Hospitalci

Medieval Academy of America
The Knights of Saint John and the Hospitals of the Latin West
Author(s): Timothy S. Miller
Reviewed work(s):
Source: Speculum, Vol. 53, No. 4 (Oct., 1978), pp. 709-733
Published by: Medieval Academy of America
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THE KNIGHTS OF SAINT JOHN
AND THE HOSPITALS OF THE LATIN WEST
BY TIMOTHY S. MILLER
THE Knightsof SaintJohn, founded afterthe conquest of Jerusalem (1099),

were renowned in Europe as Christiansoldiers. 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 institutionsin the citiesof 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 firstLatin Christiansto organize a hospital for the
sick, and they assert that the roots of the new institutionare to be found
eitherin Islamic societyor in Byzantium.2In thisstudyI propose to examine
the Hospitallers and their infirmaryin more detail, concentratingon two
important questions. First, to what extent was the Knights' Hospital in
Jerusalemindeed somethingnew to Latin Christians,and to what extentwas
it a natural outgrowthof native European movements?Second, what impact
did Byzantiumand 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 stimulatinghospital 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 institutionsin the West that treated the sick, although the ter-
minology used in the sources does not always distinguishclearly between
hospitals and other houses of charity.
I L. Le Grand, Statutsd'Hotels-Dieuet de Leproseries

(Paris, 1901), and "Les Maisons-Dieu, leur
60 (1896), 95-134, emphasize the impor-
statutsau XIIIe siecle," Revue des questionshistoriques
tance of the Knights of Saint John in the development of hospitals in France. G. Schreiber,
"Byzantinischesund abendlandisches Hospital," Gemeinschaften des Mittelalters(Regensberg:
Munster,1948), p. 22, also attributesan importantrole in hospital developmentin the West to
the Knights.J. Riley-Smith,TheKnightsofSt.JohninJerusalem and Cyprus[1050-1310] (London,
1967), the most recent political historyof the order, mentions the influenceof 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 likelyinspiration.See also E. Wickerheimer,"Organisation et legislationsanitaires
au royaume franc de Jerusalem (1099-1291)," Archivesinternationales d'Histoiredes Sciences4
(1951), 699.
3 William McNeill, Plagues and Peoples (New York, 1976), pp. 59-63, deals in general withthe
phenomenon of urbanizationand diseases. C. Probst,"Das Hospitalwesen im hohen und spaten

Mittelalterund die geistliche und gesellschaftlicheStellung des Kranken," SudhoffsArchiv:
50 (1966), 246, emphasizes the importance of population
fur Wissenschaftsgeschichte
Zeitschrtft
increase and population concentration during the twelfthcentury in the development of
hospitals.
709

710 The Knightsof SaintJohn
Before 800 Latin documents used the Greek word xenodochium to describe
houses of public charity.Thereafter, the Latin word hospitalwas common,
though writersstill frequentlyemployed the Greek term.4Both xenodochium
and hospitalrefer to travelers'inns.5 Since wayfarersoften fell ill on thei
journeys both because of the hardshipsof medieval traveland because of the
new diseases encountered fromplace 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 withsome casual care for travel-
ers strickenby disease, but the termshospitaland xenodochium were used for
both institutions.6Though the Greek East developed a distinctiveword,
nosokomeion, for hospitals dedicated to the sick, the Latin West continued to
use the more general terms. Because of this confusion in terminologyone
must be careful to determinewhen medieval sources are describinga simple
hospice and when theyare referringto what we shall call a true hospital,i.e.,
an institutionwhich focuses attentionprimarilyon curing the diseased by
providing a strictregimen, medicine, and physicians.
The Latin documents from the Merovingian and Carolingian periods
frequentlymention hospices. These were often built next to monasteriesor
in the surviving Roman towns of Italy and southern Gaul. Upon closer
examination,however,veryfewof thesexenodochiaseem to have operated as
true hospitals. Though the hospice founded by King Childebert in Laon
during the sixthcenturywas designed to serve pilgrimsand to provide care
(cura) for the sick, there is no reference to a disciplined regimen for the
patients,to hospital wards, or to the activitiesof a physician.7Adalhard of
Corbie establisheda similarxenodochium in the eighthcentury.8His hospice,
like most of those in Gaul, resembled the xenodochium in ninth-centuryOr-
leans, which Theodulf, the Carolingian bishop and poet, described in a short
poem, "Here let the tiredreceive support,the languishingmedicine,and the
sorrowfuljoy."9
Two hospices in Merovingian Gaul, however, seem surely to have
functioned as true hospitals, one established by Bishop Praeiectus of Au-
vergne in Clermontduring the seventhcenturyand the other by an uniden-
tifiedbishop about the same time in Poitou. Both were small institutions,
housing twentypatients in Clermont and twelve in Poitou.10 In connection
4G. E. Gask and J. Todd, "The Origins of Hospitals" in Science,Medicine,and History:
Essayson
theEvolutionofScientificThoughtand MedicalPracticeWritten in Honourof CharlesSinger,ed. E. A.
Underwood (London, 1953), p. 130, and n. 24.
5 Concerning Greek terms see P. Koukoules, ByzantinonBios kai Politismos(Athens, 1948),
2:141; concerning the Latin termhospitalsee Du Cange, Glossarium Mediae et InfimaeLatinitatis,
s.v.
6 L. C. MacKinney,EarlyMedievalMedicinewithSpecial 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.

The Knightsof SaintJohn 711
withthese two hospitalsone ought to recall Henri Pirenne's thesisregarding
Merovingian Gaul. Throughout this period Syrians,Greeks, and Jews from
the Greek East inhabitedmany townsof Gaul both in permanentsettlements
and in temporarymerchant quarters." Describing the foundation of the
Clermont hospital, the Passio Praeiectiepiscopistates that Bishop Praeiectus
organized the xenodochium "followingthe customs of the orientals."'2 The
Latin texthere seems to mean thatthe bishop was observingEastern practice
in using his own propertyrather than church funds to finance the hospice.
The text,however,could also refer to the specialized medical nature of the
institution,a characteristicnot common in Frankish hospices. Whatever the
meaning, the passage indicates that Praeiectus was in contact with Eastern
traditions,most likelythroughthe oriental merchants,men who were famil-
iar withthe many true hospitals in the Eastern Empire and who could have
advised Praeiectus in ordering his establishment.
Two otherxenodochiaof the West seem to have been true hospitals,one in
VisigothicSpain, founded by Bishop Masona of Merida (573-606), and the
other operating in Rome during the seventhand eighthcenturies.13 Both of
these citieswere in close contactwiththe Greek East. At Merida many of the
bishops were Greeks and trade with Byzantium was brisk; at Rome men
fromthe eastern Mediterraneanwere oftenelected to the papacy, and Greek
monasteries were numerous.'4
Outside of these four examples the xenodochiaof the West do not appear
to have been true hospitals. Certainlythe hospices attached to Benedictine
monasterieswere not for the treatmentof the ill; theywere designed only to
house travelers.Although St. Benedict's Rule einphasized that Christ had
commanded his followersto care for all the sick,in practice it establishedan
infirmarylimited to sick monks.15 Thus, the plans for the great ninth-
centurymonasteryof St. Gall included a large, well-equipped hospital for
the monksbut provided as a public xenodochium a mere guest house, separate
from the cloister.16
The true hospitalsof 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 fromByzantiumunder the Carolingians,
the urban xenodochiadeclined. Moreover, as the Roman legal concepts of
H. Pirenne, Mohammedand 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,fabricarecuravit." See also MacKinney,
Medieval Medicine,pp. 176-77.
13 Concerning Merida, Paul the Deacon, De vita patrumemeritensium, MPL 80:139. See also
Luis Vazquez de Parga, Las Peregrinaciones a Santiago de Compostela(Madrid, 1948), 1:449-51.
Concerning Rome, LiberdiurnusRomanorum pontificum,ed. Hans Foerster (Bern, 1958), p. 124;
for the date of the Liber diurnus,see pp. 21-36.
14 Fr. Dvornik, Les Legendesde Constantineet de Methodevues de Byzance (Prague, 1933), pp.
285-91, discusses in detail the extentof Greek monastic settlementin Rome. Paul the Deacon,
De vita patrumemeritensium, MPL 80:128-30, demonstratesEastern contacts of the bishops of
Merida.
15BenedictiRegula, ed. R. Hanslik (Vienna, 1960), chap. 36, p. 95.
16
MacKinney, Medieval Medicine,p. 177.

corporate rights and legal personhood fell victim to the German idea of
Eigenkirchen,hospices establishedby privateowners often revertedto secular
use.'7 The xenodochiawhich managed to surviveusually became the property
of monastichouses which had no interestin maintainingelaborate hospices.
Most abbeys considered the hospices of secondary importance and aban-
doned them whenever theybecame a financialburden.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 fromthe early medieval West to Latin Christendomafter
the mid-pointof the eleventhcentury,i.e., to Europe afterthe beginningof
the urban revolution.We will consider, on the one hand, the demographic
trendsdeveloping in the West during thisperiod which establishedthe need
for true hospitals,and, on the other, the failure of native Western institu-
tions alone to meet thisneed, a failurewhich led the West to the Knightsof
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 inhabitantstripled between 1086 and 1346.20 Across the conti-
nent the population no doubt increased at a sirmilar rate, expanding arable
lands and swellingthe ranks of the urban populace.21 As a resultof growing
population and increased trade, European towns prospered, attractingex-
cess agriculturalworkers inside their walls by offeringthe 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 centersby 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 agriculturalcommunities; until the nineteenth
century they were unable to replenish their own populations. Increased
person-to-personcontact, sanitaryproblems caused by refuse and sewage,
contaminationof the water supply,and an inferiordiet compared to village
fare,brought illness to many town dwellers,and especiallyto the susceptible
immigrantswhose relativeisolationas peasants on the land had not provided
them with exposure to the varietyof diseases endemic to towns.23Thus
urban centersnot only gainfullyemployed some of the excess population of
17
W. Schonfeld, "Die Xenodochien in Italien und Frankreich im fruhen Mittelalter,"
Zeitschrift Rechtsgeschichte
der Savigny-Stiftungfiir 43, Kan. Abt. 12 (1922), 35-38.
18 2 vols. (Stuttgart,1932), 1:49.
S. Reicke, Das deutscheSpital und sein Rechtim Mittelalter,
19Concerning Bonn see Reicke, Spital, 1:49; concerning Constance see the Vita Sancti Coun-
radi altera, MGH SS 4:444.
20
MedievalPopulation(Albuquerque, New Mexico, 1948), establishesthat
J. C. Russell,British
the English population more than tripled between 1086 and 1346.
21 L. Genicot,"On the Evidence of Growthof Population in the West fromthe Eleventhto 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 EconomicHistory
of Europe (Cambridge, 1966), 2:160-67.
23 McNeill, Plagues and Peoples, p. 67.

the high Middle Ages, but they also acted as gruesome drains which debili-
tated or eliminated the biologicallyuninitiated.24No sincere Christiancould
have remained unmoved by the widespread disease in the bustlingtownsof
twelfth-and thirteenth-century Europe.
Robert of Arbrissel,one of the great religious activistsof the high Middle
Ages and founder of the famous monasteryat Fontevrault,was renowned
for his care of the poor and the sick.25Bernard of Clairvaux warned the
wealthybishops of Latin Europe to bear in mind the miseryof the poor
crowdingtheirepiscopal towns.26Finally,Radulf Ardens,an intellectualof the
early twelfthcentury,extolled the virtuesof the poor and sick, comparing
themto the apostles,and warned the richof theirpunishmentif theyfailed to
relieve the sufferingsof the unfortunate.Radulf portrayedthe 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 twelfthcenturyindicatesthat disease was rampant among the
landless men streamingto the growingcities.27
The new conditions in the towns of Europe demanded many kinds of
public philanthropicservices:simple hospices to shelterthe wandering poor,
alms for the hungryinside the cities'walls, and some sortof medical care for
the ill. Throughout twelfth-century Western Europe the church was devot-
ing more attentionto the physicalproblems of the poor, but a surveyof the
major religious movements of the West reveals that they did not sponsor
true hospitals. Some ascetic movements avoided philanthropyalmost com-
pletely,while other more worldlyreligious communitiesturned 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
Knightsof Saint John organized their Hospital in Jerusalem,one can detect
surprisinglylittledevelopment of public infirmariesin Latin Europe.
The old monastic houses of the West did not respond with any concrete
24 E.
Patzelt,"Pauvrete et Maladies," in PovertaetRicchezzanellaSpiritualitadeiSecoliXI e XII, 8
(Todi, 1969), 165-87, points out that references to the sick increase greatlyin the sources
describing conditions of the eleventh and twelfthcenturies, 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 conditionsduring those years.
J. M. Bienvenu, "Pauvrete, misereset chariteen Anjou aux XIe et XIIe siecles,"Le MoyenAge 82
(1966), 389-424, mentionsnatural disastersand resultantcrop failuresas an explanation for the
miseryamong some of the poor. A. M. Lazzarino Del Grosso,Societae Poterenella Germaniadel
XII Secolo: Gerhochdi Reichersberg (Florence, 1974), pp. 166-67, n. 197, notices the frequent
references to the paupereset infirmiin Gerhoch of Reichersberg's treatisesand suggests that
manyof these "infirm"had been disabled by war or sufferedmutilationas a punishment.These
scholars fail to indicate that the health problems caused by urbanization and closer human
contactwere significant.C. Probst,"Das Hospitalwesen,"p. 246, does emphasize urbanizationas
a cause of deterioratinghealth conditions among the poor of Western Europe.
25 Baudri de Bourgueil, Vita Roberti de Arbrissello,
MPL 162:1055.
26 Bernard of Clairvaux, Tractatusde moribus MPL 182:815-16.
et officioepiscoporum,
27 HomiliaeRadulfiArdentis, MPL 155:1963. Concerning Lazarus see E. Patzelt,"Pauvrete et
Maladies," p. 176, who melitionsthat beggars were called in Italy lazzaroni.See also Gerhoch of
Reichersberg,MPL 193:1070, who compares the poor of his time with Lazarus.

program to relieve the sufferingcaused by rapid urbanization. Though the
great abbey at Cluny, one of the centersof Benedictine monasticismduring
the eleventh and twelfthcentury,maintained two guest houses, neither of
these provided any special treatmentfor the ill.28 In the many Cluniac
monasteriesand priories along the pilgrimroutes to Corhpostela,the monks
did not offerany more to the traveler,sick or healthy,than theydid at the
mother house.29 Peter the Venerable, abbot of Cluny (1 122-1156), omitted
any statementabout care for the sick in his long exhortationon receiving
guests.30
By the late eleventh centuryWestern monasticism,an institutionincreas-
inglyunder attack from many quarters of society,reached a point of crisis.
Modern scholars have stressed that the holding of propertyand the osten-
tatious display of wealth by the old Benedictine abbeys were the grounds of
discontentvoiced against the monks.3' The Cistercianreformwas one solu-
tion to the problem of wealth, a movement creating abbeys humble in
appearance which collected no rents and which removed themselves still
fartherfrom the entanglementsof the world. As a consequence of their
contemplativenature, one would not expect to find the Cistercianspromot-
ing true hospitals. The order's statutesof 1134 provided care only for sick
monks.32 Moreover, in 1157 the general chapter specificallyforbade the
order's doctors to practiceoutside the monasteriesor to treatlaymen.33This
contemplative attitude, reinforced by the remote locations of Cistercian
abbeys, prevented the order from developing public infirmaries.
Besides the Cistercianmovement,there were, however,other attemptsto
steer the religious life in new directions. Although Citeaux criticized the
older Benedictine abbeys for theirworldliness,some communitiesof Augus-
tiniancanons accused them of avoiding the world, of failingto heed Christ's
command to serve others. Because these communitieswere located in the
episcopal towns especially subject to the pressures of rapid population in-
crease, theyfirstrecognized the need for a more philanthropicChristianity.
As testimonyto this new spirit stands a constitutionfor canons regular of
unknown provenance but dating surelyfrom the late eleventh century.The
281J. Evans, MonasticLife at Cluny[910-1157] (London, 1930), pp. 92-95. See also N. Hunt,
ClunyunderSt. Hugh (Notre Dame, Indiana, 1968), pp. 65-66 and 88, who observes that donors
to the monasteryoften required that they be admitted as monks to the monasterywhenever
theybecame ill or when theyreached old age. Such clauses reveal thatsocietyneeded a place for
its ill and infirm,but the lack of such facilitiesfor laymen forced wealthiersufferersto become
monks in order to receive adequate treatment.
29
Vizquez de Parga, Las Peregrinaciones, 1:450-51.
30 The Letters ofPetertheVenerable,ed. G. Constable (Cambridge, Mass., 1967), Letter 28, pp.
74-75.
31
Raoul Manselli, "Evangelismo e Povertt," in Povertaet Ricchezza,p. 25; J. Leclercq, "The
Monastic Crisis,"in Cluniac Monasticism in theCentralMiddleAges (Hamden, Conn., 1971), pp.
219-28.
32 Statutacapitulorum generaliumordiniscisterciensis, ed. J.-M. Canivez, 8 vols. (Louvain, 1933),
1:30.
33 Ibid., p. 65.

canons attacked the monks for their self-centeredasceticism and extolled
their own community'sactivityin ministeringto the spiritualand temporal
needs of men.34Though these canons did not establisha true hospital,they
were aware that Christexpected his disciples to do more than seek a distant
refuge for the practice of personal asceticism.35
Among the new communitiesof canons in twelfth-century Europe, the
most organized movement was that of St. Norbert. He founded his first
house at Premontreoutside Laon, prescribingan active,apostolic life for his
followers. These Premonstratensians,however, soon adopted the ascetic
spirit of the Cistercians and never became effectiveagainst the social and
religious problems of the towns. Nevertheless,the early years of St. Nor-
bert's order reveal a tension between the contemplativelife and the active
apostolic vocation.36Possiblyas a consequence of theirinitialactive orienta-
tion,the Premonstratensiansincluded in theirstatutesof 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
furtherdevelopment of this hospice, their concern for public medical care
indicates that reformingreligious men in the West were beginning to ap-
preciate the need for true hospitals.
The Augustinianrule, which regulated the lives of clerical canons such as
the Premonstratensians,provided the frameworkfor still another religious
movement of the twelfthcentury,the communitiesof lay brethren. These
seem to have developed firstin Germanyat the reformingabbey of Hirsau.
Under Abbot Wilhelm (1069-1091), some of the lay brothersor conversiof
Hirsau were organized as an independent communitysubordinate to the
abbey and were placed in charge of its hospice.38 Subsequently, such lay
brotherhoodsspread across Germanyand were in the words of the Chronicon
of Bernold, "in no way inferiorto the monks."39In 1121 the archbishop of
34 The constitutionsof this communityof Augustinian canons is published by J. Leclercq,
"Influence de Gregoire VII dans le reforme canoniale," Studi Gregoriani6 (Rome, 1959-61),
199-223. For the sectionscriticizingmonks and extollingthe 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 Entwicklungdes Augsburger Burgertums,"Bayerische
Akademieder Wissenschaften, Philologisch-Historische
Klasse, Sitzungsberichte
1969 (Munich, 1970),
22-23, who links the movementof 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 regulierset la vie economique des XIe et XIIe siecles,"in La Vita Communedel Clero
nei secoliXI e XII, 1 (Milan, 1962), 72-81. The new canonries were importantin ministeringto
the larger urban population and represented a break with the older cathedral chapters which
had inherited their structuresfrom the rural aristocraticsocietyof the Carolingian period.
35 Leclercq, "Gregoire VII," p. 218: "Ad discipulos autem quos dominus missitin messam
suam, quorum vicem canonici in eclesia tenent....
36 H. M. Colvin, The WhiteCanons of England (Oxford, 1951), pp. 6-8.
37Les Statutsde Premontre, ed. P1. F. Lefevre (Louvain, 1946), p. 60. In the thirteenthcentury
the canons also maintaineda number of hospitalsin England. See Colvin, WhiteCanons,p. 143.
38 Reicke, Spital, 2:50.
39 MGH SS 5:452: "[laicil qui, etsi habitu nec clericinec monachi videntur,nequaquam tamen
eis dispares in meritisfuisse creduntur."

Salzburg assembled a group of lay brothersto whom he entrusteda hospice
he himself had renovated.40Bishops and laymen followed this example,
founding throughoutGermany new xenodochiacompletelyfree 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 brothersrevived
them by elevating them to the central position of their religious lives.
France witnesseda parallel development. At FontevraultRobertof Arbris-
sel establishedat the beginningof the twelfthcenturyseveral hostels for the
poor and sick in which both male and female conversiserved as part of the
religious life.42In 1162 an independent house of lay brethrenwas minister-
ing to the poor in the townof Aubrac. The statuteswhich survivefromthat
communitysuggest 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 Canterburyin the late
eleventhcenturyand installedlay canons as attendants.44A foreignernamed
Rahere founded the famous hospice of St. Bartholomew, Smithfield,near
London in 1123, when he gathered an Augustinianbrotherhood and began
work on the dormitorybuilding.45
Mindful again of the difficultyin medieval Latin terminology,one must
consider whether these new hospices were true hospitals.46Neither Arch-
bishop Conrad at Salzburg (1123) nor the bishops of Hildesheim (1161)
and of Ulm (1183) mention the sick.47At Hildesheim the charterstates that
the increase in destitute persons in recent years had rendered the old
hospice obsolete, an observationindicatingonly that population pressures in
the countrysidewere pushing excess peasants into the citiesand swellingthe
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 xenodochiain Germany were functioningas true hospitals. In
England the situationwas similar. Most of the hospices reorganized under
Augustinian brothers were to shelter and feed the poor flowing into the
cities.49Archbishop Lanfranc's hospice at Canterbury,however, was an ex-
ception,for it seems to have served primarilythe diseased among the poor.50
40 Reicke, Spital, 1:56.
41 Ibid., p. 49.
42
MPL 162:1054-55.
Vita RobertiArbrissello,
43 Le Grand, Statuts,p. 16.
44 Monasticon Anglicanum,ed. William Dugdale, 6 vols. (London, 1830), 6, 2:615 [= Eadfmeri

HistoriaNovorumin Anglia, ed. M. Rule (London, 1884), p. 15].
45 J. C. Dickinson,The OriginsoftheAustinCanonsand TheirIntroduction intoEngland (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 hospitalisaptis pauperum receptaculisomnino careret ac
debita ipsis situs et angustia loci denegaret."
49 The hospice reorganized afterthe Norman conquest in York was constructed"pauperibus
ad ipsam civitatemconfluentibus."See MonasticonAnglicanum,6, 2:608.
50 Ibid., p. 615.

Many among the indigent fell ill because of unhealthy conditions in the
cities, as we observed earlier. Lanfranc's institutiongrew naturallyout of
health problems which inflictedthe paupers of his diocese. Granted the
widespread disease among Europe's poor in the twelfthcentury,it is surpris-
ing that the archbishop had no imitators.Even Fontevrault,which surely
treated the sick withspecial attention,did not operate a true hospital.51 The
statutesgoverning the brothersof the hospice in Aubrac do not once men-
tion infirmii but talk only of the poor guests of the house.52 During the
twelfthcentury,however,one importanthouse of Augustiniancanons began
to focus its charitableactivitieson the treatmentof the sick, the xenodochium
or hospitalin 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 firstsuperior of the brothers- they did not call themselves
knightsuntil the end of the twelfthcentury- was a layman supervisinga
xenodochium attached to a traditionalBenedictine 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
takingover the care of hospices at Hirsau and throughoutGermany.53The
firststatutesof the Jerusalem brotherhood, the Rule of Raymond du Puy,
were influencedby the regula of other Augustinian houses; by 1184-85 the
papacy classified the Hospitallers of Jerusalem among the Augustinian
communities.54Thus, the Knights and their hospice were part of a
European-wide movement of lay brotherswho were dedicated to maintain-
ing houses of public charity.
The hospice of the Hospitallers, however, was distinct from the other
xenodochiain the lands of Latin Europe in that it very early exhibited the
attributesof a true hospital. Though we have no one document which
describes in every detail how the twelfth-century Hospital of the Knights
functionedor what was its daily routine,stillit is possible to collate passages
fromthe statutesof the order and frompapal lettersand pilgrimaccounts to
obtain a fairlyclear 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,Godfreyof Bouillon, granted many estates to Gerard and his follow-
ers.55Under the firstking of Jerusalem,Baldwin (1 100-1 118), nobles of the
51Vita RobertiArbrissello,
MPL 162:1055.
52
Le Grand, Statuts,pp. 16-21.
53 William of Tyre, Historiarerumin partibustransrnarinis gestarum,in Recueildes historiens des
croisades.Historiensoccidentaux(Paris, 1884), 1:825-26, reflectsa developmentvery similarto 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, Cartulairegeneral d'ordredes Hospitaliersde St.-Jeande Jrusalem
(1100-1310), ed. J. Delaville le Roulx, 4 vols. (Paris, 1894), l:cart. 690, p. 458 (cited hereafter
only by cartularynumber and page).
55Cart. 1, p. 1.

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 congregationand officallyrecognized it as a corporationwhich 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-thirdof his realm.58All these early documents
acknowledge an institution,usually called the Hospital, maintained by
Gerard and the members of his order for the aid of pilgrimsand the poor.
These documents do not indicate that Gerard supervised a true hospital;
neither the papal documents nor the testamentsof nobles describe care for
the sick. The firstsubstantialevidence of an infirmaryis 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 affirmingcustoms already in use, reflectsconditions 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 charitablepractices and
treatmentof the sick. Statingclearlythat the order's wealth is for the poor,
chapter six of the Rule taxes the far-flungestatesone-thirdof theirrevenue
for the Hospital.60Chapters one and two mentionthe brothers'dutyto act as
servants of the poor, but only chapter sixteen describes services provided
exclusivelyfor the sick.61 According to this chapter the Hospitallers must
greet the sufferingman, have him confess his sins, and administer the
Eucharist. After ministeringto his spiritual needs, the brothers ought to
carryhim 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 confirmsthat
the Hospitallers' charitiesin Jerusalem included all formsof almsgiving,it
provides evidence that the house of the sick was a prior concern. Afterits
expenses had been met, the rest of the resources,collected fromthe order's
estates,were distributedas alms.62Moreover, among the cartulariesof the
order an official styled the custosHospitalis infirmorum appears in 1155;
Pontius is the firstto hold this office,followed in 1163 by a certain Piota.63
Such an officeindicatesan organized institutionwhose main dutywas minis-
tering to the infirm.
The most detailed informationon the Hospital during the twelfthcentury
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 hereafteras 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.

1177 to 1187. The general Chapter of 1182 probably approved these stat-
utes as a response to growingcriticismof the order's militaryinvolvement,or
perhaps it employed them to correctabuses in the Hospital's administration
due to increased militaryexpenses.64 As a result, the Statutes of 1182, as
opposed to the Rule of Raymond du Puy, deal almost exclusivelywith the
physicaloperation of the Hospital. Chapter four requires that the brothers
maintain four wise doctors to diagnose diseases and to prescribe medicine;
the followingchaptersregulate diet, sleeping arrangements,and clothingfor
the patients. The brethren must also guard the sick day and night and
provide them withservants.65A papal letterof 1184 mentionsnot only four
doctors but also four surgeons in the Hospital.66
In their brief descriptionsthe pilgrims of the late twelfthcentury 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.67Theodoricus, who visited Jerusalem in 1187, was
impressed by the size of the institutionand the number of patients.68He
estimatedthatmore than 1,000 patientswere there,whileJohn of Wurzburg
put the number at 2,000. Though these figuresare no doubt exaggerated,
they do reflectthe Hospital's impressivesize. Both pilgrimsobserved sepa-
rate rooms which probably served as wards.
The statutesof the order and the pilgrims'accounts leave no doubt that
the Hospital of St. John in Jerusalemprovided true care for the ill,not mere
sustenance. It offered the services of doctors and surgeons, a specificdiet,
and the medicines available to medieval physicians. Thus, the available
sources clearly suggest that by the second half of the twelfthcentury 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 letterof 1113 Pope Paschal referred to
xenodochiaand ptochiaof 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,specifiedin
1137 that the Knights treated the infirmin the houses of his kingdom.70
Moreover,in the Statutesof Roger des Moulins (1182), one paragraph refers
specificallyto domusinfirmorum in the priories outside Jerusalem and to the
commanders' responsibilitiesto serve the sick in these houses.7' In the thir-
teenthcenturythe order's conventin 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 militaryinvolvement.
65
Statutes of Roger des Moulins (cited hereafter as Statutes): cart. 627, pp. 426-27.
66 Cart. 690, p. 458.
67
John of Wiirzburg,"DescriptioTerrae Sanctae," ed. T. Tobler in DescriptionesTerraeSanctae
ex saeculo VIII, IX, XII, et XV (Leipzig, 1874), p. 159.
68 Theoderici Libellusde 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.

aid the infirm.72These examples indicate thatthe larger prioriesin the West
were also providingtrue hospital care. Though there are no statementsthat
these hospitalsemployed doctors,indirecttestimonyfromthe Statutesof the
Teutonic Knightssuggeststhat theydid.73Thus, not only the great Hospital
in Jerusalembut also the smaller houses in Western Europe were function-
ing as true hospitals by the late twelfthcentury.
Toward the end of the twelfthcenturyhospices other than those of the
Knights began to focus more care on the treatmentof the sick. A certain
Guy organized a community of Augustinian brothers to administer a
xenodochium in the cityof Montpellier. By 1204 these men were managing
hospices in Rome and other southern cities.74The statutesof Guy's com-
munities along with the correspondence of Innocent III prove beyond a
doubt that these lay brotherswere attendingthe sick in theirhospices.75Of
even greater significance,however, for the historyof hospitals in the Latin
West was the close dependence of these statuteson the Rule of Raymond du
Puy. Over one thirdof the Statutesof Montpellierderived fromthe Rule of
Raymond du Puy, including the crucial section describing the reception of
the sick and the care they were to receive.76
In northernand central France independent hospice communitiesbegan
to commit their constitutionsto writingabout the same time that the hos-
pices of Montpellierwere proliferatingin southern France. The Hotel-Dieu
(hospice) in Angers, which published its rules about 1200, was the firstof
these independent houses to include specific references to the diseased.
Although the heading of these statutesrefers to the institutiononly as the
House of the Poor, chapters five,six, and seven outline specificduties which
the brothers must carry out in locating the ill inside the city,in bringing
them to the hospice, and in attendingtheirspiritualand physicalneeds. The
Hotel-Dieu in Angers borrowed these regulationsconcerningthe care of the
sick directlyfrom 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 writtenregula-
tions,using the Rule of Raymond du Puy as the immediate archetypeboth
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, pointsout thatthe statutesof 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 Hospitalariorumin pauperibus et infirmis"(quoted froma Bull
of Innocent III by Le Grand, "Les Maisons-Dieu," p. 104). Thus it is likelythat the practice
concerning hiring doctors for provincial infirmaries,described in the statutesof the Teutonic
Knights, came from the customs of the Hospitallers.
74 Innocentii III regesta,MPL 214:85; Regula ordinisSanctiSpiritusde Saxia, MPL 217: 1130-31.
75 Le Grand, "Les Maisons-Dieu," p. 105, observes thatthe only extantcopy of statutesfor the
house at Montpellierdates 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.

the brothersin cases of violence or of concealed private property.78These
statutesof 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 committingits rules to writingin 1217, the Hotel-Dieu at Paris also
borrowed the chapters regarding the reception and treatmentof the sick
fromthe Rule of Raymond du Puy and even adopted several sectionsof the
Statutes of Roger des Moulins, the second body of Hospitaller legislation,
concerningnight-timesupervisionand the provisionof clothingfor 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 twelfthcenturymarks a dramaticchange in the
orientationof hospices. When the Teutonic Knightsbecame an independent
militaryorder in c. 1190 theyaccepted the Hospitaller disciplinefor 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 formerlybeen managed by
independent houses of lay brothers.82Their statutes,issued in 1240, testify
that theirhospitals maintained nursing sistersand male servantsto 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 WesternEurope the late twelfthcenturywitnesseda dynamic
increase in the number of hospices influencedby the Rule of Raymond du
Puy and the Statutes of Roger des Moulins. But again, one must examine
carefullythese new foundations of the high Middle Ages to confirmtheir
functioningas true hospitals.Though the statutesof the hospice at Montpel-
lier do not mention physiciansor special medicines, they require remedial
baths administeredby the nursingsisters.84More importantly,by stipulating
that the brothersshould search the citystreetsonce a week and carry back
the sick to the hospital, they demonstratethat this hospice was no longer a
travelers'inn or a simple poor house but was concentratingits effortson
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 constitutionsde 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 ordinisS. Spiritusde Saxia, MPL 217:1145-46.
85 Le Grand, Statuts,p. 23, and n. 1.

Though the documents of the Hotel-Dieu at Paris from the twelfthcen-
turydo not once referto the treatmentof patients,at the end of the century,
at the very time many of the urban hospices were adopting the regulations
of the Hospitallers,theybegin to speak exclusivelyof the sick.86In spite of
frequent allusions to an infirmarythe Parisian statutes of the thirteenth
centurymake no provision for a resident doctor.87The cartularies of the
community,however, testifythat in 1221 a surgeon was treatingthe bed-
ridden in the infirmaryand thatin 1231 a doctor practicedin the hospital.88
On the other hand, these same sources do not record before the fourteenth
centuryresidentdoctors such as those of the Hospital in Jerusalem.89Never-
theless, that a physician and a surgeon treated patients during the early
thirteenthcentury indicates that the Hotel-Dieu was by that time a true
hospital. Though a modest operation compared to the Hospital in
Jerusalem,it now concentratedon the treatmentof the sick as its principal
goal. Moreover,Jacques de Vitry,a man trained in Paris and widelytraveled
in the eastern Mediterranean,classifiedthe 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 eleventhand twelfthcenturieswhen Europe's growingpopula-
tion, more mobile patterns, and urban centers began to spread disease
among the poorest class, the native institutionsof Western Christianity
responded slowly. There are some notable exceptions. As we have seen,
Lanfranc founded a hospice at Canterburywhich seems to have functioned
as a true hospital; at FontevraultRobert of Arbrisselofferedspecial charity
to the diseased. Finally, at Premontre the followersof St. Norbert treated
laymen who sufferedfromdisease. Despite theirearnest effortsto 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
edificewhose very size and whose location among the holy places helped to
fire the religious sensibilitiesof Western Europeans. Frederick Barbarossa
(1152-1190) praised the Hospital for its inestimableworksof mercyand for
the practiceof charity,whichit demonstratedon an extraordinaryscale.91In
his exuberance Pope Celestine III (1191-1198) linked the Hospital with
Christhimself,maintainingthat the Savior had left the edifice as a miracu-
lous giftfor mankind and that the Virgin had rested there.92Such apocry-
phal links between the Hospital and the persons of the New Testament
increased its prestigeand gave it influencefar exceeding the impactof other
86
E. Coyecque,L'Hotel-dieudeParis au moyenage: Histoireetdocuments
(Paris, 1891), p. 62 and n. 3.
87
Le Grand, Statuts,pp. 43-53.
88Coyecque, L'Hotel-Dieu,p. 100.
89 Ibid., p. 97.
90HistoriaoccidentalisofJacquesde Vitry,ed. J. F. Hinnebusch (Fribourg, 1972), pp. 149-50.
91 Cart. 270, p. 203.
92Cart. 911, pp. 577-78.

Western institutionssuch as Lanfranc's house at Canterburyor the public
infirmaryat Premontre.The Hospital thus inspired men of Latin Christen-
dom by providing a living model of Christian charitywhich 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 thatWesternEurope 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 citysubject to Byzantine
and Arab influences. In the Islamic lands and in the East Roman Empire
institutionshad flourishedfor centuries which could well have affectedthe
Hospitallers in developing their infirmary.
In Byzantiumtrue hospitals had been open most probablysince the reign
of Constantius (337-361), although positive evidence does not appear until
the sixthcentury.During the fourthcenturya religious movementinspired
by Eustathius of Sabasteia developed a form of urban monasticismwhose
adherents did not live as hermitsor dwell in large cenobitic monasteriesin
the countryside but rather formed smaller urban communities (synoikiai)
which took part in the life of the city.93Among the institutionsinspired by
Eustathiusand his followerswere charitablehouses 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
establishedecclesiasticalinstitutionsto relieve the sufferingof 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 definitelytrue
hospitals. Nevertheless, the sources clearly reveal that urban Christian
movementsin the East had very soon recognized the need to provide care
for the sick and unfortunatein their midst.95Eustathius 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'ssuccessful effortsto incorporate them into the or-
thodox episcopal structureenshrined these agents of practicalcharityamong
the hallowed traditionsof Eastern Christianity.96
Among the philanthropicinstitutionsof East Rome the xenon(xenodochion)
of Sampson is the firstwhich the sources describe clearly as a true hospital.
93 G. Dagron, "Les moines et la ville,"Traveauxet Memoires 4 (1970), 250-52.
94 Ibid., pp. 247-52; Regulae breviustractatae,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
stressesthe disruptionthe urban monks caused and examines the role of the Greek fathersin
tryingto subdue them.

Prokopios mentions its destructionin 532 and its restorationby Justinian
(52 7-565).97 TheMiraclesofSaintArtemios, a saint'slifefromthe earlyseventh
century,supplements Prokopios's account with some interestingdetails. A
certain Stephen, a deacon of Sancta Sophia, sufferingfrom an infectionof
the groin, entrustedhimselfto the surgeons at the Sampson xenon.Though
he had a house and familyin Constantinople,the surgeons committedhim
to the xenonbed for three days for an operation.98The Sampson xenonwas
thus a true hospital withresidentsurgeons and beds for patients.Moreover,
though it is termed a xenon (Greek for hospital), it offered treatmentto a
resident of Constantinople who was also a man of some substance. The
Sampson hospital was thus not an inn or a place offeringsimple care to the
poverty-stricken ill but was an institutionfor 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
patternsof the East Roman Empire. Constantinoplewas continuallyattract-
ing from the provinces men of all classes who came for ecclesiastical,com-
mercial,and governmentalreasons. In such an entrepotimmigrantsas well
as old residentswere constantlyexposed to new microbes.Both endemic and
epidemic diseases created such an unhealthy environment that even the
wealthy had difficultysurvivingfor many generations.99Faced with such
human miserythe Constantinopolitanchurch 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 communitiesof urban
monks, the Eustathian synoikoi, were already dedicated to serving lay town
dwellers.100In the Eustathian movement the monks themselvestreated the
sick,but gradually a traditiondeveloped that the monks were not to partici-
pate in the actual work of the public infirmary.Still, Eastern monasteries
continued activelyto support true hospitals and many other public philan-
thropic institutions,while in the West the Benedictine abbeys seemed un-
comfortableserving laymen and frequentlyallowed even their simple hos-
pices to deteriorate. True hospitals ministered to the city populations
throughout the historyof the Greek empire; some of the monastic typika
which outline in detail the functioningof these hospitalshave survived. One
such typikon, drawn up by Emperor John II Komnenos (1 118-1143) to estab-
lish the imperialmonasteryof the Pantokrator,provides a detailed outline of
procedures in itspublic infirmary.101In thishospitala staffof thirty-six
served
thirty-eightmale patients, while another eleven persons attended twelve
97 Prokopios, De aedificiis1.2.14-17.
ed. A. Papadopoulos-Kerameus, Varia GraecaSacra (Petersburg,1909),
98Miraculae S. Artemii,
pp. 25-28.
99R. Jenkins,"Social Life in the ByzantineEmpire," in The Cambridge MedievalHistory(Cam-
bridge, 1967), 4, 2:87-88.
100For a general discussion of nosokomeiasee Koukoules, Bios, 2:141-47.
101A new criticaledition with introductionand index has been published by P. Gautier, "Le
Typikon du Christ Sauveur Pantocrator,"Revue des EtudesByzantines32 (1974), 1-145.

female sufferers.The staffincluded surgeons, chief doctors, simple physi-
cians, various grades of assistants,and manual servants.Moreover, the typi-
kon divided patientsand staffinto fivespecialized wards. The entiremedical
complex was supervised by two administrators,one of whom, the oikonomos,
was perhaps a monk of the monastic community.102
The typikon of the Pantokratordemonstratesclearly that this institution
was a true hospital. Moreover, a seventh-centuryhagiographical text indi-
cates that the Pantokrator was not unique in Byzantium.103There were
apparentlynumerous hospitals organized along the same lines as the Com-
nenian xenon of the twelfth century.104Thus, from the sixth-century
Sampson xenon to the twelfthcentury when the Knights of Saint John
developed their medical services in Jerusalem, the East Roman Empire
possessed true hospitalswhichcould well have provided an archetypeforthe
early Hospitallers.
In the Moslem lands of the eastern Mediterranean true hospitals had
opened theirdoors in the reign of Harun-al-Raschid(786-809), who estab-
lished in his capital cityof Baghdad a bimaristan (Persian: house of the sick)
which bore his name.105Harun was indirectlyinfluenced by Byzantium in
organizinghis hospital since Djibra'il b. Bakhtishu,the man-who advised him
on itsorganizationand was its firstdirector,was a Christianof the Nestorian
creed from the hospital of Djundaysabur in Khuzistan. Here Nestorians
fleeingByzantinepersecutionin the fifthand sixthcenturieshad established
a true hospital with the support of the Sassanid dynasty.106 By the time of
Harun's reign,thishospital and attendantmedical 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-blicworks. Constructinghospitals was one expression of a ruler's
concern for his subjects. Thus, the Buwayhid prince, Adud al-Dawlah,
opened the greatestof 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. Artemii28-31 mentionsarchiatroiand hyperourgoi at the Christodoulos,two
of the Pantokrator.Moreover, the archiatroi
classes of physicianswhich appear also in the typikon
of the Christodoulosxenonworked in monthlyshiftsjust as the physiciansof the Pantokrator.
For a summaryof the historyof true hospitalsin Byzantiumsee A. Philipsborn,"Der Fortschrittin
der Entwicklungdes byzantinischenKrankenhauswesens,"Byzantinische 54 (1961), 338-
Zeitschrift
65.
105 S. Hamarneh, "Development of Hospitals in Islam,"Journalof theHistory ofMedicineand
Allied Sciences17 (1962), 367-68.
of Islam (London, 1965), 2:1120.
106 Ibid., pp. 367-68; Encyclopedia
107Encyclopedia of Islam (London, 1960), 1:1223.

108
Hamarneh, "Hospitals in Islam," pp. 369-70.

From Baghdad true hospitals spread to other Moslem cities; one of the
most illustriouswas built by the Turkish emir, Nur al-Din, in Damascus in
1156. Ibn Djubayr, the famous Spanish travelerof the late twelfthcentury,
left an account of the al-Nuri hospital's routine wherein he mentions daily
rounds conducted by the physicians and careful writtenrecords of pre-
scribed treatments.109
Besides the hospitals treatedhere, there were manyother 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 citieswith one
another and withsmaller urban centers,creatingan environmentconducive
to the spread of diseases. By supporting hospitals the caliphs and newer
princely clans attempted to gain popularity among the city masses whose
urban habitatconstantlythreatenedthemwithsudden illnesses.-12 So, too, in
Constantinople and in the large Byzantine towns of Anatolia the sea
terminiof overland caravan routes to India and the Far East - the Greeks
sufferedfromsimilar microbe attacks.113 Both the Byzantine emperors and
the orthodox church realized earlyin the empire's development thatpolitical
and doctrinal stabilityin urban centers required conspicuous support of
public charities,including care for the many who sufferedfrom disease.14
As a resultof economic and urban conditionsboth Byzantiumand Islam had
perforceorganized caritativeinstitutions,including true hospitals,on a scale
unknown to the agrarian West. In either society were institutionswhich
could have served as models for the Hospital in Jerusalem.
J. Riley-Smith,the most recent historian of the Knights of Saint John,
statesthatArab medical centersmost probablyinspired the firstHospitallers,
suggestingas grounds for his supposition the Arabs' political domination of
Palestine.15 Since 638 the Arabs had controlledJerusalem. 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 Encyclopediaof Islam, 1:898-99. See also Middle EasternCities,ed. M. Lapidus (Berkeley,
1969), pp. 21-25.
112
Hamarneh, "Hospitals in Islam," pp. 38041.
113
Schreiber,"Hospital," pp. 23-24; concerningAnatolian cities,see Sp. Vryonis,The Decline
of Medieval Hellenismin Asia Minor and theProcessof Islamization from theElevenththroughthe
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 Constantinopleto organize hospitals and other caritativeinstitutions.

I" Riley-Smith,Knights,p. 335; Hans Prutz, Die geistlichen Ritterorden(Berlin, 1908), p., 39.

Jerusalem by the eleventh century.A closer examination, however, of the
balance of power in medieval Palestine,combined witha carefulstudyof the
Knights' origins, demonstrates that Byzantinexenoneswere the models for
the Hospital.
Before the Arab conquest of JerusalemByzantinemonasteriesand philan-
thropic institutionsincluding true hospitals had operated in the Holy City.
During the fifthcentury Saint Theodosios opened two treatmentcenters
near Jerusalem,one for sick laymen and one for ailing monks.116 Afterthe
Arabs took over Palestine,ByzantineChristianinstitutionsdeclined, but they
did not disappear. From the seventh to the eleventh century orthodox
patriarchscontinued to sit in the city.Besides the continual presence of an
organized church in the region, Palestinewas subject to East Roman political
influenceduring 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,receivingenvoysfrommany citiesincludingJerusalem.117 Though the
emperor John Tzimiskes (969-977) occupied Caesarea, only fiftykilometers
fromJerusalem, the Holy City itselfnever came under Byzantine political
control. Nevertheless,throughoutmuch of the eleventh centurythe Greek
emperors played an importantrole in Jerusalem as the protectorsof the
Christiansthere. When Constantine IX (1042-1055) undertook the recon-
structionof the Church of the Holy Sepulchre, Moslem and Christiancon-
temporaries agreed that Christianswere almost in control of Jerusalem; a
rumor circulated that the emperor himselfwas inside the city.118
Though Byzantine prestige in the Holy Land sufferedseverelywith the
attacksof the Turks in the late eleventh century,it asserted itselfagain 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 theiroverlord Emperor Manuel I
(1143-1180).119
Having considered the Byzantineinfluencein Palestine,let us outline now
the specificevents and institutionswhich gave birthto the Knightsof Saint
John and theirHospital. In the twelfthand thirteenthcenturiestwo versions
of the Knights' origins circulated. The firstwas apocryphal, stressing a
biblical foundationand placing the Hospital in the midstof New Testament
events.The second traced its foundationto Amalfitanmerchantswho traded
regularlyin Jerusalem during the eleventh century.120This second account
116
des Theodorosund Kyrillos,ed. H. Usener (Leipzig, 1890), p.
Der Heilige Theodosios:Schriften
41.
117
G. Ostrogorsky,A Historyof theByzantineState (New Jersey,1969), pp. 297-98; S. Runci-
man, A Historyof the Crusades(Cambridge, 1968), 1:31.
118
G. Schlumberger,L'Epopee byzantine(Paris, 1905), 3:23, 131, 203-4; Runciman, Crusades,
1:36-37.
119
Runciman,Crusades,2:350; Ostrogorsky,ByzantineState,p. 386.
Knights,pp. 32-34.
120 Riley-Smith,

rests primarilyon 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'saccount, writtenbetween 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
Synthesizingthese various sources, one obtains a coherent picture of the
Hospital's foundation. Sometime after the end of the Christianpersecution
under the Egyptiancaliph, al-Hakim (1014), Amalfitanmerchantsrequested
permissionto restorethe old Latin monasteryand -hospiceof St. Mary. Once
the refurbishingwas complete, theystaffedthe 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 merchantsalso founded a conventof nuns to administera hospice for
women. During the eleventh century the number of pilgrims and poor
travelersfromthe West continued to increase so thatthe Amalfitansdecided
to build a third hospice and church for all poor travelers regardless of
origin. They entrusted this institutionto lay brothers,the future Hospital-
lers, whose prior was appointed by the abbot of St. Mary's.122Shortlyafter
the firstcrusade these brothersunder theirprior Gerard had organized true
hospital services in their hospice.
Though both Islamic and Byzantineinfirmariescould have influencedthe
brothers ih developing their xenodochiumfor the sick, the historyof the
Hospital's foundationindicatesa Byzantinerather than a Moslem archetype.
First,Amalfi,the cityfrom which the founders of the Hospital hailed, had
closer ties with Byzahtium than any other Western community-with the
exception of Venice.123Moreover, Amalfitansof the eleventh centurywere
in contact with orthodox monasticism,since theyhad founded in the reign
of John Tzimiskes (969-976) a monasteryfor theircitizenson Mount Athos
and -a little later organized a religious house in Constantinople itself.124
Through this close relationship with Eastern religious houses they must
surelyhave learned of the Eastern monks' dedication to the maintenance of
hospitals. Second, a certain Mauro and his son Pantaleone, the chief con-
tributorsto the Amalfitanreligious houses in Jerusalem,were membersof a
familywith close ties-to the Eastern Empire.125Mauro himselfpossessed a
palazzo in Constantinople; Pantaleone had received the title of consul
(hypatos)fromEmperor ConstantineX (1059-1067) as a reward for support-
ing the Byzantinegovernmentof southern Italy.126He also gave gold doors,
121
Ibid., pp. 34-36; William of Tyre, Historiarerumin transmarinis gestarum,1:822-26.
122
The chronologyof the Amalfitanfoundation is worked out by Riley-Smith,Knights,pp.
34-35.
123J. H. Pryor,"The Origins of the Co-mmendaContract,"SPECULUM 52 (1977), 14 and 26.
124
A. G. Paspates, ByzantinaiMeletai Tbpographikaikai Historikai(Constantinople, 1877), pp.
137-38.
125
Aime of Monte Cassino, L'ystoirede li Normant,ed. V. de Bartholomaeis,Fontiper la storYia
d'Italia. Scrittori
76 (Rome, 1935), p. 342.
126
Ibid., p. 342; W. Heyd, Histoiredu Commerce du Levant (Leipzig, 1936), 1:100-101.

made in the workshops of Constantinople,to several churches of southern
Italy.127
Third, the very church around which the Amalfitansconstructed the
Hospital indicates a link with Byzantium. These merchants from Italy did
not build a totallynew structurefor the church and hospice outside the
monasteryof 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 originallyto Saint John the Baptist by Byzan-
tines during the fifthcentury.The great orthodox patriarchof Alexandria,
John the Almoner, had restored the church about 626, confusing later
generationsas to whichJohn was the building's patron saint.128A document
of the early ninth century is the last to refer to the church as active.129
Thereafter,one cannot determinewhetherit remained open as a Byzantine
shrine, but, since there were no major upheavals in Palestine until the
caliphate of al-Hakim, one would suspect thatorthodox Christianscontinued
to use it.
The Georgian version of "The Capture of Jerusalem" by Antiochus
Strategosmentionsa gerokomeion or hospital forthe care of the aged attached
to thischurch of St. John in 614.130 A gerokomeion in the East Roman Empire
resembled a true hospital and included in its constitutionrules 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
formerlybeen the chapel of a similar orthodox philanthropicinstitution.
The Amalfitanoriginsof the Hospital, the East Roman connectionsof the
Mauro family,and the Byzantine historyof the Knights' conventual church
all demonstratea close link between orthodox traditionsand the new Latin
house in Jerusalem. But more important for our argument than these
specificindicationsof Byzantine influenceis the Hospital's intenselyChris-
tian nature. It was, first,a religious house, staffedby lay conversisubject
originallyto a Benedictine abbey and later to theirown master. Second, its
brotherssaw labor in its infirmaryas the practice of Christianvirtueand as
an integral part of the religious life. Finally, it incorporated prayer and
liturgyin the prescribed treatmentof the ill.132
These specificallyreligious practices the Hospital shared with the xenones
of Byzantium.First,all orthodox houses were associated withmonasteriesor
127
Heyd, Commerce,1: 102-3.
128
H. Vincent and F.-M. Abel, Jerusalem:Recherches de topographie,
d'archeologieet d'histoire
(Paris, 1922), 2:645-46; Riley-Smith,Knights,pp. 34-35.
129 "Commemoratorum de casis dei vel monasteriis,"in ItineraHierosolymitana et descriptiones
TerraeSanctae, 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 essentialcharacteristicsof the Hospital are apparent fromthe Rule: cart. 70,
pp. 62-68; and the Statutes:cart. 627, pp. 425-26. See also the letterof Pope Lucius III, cart.
634, p. 431.

churches; from the Eustathian houses of the fourthcenturyto the Panto-
kratorof Comnenian Constantinoplemonasticcommunitiesadministeredthe
true hospitals of the empire.133 Second, the typikaoutlining 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
sentimentsoften moved the caliphs and princes to set up hospitals and to
endow them richly,their organization was secular.136It is unlikelythat the
secular infirmaries of the "infidel" Moslems could have inspired so
thoroughlya Christian institutionas the Hospital.
If, indeed, the Hospital in Jerusalem inheriteditscustoms fromByzantine
hospitals, one would expect to find concordances between the rules of
Raymond du Puy and Roger des Moulins on the one hand and the typikaof
East Roman institutionson the other. The Hospital has most often been
compared with the Pantokratorand, surely, there are some similarities.137
The differences,however, between the institutionin Jerusalem and the
Pantokratorare striking.The Constantinopolitanhospital maintaineda large
staffof doctors,divided the patientsinto fivespecificwards, required medic-
inal baths, and prescribed many other routines which are not found at the
Hospital.'38 One must remember,however,that the Pantokratorwas one of
the richest of infirmaries,located in Constantinople at the very center of
Byzantine societywhere it enjoyed imperial patronage and the support of a
well-organizedmedical 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 favorableresults.The
typikon of one such hospital survivesfrom the monasteryof 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 monasticoriginsof philanthropichouses and hospitalsin Byzantiumsee above, p.
723. For the monasticconnectionsof the Sampson xenonsee R. Janin,La Geographie Ecclesiastique
de l'Ernpire
Byzantine,Pt. 1: La Siegede Constantinople
etle Patriarchat vol. 3: Les Egliseset
Oecumninique,
les rnonasteres(Paris, 1969), p. 562. Concerning the Pantokratorsee 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,Bulletinde l'Institut archeologique russea Constantinople13 (1908), 53.
135 "Le Typikon du Pantocrator,"pp. 99, 11. 1154-61 concerning the liturgies,p. 89, 11.
1002-5, concerning confessions.

136
Hamarneh, "Hospitals in Islam," pp. 379-80; Encyclopediaof Islam, 2:1120.
137
Schreiber, "Hospital," pp. 3-79; Riley-Smith,Knights,p. 335. Regarding confessions"Le
Typikon du Pantocrator,"p. 89, 11. 1002-5, cf. Rule, chap. 16: cart. 70, p. 67. Regarding
liturgicalcandles "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.

hegoumen(abbot). Its rule provided specificinstructionsfor beds, coverlets,
and clothing for the patients,specificallycaps, shirts,and cloaks. The Stat-
utes of Roger des Moulins are parallel, allottinga bed, a coverlet,and a cap
withcloak and slippers to each patient.140The number of servantsassigned
to wait on the patientswas veryclose in the two houses, eightat Kosmosotira
and nine at Jerusalem.141 Moreover, both hospitals included the liturgy
among the prescribed routines and required fittingburials for patientswho
died while under treatment.142 Finally,unlike the Pantokrator,Kosmosotira
did not possess a highly specialized staffof physicians but only a single
doctor and an adequate supply of medicine, a requirement in the same
spiritas the Hospital's provisionsfor fourwise doctors,knowledgeable in the
preparation of necessary medicines.143
Although the Statutesof Jerusalemresemble in many details the typikon of
Kosmosotira,this correspondence does not imply that the great Hospital of
the Knights borrowed its customs directlyfrom the monasteryat Ainos. It
indicates rather how the general practices in Byzantine xenones,practices
varyingfrominstitutionto institution,formedthe traditionwhich impressed
the early Hospitallers. Whether the Amalfitansdrew up guidelines for their
hospital patterned on xenoneswhich theyhad seen on Athos or in Constan-
tinople,or whethersome house in Jerusalem,perhaps even the old geroko-
meion of St. John, was the exemplar is not clear, but that the hospitalinstitu-
tions of Byzantium inspired the Amalfitan founders and the Hospitallers
who succeeded them seems certain.
The Hospitallers did not simply adopt the Byzantine xenonesand their
orthodox institutions;they altered these traditions in important ways to
adapt them to the Latin Christianworld. First,the Knights freed themselves
from any connection with their parent house of St. Mary's. Basil of Cap-
padocia and John Chrysostomhad successfullyincorporated the support of
charitable institutionsinto the fabric of Byzantine monasticism,but the
Benedictine traditionhad not developed specialized public philanthropy.144
Though at firstthe Hospital of the Knightsshared also the Byzantinexenon's
dependent status vis-'a-visthe 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 Hospitallersliberated theircommunityand 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 BreviusTractatae,MPG 31: 1184; BenedictiRegula, ed. R. Hanslik (Vienna, 1960),

chap. 36, p. 95, refersonly to the care of sickmonks.ConcerningBenedictineneglectof hospices
see Reicke, Spital, 1:49.
145 Concerning the location of.the hospice with respect to the parent monasterysee John of
Wiirzburg,"Descriptio," pp. 159-60; cf. "Typikon de la Kosmosotira," p. 53. See also A. K.

Orlandos, Monasteriake Architecktonike (Athens, 1958), p. 76.

the abbey of St. Mary. The brotherswere now free of any tendencyon 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, controllingits own resources for the support of its
true hospitals, leaving Benedictine monasticism and its various reform
movements to their contemplativelife.
The Knights of Saint John also made Byzantine hospital discipline avail-
able to the West by offeringa Latin rendering of Greek infirmarycustoms.
The Statutesof Roger des Moulins (1182) are a Latin paraphrase of certain
clauses in Greek typika.146The Knights, however, did more than simply
translateByzantineregulations.The Rule of Raymond du Puy has no paral-
lel among Byzantinemonasticdocuments. It regulated the communitylife of
lay brotherswhose principal religious duty was service in the Hospital. The
typikaof Byzantine monastic communities,in contrast,said almost nothing
about the monks' hospital duties. The charterof the Pantokrator,for exam-
ple, did not once refer to the monks' labor in the xenon,while one clause
mighthave excluded them fromsuch work.147Though the resources of the
Pantokratormonasterywere unquestionablycommittedto the maintenance
of the public infirmary,one has the impression that the hospital staffwas
composed exclusivelyof laymen. The Kosmosotira typikon also lacks a chap-
ter indicating that the monks dedicated themselves in any special way to
hospital service. Again, thismonasteryhad at all times to support the public
hospital,yetsome of the actual workersmighthave been hired laymen.148In
contrast,the Rule of Raymond du Puy opens with the statementthat the
brothers' prime mission was to serve the poor sick, while the Statutes of
Roger des Moulins suggest that the brothersthemselveswaited on hospital
patients.149
The Rule of Raymond du Puy also differsfromany Byzantinedocument
by introducingthe feudal notion of service to a lord. The brotherHospital-
lers were to regard the sick of the Hospital as theirlords (domini)and show
them the faithfulservice of vassals.150Moreover, through theirpropaganda
in the West the Knightsemphasized the relationshipof the feudal virtuesto
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 theirlabors on behalf of the sick as the knightswho foughtin
the crusade.151 In the same spiritdonations forthe maintenanceof the order
47 "Typikon du Pantocrator,"p. 63, 11.559-61: KvnWt(uoVj?VtOt 7cpoacYlaiav Kai 8aat i6v
61aKOV16V 6L7atTOOa1 Tiv 94o06V Tq govfq 8laTpt3lv iv
0og6?g T6V jovax%v t1anto01TjaiTat....
148 "Typikon de la Kosmosotira,"pp. 48-49: (TorgKdgVOuat) 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 nostramfraternitatem intraveruntvel intrabunt,ita

sint securi de Domini misericordiaquasi militantin Hierosolimis,et recipient . . . gloriam et
coronam justicie."

and its hospital could atone for the sins of the benefactorsand their fami-
lies.152By suggestingthat men could win the rewards of virtue not only for
valor on the battlefieldbut also for devoted serviceon behalf of the sick,the
Knights were able to tap a rich source of popular pietyamong the knightly
class and fireenthusiasmfor a formof charitywhichother Westernreligious
movementshad neglected. The twelfthcenturysaw a great surge in religious
devotion among the knightsof the West, a piety which was expressed in
crusading zeal but which also turned to the corporal works of mercy. The
Hospitallers played an importantrole in channeling that zeal toward the
service of the sick.
It is doubtful that the Greek hospitals of Constantinople would have
found an enthusiasticreception in Latin Christendom without the funda-
mental adaptations wroughtby the Knights of Saint John. As we observed
earlier, the Greek monasteries gave unwavering financial support to true
hospitals,but the monks themselvesdid not devote any special zeal to such
corporal works. Indeed, by the twelfthcenturymost of the hospital services
seem to have been carried out by professionalphysiciansand 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 exclusivelyto hospital work was
needed to establishand manage public infirmaries.The Hospitallers fulfilled
that role.
3. CONCLUSION
This studyhas demonstrated,first,that Western Europe during the early
Middle Ages did not develop true hospitals.Though therewere a few public
infirmariesin 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 twelfthcentury,Latin Christiansgreeted this institu-
tion as somethingnew. Second, we have seen thatByzantiumand 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 inspiringthe Hospitallers. The Knightswere, after
all, part of a wide movementof lay brotherswhichbegan in eleventh-century
Germany. In the final analysis the adaptations wroughtby the Hospitallers
on the Byzantinexenonescreated a new institution,inspired by the public
infirmariesof East Rome, but growing naturally from Western religious
movements.153
DUMBARTON OAKS
152Cart. 46, p. 39.

153
I thankprofessorsGeorge Dennis and Michael Metzger of Catholic Universityfor correct-
ing the typescriptand Mrs. B. Gutekunstof the Humanities Division, Mullen Library,Catholic
University,for her assistance in ordering and reservingthe books for this project.


Hospitalci

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THE Knightsof SaintJohn, founded afterthe conquest of Jerusalem (1099),

1. THE HOSPITALS OF THE WEST

I L. Le Grand, Statutsd'Hotels-Dieuet de Leproseries

phenomenon of urbanizationand diseases. C. Probst,"Das Hospitalwesen im hohen und spaten

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eis dispares in meritisfuisse creduntur."

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44 Monasticon Anglicanum,ed. William Dugdale, 6 vols. (London, 1830), 6, 2:615 [= Eadfmeri

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

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house at Montpellierdates from the mid-thirteenth century.Nevertheless,he believes that this

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2. THE HOSPITALS OF THE EAST AND THE ORIGINS

We have seen thatWesternEurope greeted the Hospital as a novel institu-

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102 Ibid., pp. 8-12.

107Encyclopedia of Islam (London, 1960), 1:1223.

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109 Ibid., pp. 371-72.

of the orthodox church in Constantinopleto organize hospitals and other caritativeinstitutions.

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1002-5, concerning confessions.

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

144Regulae BreviusTractatae,MPG 31: 1184; BenedictiRegula, ed. R. Hanslik (Vienna, 1960),

Wiirzburg,"Descriptio," pp. 159-60; cf. "Typikon de la Kosmosotira," p. 53. See also A. K.

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151 Cart. 46, p. 39: "quicumque autem in nostramfraternitatem intraveruntvel intrabunt,ita

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152Cart. 46, p. 39.

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