Hospital management

In this chapter the various structures of hospital management are examined. As the model for charity in the eleventh and twelfth centuries was almost exclusively religious, these institutions were universally organized within some format of religious or semi-religious community that provided housing for staff and administrators as well as, patients, the poor, and pilgrims. Confraternities, converse, regular canons, neighbourhood associations and semi-religious groups such as the Humiliati were all involved in managing hospitals. This chapter provides an analysis of the groups and individuals who administered the hospitals and their affiliations with other larger religious and community entities.

The foundation of hospitals

Chapter two examines the phenomenon of the rapid growth of the foundation of hospitals in the twelfth and thirteenth centuries. A comprehensive consideration of these hospitals’ foundational charters provides insight into the location, purpose, need, and political context of the origins of the hospital movement. Various founders including bishops, confraternities, individuals and neighbourhood associations as well as the differences between rural and urban facilities are considered. The geographic importance of pilgrimage and trade routes to the establishment of hospitals is also explored.

Hospitals and charity: history and context

Chapter one locates the rise of the hospital movement in northern Italy within the context of the changing religious, social, and political environment of the city-states. It traces the evolution of the ideas of charity and poverty from the early to high Middle Ages suggesting that a fundamental shift occurred in both the mechanisms of collecting and distributing charity, and in the perception of poverty and need. The chapter introduces the hospital’s central function in this distribution and administration of charity and illustrates how the hospital and other charitable organizations played a role in the appropriation of power and influence by urban citizens.

Conclusion

The conclusions chapter summarizes the findings of the earlier chapters and reiterates the claim that throughout northern Italy, beginning as early as the twelfth century, as result of the pious impulse of an emerging class of cittadini, the focus of religious charitable activity was targeted on specific localized communities resulting in the founding of small, community-cantered hospitals. Over the following three centuries management of these hospitals evolved from grass-roots initiative of the community, through ecclesiastical reform and finally was appropriated by the civic government of the city-states. This evolution mirrored changes in urban society during the period and provides and excellent lens through which to view late medieval Italian society and religious culture.

Reform and consolidation

Chapter six traces the reform efforts of the fourteenth and fifteenth centuries, which eventually led to the consolidation of small independent hospitals into large civic institutions that became increasingly medicalized. Health boards created after the Black Death led to secularization of health care and poor relief. These social service institutions evolved over the early decades of the century and were a gradual response to the evolving needs and challenges of the population and the end of the communal era. This unification and institutionalization of civic oriented hospital care, resulted in one large Ospedale Maggiore, which was duplicated in towns and cities throughout Italy in the mid fifteenth century. It signified the end of the small, independent hospital movement that had so transformed the landscape of urban society earlier in the Middle Ages. The process of centralization that swept hospitals up in its wake was a universal feature of Italian state-formation in the age of the Renaissance

Internal life of the hospital

Chapter four provides a detailed description of the physical plant of the hospital, the daily life of individuals, and rules and statutes followed by its members as well as consideration of the social composition of donors, workers, and recipients of hospital services. The chapter includes a thorough examination of documentation such rules, statutes of operation, oblation ceremonies, inventories, wills and bequests in order to illuminate some aspects of the physical structure, living conditions, internal and external relations of members, and relationships between the hospitals and ecclesiastical and civic authorities. The fact that much of our information on these institutions comes from ecclesiastical visitation and dispute settlement documentation suggests the challenges faced by hospitals.

Jurisdictional disputes

Chapter five examines the process of greater secularization in the management of the facilities and attempts by the church officials to reassert control and authority over these groups in the late fourteenth and early fifteenth centuries. The endemic conflict between and within cities, and with the institutional church and imperial powers, resulted in a politicization of all civic organizations, but in particular of the administration of the hospital. Institutional mismanagement and even corruption resulted as the pious impulse was politicized. Efforts by the ecclesiastical authorities to combat this degeneration were frustrated by their own inability keep a clean house. At the same time, civic authorities who, increasingly needed the social services offered by the hospital and hoped to profit from the income of the facilities, worked to appropriate control and authority over the institutions.

Introduction

This chapter introduces the purpose of the book and provides an outline of the organization of the chapters. The argument is made that the medieval hospital provides an excellent vehicle for examining the alteration of the civic jurisdictional landscape of the city. The hospital movement also illustrates the nature of religious life and charitable activity among lay citizens. The evolution of the medieval hospital illuminates the transition of influence, status, wealth, and power from ecclesiastical authorities to the lay citizenry and from them, finally, to the civic authorities of the budding modern state. Over the course of the twelfth through fifteenth centuries medieval hospitals in Italy, originally intended to house pilgrims and comfort the dying, evolved from religious institutions reflecting communal and personal piety to civic facilities intended to provide a comprehensive social welfare and medical service to the urban community.