This study of medieval hospitals is not about their governance, personnel, or works but rather their status in canon law as religious institutions. While Byzantines had separate names for discrete varieties of hospitals, and the West called them xenodochia or hospitals, this study employs the term welfare house to describe what the author terms a messy collection of institutions.
What is the origin of the law of hospitals? Watson argues against a generally held view that such law descended from Justinian's Corpus iuris civilis. She believes instead that a distinctly western law emerged in the early Middle Ages. Her intent is to use this law, as it applied to hospitals that did not belong to any religious order, to discover a western legal model for hospitals. This model would be rooted in Roman provincial law and derive from the acta of prelates, councils (ecclesiastical as well as secular) and canonists. It would distinguish hospitals from churches and monasteries.
Watson acknowledges that there are few references to hospitals in her sources. The cause was not a lack of society's concern for the poor but rather the absence of legal precedents and the very character of these hospitals—entities that were religious but not ecclesiastical. Nonetheless, in subsequent chapters, she explores the treatment of hospitals in the councils of Merovingian and Carolingian France, as well as Carolingian Lombardy, provincial Roman law, and general councils of the twelfth and thirteenth centuries.
The extant legislation shows that ecclesiastical authorities did not seek control over welfare houses but instead sought to protect their assets from fraud and abuse. For example, those labeled as “murders of the poor” might be subject to excommunication. While there are shifts in emphasis from time to time and place to place, a coherent portrait of these hospitals emerges. Hospitals are defined as testamentary institutions because most were founded by pious individuals through bequests. To encourage such gifts, church authorities emphasized the right of such individuals to so dispose of their earthly wealth post mortem. Furthermore, any individual with means and intent was free to establish a hospital without the need of an episcopal license unless the hospital also housed a church or chapel. The exact nature of the hospital—its manner of governance, the character of its clientele, and the nature of its services—was established by the donor's act of foundation. Consequently, the hospital landscape reflects the individual and diverse character of these acts of foundation. For the most part, the responsibility of authorities, ecclesiastical and secular, was to maintain or restore the initial disposition of the donor and to defend the assets of the hospital against any who would seek to defraud the hospital. Thus, what legislation that does arise deals with intent and assets—not the physical property of the hospital or the manner of its operation.
At the onset of the thirteenth century, two figures sought to bring hospitals under direct ecclesiastical jurisdiction. The first, the canonist Bernard of Pavia, equated hospitals with churches and monasteries and placed all under episcopal authority. But later compilations, and particularly the Liber extra of Gregory IX, did not accept this innovation. The other initiative came from Robert de Courson, appointed as papal legate in France for the years prior to Lateran IV. Courson is associated with two hospitallar decrees, one promulgated in Paris in 1213, the other in Rouen in 1214. Both mandated that in hospitals of a certain size a religious rule be mandated for those who served the poor. While this was the practice of some hospitals or hôtels-dieu in northeastern France and the Low Countries, it does not appear elsewhere. Notably, the topic was not addressed at Lateran IV. Watson believes that Courson's initiative failed to gain currency precisely because it placed hospitals under the Church's jurisdiction. Those same Parisian reformers, associated with the circle of Peter the Chanter who advocated for greater discipline over hospitaller communities, also argued that the Church had a financial duty to aid the poor with its economic resources. Presumably ecclesiastical authorities preferred to be the custodian of alms, not their source. As Innocent III wrote in his Libellus de eleemosyna: “Until you find the just man to whom to give, it is to the priest to whom you owe. For the priest is held to be just . . . on account of his office.”
The Council of Vienne (1311), through its canon Quia contingit of 1317, promulgated the most extensive treatment of hospitals in the medieval era. Limited to hospitals not affiliated with an order, this canon classified institutions as hospitals, shelters, leprosaria, or alms houses. The council, however, broke no new ground. Most notably, it asserted that bishops had an ultimate duty to intervene in the affairs of hospitals when their administrators or higher authorities failed to preserve an institution's assets and mission. It also forbade hospitals to finance benefices and expressed the hope that authorities would appoint able men of good reputation as administrators. As in the past, the Church was willing to serve as a guardian of charity but not as an overseer of institutions. Watson argues that when the Council of Calcedon (451) placed churches and monasteries under the jurisdiction of bishops, it meant to leave hospitals to the care of the laity. This laic responsibility is reflected in the legislation of the medieval era and can be found today in Benedict XVI's encyclical Deus caritas est (2005) where the obligation of charity is said to be universal and a responsibility of the laity. We know that medieval charity with its hospitals was a diverse phenomenon. Watson, through her examination of law, provides a clear explanation why this is so.
