In recent years, as scholars have sought to contextualize medieval hospitals without relying on either modern institutional models or historiographical assumptions, the literature on these institutions has expanded rapidly. Adam Davis's contribution is particularly valuable for several reasons. First, it looks at the hospitals of a sizable and significant geographical region; in part because of the understudied nature of the evidence, works on hospitals often focus on a single city or even a single institution. Moreover, Davis uses a wide range of published and archival sources to elucidate the intellectual, economic, and social contexts that informed the institutional growth of hospitals in twelfth- and thirteenth-century Europe. He characterizes hospitals as standing at an intersection between lay and religious life; certainly, the ways in which they served the poor and the communities around them made them institutions that have challenged both scholarly and contemporary attempts at definition. The argument of this book is that the "rise of the hospital" in the twelfth and thirteenth centuries was driven both by the commercialization of medieval Europe and by the transformation of ideas of charity, and that these phenomena, in turn, were crucially interlinked.
As Davis convincingly argues, modern discomfort with the economy of salvation has sometimes resulted in a neglect of medieval charity as a subject for serious historical inquiry. Donors to hospitals often had intimate connections to hospitals, and thus a close knowledge of their needs and routines. This has been pointed out intermittently by hospital historians over the past century (the earliest such analysis of gifts I know of is Franz Meffert, Caritas und Krankenwesen, 1927). But the ability to examine such a body of evidence as Davis has is rare, and the archival sources he uses were previously unstudied. The suggestion that the rise of affective piety and devotional practices may have cultivated an empathetic capacity to identify with Christ's poor and the desire to help them may not be original, but Davis's analysis of how Champagne's hospital donors would have encountered such ideas through popular sermon literature enriches the study and the argument.
In making charitable donations to hospitals, the men and women of Champagne received "valuable and calculable spiritual benefits" (8) in exchange. In examining changing definitions of charity in late medieval Europe, Davis argues that Champagne provides a good regional case study because it was a center of both commerce and reform of the canons regular. It is here that my only significant reservation about the book's argument arises. As a scholar of medieval hospitals--their often fragmentary archives, and their particularized and voluminous historiography--I share and applaud the goal of finding ways in which the institutional growth and patronage of hospitals in the later Middle Ages can be cohesively explained. But I wonder about the ways in which Champagne's thriving commercial identities, its merchants and its famous fairs, may have shaped precisely this in distinctive ways.
One of the values of Davis's work is the way in which he contextualizes hospitals. In the first chapter, he draws on theological writings, sermons, and hagiography in order to construct an argument about the progression of medieval understandings of charity "from penance to commerce." Innocent III's Libellus de eleemosyna, which enjoined a hierarchy of charitable giving (after meeting one's own needs, those of parents, friends, and relatives, those of the righteous stranger) might have influenced gifts to hospitals, as such gifts would be guaranteed to provide support for neighbors and relatives, as well as righteous strangers (43-44). Such influential and widely-circulated authors as Aquinas and Peter Lombard, as well as other theologians, elucidated the merits of charity as an act of both justice and mercy. Davis also discusses the vitae of hospital saints, including the local Jean de Montmirail, whose 1230 vita emphasized his parallels with St. Martin. Examining the place of hospital saints in topographies of charity strikes me as a relatively unexplored avenue for further study, building on work like that of Ottó Gecser. Davis presents a very compelling picture of how sermons and exempla circulating in Champagne presented almsgiving transactionally, as an exchange with God in the person of the poor and, simultaneously, as judge of all human affairs. Certainly, the importance of the works of mercy (represented in art and architecture as well as text) and the idea of serving Christ in the poor are found elsewhere. But I think the textual culture and mentalités which Davis so impressively evokes may be a bit more circumscribed than he argues.
The second chapter, "The Creation of a Charitable Landscape," describes the growth of hospitals in Champagne. (A curious absence in this chapter is a mention of Anne Lester's "Crafting a Charitable Landscape," despite the echo in the title.) The patronage of hospitals was characteristic of the counts and countesses of Troyes, and was also associated with the expansion of the fairs. The agency of hospitals, and how the choices of hospital staff could result in conflict with comital patrons and urban governments alike, are the subject of welcome attention. Davis notes a wave of hospitals coming under the oversight of monastic houses, or otherwise being regularized, in the 1200s-1230s. He argues, however, that such reform efforts were localized and did not become incorporated in canon law. I am far less certain of this analysis, as a similar wave of hospitals receiving new statutes in the first decades of the thirteenth century is observable in the German lands. More comparative work, I believe, is called for here.
In the third chapter, Davis argues that lay donations in exchange for works of mercy exemplify the rise of linked ideas of charity and commerce. To my mind, more comparison between hospitals and monasteries might aid this argument. As Davis notes, many donations to hospitals took the form of "redemptive almsgiving" (131-139). Anniversary Masses were celebrated in hospital chapels; hospitals received donors' bequests in coin and kind, to be distributed in alms and to support liturgical functions. The fact that, in Champagne, payments to hospitals were often made at fair-time is, to my knowledge, exceptional. Elsewhere in Europe, such payments were linked to saints' days. Davis attributes the emphasis in donation charters on helping the sick-poor to pragmatism, an emphasis on the charitable value of the (transacted) works of mercy; it also echoes formulae in conciliar legislation. Notably, Davis throughout includes leprosaria alongside multipurpose hospitals. Though he himself does not comment on this, I see this as a worthwhile element of the book's contribution, as leprosariahave too often been segregated in the historiography of medieval hospitals. The example of a gift given to a leprosarium by the brother of one of the leprous women in residence there, for instance, neatly counters the resilient stereotype of medieval leper hospitals and their residents as socially separate from the communities where they were situated.
Chapter 4, "Managing a Hospital's Property," is comparatively brief but provides a useful case study of hospital account books and what they reveal of hospitals' revenues, receipt of donations, and economic activity. Davis examines hospitals with varying incomes and urban locations, and teasing out patterns in the diverse economic activities of hospitals throughout the county of Champagne is useful. Account books, as Davis observes, can be a valuable source of information on the infamously elusive question of how hospitals provided therapeutic care, for example through the purchase of medicinal ingredients. Davis provides a welcome corrective to some earlier scholarship on hospital corrodians, observing that a paying boarder cost the hospital roughly twice as much as he paid. The claim that not much attention has been paid to hospitals as participants in--and sometimes engines of--urban economies is, however, an exaggeration if not an inaccuracy, certainly when taking German scholarship into account (165).
The fifth chapter discusses multifaceted relationships to hospitals, permeable boundaries between those receiving and giving care, and what sermones ad status can tell us about ideals of hospital care. Davis observes that providing support for staff in old age could be regarded as a work of mercy, a point which has received insufficient scholarly attention, in my view. The diverse social composition of hospital staff, moreover, could mean that those who served the sick-poor might become themselves the recipients of care. This is another point where Davis's documents enable valuable contributions and stimulus to future scholarship. Chapter 6 continues the focus on hospitals' multifaceted relationships with the sick-poor, discussing diet, hospital cultivation of resources, and evidence, or lack thereof, for diseases affecting the skeleton. Davis notes that hospitals provided informal and external care, as well as care for short- and long-term residents. In analyzing such care, I believe he is right to highlight the importance of spiritual care and that of the social and emotional support provided by hospital staff for residents. This expansive definition of care, far from being a modification to a fundamentally medical model, forms part of an impressively rigorous and holistic study of medieval hospitals in their context.
As a whole, the monograph is a valuable contribution to the abundant literature on medieval hospitals. Moreover, it is written in such a way that it should be accessible and interesting to those not immersed in that literature, whether medievalists in other subfields, or historians of other eras in the history of medicine.