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Cultures of Healing
This volume brings together for the first time an updated collection of articles
exploring poverty, poor relief, illness, and health care as they intersected in
Western Europe, the Mediterranean and the Middle East, during a ‘long’
Middle Ages. It offers a thorough and wide-ranging investigation into the
institution of the hospital and the development of medicine and charity,
with focuses on the history of music therapy and the history of ideas and
perceptions fundamental to psychoanalysis.
The collection is both sequel and complement to Horden’s earlier volume
of collected studies, Hospitals and Healing from Antiquity to the Later Middle
Ages (2008). It will be welcomed by all those interested in the premodern
history of healing and welfare for its breadth of scope and scholarly depth.
Peregrine Horden is Professor of Medieval History at Royal Holloway,

University of London. He is co-author, with Nicholas Purcell, of The
Corrupting Sea (2000) and of both its forthcoming successor and a collection
of supplementary studies entitled The Boundless Sea. He is also writing a
global history of hospitals.
VARIORUM COLLECTED STUDIES SERIES
Also in the Variorum Collected Studies Series:
PETER MEREDITH, edited by JOHN MARSHALL

The Practicalities of Early English Performance: Manuscripts, Records,
and Staging Shifting Paradigms in Early English Drama Studies (CS1069)
MEG TWYCROSS, edited by SARAH CARPENTER and

PAMELA KING
The Materials of Early Theatre: Sources, Images, and Performance
Shifting Paradigms in Early English Drama Studies (CS1068)
SEYMOUR DRESCHER
Pathways from Slavery
British and Colonial Mobilizations in Global Perspective (CS1067)
DAVID JACOBY
Medieval Trade in the Eastern Mediterranean and Beyond (CS1066)
GILES CONSTABLE
Medieval Thought and Historiography (CS1065)
GILES CONSTABLE
Medieval Monasticism (CS1064)
Cultures of Healing
Medieval and After (CS1073)
Peregrine Horden
For more information about this series, please visit: https://www.routledge.

com/history/series/VARIORUMCS
Cultures of
Healing
Medieval and After
Collected Studies
Peregrine Horden
First published 2019
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
52 Vanderbilt Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa
business
© 2019 Peregrine Horden
The right of Peregrine Horden to be identified as author of this work
has been asserted by him in accordance with sections 77 and 78 of
the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic, mechanical,
or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British
Library
Library of Congress Cataloging-in-Publication Data
Names: Horden, Peregrine, author.
Title: Cultures of healing : medieval and after / Peregrine Horden.
Description: Milton Park, Abingdon, Oxon ; New York, NY :
Routledge, 2019. |
Series: Variorum collected studies series | Includes bibliographical
references and index.
Identifiers: LCCN 2018040531 | ISBN 9781472456144 (hardback) |
ISBN 9780429023590 (e-book)
Subjects: LCSH: Medicine, Medieval. | Hospitals, Medieval.
Classification: LCC R141 .H66 2019 | DDC 610.9/02—dc23
LC record available at https://lccn.loc.gov/2018040531
ISBN: 978-1-4724-5614-4 (hbk)

ISBN: 978-0-429-02359-0 (ebk)
Typeset in Times New Roman
by codeMantra
VARIORUM COLLECTED STUDIES SERIES CS1073

CONTENTS
Preface ix
Acknowledgements xii
1 The World of the Hospital: Comparisons and continuities 1

(with John Henderson and Alessandro Pastore)
The Impact of Hospitals 300–2000, ed. John Henderson,
Peregrine Horden, and Alessandro Pastore (Oxford:
Peter Lang, 2007), pp. 1–56
2 Poverty, Charity, and the Invention of the Hospital 33

The Oxford Handbook of Late Antiquity, ed. Scott
Fitzgerald Johnson (Oxford: Oxford University Press,
2012), pp. 715–743
3 The Earliest Hospitals in Byzantium, Western Europe,

and Islam 63
Journal of Interdisciplinary History, special issue,
ed. Mark Cohen, ‘Poverty and Charity: Judaism,
Christianity, Islam’, 35.3 (2005), pp. 361–389
4 Sickness and Healing [in the Christian World, c.600–c.1100] 91

The Cambridge History of Christianity, vol. III: Early
Medieval Christianities, c.600–c.1100, ed. Thomas F. X.
Noble and Julia M. H. Smith (Cambridge: Cambridge
University Press, 2008), pp. 416–432
5 The Late Antique Origins of the Lunatic Asylum? 113

Transformations of Late Antiquity: Essays for Peter
Brown, ed. Philip Rousseau and Emmanuel Papoutsakis
(Farnham: Ashgate, 2009), pp. 259–278
v
C ONTENTS
6 The Sick Family in the Early Middle Ages:

The evidence of Gregory of Tours
Not previously published 133
7 What’s Wrong with Early Medieval Medicine? 144

Social History of Medicine, 24 (2011), pp. 5–25
Postscript to Chapter 7 176
8 Cities Within Cities: Early hospital foundations and

urban space 178
Stiftungen zwischen Politik und Wirtschaft. Ein Dialog
zwischen Geschichte und Gegenwart, ed. Sitta von
Reden, Historische Zeitschrift Beiheft no. 65 (Munich:
De Gruyter Oldenbourg, 2015), pp. 157–175
9 Alms and the Man: Hospital founders in Byzantium 195

The Impact of Hospitals 300–2000, ed. John Henderson,
Peregrine Horden, and Alessandro Pastore (Oxford:
Peter Lang, 2007), pp. 59–76
10 The Uses of Medical Manuscripts 210

Medical Books in the Byzantine World, ed. Barbara
Zipser, Eikasmós: Quaderni bolognesi di filologia
classica, Studi Online 2 (Bologna, 2013), https://www.
scribd.com/document/253114392/02-Zipser-Medical-
Byzantine-Books, pp. 1–6
11 Medieval Hospital Formularies: Byzantium and Islam

compared 215
Medical Books in the Byzantine World, ed. Barbara
Zipser, Eikasmós: Quaderni bolognesi di filologia
classica, Studi Online 2 (Bologna, 2013), https://www.
scribd.com/document/253114392/02-Zipser-Medical-
Byzantine-Books, pp. 145–164
12 A Context for Simon of Genoa’s Medical Dictionary

(Clavis sanationis): Medicine at the Papal Court in the
Later Middle Ages 233
vi
C ONTENTS
Simon of Genoa’s Medical Lexicon, ed. Barbara Zipser

(Berlin: De Gruyter, 2013), http://www.degruyter.com/
viewbooktoc/product/247622, pp. 15–29
13 Small Beer? The parish and the poor and sick in later
Medieval England 245
The Parish in Late Medieval England, ed. Clive Burgess
and Eamon Duffy, Harlaxton Medieval Studies 14
(Donington: Shaun Tyas, 2006), pp. 339–364
14 Musical Solutions: Past and present in music therapy 273

Music as Medicine: The History of Music Therapy since
Antiquity, ed. Peregrine Horden (Aldershot: Ashgate,
2000), pp. 4–40
15 Paracelsus: Renaissance music therapy and its alternative 302

2000), pp. 147–153
Postscript to Chapter 15: Music therapy in Rabelais 307
16 Aspects of Music Therapy in the Nineteenth and

Twentieth Centuries: Romanticism, the USA,
Mesmerism, Theosophy 310
2000), pp. 315–337
17 The Prehistory of Infant Sexuality 325

Not previously published
18 Thoughts of Freud 342

Freud and the Humanities, ed. Peregrine Horden
(London: Duckworth; Bristol Classical Press, 1985), pp. 1–25
vii
CONTENTS
19 Pandaemonium: 365
Demons and Illness from Antiquity to the Early-Modern
Period, ed. Siam Bhayro and Catherine Rider
(Leiden: Brill, 2017), pp. 412–418
Index 373
viii
PREFACE
The studies collected here explore the domains of poverty and poor relief,
and illness and health care, as they overlap or intersect in western Europe,
the Mediterranean and the Middle East, during a ‘long’ Middle Ages.
A more descriptive, if scarcely commercial, title might be: ‘Healing and care
of the sick and needy in the context of political, social, cultural and religious
history, from Late Antiquity, through the Middle Ages, and into more re-
cent centuries where there are topics illuminated by a medieval perspective’.
‘Cultures of Healing’: the ‘healing’ in the actual title thus has to be taken
in a very broad sense. It embraces the attempted ‘social healing’ of char-
ity, Jewish, Christian, and Islamic (Chapters 1–5, 8, 9, 13); the healing of
body, mind, and soul variously practised by priests, doctors, and others;
the auto-therapy of ordinary people with no special credentials or experi-
ence (2–7, 12, 13). The ‘cultures’ in the actual title stands for all the relevant
contexts (political, social, and so on) in which the kinds of healing studied
were embedded and in terms of which they must be understood. It is meant
to evoke an open, anthropological conception of culture, not one confined
to cultivated elites (e.g. 4 and 19). In many ways what I do is standard so-
cial history of charity and medicine. I have always resisted the reduction of
everything to discourse or social construction, and do not think Foucault
had all the answers. A recent ‘turn’ in the study of health and disease away
from the constructivist towards the ‘hard data’ of ancient DNA and the like
suggests that a synthesis of several different types of evidence and approach,
textual and archaeological, in the history of healing remains desirable, and
may even be moving from the rear- to the vanguard. That is what I have
tried to practise. I am drawn to the histories of charity and medicine be-
cause both require transects through society, potentially involving every
social group, every kind of subject, every type of data.
‘Medieval and After’: the study of both charity and medicine also can
benefit from a view over the long term, whether the focus is Hippocratic
medicine, the paradigm of which was not finally dissolved until well into
the nineteenth century, or religious charity with its roots in the Bible or
ix
P REFA C E
the Qur’an. Questions of continuity or discontinuity, novelty or tradition,

are important and can be tackled only by trampling down chronological
boundaries. That is why it is often useful for a medievalist to move later.
As a historian of medicine who loves music, I ventured into the history of
music therapy, which I first came across in medieval Islamic hospitals be-
fore turning to study several of its more recent forms. Doing that took me
from antiquity and the Middle Ages to the sixteenth to late twentieth cen-
turies (14–16).1 I am emphatically not tracing some grand transition from
medieval to modern, partly because I do not know what ‘modernity’ is, and
partly because of its inherent teleology. So much theorizing of modernity
implies that history is a one-way street, and a comparativist historian who
looks across several centuries or periods needs to move in more than a single
direction. I once strayed into the history of Freud and psychoanalysis (18),
treating it as a part of the intellectual history of the last century, a culture
of healing if ever there was one. But reading in that area not only joined up
with topics in the history of psychotherapy that I had come to under the
music therapy heading (16); it helped me approach questions prompted by
evidence of early medieval monasticism (17). More generally, though I do
not argue the case in what follows, I have found in psychoanalysis – with its
dynamic system of invisible entities, technical rhetoric, immunity to critique
and counter-example, assumed explanatory power, and crucial complicity
between therapist and patient – a very helpful analogy for the successes of
medieval Galenic medicine.
This collection complements and overlaps with my earlier Hospitals and
Healing from Antiquity to the Later Middle Ages (2008). The hospital, an
institution in which healing, charity, and politics meet, remains a preoc-
cupation here, viewed both over the long term and in close-up, as I worry
away at its origins and early diffusion, at the medicine that has been dis-
pensed within it, and at its effects on the poor and sick and on society as
a whole (2–5, 8, 9, 11). Other forms and sources of charity are adduced for
comparison and in one case, as a contribution to the history of the medieval
parish, they are given a study of their own (13). A variety of healers appear:
not only learned doctors but also nurses, saints in their shrines, alchemists
prolonging life, magicians (e.g. 4, 6, 12). Likewise, a variety of sources and
explanations of illness or perceived abnormality, including sexual and men-
tal abnormality: humours, demons, families, sinfulness (and the Freudian
id) (4–6, 18). There is also a range of medicines, from the usual sort of drugs
to soothing music and vulture’s giblets (14–16, 7). The geographical focus
is western Eurasia, but there are brief excursions to America (1, 16). And
I plan, elsewhere, to pursue the history of ‘the first hospitals’, in a mono-
graph of that title, on a global scale.2
I have arranged the chapters as far as possible by period covered, rather
than by theme, putting fourth-century hospitals first, after an opening pan-
orama, and ending with the recent ethnography of demons.
x
P REFA C E
The old-style Variorum offered photographic reprints, the listing of ad-

denda and corrigenda being the only means of updating. The new style of
text derives from the author’s computer, and that presents both temptation
and challenge. The challenge is that the original computer file, assuming
one can find it, never exactly matches what was eventually published. The
temptation, since corrections can now be made anywhere in the text, is to
start extensive rewriting – to which there might be no end. I have resisted
temptation (this one at least) and not rewritten on that scale. The principle
has been to respect the integrity of the original form and argument of each
paper. Thus, two previously unpublished papers from a few years ago have
been checked and the references have been updated, but they have not been
recast (6 and 17). Three contributions, as indicated in their opening notes,
have been carved out of larger originals but not otherwise fundamentally
changed (1, 15, 16). Overlaps between papers, as I tackle the same prob-
lem at different times and from different angles, have not been removed:
I wanted each paper to be self-sufficient. I have, however, allowed myself
very minor alterations, correction of local errors, and omission of a few
topical references that date a piece, and I have inserted proper notes in place
of brief in-text cross-references to other parts of the volumes in which some
chapters first appeared. I have not updated existing endnotes systematically
(especially with such a fast-developing profession as contemporary music
therapy), but I have added a few more recent references in square brackets.
Where fuller discussion of the newer literature of the subject seemed called
for, I have written a separate Postscript (7, 13, 15, 18). Much of the labour
has focused on getting the computer file to match what is in print. But oc-
casionally I have reversed the well-intentioned ministrations of editors and
copy-editors and restored a slightly longer, slightly different original – the
director’s cut.
Oxford Peregrine Horden

August 2018
Notes
1 See now also P. Horden, ‘Ottomans, Neo-Ottomans and Invented Tradition in
Hospital Music Therapy’, in L. Clark and E. Danbury (eds), ‘A Verray Parfit
Praktisour’: Essays presented to Carole Rawcliffe (Woodbridge: Boydell, 2017),
pp. 175–183.
2 For an analogous attempt at a global, comparative history (and anthropology)
of humours, see Peregrine Horden and Elisabeth Hsu (eds), The Body in Balance:
Humoral Medicines in Practice (New York: Berghahn, 2013).
xi
Acknowledgements
The author and publishers wish to thank the following for permission to
reprint articles in this collection:
Ashgate Publishing (5, 14, 15, 16); Bristol Classical Press (18); Cambridge
University Press (4); De Gruyter Oldenbourg (8, 12); the editor of Eikasmòs
(10, 11); Koninklijke Brill NV (19); Massachusetts Institute of Technology
and the editors of the Journal of Interdisciplinary History (3); Oxford Univer-
sity Press (2, 7); Paul Watkins Publishing (Shaun Tyas) (13); Peter Lang AG,
Internationaler Verlag der Wissenschaften (1, 9).
The author thanks Michael Greenwood, John Henderson, Alessandro
Pastore, and John Smedley for their support, Humaira Erfan-Ahmed and
Leen Van Broeck for indispensable help with the preparation the text, and
Sarah Barrett for meticulous copy-editing.
The research for these articles was variously supported by All Souls Col-
lege, Oxford; Royal Holloway University of London; and the Wellcome
Trust.
xii
1
THE WORLD OF THE
HOSPITAL
Comparisons and continuities
I A cross-roads of hospital history?

Vienna around the year 1780.1 Anyone with a time machine and a desire to
gain some vantage point on the long-term history of hospitals, but allowed
just one period and place to visit, could make a far worse choice of venue. In
this city with a population of over a quarter of a million people, some 1,000
hospital beds were available for the care of the sick and needy. They were
distributed across a range of institutions that varied greatly in size and ser-
vices. But most exemplified a tradition of Catholic charity that would have
been instantly recognisable back in the Middle Ages. Under the Church’s
aegis, though subsidised – inadequately – by the government, they offered
shelter and nursing to poor immigrants, the homeless, the elderly, and the
needy sick. There was the Bürgerspital, the oldest in the city, with 200 beds,
founded in the thirteenth century. There was the Bäckenhäusel, which had
been established as a lazaretto or plague house in 1656, a year in which the
Viennese suffered very badly from plague. And there was the Great Poor-
house, dating from 1693. Reports of high institutional mortality, in these
and a few other lesser establishments, did nothing to diminish their reputa-
tions as gateways to death. By the 1780s one-third of hospital patients were
reckoned to have contracted the morbus Viennensis, the ‘Viennese disease’
of pulmonary tuberculosis.
At the more salubrious end of the spectrum, a few private institutions
such as the seventy-bed Spanish hospital could attract paying middle-class
patients, and a monastic hospital in the city even set aside rooms for the
nobility. Nor was learned medicine lacking. Formal clinical medical in-
struction was already several decades old in Vienna in 1780. It had been
formally instituted in 1753 by Gerard van Swieten, the Empress Maria The-
resa’s personal physician and a disciple of Hermann Boerhaave, whose ward
round was observed by his students in Leyden’s municipal hospital from the
gallery of a special ward.2 This ward was the collegium medico-practicum,
in which lay six male and six female patients each selected for some exem-
plary pathological condition. In Vienna another Boerhaave student, Anton
1
T H E W ORL D OF T H E H OS P ITAL
de Haen, carried out what has been famed (mistakenly) as the first such
bedside teaching.3 It took place in two rooms of six beds each in the Bürg-
erspital, by the eighteenth century metamorphosed into a retirement home
for the elderly. This contribution to university teaching was financed by the
emperor, and was part of a sweeping curricular reform designed to produce
a corps of well-trained professionals who would oversee, police-like, the
public health and medical needs of the Austrian masses. Though a follower
of Hippocrates, and thus guided by two thousand years of tradition in his
clinical observations, de Haen also developed an interest in thermometry,
and many of his colleagues were engaged in research that would, within
decades, contribute to the dissolution of the Hippocratic paradigm.
In 1784, not only the teaching but the whole configuration of V ienna’s
hospital regime changed. Having seen the fire-ravaged and decrepit Hôtel-
Dieu in Paris while visiting his sister Marie Antoinette in 1777, Joseph II
decided to centralise hospital care and to confine it to the sick, emulating
(as he hoped) the best and avoiding the worst of the French model.4 Poor
relief was clumsily devolved to parishes and fraternities. Foreign beggars
were expelled. The assets of twelve existing Viennese hospitals were ‘nation-
alised’. The massive old alms house was turned into the two thousand-bed
Allgemeines Krankenhaus or General Hospital, although it still sheltered
the poor as well as providing medicine for the sick.
In accordance with Enlightenment rationalism, the general hospital was
neatly divided into four medical and two surgical sections, one venereal
section, and one for contagious diseases. There was a lying-in facility, a
tower for the insane, and an establishment for foundlings. Some space in
private rooms was reserved for patients with means. The emphasis lay on
using secular medicine to help the sick recover. The hospital had a staff of
some fifteen university-educated physicians, an equal number of surgeons,
and 140 lay attendants. Yet even though no altars were to be seen, two resi-
dent Catholic priests toured the wards daily, administering the sacraments.
By 1800, after some vicissitudes, the hospital had added its own medical
library. Stables were converted into isolation wards. A surgical amphithe-
atre was constructed so that operations would no longer be performed on
the wards; and there was a new mortuary in which physicians and senior
students dissected their own deceased patients. Since 1785, there had also
been a subordinate military hospital, the Josephinum.
Some of these reforms and developments were attributable to Johann Peter
Frank, author of the System of a Complete Medical Police.5 His totalitarian
ambitions for the health of the masses appealed to Joseph II’s ‘enlightened
despotism’. The emperor’s successor but one, Francis II, appointed Frank di-
rector of the General Hospital in 1795, his mission being in part to combat the
enormous risk of cross-infection run by patients in such a large establishment.
What first strikes the time traveller about the hospitals of late Enlight-
enment Vienna is their sheer variety and the range of functions that they
2
performed, even when rationalised by despotic emperors and medical

‘policemen’. The poor – whether indigenous or immigrant – the aged, the
pregnant, the insane, the syphilitic are all embraced by them, alongside the
acutely and chronically sick. The environment in which some attempt is
made to meet their needs is an ‘over-determined’ one (the Freudian anal-
ogy surely permissible in this of all cities). That is, it is subject to pressures
from every conceivable direction – demographic, financial, governmental,
and ideological as well as medical. It has to be interpreted within the widest
context of Viennese history.
Aspects of this hospital scene apparently point to the future. In the gen-
eral hospital there is a clear shift from almshouse to house of the sick: the
new purpose is to promote recovery rather than to offer palliative care. This
hospital is no longer primarily an agent of poor relief. University-trained
physicians are present, if not in proportionally very large numbers. There
is a degree of secularisation: in the absence of altars, the liturgical round
becomes far less prominent than the ward round.
‘Fast forward’ only a few decades and it is in the maternity wards of
the same general hospital that, in 1848, Ignaz Semmelweiss will make the
observations and deductions that herald modern – biologically effective –
antisepsis. Such antisepsis is one of the essential preconditions of the hospi-
tal as we have known it in the later twentieth and early twenty-first centuries:
the hospital that is accepted, and indeed preferred, as the place of treatment
for serious conditions by all socio-economic groups, not only the poor. In
Enlightenment Vienna, there were already better-off patients paying for pri-
vacy and superior medical attention, and their history is a good deal older
than that. Frank was combating the cross-infections that would keep many
away from hospital wards.
Also pointing to what we take to be modernity is the use of the wards
and the autopsy room by physicians or surgeons for medical education
and enquiry. We are at an early chapter – though by no means the first, as
Boerhaave shows, without even looking back to the real beginnings in the
Renaissance – in a story that will lead to the conception of the hospital as
situated at the ‘cutting edge’ of medical technology and research.6 In such
a hospital, so its critics have contended, patients almost cease to be persons
and become more like specimens. Removed from their normal surround-
ings, they can be treated in ways that ignore those surroundings precisely
because the physician is now focusing on disease entities, undistracted by
the ‘whole person’. That reductionism, which only in relatively recent times
has shown any sign of being reversed in favour of paying attention to patient
‘narratives’, originates in clinical education and its conceptual or physical
alignment of cases that are medically, rather than socially, similar.
Such education was centuries old in Joseph II’s Vienna, and is one respect
in which the example of the city’s hospital seems to point us back in time as
well as forwards. Another respect is the emperor’s desire for centralisation
3
under governmental control. This is really a phenomenon that historians

label ‘early modern’ or even ‘Renaissance’ rather than ‘Enlightenment’.7 In
many ways it was old-fashioned in France when Joseph visited his sister and
inspected the massive and not very salubrious Hôtel-Dieu. Large hospitals
had long been seen by reformers to generate at least as much disease as
they cured. In France, where the general hospitals were most numerous
and prominent, their mission to house and discipline the disorderly poor
actually had the effect of enhancing the medical, curative function of other
smaller hospitals, to whom they passed suitable cases.
The old hospitals still functioning in Joseph II’s time not surprisingly take
us deepest into the past of hospital history. Here was exemplified a tradition
of Catholic charity that, if a millennium younger than the Hippocratic med-
icine with which it could be associated, was still of considerable antiquity.
The earliest of Vienna’s surviving hospitals had been a part of a great wave
of foundations that spread right across western Europe in the ‘high’ Mid-
dle Ages of the twelfth to thirteenth centuries. The lack of ‘true’ medical
attention, the low discharge rate, and the corresponding patient mortality
were always likely to be exaggerated by later ‘reformers’ of the sixteenth to
eighteenth centuries, blackening the objects of their reform to an extent that
later historians can easily accept too uncritically. The least we can say, by
way of counter-argument, is that there were notable havens in which the best
and most expensive of contemporary medicine was available free to patients.
And it was not only in Protestant northern Europe that an emphasis on en-
suring the patient a safe passage to the other world was counterbalanced by
a this-worldly concern to get a sick or injured labourer quickly back to work.
That aim had for example been demonstrated much earlier in some of the
hospitals of Italian Renaissance cities. Still, surveying European hospitals
over several centuries preceding the reign of Joseph II makes three conclu-
sions unavoidable. First, hospitals were essentially institutions of charity in
which the primary criteria of admission were as likely to be economic and
social as they were to be medical. Second, secular medicine was almost al-
ways subordinate to the therapy of the sacraments in Catholic countries, or
to the ethical imperatives of a godly community in Protestant ones. Finally,
those who could afford to stay at home for treatment or poor relief nearly
always did so. It was only when hospitals, under financial pressure, took in
better-off pensioners offering lifetime security in return for benefactions that
the choice between hospital and home became more evenly balanced.
II A view of the long term in hospital history

Taking Vienna c.1780 as a ‘moment’ in hospital history alerts us to many
components in the generally accepted outlines of the subject.8 I shall now
retrace those outlines, adding some minor modifications without, I hope,
distorting the received view, and giving proportionate space to the medieval
4
and early modern period instead of cantering briskly through them as a

mere warm-up to ‘modernity’. More substantial reservations and additions
will be set out in the next section.
Hospitals were originally Christian charitable foundations for the over-
night care of transients or immigrants, the local poor also lacking in the
support networks that transients would have left behind, and the sick who
could not pay for treatment.9 They had, as we shall see later, a few forerun-
ners in pagan antiquity, but they were essentially an architectural expression
of the Christian charitable imperative. They began to be founded by rulers,
leading churchmen, and wealthy pious individuals after the ‘establishment’
of the Christian Church by Constantine in the early fourth century. These
xenodocheia (houses for strangers, as they were originally called) spread
rapidly across the Byzantine empire and, more slowly, around the Medi-
terranean, to France, Italy, and Spain. Some, especially in major pilgrim-
age centres, were quite large. Some, again in the largest cities, were highly
‘medicalised’ in that they had wards for specific diseases or conditions, and
physicians and surgeons on their staff. Others specialised in the care of the
poor, the elderly, the blind, and so on.
In general, early medieval hospitals increase in size and complexity, and
probably also in numbers, as one traverses Eurasia in an easterly direction.
Thus western European hospitals were, on the whole, more hospice-like,
offering the ultimate therapy of the sacraments, less intent on returning
patients to the community than in easing chronic need and the effects of
aging – or of leprosy. The biggest Byzantine hospitals displayed a more
obvious emphasis on secular medicine. When the ‘hospital idea’ was ex-
ported from Byzantium to Islam, primarily through the intermediary of
Christian communities in Islamic lands, in the ninth and tenth centuries,
hospitals attained what it is tempting to conceive as a new stage in their
development. Islamic hospitals were not so overwhelmingly charitable,
catering more prominently for well-to-do patients. They offered medical
treatment by court physicians. They were, indeed, centres of medical learn-
ing and teaching. And many of them introduced a relatively novel element:
they housed the insane – treating them perhaps harshly, but in a medical
manner, as sick rather than possessed.
The hospital spread eastwards, across Asia, principally with Islam (as did
Islamic medicine) rather than with Christian missionaries. Thus one major
chapter in hospital history is the story of Islamic foundations, a story that
stretches with few interruptions from tenth-century Baghdad to parts of
India and Sri Lanka in the present day. But the next major phase of European
hospital history begins in the twelfth century.10 In Byzantine Constantino-
ple, medicalisation seemingly reached its apogee in the Pantocrator hospital
(attached to a monastery) in which there were almost more physicians and
support staff than patients. In the Crusader states the Knights Hospitaller’s
hospital of St John in Jerusalem stands out as, by western standards, a
5
medically intensive establishment, and as one which showed its charitable

ethos in a pronounced and individual way, by proclaiming the ‘Lordship
of the Poor’ – whom the Knights of St John were to serve as if the poor
underlings were really their ‘feudal’ superiors.11 More generally, across the
Crusaders’ home territories in western Europe, hospitals were founded for
the poor and, among the sick, especially for the leprous. Yet this was not be-
cause paupers and lepers were becoming proportionately more numerous,
but because the prayers of such unfortunates were increasingly recognised as
a sure means of helping donors’ souls through purgatorial fire. The Catholic
doctrine of purgatory may not have solidified until the thirteenth century,
but its ingredients were already clearly recognised long before.
In parts of northern Europe, the wave of foundations that began in the
twelfth century had lost impetus by the time of the Black Death. Fewer
hospitals were founded. In England, for example, the almshouse, with
its distinct if conjoined dwellings for the respectable elderly, became the
favoured type of foundation. Many existing hospitals also mutated into re-
tirement homes, into chantries (offering liturgy rather than charity), or into
colleges of priests.
Naturally there were exceptions to this general picture, mostly to be found
in the larger cities. Paris, with its Hôtel-Dieu, is one of them. No medieval
English hospital could measure up to its size or the number of its medical
personnel. The main contrast to the northern pattern is, however, to be
found in southern Europe, to some extent in Spain,12 but especially in the
Italian city-states of the later Middle Ages and Renaissance. The hospitals
of Renaissance Florence in the fifteenth and sixteenth centuries were, for
example, widely admired and often the objects of emulation, as in the case
of Santa Maria Nuova, which became the model for the Savoy Hospital in
London. In their combination of a continuing religious ethos – altars in view
of the patients, the literal centrality of the sacraments to daily life – with lay,
sometimes civic, control, they show how difficult it is to carve hospital his-
tory up into periods. For they straddle the end of the Middle Ages and the
beginnings of the early modern period. And, right back in the fourteenth
century, they already anticipate what are usually taken to be early mod-
ern features of hospitals in major cities: lay control, centralisation, learned
physicians in attendance, pharmacies attached, rapid turnover of patients
(no gateways to death here, although women patients did stay for longer
than men). It is in Italy too that we encounter the first specialised hospitals
in Europe to have been founded in any numbers since the leprosaria of the
twelfth and thirteenth centuries: large foundling hospitals like the famous
Innocenti in Florence and, later, hospitals for victims of the era’s two great-
est scourges, plague and the Great Pox.13
A degree of continuity across the supposed medieval/early modern divide
is evident not only in Catholic Europe but even in England. The dissolution
of almost all hospitals at the Henrician Reformation, as well as monasteries,
6
obviously marked a break in hospital history. But many hospitals were quite
rapidly refounded and new ones added – not just in London (as is commonly
observed), but in provincial cities such as Norwich.14 These hospitals of the
later sixteenth century broke with English traditions only in one respect,
which aligns them more with their continental coevals. They, or the bigger
ones at least, had attendant physicians; they were attuned to ideas about
the potential of hospitals that had been aired in Italy over two centuries
previously.
As we move closer in time to the Viennese example with which we began,
we return to developments already sketched. The French model has usually
been taken as defining the next distinct phase. In this, a division arose. On
the one hand, there were the general hospitals that provided some medical
care, but served primarily as catch-all establishments for the supposed
work-shy, vagrants, gypsies, religious dissidents, prostitutes, beggars, the
disabled, and the insane. On the other hand, there were the older hôtels-Dieu
that, with the aforementioned social groups interned elsewhere, could con-
centrate more on acute and curable sickness.15 But it should be remembered
that the hôpital général was not peculiar to France. It was in some respects
an elaboration of that English sixteenth-century invention and export, the
workhouse. Further, the apparently clear distinction between it and the
hôtel-Dieu is muddied by all the other kinds of hospital that continued to
develop alongside them, in France and elsewhere in Europe. These included
lying-in hospitals, hostels for vagabonds, houses for the reform of prosti-
tutes, ‘conservatories’ for the moral education of orphans, and, not least,
the military hospital, ‘a kind of laboratory for experimentation in medical
services within a hospital setting’.16
At the opposite extreme from the governmental schemes manifested in
large general hospitals, we find the ‘voluntary hospitals’. These establish-
ments began to appear in England in the 1720s, and are often treated as
another distinct chapter in hospital history. They are projected against a
background from which hospitals had mostly disappeared, which makes
them seem a novel departure. And they are presented as peculiarly English
when in fact they had continental counterparts or imitations, in Germany,
Switzerland, and elsewhere. Seen in the longue durée of hospital history their
peculiarity is less in the fact that they were, at least to begin with, controlled
by their leading (financially most beneficent) ‘voluntary’ subscribers than in
the particular way in which this control was exercised. Hospital benefactors
had been determining the nature of institutions to which they lent their sup-
port since the earliest Christian foundations of the fourth century. They had
set the criteria of admission in generic terms, and doubtless exercised influ-
ence over the selection of individual patients on occasion. What was new
in the eighteenth century was the regularising of this connection between
patron and patient, such that the purchase of a subscription at a particular
level brought corresponding privileges in the nomination of inmates.17
7
Power to the patrons is one strident theme in hospital history of the

e ighteenth century – and many preceding centuries. The equivalent for the
nineteenth century and since is conventionally: power to the physicians,
and to the surgeons; and then power to the professional administrators.
The centuries do not divide neatly, of course; and developments since the
late eighteenth century are so many and various that they defeat all brief
generalisation. The two largest and clearest phenomena of the nineteenth
and early twentieth centuries are surely these. First, the enormous expan-
sion of patient demand for hospital services (crudely estimated as a tenfold
increase across the nineteenth century in Britain)18 and the concomitant in-
crease in the number of hospital beds (over fourfold in England and Wales
between 1861 and 1938).19 Second, the growing status of hospital medicine
and surgery, such that by about 1920 they had achieved the dominance that
we take to be the defining feature of the modern hospital. General hospitals
consumed more resources and offered a greater range of services than any
other type of health care provider. So it was c.1800–c.1920, so it has been
ever since.20
To elaborate only on the second phenomenon: from the later eighteenth
century, doctors on the whole supplanted governors in the determination
of hospital admissions, staff appointments, and overall policy. For the first
time in history, hospital medicine was different in kind from non-hospital
medicine, and not just a simplified, cheaper, version of a medical ‘vernac-
ular’. New techniques and instruments – the electro-cardiograph in the
nineteenth century, the iron lung and dialysis machine in the twentieth –
were either developed in hospitals or were used in them as nowhere else.
The medicine with which they were involved was based conceptually in
pathological anatomy – as revealed in the post mortem and refined in the
hospital laboratory. With effective antisepsis and anaesthesia, the hospital
became by the early twentieth century the almost exclusive locus of surgery
too. The criteria for admission were now chiefly medical rather than socio-
economic. In England, as the Poor Law hospitals of the later nineteenth
century removed pauper patients from the voluntary hospitals, so the lat-
ter became far more acceptable to paying patients than they had ever been
before – either middle-class fee-payers or the working poor who contributed
to some insurance scheme. Design was changing too – the pavilion style
advocated by Florence Nightingale being adopted in response to concerns
about the hospital environment and the need for fresh air and cleanliness.
(Such concerns were hardly new and clearly affected hospital architecture
in, for instance, Renaissance Florence, but on the basis of a very different –
humoral – medical theory.) Reference to Nightingale is a reminder, if any
were needed, to add to the overall picture the changing image of the hospital
nurse between 1830 and c.1918 – from relatively unskilled carer to respectable
educated professional – even though the image does a serious injustice to the
8
longer-term background of women in nursing orders who provided h ospital

food and basic medication and surgery in eighteenth-century France,21 not
to mention earlier generations of women who had been dispensing remedies
in hospitals since the Middle Ages.22
Enhanced specialisation is the final major feature of nineteenth to
t wentieth century hospitals to be noted: hospitals for teaching; eye, skin,
and fever hospitals; and above all that characteristically nineteenth-
century phenomenon, the lunatic asylum. The insane had a long if patchy
history of being admitted to general hospitals in Europe since the later
Middle Ages (earlier in some places, especially in Islamic lands, but even
in the late antique Mediterranean world).23 Small private asylums pro-
liferated in the second half of the eighteenth century, but the large, ded-
icated asylum and the whole social and legal culture of ‘asylumdom’ is
a nineteenth-century development lasting until the decarceration move-
ment of the 1960s. By the mid-nineteenth century, in parallel to the cen-
trality of the hospital to general medicine, ‘the asylum was endorsed as
the sole, officially approved response to the problems posed by mental
illness’.24
Perhaps the most recent phase to date in hospital history should be as-
signed a beginning in the 1960s. What distinguishes the twentieth century
may prove to be less the formation of the British National Health Service or
the elaboration of national or individual insurance schemes in other coun-
tries, but the sharply rising costs of the capital- and technology-intensive
hospital medicine, of which such schemes are only particular expressions.
The critique of hospitals that emerged in the 1960s and that has continued to
be voiced in the twenty-first century seemingly marks the end of a relatively
brief, quite positive, phase in hospital history. There had been ‘anti-hospital’
movements before, in later medieval England perhaps, as patrons favoured
other types of foundation, and at the close of the late eighteenth century
for example;25 and the hospital had often (although not nearly as often as
modern historians used to maintain) been stigmatised as a locus of pauper-
ism, infection, and death. Yet it has experienced no downturn in its general
reputation quite as dramatic as that registered by the biomedical ‘high-
tech’ hospital in the later twentieth century. After many decades of growing
popularity, hospitals are now a focus of those anxieties about bureaucratic,
corporate modern medicine, its costs and allegedly skewed priorities, and
the nosocomial infections that it passes to those whom it should be curing –
anxieties that enhance the attraction of alternative therapies. Hospitals are
likely victims of further cost-reducing decentralisation: the devolving of ser-
vices to outpatient clinics and primary health care providers. It is not hard
to foresee a time when the power and cheapness of computer-run medical
technology could nullify the economies of scale and concentration that have
been the rationale for hospitals’ existence since the time of Joseph II, if not
9
from the very beginning. As the late Roy Porter wrote in one of his last
books:
Whether, for its part, the general medicine of the future needs, or
can afford, the ever-expanding hospital complex remains unclear.
Today’s huge general hospitals may soon seem medicine’s dino-
saurs. Will they go the way of the lunatic asylums?26
III Minding the gaps

Such is one possible view of the long term in hospital history, from the fourth
century to the twenty-first. It adds a few local twists and comments of its own,
but essentially is meant to convey a broadly uncontroversial narrative. It is,
of course, nevertheless seriously deficient, and not just in the ways that inev-
itably attend summaries of over 1,500 years of history in a few paragraphs.
Some of the deficiencies are glaring. First, the story has been mainly
European. I have not so far mentioned hospitals in North America.27 The
earliest such hospital is the Pennsylvania Hospital (1751), followed by the
New York Hospital (1791) and then, after a pause, the Massachusetts Gen-
eral (1821). These were modelled on the English voluntary hospitals, and,
in simplified outline, the story of American hospitals is that of European
hospitals – telescoped in the initial stages, varied in subsequent ones, but
still overall clearly recognisable. The wealthy physicians who specialised in
diseases of the rich nonetheless used poor patients to burnish their exper-
tise, and these patients lay in the hospitals philanthropically financed by the
physicians’ rich patients.
The multiplication of institutions that in Europe began in the twelfth
c entury came late to North America even when allowance is made for its
having started only in 1751. A survey of 1873 revealed no more than 120
general hospitals in the entire country. The Civil War, with its one million
hospital cases in the North alone, seemingly produced no major lasting
changes to hospital provision. At the end of the war the military hospitals
were closed and most of the soldiers still needing treatment were packed off
to their families. It required the unprecedented immigration, urbanisation,
and industrialisation of the century’s closing decades to produce a signif-
icant expansion of hospital establishment. By 1909 there were over 4,300
hospitals with 420,000 beds, but it had been only relatively recently (after
c.1880) that middle-class patients could be enticed to occupy any of them.
There is obviously much more to American hospital history – and not
only since 1900. In keeping with the Eurocentricity of most hospital h istory
written in English, America is so far only North America, and only since
1751. Yet there is wider history, both earlier and contemporary, that r emains
to be written in detail: colonial hospitals, exported from Old Spain to
New Spain, for instance, as instruments of attempted control, conversion,
10
acculturation, the containment of epidemics – and even medical experimen-

tation.28 There was a hospital on the Spanish Caribbean island of Santo
Domingo from the very early sixteenth century, and one opened in what
would become Mexico City soon after the subjugation of the A ztecs. It was
followed in the 1530s by the first establishment exclusively for indigenous
people. By the beginning of the seventeenth century there were some 128
hospitals in New Spain. Later that century, in New France, supposedly even
the rich settlers availed themselves of hospital services.
This colonial hospital history of course extends to Asia and, later,
A frica.29 In Asia it again begins in the early sixteenth century. The Portu-
guese founded a hospital in Goa – for their own soldiers and seamen – soon
after the creation of the colony in 1510. In the comparatively brief period
during which Japan was open to foreigners, 1549–1639, the Portuguese were
responsible for the first western-style hospital at the other end of Asia.30
Such a history is but one aspect of the ‘globalisation’ of the hospital, the
earlier phases of which were outlined above. Filling out the picture in this
way does not go far enough, however. The narrative presented in section II
above was not only European. It was also Christian. It takes the beginnings
of Christian hospitals in the fourth century ce as the beginnings of hospital
history tout court. That does some injustice to the various settings in which
historians of the ancient world have, mostly without convincing result, tried
to detect the pagan equivalent of the Christian hospital: in the courtyards
of healing shrines in which the sick camped out for days at a time hop-
ing for a therapeutic dream; in doctors’ private clinics; and, above all, in
the valetudinaria (literally, recovery homes; seldom medicalised; and few in
number) in which some sick or injured soldiers and slaves were for a short
time, during the ‘high’ Roman Empire, nursed back to health.31
Beginning – as we did – with Christianity may do another, and perhaps
greater, injustice to the Jewish contribution. Jewish hospitals are first clearly
attested in the sixth century ce. But both their medical development and the
extent to which they inspired or imitated Christian hospitals remains unclear.
It may be that, within synagogue complexes, a room or rooms had been set
aside, hospital-like, for lodging transients a long time before the sixth century.
And there was at least one first-century ce hospital-cum-guesthouse to cope
with the great influx to the Jerusalem Temple. The history of the Jewish hos-
pital deserves to be rescued from the margins and set alongside that of, on the
one hand, the Christian hospital and, on the other, the mutation of the clearly
Christian-inspired hospital idea characteristic of hospital founders in Islam.
Three religions of Abraham; three intertwined histories of hospital ‘dias-
poras’. Even recognising that does not take us quite far enough. Hinduism,
Buddhism, and Jainism each have their hospital histories – charitable in em-
phasis, and to that extent rather like the Judaeo-Christian type; but in the
case of Jainism also producing the unusual feature (unusual in pre-modern
times) of the hospital for sick animals.
11
This wider history of Asian hospitals brings out interesting, though pre-
sumably coincidental, similarities between East and West. It is not just that
the groups to whom hospital charity is extended are similar – the sick poor,
those unable to work, widows, orphans and so on. Chronological parallels
are also detectable. In the early fifth century ce, for example, a Chinese
Buddhist pilgrim touring India recorded:
The cities and towns of this country are the greatest of all in the
Middle Kingdom. The inhabitants are rich and prosperous, and
vie with one another in the practice of benevolence and righteous-
ness […] The heads of the Vaiśya [merchant] families in them [all the
kingdoms of north India] establish in the cities houses for dispens-
ing charity and medicine. All the poor and destitute in the country,
orphans, widowers, and childless men, maimed people and cripples,
and all who are diseased, go to those houses, and are provided with
every kind of help, and doctors examine their diseases. They get the
food and medicines which their cases require, and are made to feel
at ease; and when they are better, they go away of themselves.32
This has been called an account of a ‘civic hospital system’.33 It may not
quite be that, but it prompts interesting comparisons with the hospitals
contemporaneously being founded in the Byzantine empire.
The Middle Ages reveal other parallels. The medieval wave of E uropean
foundations beginning in the twelfth century is echoed in the government-
sponsored poorhouses and hospitals being set up in northern Sung China.34
A little later, at the time this western wave was cresting, around 1200 ce
Jayarvarman VII of the Cambodian kingdom of Angkor was founding or
restoring 102 hospitals across his kingdom. Some details of their intended
organisation can be derived from inscriptions, for instance the stele of
Say-feng, close to Vientiane in Laos, and among the northernmost points of
the Angkorian kingdom. To quote an authoritative summary:
The text of this inscription mentions the persons employed by

the hospital: nursing staff and servants. The hospital is open to
the four castes. Two doctors are to attend to each caste; they are
assisted by a man and two women ‘with a right to lodging’. The
personnel also includes: ‘two dispensers responsible for the distri-
bution of remedies, receiving the measures of rice. Two cooks, with
a right to fuel and water, who have to tend the flowers and the lawn,
and to clean the temple […] fourteen hospital warders, entrusted
with the administration of the remedies […] two women to grind
the rice.’ As the hospital is a religious foundation, ‘two sacrificers
and one astrologer, all three pious, are to be named by the Superior
of the royal monastery. Every year each of them shall be provided
12
with the following: three coats and three lengths of cloth, fifteen
pairs of garments, three pewter vases.’ In addition they were to
receive paddy, wax and pepper. The sick are to be fed with ‘the
rice forming part of the oblation to the deities [fixed] at one bushel
a day’ and with the remains of the sacrifices. The text next gives a
long list of the medicaments placed by the king at the disposition
of the sick: honey, sesame, clarified butter, a mixture of pepper,
cumin and rottleria tinctoria, musk, asafoetida, camphor, sugar,
‘aquatic animals’, turpentine, sandalwood, coriander, cardamum,
ginger, kakola, origano, mustard seed, senna, curcuma aromatica
of two kinds etc.35
To mention only one other, final, example: in nineteenth to twenty-first

c entury India, hospitals dispensing either Ayurvedic medicine, or Unani
tibb – the ‘Greek medicine’ brought to India by Islam – have been erected, if
not alongside, then not far from those dispensing western biomedicine.36 Of
course, the different medical systems have not remained uncontaminated by
one another; in particular, Ayurveda and Unani tibb have accommodated
aspects of their therapeutics to biomedicine. But the globalising of biomed-
icine has hardly produced a uniformly modern medical landscape, whether
in hospitals or in medicine generally.
IV Against grand narrative

Hospital history is large and complicated – far more so than conventional
Christocentric, Eurocentric accounts suggest. Not surprisingly, historians
who seek an Olympian view try to divide this history up into phases or
stages; I have done the same in the opening sections.
Several classifications are currently on offer, all essentially similar. Back
in 1936 Henry Sigerist sensibly divided hospital history into three broad
stages.37 The first saw the institutional care of the sick arising in the medical
facilities incidentally offered by poor houses, guest houses and (implausible
as it now seems) prisons. The second stage began in the thirteenth century,
when hospitals emerged as medical institutions for the indigent and depend-
ent. The third, and so far final, stage began in the mid-nineteenth century
when the ‘progress of medicine and surgery’ induced the emergence of the
modern hospital – the hospital that we, in the 2000s, know and (sometimes)
love.
Much more recently than Sigerist, Guenter Risse, who in a very helpful
monograph favours a series of case studies over a continuous narrative,
nonetheless essays a summary typology.38 Overall he sees hospitals as sym-
bols of community, deliverers of social welfare, and mechanisms for coping
with suffering, illness, and death. The hospital is first, originally, a ‘house of
mercy’; then in the later Middle Ages (also the start of Sigerist’s phase two)
13
a ‘house of segregation’; then in the Renaissance a ‘house of rehabilitation’.

In the eighteenth century the hospital becomes a ‘house of care’, as doctors
come to dominate (in ways sketched above). From the 1880s it is a ‘house
of surgery’, because of antisepsis, and for the first time it is used on a sig-
nificant scale by the middle classes. For the last century or so, it has been a
‘house of science’.
Risse’s typology is elegant and memorable – and subtly qualified in all the
appropriate ways. It may be preferable to proceeding by conventional his-
torical periods (medieval, early modern, Enlightenment, and so on); as does
Lindsay Granshaw, whose final division and longest section in her excellent
survey article is, however, somewhat crudely, ‘early modern and modern’.39
But the problem with all these various ways of dividing up the hospital’s
past is not their artificiality or over-simplicity. All chronological schemes
over-simplify, and are to be judged only by the heuristic value of the gener-
alisations that result from them. The problem, rather, is in the way that the
particular historiographical schemes that hospitals have attracted are all
skewed towards a modernity defined by medicalisation. The background
assumption is that true hospitals are medicalised – with medicalisation
defined basically in terms of the presence of doctors and surgeons and, at a
more sophisticated level, of the degree of authority that they wield, over the
patients and over the institution as a whole. For Sigerist, that process began
in the thirteenth century. For Risse, as for many others, it belongs above all
to the nineteenth century and since. Whatever its particular inflection, the
underlying idea is that there has been a great ‘before’ and ‘after’ in hospital
history; some pivotal period in which charity gives way to medicine, care to
cure, stigma to pride, the mortuary to the recovery room, the poor to the
middle classes.
Why do we tend to think like this? Why do we look so persistently for
the ‘genesis of the modern’, assessing over 1,500 years of hospital history
on a yardstick calibrated for the last two centuries? The economic history
of Europe since antiquity is not (or not usually) conceived solely as a search
for the origins of industrial capitalism, nor the history of transport as a
frustratingly long build-up to the railway and the steamship. Yet the his-
toriography of hospitals is more often than not written with an eye on the
present, or at least on the modern. Sometimes this is an effect of the rhetoric
of hospital reformers over the past two centuries: reformers have tended
to exaggerate the difference of ‘before’ from ‘after’, as if they are always
engaged in dragging their particular hospitals from medieval darkness into
modern light.
Historians have occasionally been seduced by this rhetoric from the past.
But they have also generated theories of their own. The sociologist Nicholas
Jewson strikingly identified the ‘disappearance of the sick man’ (and woman)
in hospitals around the turn of the nineteenth century. A system of hospital
medicine founded in a holistic view of the individual patient and his or her
14
environment gave way to a reductive clinical emphasis on diseased parts;

the individual person was disregarded (an accusation normally reserved for,
and perhaps unduly influenced by, later twentieth-century medicine).40
The most famous proponent of a ‘big bang’ theory of the origins of the
modern hospital is of course Michel Foucault. His identification of the
French Revolution as the brief but explosive period of ‘the birth of the clinic’
has proved so influential that historians have to continue rehearsing it even
though few of them now accept it. Indeed, his account perhaps continues to
enjoy currency precisely because it offers a clear theory to attack so that a
more ‘smoothed out’ view of hospital medicine in the eighteenth and early
nineteenth centuries can be substituted without having to arrive at some
alternative conception of the period. This ‘smoother’ historiography finds
medicalisation (when it happened at all) to have been a far more complex
phenomenon than Foucauldians have alleged, yielding perhaps surprising
agents of change:
Probably the most medical process in [French] hospitals in the

s eventeenth century was the diffusing of nursing communities. Far
from such women being – as is often simplistically alleged – the
bearers of a religiously inspired anti-medicine, careful study of the
contracts they passed with hospitals reveals nursing communities
as a prime agent of hospital medicalization.41
Or again:
to a considerable extent, we may see in military hospitals one of

the prime sites in which the hospital patient qua patient was con-
structed over the eighteenth century, long in advance of the ‘birth
of the clinic’ in the 1790s. Their overtly functional orientation made
it more likely that their inmates were more truly sick than might be
the case in civilian hospitals.42
The modern medicalisation of the hospital – however we define ‘modernity’

and ‘medicalisation’ – is undeniably important. But it does not have to skew
the overall history of hospitals – an outline into which specialists insert their
particular contributions – to quite the extent that it mostly has up to now.
It may be that, for the first millennium of its history, indeed for longer than
that, the modal hospital – the commonest form of hospital – was charitable,
funded for the poor and offering the therapy of religion, a regulated envi-
ronment, and a proper diet, rather than the attentions of secular physicians.
That first millennium must be viewed in its own light, rather than that cast
by the period since 1900.
Alongside the modal European hospital, we must also place others that
make up the rest of the global population. The modal hospital of the early
15
Byzantine empire was grounded in the therapy of the sacraments, even

though right from the documented beginning of Byzantine hospitals some
foundations had doctors attached. The modal Islamic hospital of say the
eleventh century, like the modal Cambodian hospital of the twelfth, was on
the other hand highly medicalised, to judge simply by medical manpower.
Considering Renaissance Florence, the highly medicalised, seemingly mod-
ern, though still essentially religious, Santa Maria Nuova may distort our
overall picture. But the modal Florentine hospital of the fifteenth century
remained what it had been in the twelfth – small, without medical staff, and
providing overnight accommodation to pilgrims and poor travellers rather
than treating large numbers of sick people.
As we move later in period so the mode becomes more elusive. We saw at
the start, with the example of Josephine Vienna, and later when we returned
to the Enlightenment in England and France, that towards 1800 the hospital
population was still extremely diverse, old and novel elements kaleidoscopi-
cally interconnected. And the twentieth century? It might seem obvious that
the modal hospital has been the one at the forefront of medical technology
and intervention. But that may be true only on a circular definition – that
all genuine hospitals are medicalised to that degree. If we add to the list of
hospital types the hospices for palliative care of the terminally ill that have
multiplied since the 1970s, and other similar institutions that would have
been counted as hospitals in any period before c.1800, then the mode may
not be so certain. Abandon the outright privileging of western biomedicine;
add in the global ‘population’ of famine relief centres, Ayurvedic hospitals,
private hospitals owned and run by individual physicians (as in twentieth-
century Japan), small temporary clinics offering only basic medication,
leper sanctuaries – and the most common form of hospital in the world since
1900 may not be the technological showcase we thought it was.
V Hospital historiography
Of the making of hospital histories there is no end. The modal study has
been to a great extent local, institutional, somewhat introspective, perhaps
celebratory – a story of physicians and local activists, of progress. Yet since
the 1970s a ‘new’ hospital historiography has also developed. It is com-
parative (not looking at just one institution at a time) and in the broadest
sense sociological or contextual. That is, it studies hospitals in their social,
cultural, and religious as well as their medical setting, recognising that there
is always much more to a hospital than its doctors.
An excellent sample of this more recent approach – now not so new, of
course, but still not the numerically dominant form of historical writing on
the subject – is the collection edited by Lindsay Granshaw and Roy Porter,
The Hospital in History (1989).43 Theirs is a volume of enormous chrono-
logical scope, ranging from about 1100 to 1980. And, although six of its ten
16
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A week after we went to Gauhati, news came from Manipur that
Mr. Heath, our successor, was very ill indeed with dysentery. And as
every day went by, bringing reports of his condition, sometimes
better, and then worse again, we began to fear that he would not
recover. At last one day a telegram came saying that all was over,
and that he had died the previous evening. We were both very sorry
to hear it. We had liked what we saw of him so much, and had been
so sorry to leave him there, apart from our own sad feelings at going,
knowing that he disliked and dreaded the place so much. It seemed
terribly sad. I knew well, too, that it would mean our returning there,
and much as I had regretted leaving, I did not want to go back.
I cannot tell why the dislike had arisen within me at the thoughts of
returning; but the journey was so long, and the time of year so trying,
and on the top of that there was the feeling that a man whom we had
known and liked had just died in the house, and that if we went back
it would be to rooms that were full of his things, and associations
quite unlike those we had left behind us. Maybe that a warning of all
that was yet to come filled me with some unknown presentiment of
evil; but it seemed as though our return there was inevitable.
Within twenty-four hours after we had heard of Mr. Heath’s death
came the letter offering Manipur again to my husband. I watched his
face light up as he read it, full of eagerness to get back to the place
he loved, and I knew that I could never tell him that I did not want
him to go. My reasons for not wishing to return seemed childish, and
I thought he would not understand the superstitious ideas which filled
me with dread at the idea of going back. So when he came to me
with the letter and asked me to decide whether we should say yes or
no to it, I said we had better accept what it offered.
As it was so late in the year for travelling, and the weather so hot
and unhealthy, my husband decided to leave me in Shillong on his
way to Manipur, and let me follow in October. It was with a heavy
heart that I superintended the arrangements for the return journey.
An undefinable dread seemed to predominate over all I did, and I bid
good-bye to my husband when he left me behind in Shillong with a
very heavy heart, and my anxiety was not lessened when I heard
from him day after day, giving me terrible accounts of all he was
going through on the way. Every one of his servants, with the
exception of the Khitmutghar, got ill with fever and other complaints
peculiar to the time of year. They had to be carried the whole way,
and my husband had to cook his own dinner and groom his horses
himself every day, besides having to unpack all the necessary tables
and chairs at each halting-place, and do them up again before
starting off next morning. It was only a mercy that he did not get ill
himself to add to the other miseries, and that I was not there to make
extra work for him. Very glad was I to hear from him at last that he
had arrived safely at Manipur. I don’t think he felt very bright at first.
He was quite alone there. The regiment was still away in the Chin
Hills, and rumours were afloat that when it did return most of the
men were to be drafted to Shillong, and only a wing left to garrison
Langthabal. My husband complained, too, that the Residency had
somewhat gone to seed since we left. During Mr. Heath’s illness and
the time which elapsed between his death and our return the
servants had all taken a holiday, so there was a good deal to be
done to get things into order again. Several rooms in the house that
contained the dead man’s effects were kept locked up, and it was
some time before my husband could get the whole house opened
and the things sent away down to Calcutta.
Meanwhile I was enjoying myself very much, having got over my
first feelings of loneliness, and made friends with everyone in the
place, more or less. Shillong is a lovely little station nestling away
amongst the Khasia Hills, in the midst of pine woods, and abounding
in waterfalls and mountain-torrents. The climate is delicious all the
year round, and the riding and driving as good, if not better, than any
hill-station in India. Life there was very pleasant, not a
superabundance of gaiety, but quite enough to be enjoyable. I have
spent some very happy days there with some good friends, many of
whom, alas! I can never hope to see again; and the memories that
come to me of Shillong and my sojourn there are tinged with
sadness and regret, even though those days were good and
pleasant while they lasted.
Things have changed there now, that is, as far as the comings and
goings of men change, but the hills remain the same, and the face of
Nature will not alter. Her streams will whisper to the rocks and
flowers of all that has been and that is to be. So runs the world.
Where others lived and loved, sorrowed and died, two hundred years
ago, we are living now, and when our day is over and done there will
be others to take our place, until a time comes when there shall be
no more change, neither sorrow nor death, and the former things
shall have passed away for ever.
CHAPTER VIII.
A terrible experience—A Thoppa and a journey in it—Its difficulties and dangers—
The Lushais—Arrive at Sylhet—Find the Coolies have levanted—A pony
journey ends disastrously—A night walk—Accident to Mr. A⸺.—Arrive at a
teahouse—Not a shadowy dinner.
I left Shillong early in November, 1889, travelling part of the way

towards Manipur quite alone, and had a terrible experience too. I had
arranged to journey a distance of thirty-eight miles in one day. I sent
one of my horses on the day before, and started in a ‘Khasia
Thoppa’ down the last hill of the range upon which Shillong is
situated, which brings you down into the plain of Sylhet. A Thoppa is
a very curious mode of locomotion. It is a long cane basket, with a
seat in the middle, from which hangs a small board to rest your feet
upon. Over your head is a covered top made of cane, covered with a
cloth. You sit in this basket and a man carries you on his back,
supporting some of the weight by tying a strap woven of cane on to
the back of the Thoppa, which he puts over his forehead. The
Khasias, luckily, are very strong men, but they think it necessary
always to begin by informing you that you are much too heavy to be
lifted by any single individual, unless that said individual be
compensated at the end of the journey with double pay.
You ask him what you weigh, and he scratches an excessively
dirty head, shuts up one eye, spits a quantity of horrible red fluid out
of his mouth, and then informs you that he should put you down as
eighteen or nineteen stone, and he even will go as far as twenty
sometimes. This, to a slim, elegant-looking person, partakes of the
nature of an insult, but eventually he picks you up on his back and
proceeds along the road with you as fast as he can, as if you were a
feather weight. Going along backwards, and knowing that, should
the man’s headstrap break, the chances are you will be precipitated
down the Khud,[7] are certainly not pleasurable sensations; but it is
astonishing how exceedingly callous you become after a lengthy
course of Thoppa rides up in the hills. Sometimes your Thoppa
wallah[8] may be slightly inebriated, when he will lurch about in a
horrible manner, emit a number of curious gurgling noises from the
depths of his throat, and eventually tumble down in the centre of the
road, causing you grievous hurt.
At other times he will take into consideration that it is a cold night,
the Memsahib is going to a Nautch,[9] and will be there four or five
hours, while he is left to his own reflections outside, waiting to carry
her home again when her festivities have subsided. Having arrived
at the conclusion that the cold will probably by that time be intense,
he will come to take you to the scene of action enveloped in every
covering that he can get together. After he has carried you a short
way he begins getting hot, and rapidly divests himself of his many
wrappers, placing them on the top of your machine, where they
flutter about, hitting you now and then playfully in the mouth or eye,
as the case may be, and making themselves as generally
unpleasant as they possibly can. Having done so, they end by falling
off into the road. Your Khasia perceives them, and immediately
descends with you on to his hands and knees, and grovels about
until he recovers the fallen raiment. During this process your head
assumes a downward tendency, and your heels fly heavenwards;
and should you move in anyway ever so slightly, you immediately
find yourself sitting on the ground in a more hasty than dignified
attitude, upbraiding your Khasia in English. You may swear at a
native and abuse all his relations, as their custom is, in his own
language, and you will not impress him in any way; but use good
sound fish-wife English, and he will treat you as a person worthy of
respect.
On my journey from Shillong, at the time of which I write, I fell in
with two very amiable Khasias. One could speak Hindostanee rather
well, and he walked beside me as I travelled down the hill and talked
to me on various interesting subjects. He asked me a great deal
about the Lushais, and I invented some wonderful anecdotes for his
delectation. When we parted, I think I had impressed him with the
idea that I was a person of great moral worth.
At the foot of the hill I got into a small train, the only railway to be
found at present in that side of Assam. I think it only extends over
about twelve miles of country, and there are about four trains, two up
and two down daily. They do not trouble themselves by putting on
too much speed. We, my servants and I, travelled as far as we could
in it, and then I found myself within twenty miles of Sylhet—my
proposed destination—in lots of time to ride in comfortably before
dark, and get my servants and baggage in at the same time. But,
alas! the inevitable fate of the traveller in Sylhet was destined to be
mine, too, on this occasion; and when I got out of the train, expecting
to find my coolies waiting for me, I found a wretched police inspector,
who informed me that the coolies had all run away, and he could not
get me any more. What was to be done I knew not, but after some
delay I met a young fellow whom I knew slightly, as he was
connected with the railway, and I had seen him passing through the
district once before. He was a perfect godsend to me on this
occasion, and after some hours’ hunting for coolies he managed to
get the requisite number, and started them off with my luggage.
The next thing to be done was to start myself. Mr. A⸺ kindly
offered to go with me half-way, as it was then four o’clock, and only
two hours of daylight left. Off we started, he on the most
extraordinary pony I have ever seen, that looked as though it might
fall down at any moment, and I on a small Manipuri pony I had taken
with me up in the hills. We started off galloping, and went as hard as
we could for six miles. I hoped that about seven miles from Sylhet I
should find a pony-trap waiting for me which a planter had offered to
send to meet me, so I did not spare my small steed, as I knew he
would not think anything of twelve miles.
By the time we got to the river, where I expected the cart to meet
me, it was almost dark. My poor pony was terribly tired and hot, but
Mr. A⸺’s curious old beast seemed none the worse. We crossed
the river on a ferry, and then found there was no cart on the opposite
side. It was a terrible blow, for our ponies had done enough as it
was. Night was rapidly overtaking us, and seven miles of the road
lay before us to be got over somehow. I had passed all my coolies
three miles away on the road from the railway, and knew that they
would not be in for hours. There was nothing to be done but to go on
as best we could. There were tracks of the cart-wheels in the road,
so I knew it had been there, and it made it all the more annoying. It
was no good trying to gallop on, as my pony was so tired he could
scarcely crawl.
We proceeded slowly for about two miles. It was getting darker
every minute, and at length we could see nothing at all, but knew
that we had still five more weary miles to travel over. Mr. A⸺
suggested our urging our horses into a canter, which ended
disastrously for me, as my pony caught his foot in something on the
road and landed on his head. That was the end of all idea of riding,
so I got off, hauled him up on his legs by dint of much persuasion,
and started off walking. The road was ankle-deep in loose sand,
jackals hurried by us at every moment, and noises startled me at
every turn. At last I remembered that the planter who had sent the
cart out lived somewhere in that neighbourhood. When we had been
quartered in Sylhet, I had often ridden past his house, though I had
never been actually up to it, and I told Mr. A⸺ that I thought we
had better steer for his bungalow, if we could only find the road up to
it. We went on as fast as we could, considering, and at length saw
the lights of the house standing some distance to our left away from
the road.
The next thing was to find the way up to it. My companion asked
me to look after the ponies—a rather unnecessary precaution, as
they were too tired to need any looking after—and he proceeded to
try and find the road. After a little while I heard a stifled call in the
distance, which was repeated, and then I discovered that poor Mr. A
⸺ had fallen into a horribly wet, slushy rice-field, and needed my
help to extricate him. Having given him the necessary aid, and
hauled him out, we decided that any more searching for the road up
to the house would be a futile waste of energy, and were preparing
to make the best of our way into Sylhet, when a coolie woman came
by, and we rushed at her and asked if she could show us the way to
the Sahib’s bungalow. She seemed very much alarmed at our
sudden appearance, as we were then only dimly visible by the light
of the rising moon. However, she said after a little that she would not
mind conveying us up to the house, provided that we would allow her
a fair start in front of us, as she professed to be much alarmed at our
horses.
We proceeded slowly and solemnly behind her, and at length
found ourselves not at the bungalow, but at the tea-house, an
erection made of corrugated iron in which the tea was manufactured.
All round this building there were wire stays which were fastened in
the ground and attached to the roof, to prevent the latter being blown
off in storms of wind. My poor tired pony caught his feet in one of
these wires and tumbled down; so, thinking that it was better to take
what rest he could, he did not trouble himself to get up again. It was
not much good scolding our guide, but we seemed no better off than
we had been in the road below, and the lights of the bungalow
gleamed just as far away as before. Mr. A⸺ suggested shouting,
so simultaneously we all lifted up our voices and shouted as loud as
we could.
At length, after doing this a great many times, a light appeared in
the door of the bungalow; and a few minutes afterwards the figure of
my friend the planter became visible descending the hill upon which
his house was situated, and coming armed with a big stick to see
what evil spirits were in possession of his tea-house.
Very much surprised was he when he found there was a lady in
the case, and not a little disconcerted over his own appearance, as
he was not clad in raiment suitable to the entertaining of female
visitors.
I was much too tired, however, to notice whether he was got up for
the occasion or not, and he seemed a perfect godsend to us both
after all we had gone through.
He soon took us up to his house, and in half an hour gave us
dinner. Real dinner, too—not a shadowy make-belief; but soup,
entrée, and joint, just as though we had come by invitation, and this
had been the result of some days’ preparation.
How we did eat! There was little doubt that we appreciated the
excellent fare set before us, and at the end of it I felt a different
being.
Our friend the planter had meanwhile got himself up regardless of
expense, and offered to drive me into Sylhet, an offer which I most
gladly accepted, leaving the poor Jabberwock in a comfortable
stable, with a large bundle of grass in front of him, which he was too
tired to eat.
We did not take long to get over the four miles to Sylhet, where I
bade farewell to the planter and Mr. A⸺, who returned with him to
the garden.
I had the pleasure of lying down on a bed with no bedding, and
waiting until my coolies and baggage should arrive, with part of my
muddy habit rolled up to serve for a pillow; and very well I slept for
three good hours, when at two o’clock in the morning my goods and
chattels commenced dropping in, and I was able to go to bed in real,
sober earnest.
Next morning the Jabberwock arrived, looking rather miserable,
with a very large swelling on his leg, and a bad girthgall; so there
was no possibility of our continuing our journey that day, as the
servants all said they were dying, and could not move on at any
price. However, the day following they had recovered sufficiently to
proceed another fifteen miles; and after three more days I arrived at
Cachar, where I found my husband, who had come down from
Manipur to meet me.
CHAPTER IX.
Return to Manipur—Mr. Heath’s grave—Old Moonia—A quarrel and fight between
Moonia and the Chupprassie’s wife—Dignity of the Chupprassies—The
Senaputti gets up sports—Manipuri greetings and sports.
It was strange finding myself back in Manipur after nearly nine

months’ absence; but though the house had had several
improvements made to it, and the grounds were prettier than when
we had left in February, I could not settle down in the place as I had
done before. Poor Mr. Heath was buried in our own garden, quite
close to the house—so close, in fact, that I could see his grave from
my bedroom window. There had been two graves there before—one
was Major Trotter’s, who was once political agent at Manipur, and
died there from wounds which he had received fighting in Burmah;
the other was that of a young Lieutenant Beavor, who had also died
at the Residency, of fever. But we had never known either of these
two men, so that I did not look upon them in the same light as I did
on Mr. Heath, and his sudden, sad death seemed to haunt me. Once
a friend of mine remarked to my husband, ‘What an unlucky place
Manipur is! I have seen so many political agents go up there, and
something always seems to happen to them.’ Hearing this gave me
a cold shudder, and I longed to get my husband to give up a place so
associated with gloomy incidents, and take some other district in the
province. Not that I was ever really afraid of anything tangible.
THE GARDENS OF THE RESIDENCY AT MANIPUR.
I rode alone all over the country, fearing nothing from the
inhabitants, who knew me, and would have been only too ready to
help me had I needed aid; and I have been left for days together
quite alone at the Residency while my husband had to be out in
camp. Once he had to go down to Tammu in Burmah, five days’
journey from Manipur, and I was too ill to go with him, so stayed
behind.
For sixteen days I was there all alone. We had no neighbours
nearer than a hundred miles off, and I never even heard English
spoken until my husband returned. The old ayah used to sleep on
my doormat at night, and I always had sentries outside the house,
back and front. I used to hear, or imagine I heard, all kinds of noises
sometimes, and get up, waking the old woman from her noisy
slumbers to come and do a midnight parade all round the house,
searching in every nook and corner for the disturber of my rest,
which was probably nothing more harmful than an antiquated bat
roaming about in the roof, or a rat in the cellars beneath the house.
The poor old ayah used to pretend to be very valiant on these
occasions and carefully hunt in every dark corner which I had
already turned out; but she was always glad to get back when the
search was ended to her own venerable blanket, in which she used
to roll her attenuated form, and snore away the long vigils of the
nights.
Poor old Moonia! she was a faithful old soul, and has tramped
many a mile after me in my wanderings backwards and forwards.
She was a lazy old woman, but if I told her so, she gave me warning
on the spot. She did this very frequently—on an average, six times a
month; but after a little I got accustomed to it—in fact, I may say I got
rather to like it—and I never by any chance reminded her of her
promised flitting, or took any notice of the warning when she gave it
to me. She was a very quarrelsome old creature, and had some very
bitter enemies. First and above all she detested the head bearer.
She hated him with a deep and deadly hatred, and if she could do
him a bad turn she would do it, even though it caused her much
fatigue, bodily and mental, to accomplish it. Next to the bearer she
disliked the wife of one of the Chupprassies. This female was a
powerfully-built Naga woman, with a very good opinion of herself;
and she returned the ayah’s dislike most fully. They were always at
war, and on one occasion they had a stand-up fight. We had gone
out into camp, and as Moonia (the ayah) had not been well, I left her
at home instead of taking her with me, as I generally did. Two days
after we had started, a report reached us that she had had a terrible
fight with the Chupprassie’s wife, and the latter had injured her very
seriously. We heard nothing more about it at that time, so I imagined
that the ayah’s wounds were healing, and that I should not be
informed as to details at all. Not so, however. We returned to the
Residency a fortnight later, and I sent for my abigail as usual,
receiving in return a message saying that she could not come, as
she was still dangerously ill. Having, however, insisted on her
appearing, she came—very slowly, and with her head so enveloped
in coverings that I could not see even the tip of her nose. Groans
issued forth at intervals, and she subsided on to the floor directly she
entered the room. After a little parleying, I persuaded her to undo her
various blankets, and show me the extent of her injuries. They were
not serious, and the only real wound was one on the top of her head,
which certainly was rather a deep cut. However, I soon impressed
upon her that I did not think she was as near death’s door as she
evidently imagined, and let her return to her own apartments, vowing
vengeance on her adversary.
Moonia presented a petition soon afterwards, and my husband
had to try the case, which he proceeded to do in the veranda of the
Residency. The evidence was very conflicting. All the complainant’s
witnesses bore testimony against her, and vice-versâ; and the
language of the principal parties concerned was very voluble and
abusive. The ayah made a great sensation, however, by producing
the log of wood she had been beaten with, covered with hair and
blood, and the clothes she had worn at the time, in a similar gory
condition. The hair in the stick was very cleverly arranged. Where it
had originally come from was not easy to define; but it was stuck in
bunches the whole length of the stick, and must have been a work of
time and ingenuity. However, there were many exclamations of
commiseration for the complainant, and eventually the defendant
was fined one rupee, and bound over to keep the peace.
Then ensued a funny scene. The ayah argued that the fine
imposed was not heavy enough, and the adversary threatened her
with more violence as soon as she should leave the presence of the
Sahib; and they swore gaily at each other, as only two native women
know how to swear, and had to be conveyed from the court in
different directions by a small guard of the 43rd Ghoorkas, who were
mightily amused at the whole business. I thought at the time that
should the Chupprassie’s wife ever get an opportunity of wreaking
vengeance on the ayah, she was just the sort of woman to make that
revenge a deep one; and I pitied the ayah if she ever fell into her
hands. The day did come before very long; but of that I shall speak
later on.
Our Chupprassies were very useful, but very lazy, and puffed up
with pride in their own loveliness. Their red coats with the ‘V.R.’
buttons, covered with gold braid, lent them much dignity; and there
were many little offices which they absolutely refused to perform
because they wore the Queen’s livery, and considered themselves
too important. For instance, I requested four of them once to go into
the garden and catch grasshoppers out of the long grass with which
to feed a cage full of little birds. One of the four alone condescended
to go; the rest solemnly refused, saying that they could not demean
themselves by such a performance, and that I must get the Naga
boys out of the village to do it for them. And I had to give in to them
ignominiously.
These ten Chupprassies were all supposed to be interpreters of
some kind or another; but for the most part they could speak no
other dialect but their own, whatever that happened to be, and had
no idea of translating it into any other tongue.
Altogether, they were decidedly more ornamental than useful. Two
of them rode extremely well, and they acted as my jockeys in some
pony-races which the Senaputti got up one Christmas Day, amongst
other sports, for the amusement of our Sepoys and his own.
The Senaputti had got the idea of this Gymkhana from having
seen the 44th Ghoorka sports on one occasion at Langthabal, when
that regiment was stationed there, and besides the ordinary races
and competitions the Manipuris had some which I have never seen
anywhere else. One feat they performed was to lay a man on the top
of six bayonets. The bayonets were fixed to the rifles, and the latter
were then driven into the ground like stakes with the points upwards.
A man then lay down flat on the ground and made himself as stiff as
possible, when he was lifted up by four other men, and laid along the
tops of the bayonets. Had he moved they must have gone into him,
and we never knew how the performance was managed, or whether
they fixed anything on the points of the bayonets to prevent their
piercing his flesh; but it did not look a nice trick at all, and one always
dreaded an accident. There was wrestling, too, in which the princes
took part, and foot races, and the Senaputti gave the prizes, mostly
in money. And to wind up there was a play. The Maharajah had three
jesters, exactly like the old English fashion of having court-jesters to
amuse royalty.
The Manipuri specimens were very funny indeed. Their heads
were shaved like the back of a poodle, with little tufts of hair left here
and there; and their faces were painted with streaks of different-
coloured paints, and their eyebrows whitened. They wore very few
clothes, but what they had were striped red and green and a variety
of shades. They walked up to the tent where we were sitting to watch
the sports, all leaning against each other, and carrying on a lively
conversation in Manipuri, which seemed to amuse the spectators
very much. On reaching the door of the tent they all fell down at our
feet, making terrible grimaces by way of greeting, and then they
picked each other up and retired a few yards off and commenced the
performance. One disguised himself as an old woman, and another
as a native doctor, and the third as a sick man, lying on the ground
covered with a white sheet. Someone out of the crowd was
impressed into the play, and he had to call the doctor to the sick
man, who was meanwhile heaving up and down upon the ground in
a very extraordinary manner. The doctor came and poked him about,
making observations in Manipuri, at which everyone roared with
laughter; and then the old woman arrived and dragged the doctor off
home. She was supposed to be his wife, and as soon as she
appeared a scuffle ensued, in which the old woman’s clothes fell off.
We thought best to beat a retreat, as the play was beginning to be
rowdy and the dialogue vulgar; but I believe that it went on for some
hours afterwards, as we heard shouts of laughter proceeding from
the direction of the polo-ground, where the sports were held, late at
night; and the princes told us the next day that it had been a very
good play, and the only pity was that we had witnessed so little of it.
CHAPTER X.
Bad relations between the Pucca Senna and the Senaputti—Rival lovers—
Quarrels in the Royal Family—Prince Angao Senna—Pigeon contests—The
Manipuris’ fondness for gambling—Departure of the Ghoorkas—Too much
alone.
All was peaceful at Manipur around us until September 11, 1890.

As day after day went by, we seemed to get to know the royal family
better. Rumours of strife amongst the brothers reached us from time
to time, and petty jealousies showed themselves in some of their
dealings—jealousies that the weak will ever have for the strong, in
whatever country or community it may be. But we were good friends
with them all, though it was difficult at times to avoid giving cause for
disputes between the Pucca Senna and his more powerful brother,
the Senaputti. If one came more often than the other, that other
would get annoyed, and refuse to come at all for some time. The
Pucca Senna got very angry, because the Senaputti frequently
escorted the young princesses on their visits to me, and on one
occasion he tried to arrest some of their attendants in the road when
they were leaving the Residency, which might have been the
beginning of a very serious disturbance, had not my husband,
hearing privately that something of the kind was meditated, sent an
orderly and a Chupprassie with the girls to see them safely as far as
the palace.
The Senaputti had left the Residency on that occasion some time
before the young princesses went away. Poor children! they were
very much alarmed at the attempt to waylay their attendants, and it
was a very long time before they summoned up enough courage to
pay us another visit.
We knew that the Pucca Senna and the Senaputti were rivals, too.
Both wished to marry a girl who was supposed to be the most
beautiful woman in Manipur. She rejoiced in the name of Maïpâkbi,
but I never thought her as pretty as some of the young princesses
who used to come and see me. She was not a royalty herself, but
was the daughter of a wealthy goldsmith who lived near the palace;
her father was a prominent member of the Maharajah’s durbar, or
council. She was taller, though, than the average Manipuri, about
sixteen years of age, and very fair, with quantities of long black hair.
She was always very well dressed, and had a great many gold
bracelets on her arms, and some necklaces of pure gold which
weighed an enormous amount.
‘Fine feathers make fine birds,’ says an old proverb, and in this
case it was certainly true; but the two princes thought her beautiful,
and were at daggers drawn about her. We had a big nautch one
night, to which Maïpâkbi came as chief dancer. All the princes were
there to see it, and the two rivals for the young lady’s affections sat
one on each side of me. The Senaputti was all cheerfulness and
good-humour, but the Pucca Senna was very gloomy and morose,
and at the end of the evening my husband said we must never ask
the two brothers together again. Shortly afterwards we heard that
they had had a terrible quarrel, in which the Maharajah had taken the
part of the Pucca Senna, and that the Senaputti had sworn never to
speak to the latter again, an oath which he kept to the letter.
Meanwhile I went away to the hills, and all seemed to go on quietly
for two or three months, though a storm was brewing in the
meanwhile, which only needed an opportunity to burst forth and
overwhelm the reigning power in destruction. The eight brothers split
up into two factions—the Maharajah, Pucca Senna, Samoo
Hengeba, and the Dooloroi Hengeba formed one side; whilst the
Jubraj, Senaputti, Angao Senna, and the young Zillah Singh all
leagued together. Of the first four named, the Samoo Hengeba and
the Dooloroi Hengeba are the two that have not been mentioned
previously. The first of these was the officer in charge of the
Maharajah’s elephants, numbering about sixty. It was his duty to
manage all the arrangements in connection with them, and on grand
occasions, when the Maharajah rode on an elephant, his brother, the
Samoo Hengeba, acted as Mahout.[10] The name means Chief over
elephants, Samoo being the Manipuri name for an elephant, and
Hengeba head or chief.
The Dooloroi Hengeba had command of all the Maharajah’s
doolies.[11] This mode of travelling was confined to the rich, and was
considered a mark of great dignity; not everyone could indulge in this
luxury, and those who did had to get special permission to use them,
though sometimes they were conferred upon ministers of state by
the Maharajah as a mark of recognition for their services. The
Maharajah seldom travelled in any other style, as he was a very
stout, apoplectic kind of personage, and it suited him better to be
carried than to ride or go on an elephant. His dooly was a very
magnificent affair, made of wood, with gilt hangings all round it, and
a gilt top, which could be put over it in wet weather.
Prince Angao Senna was in charge of the road between Burmah
and Manipur. He was supposed to travel up and down it to see that it
was kept in a state of repair, but I don’t think he ever did so. He was
quite young, about two or three and twenty, and I never remember
seeing him without his having a large piece of betel-nut in his mouth,
which he used to chew. It gave him the appearance of having a
swollen face, as he stuffed enormous bits of it into his mouth all at
once, exactly as a monkey will do with nuts or anything of the kind,
and people said he never cared for anything but eating and drinking
and watching pigeon-fights.
The Manipuris are great gamblers, and they used to make these
pigeon-fights the occasion for betting considerably. A good fighting
pigeon was worth a lot of money—forty or fifty rupees. They were
handsome birds, larger than the ordinary pigeon sold in the market
for an anna apiece, and they had most beautiful plumage. The
contests between two of them were generally held in the middle of
one of the principal roads. Each owner brought his pigeon to the
scene of action tied up in a cloth, and they were then put under a
wicker cage, something like a hen-coop, where they fought until one
conquered.
It was very unexciting to watch it, we thought; but the crowd of
spectators used to take a breathless interest in the combatants, and
bet considerably upon them. I never quite understood how they
decided which bird had won, as they simply beat each other with
their wings, cooing loudly the whole time, and sometimes one
seemed victorious, and sometimes the other. However, there were
doubtless points in the combat which we did not understand, and the
Manipuris always took the deepest interest in them.
Latterly, after the expulsion of the Maharajah, his brother, the
regent, put a stop to these pigeon-fights, as the gambling over them
was becoming excessive, and several of the younger princes had
been seriously involved, and the state had had to pay their debts. A
heavy punishment was inflicted upon anyone found encouraging a
pigeon-fight, and even the casual spectators received a beating,
whilst the owners of the birds, and whoever had instigated the
proceedings, were hauled up before the durbar and fined large
sums. However, Prince Angao Senna was never caught red-handed,
though we heard that he still continued to encourage and attend
these séances on the quiet.
June, July, and August went by. Day by day came letters from my
husband at Manipur full of all the little details which went to make up
his life there, and never a dream of future trouble arose to disturb our
peace of mind. The only thing that rather worried my husband was
the approaching departure of our only neighbour, an officer in the
44th Ghoorkas, quartered at that time at Langthabal. Since the
regiment had left in the winter of 1888 for Burmah, we had never had
more than a wing of it back at Langthabal, and in the winter of 1889
it was decided that the troops should be removed altogether, and our
escort increased from sixty to a hundred men under a native officer.
But this decision took some time to effect. Barracks had to be built in
our grounds for the accommodation of extra men, and these took
time in building. So that it was not until January, 1891, that the
garrison at Langthabal departed.
CHAPTER XI.
The Princes quarrel—Attack on the Maharajah—His retreat—His cowardice and
accusations—The Pucca Senna departs also—Conduct of the Jubraj.
Early in September, 1890, the storm that had long been gathering
amongst the princes at Manipur came to a head and burst. The
spark that kindled the blaze arose out of a very small matter indeed.
The young prince Zillah Singh had been quarrelling with the Pucca
Senna over everything and anything that could be found to quarrel
about, and at length the Pucca Senna got the Maharajah to forbid
Zillah Singh to sit in the durbar, at the same time depriving him of
some small offices of state which he usually performed.
The young prince lost no time in consulting with his powerful
brother and ally, the Senaputti. The result was that one night, about
midnight, when the Maharajah had retired and the rest of the palace
was wrapped in slumber, the young prince collected a handful of
followers, and with his brother Angao Senna climbed the wall leading
to the Maharajah’s apartments, and began firing off rifles into the
windows. The Maharajah had never had much reputation for
courage, and on this occasion, instead of rousing his men to action
and beating off the intruders, he rushed away for safety out at the
back of the palace, and round to the Residency.
Meanwhile, the first note of alarm was brought to my husband by
the bearer, who woke him up at two in the morning with the report
that a fight was taking place in the palace, which report was fully
confirmed by the whiz of bullets over the house; and in a few
minutes the Maharajah and his three brothers arrived in hot haste
from the palace, trembling for their safety. Some Sepoys came with
them, and a great many followers armed with swords and any sort of
weapon they had managed to snatch up in the general melée.
My husband went out as he was, to receive the Maharajah, and
got him to go into the durbar room and lie down, as he was in such a

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Cultures of Healing Medieval and After

1st Edition Peregrine Horden

Music as Medicine The History of Music Therapy Since

Literary Cultures and Medieval and Early Modern

The Transformation Discovering Wholeness and Healing

Building Networks: Exchange of Knowledge, Ideas and

Representation and Objects of Thought in Medieval

Cultures of Comics Work 1st Edition Casey Brienza

Discourses of Care Media Practices and Cultures 1st

The Medieval Record Sources of Medieval History 2nd

Peregrine Horden is Professor of Medieval History at Royal Holloway,

Also in the Variorum Collected Studies Series:

PETER MEREDITH, edited by JOHN MARSHALL

MEG TWYCROSS, edited by SARAH CARPENTER and

For more information about this series, please visit: https://www.routledge.

ISBN: 978-1-4724-5614-4 (hbk)

VARIORUM COLLECTED STUDIES SERIES CS1073

1 The World of the Hospital: Comparisons and continuities 1

2 Poverty, Charity, and the Invention of the Hospital 33

3 The Earliest Hospitals in Byzantium, Western Europe,

4 Sickness and Healing [in the Christian World, c.600–c.1100] 91

5 The Late Antique Origins of the Lunatic Asylum? 113

6 The Sick Family in the Early Middle Ages:

7 What’s Wrong with Early Medieval Medicine? 144

Postscript to Chapter 7 176

8 Cities Within Cities: Early hospital foundations and

9 Alms and the Man: Hospital founders in Byzantium 195

10 The Uses of Medical Manuscripts 210

11 Medieval Hospital Formularies: Byzantium and Islam

12 A Context for Simon of Genoa’s Medical Dictionary

Simon of Genoa’s Medical Lexicon, ed. Barbara Zipser

Postscript to Chapter 13 270

14 Musical Solutions: Past and present in music therapy 273

15 Paracelsus: Renaissance music therapy and its alternative 302

Postscript to Chapter 15: Music therapy in Rabelais 307

16 Aspects of Music Therapy in the Nineteenth and

17 The Prehistory of Infant Sexuality 325

18 Thoughts of Freud 342

Postscript to Chapter 18 362

the Qur’an. Questions of continuity or discontinuity, novelty or tradition,

The old-style Variorum offered photographic reprints, the listing of ad-

Oxford Peregrine Horden

I A cross-roads of hospital history?

performed, even when rationalised by despotic emperors and medical

under governmental control. This is really a phenomenon that historians

II A view of the long term in hospital history

and early modern period instead of cantering briskly through them as a

medically intensive establishment, and as one which showed its charitable

Power to the patrons is one strident theme in hospital history of the

longer-term background of women in nursing orders who provided h ­ ospital

III Minding the gaps

­acculturation, the containment of epidemics – and even medical experimen-

The text of this inscription mentions the persons employed by

To mention only one other, final, example: in nineteenth to twenty-first

IV Against grand narrative

a ‘house of segregation’; then in the Renaissance a ‘house of rehabilitation’.

environment gave way to a reductive clinical emphasis on diseased parts;

Probably the most medical process in [French] hospitals in the

to a considerable extent, we may see in military hospitals one of

The modern medicalisation of the hospital – however we define ‘modernity’

Byzantine empire was grounded in the therapy of the sacraments, even

I left Shillong early in November, 1889, travelling part of the way

It was strange finding myself back in Manipur after nearly nine

longer-term background of women in nursing orders who provided h ospital

acculturation, the containment of epidemics – and even medical experimen-