famous in West-
ern Europe during the twelfth century, Latin Christians greeted this institu-
tion as something new. Second, we have seen that Byzantium and not Islamic
society provided the Knights with the inspiration for their Hospital in
Jerusalem. On the other hand, one must not underestimate the role of
native Latin impulses in inspiring the Hospitallers. The Knights were, after
all, part of a wide movement of lay brothers which began in eleventh-century
Germany. In the final analysis the adaptations wrought by the Hospitallers
on the Byzantine xenones created a new institution, inspired by the public
infirmaries of East Rome, but growing naturally from Western religious
movements.153
DUMBARTON OAKS
152 Cart. 46, p. 39.

153 I thank professors George Dennis and Michael Metzger of Catholic University for cor
ing the typescript and Mrs. B. Gutekunst of the Humanities Division, Mullen Library, Catholic
University, for her assistance in ordering and reserving the books for this project.

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The Knights of Saint John and The Hospitals of The Latin West

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The Knights of Saint John and the Hospitals of the Latin West

Author(s): Timothy S. Miller

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1. THE HOSPITALS OF THE WEST

The Knights' Hospital in Jerusalem was not entirely without precedent in

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H. Pirenne, Mohammed and Charlemagne (New York, 1939), pp. 79-96.

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17 W. Schonfeld, "Die Xenodochien in Italien und Frankreich im fruhen Mittelalter,"

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program to relieve the suffering caused by rapid urbanization. Though the

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34 The constitutions of this community of Augustinian canons is published by J. Leclercq,

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Salzburg assembled a group of lay brothers to whom he entrusted a hospice

40 Reicke, Spital, 1:56.

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51 Vita Roberti Arbrissello, MPL 162:1055.

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kingdom gave large tracts of land to the Hospitallers; in Europe, too,

56Cart. 20, p. 21; cart. 24, p. 25; cart. 33, p. 31.

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72 Reicke, Spital, 2:41, n. 4.

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the brothers in cases of violence or of concealed private property.78 These

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Western institutions such as Lanfranc's house at Canterbury or the public

2. THE HOSPITALS OF THE EAST AND THE ORIGINS

93 G. Dagron, "Les moines et la ville," Traveaux et Memoires 4 (1970), 250-52.

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Prokopios mentions its destruction in 532 and its restoration by Justinian

97 Prokopios, De aedificiis 1.2.14-17.

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102 Ibid., pp. 8-12.

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109 Ibid., pp. 371-72.

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Jerusalem by the eleventh century. A closer examination, however, of the

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rests primarily on the Historia of William, archbishop of Tyre, a reliable

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made in the workshops of Constantinople, to several churches of southern

127 Heyd, Commerce, 1: 102-3.

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The hospitals of Islam were, by contrast, not religious. Though pious

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140 "Typikon de la Kosmosotira," p. 53; Statutes: cart. 627, p. 426.

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152 Cart. 46, p. 39.

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