St Mary Spital was, until Henry viii dissolved it in 1539, one of the largest medieval hospitals in England. It was situated just outside Bishopsgate on the main road from London to the North, and over the last forty or so years many piecemeal excavations and ‘watching briefs’ have been carried out in its precincts, before and after the closure of Spitalfields Market in 1991. Although all these rescue excavations were carried out by the archaeological units of the Museum of London, the publication of this work has been a very long, drawn out process. This large, new full-colour and well-produced volume has just been published by MOLA, which now, rather strangely, has no connection with the Museum of London. As in a previous volume on the same theme, published in 1997 as MOLA Monograph No. 1, this is the work of many people, though the main principal author, Chris Thomas, has remained the same for some thirty years. His co-author and colleague, Chris Phillpotts, who did most of the documentary work, alas died in 2013.

Very unfortunately, there is virtually no documentary evidence for the beginnings of the large ‘New Hospital’ outside Bishopsgate. It was perhaps started in the mid-twelfth century, but the Victoria County History and the ‘Survey of London’ in 1957 both start with John Stow’s late-Elizabethan Survey of London, which tells us that the first stone was laid in 1197, after being founded by Walter Brune and Rosia, his wife, for Canons Regular. This is repeated by William Dugdale in a garbled form, but no original documents have survived to confirm this. The archaeologists have, therefore, always assumed that there was no hospital or Augustinian priory here before 1197 and, for the medieval period, they start in this volume with a ‘pre-monastic’ phase from c 1050 to c 1150/90, followed by the ‘Augustinian foundation’ of 1197–1235. This, they say, consists of a large aisled church with a very large double-aisled infirmary hall on the west running north–south. In their next phase, c 1280–c 1350, entitled, rather melodramatically, ‘catastrophe and expansion’, the huge ‘infirmary’ becomes the north and south transept of the church, and a new smaller infirmary (with an extension) is added to the north-west. At the same time, a new claustral group of buildings are added to the north-east side of the church for the prior and Augustinian canons. There is also a supposed very small ‘canons’ infirmary’ to the east of the church (did the Augustinian canons have their own infirmaries?). The next phase, c 1350–c 1400, entitled ‘consolidation’, sees the building of an enlarged Lady Chapel on the east, and the widening of the church’s south aisle. Also, there is a ‘pharmacy’ added east of the ‘Canons’ Infirmary’ and on the north-west a small new lay sisters’ dormitory, latrine and refectory are built. The two final phases are c 1400–80, called ‘expansion and secularization’, and c 1400–1539, ‘the final years’. This building sequence and chronology largely follows that in the 1997 excavation report, so to try to follow it fully one has to go back to this report (which only has black and white photos and plans). Nevertheless, the recording and analysis of the surviving fragmentary walls and foundations on the many sites leaves much to be desired, and this is key to a future understanding of the masonry phases. A full study of the building stone types, mortars, etc, is still needed.

I should perhaps add, at this point, that in 1979 and 1988–91, I was heavily involved with the documentary research and excavation of St Gregory’s Augustinian Priory site in Canterbury, as well as with the analysis of the masonry of the St John’s Hospital, which lies on the other side of the road to it, just outside the north gate of Canterbury. The hospital, the earliest in England, was founded in c 1085 by Archbishop Lanfranc, and at St Gregory’s a first church was built at the same time, with the priests there looking after sixty men and women in the hospital. In the mid-twelfth century, a large new aisled church was built at St Gregory’s by Archbishop Theobald. This also had a new claustral group of buildings on its north side for the Augustinian canons who were now administering to the hospital inmates.

The plan of these buildings, the foundations of which were fully excavated by the Canterbury Archaeological Trust (and fully published in 2001), is very similar to those at St Mary Spital, where I acted as consultant archaeologist to the Spitalfields Development Group from 1992–4. I would therefore suggest that these claustral buildings in London were also first built in the mid-twelfth century, with the first church along the south side of the cloister. The remains of this church probably still lie beneath the chancel of the later enlarged church, and it is ironic that this area now lies beneath the western part of the modern street called ‘Spital Square’. There is a tantalising reference, apparently by Leland, but only recorded by Dugdale, who says:

This western door of the new church was into the huge new double-aisled hall of the infirmary for the male and female poor inmates, which I would also suggest was built in the mid-twelfth century. This vast hall (some 200ft from north to south), had large round pillars in it; some of the round bases in the hall were recorded in unpublished rescue excavations by Frank Cottrill (working for the Society of Antiquaries in 1935–8) before Eden House was built on the north side of Spital Square. This hall was probably following the model for a hospital set by Lanfranc in Canterbury some half a century earlier. Fragments of large round cushion capitals have also been found here, which also suggest a mid-twelfth century date, not a date after 1197. This great double-aisled infirmary must have been the main hospital building right up to the dissolution in 1539. John Stow records that it contained 180 beds, ‘well furnished for receipt of the poor’. Here, as at St Bartholomew’s and St Thomas’s Hospitals in London, which still survive in their ‘modern’ (post-Florence Nightingale!) form, are the beginnings of our great London hospitals. It is sad that we do not still have a St Mary Spital Hospital.

Having said this, I should quickly add that in the second half of this new volume, there is much very interesting new material. This relates particularly to the 10,500+ burials that have now been excavated at St Mary’s Spital (not including the Roman burials, which have still to be published). The burials themselves were published in a ‘bioarchaeological study’ in 2012 (as MOLA Monograph No. 60), but in this volume they are discussed again by the third of the principal authors, Nick Holder. He tries to contextualise the three burial sites: two smaller areas on the west, and a very large area to the south-east of the church. Remarkably, almost all the burials in this latter area have been excavated, hence the claim that it is the largest medieval cemetery to have been archaeologically excavated in Britain. The dating of the burials and the phasing of the cemeteries was ‘tested through a programme of radiocarbon dating and Bayesian modelling’. This gave a phasing that is different from that already outlined in the excavation report, though the radiocarbon dates are ‘cal ad at 68% probability’. Interestingly, the earliest two burial phases here began in 1090–1145 and 1180–1205, and so an ‘extra parochial cemetery’ has to be hypothesised, which pre-dated the hospital and priory. To me, this makes no sense. Burial here surely started in the first half of the twelfth century when the first hospital had been built, and it is worth noting that the two smaller cemeteries on the west side of the site (alongside the main road, Bishopsgate) have a clear eastern boundary against the large western wall of the infirmary hall. When new buildings were added to the north-west side of the infirmary hall (probably by the thirteenth century, for lay brothers and sisters), they were built on top of the earlier cemetery. This report also guesses that the earliest hospital of 1197 was a small building on the west side of the site (where the gatehouse was later built), with a small cemetery to the south. This also seems illogical. The small number of graves excavated here were surely just part of the larger cemetery outside the southern arm of the huge infirmary hall.

The very large cemetery to the east, which is certainly the main cemetery in the later medieval period, when it acquired its own chapel and a famous pulpit cross (second only to that in St Paul’s churchyard), gave radiocarbon dates for some burials that go back to the earlier twelfth century. This suggests that the hospital quickly required a huge new burial ground, probably for canons and lay brothers and sisters as well as the hundreds of people who died there. Holder has a complicated table with a breakdown of all the known cemeteries, with numbers of excavated burials (10,954), density (bodies per m²), osteologically analysed burials (5,523) and reconstructed original number of burials (18,195). There then follows a detailed discussion with attempted phased plans (unfortunately made difficult by ‘areas of truncation’) and many histograms for demography, etc. This is a most interesting work of some thirty pages that should perhaps be fully reviewed by an osteologist and compared with the equally large cemetery excavated at St Gregory’s Priory, Canterbury (Hicks and Hicks Reference Hicks and Hicks2001).

There is then a detailed study by Mark Samuel of the remains of the cemetery chapel, whose surviving undercroft south wall is now ‘showcased’ literally through plate glass in the new ‘Bishop’s Square’. The architectural fragments are fully studied and reconstruction drawings of the whole chapel are made, but I was sorry not to see detailed stone-by-stone drawings and analysis of the surviving masonry. At the end of the volume are a series of specialised reports on architectural fragments, ceramic building materials (but not on building stone types), pottery, finds, plant remains, animal bones, etc. There is much of interest here, too, and I was delighted to see a drawing of the fragments of alembics (medieval/Arabic distilling apparatus) in Kingston-type ware. These are tantalising glimpses of this great hospital with its ‘pharmacy’ where, in the Middle Ages, the sick and elderly could perhaps be treated as well as being cared for in the 180 beds in the great infirmary hall. Perhaps, one day, a very careful new research excavation will be undertaken beneath the east–west street of Spital Square, where the remains of the core of the hospital church, with canons’ stalls overlying remains of the earliest church, may survive, as at Canterbury. To the west, in the centre of the great infirmary hall, should lie the massive foundations of the great crossing tower, which was beautifully drawn (c 1540 by Antonis van Wijngaerde) just before it was pulled down. A detail of this can be seen on the front cover of this very interesting, but complicated, book.