In the twelfth and thirteenth centuries—a period of commercial revolution in medieval society—the charitable landscape of Europe expanded to emphasize the provision of charitable care in exchange for spiritual reward. Adam Davis argues this evolution was more than coincidence. Davis's comprehensive work on medieval charity explores the medieval hospital movement as a product of the inextricable relationship between the “commercial” and “charitable” revolutions of the twelfth and thirteenth centuries. Davis argues that, “Far from being oppositional forces, commerce and charity were remarkably symbiotic” (8).

The Medieval Economy of Salvation teases out this symbiotic relationship as it manifested in the hospitals of Champagne, where the prominent commercial activity of the fairs both supported and shaped charity in the region. According to Davis, the relationship was twofold: fairs generated the capital to support charitable institutions, while the relatively transitory population of those commercial centers created a need for the institutionalized hospitality and caregiving that hospitals provided. Commercialization also provided a new conceptual framework for charity: giving to the poor came increasingly to be understood in terms of exchange. Benefactors and beneficiaries operated within an “economy of salvation,” in which benefactors gave material support to the sick poor beneficiaries, whose status and prayers bequeathed spiritual reward on their benefactors.

Davis examines the relationship between commerce and the charitable caregiving of hospitals in six cohesive chapters. Chapter One looks beyond Champagne to consider broadly the ideological foundations of a new kind of charity that emerged in the thirteenth century. Emanating largely from the University of Paris, exempla and didactic texts exalted the virtues of a “charity in action”—as opposed to more passive, penance-based practices—and provided models for preachers to educate the laity in the redemptive capacity of charitable works. As Davis's meticulous analysis of the language of these texts illustrates, economic terms borrowed from flourishing markets articulated charity increasingly as a kind of exchange. The benefits were reciprocal; alms made to hospitals assuaged the plight of the sick poor receiving care, while the prayers offered by the recipients of alms provided benefactors a redemptive return.

Drawing on foundation charters, Chapter Two illustrates the new charitable landscape characterized by the unprecedented foundation of hospitals. As in other regions of northern France, the counts of Champagne served as significant founders and patrons of the hospitals. Unsurprisingly then, regions with the strongest comital power—places like Troyes, Provins, and Bar-sur-Aube—witnessed the most hospital foundations. The operation of these foundations was, Davis suggests, tied closely to the commercial sphere of Champagne, with a certain portion of fair revenues going toward the support of hospitals. Proliferation of hospitals in the twelfth and thirteenth centuries was, however, a result of more than comital efforts; Davis notes that donating to hospitals was “very much in vogue” (84), and a “competitive culture” of charitable giving emerged among elite members of society.

Chapter Three uses testaments and cartularies to establish the profile of hospital patrons. If urban elites used charitable giving as a means of political ascension, they were by no means alone. Davis demonstrates what he and other historians have referred to as the “democratization of charity”—individuals from all social classes gave to hospitals. And this giving, Davis contends, was becoming increasingly commercialized. Champagne commerce, anchored by a profit economy, provided the motive for giving and the means to do so. Individuals who benefited financially from commerce risked the sin of avarice; pious donations to the sick poor could combat this sin, and profits made from the fairs provided the financial means to purchase this absolution. Thus emerged an “economy of salvation,” a reciprocal relationship in which donors gave to the sick poor of hospitals, who then prayed for the souls of their benefactors.

Chapter Four considers the financial management of hospitals as charitable institutions and highlights their remarkable economic power; this reality contrasts strikingly with their portrayal by alms collectors as pitiful spaces in need of charitable support. Using account books, Davis illustrates the benefits hospitals derived from fair revenues—both directly, through their own market stalls, and indirectly, through exemption from commercial taxes and the granting of rents from fair revenues. Hospitals, as significant landholders, often put alms not toward direct care of the sick as dictated by donors, but rather invested them in the more lucrative sphere of property management. This chapter, the shortest in the book, might have benefited from a bit more elaboration and distinction between sources of income and expenditure.

Chapter Five uses a variety of sources, including statutes, hagiographic accounts, and sermons, to reconstruct the internal administration of hospitals, especially their personnel. Echoing the work of Daniel Le Blévec, this chapter concludes that “the boundaries between those giving and receiving assistance in medieval hospitals were remarkably permeable” (190). Service to a hospital allowed individuals both to fulfill the charitable imperative emphasized by the church through performance of the seven works of mercy and to benefit from the social security of life within the walls of the hospitals.

Chapter Six focuses on the recipients of care: the sick poor. It brings together archaeological findings and written records to reconstruct who these recipients were and the care they received. Excavations of hospital cemeteries indicate that most individuals were adult. Above all, they were sick and poor—the “povres malades” whose pitiful status made them, according to this new model of charity, especially powerful mediators of salvation. Without other forms of support, these poor relied on the charitable care of hospitals; the care they received there was inextricably spiritual and physical, as the health of the body depended on the health of the soul. Davis suggests, furthermore, that the fairs may have produced a certain level of vulnerability among the population of Champagne, as large numbers of transients arrived seeking opportunity.

Davis's research is extensive and exhaustive; by putting regional, practical sources like hospital accounts, testaments, and charters from Champagne in conversation with the more normative discourses of theologians and preachers, The Medieval Economy of Salvation provides a snapshot of hospitals of Champagne, not only as products of the unique commercial landscape of the region, but also as manifestations of a broader cultural movement. And it is in this that Davis's work makes such a valuable contribution to the historiography. The historiography of medieval hospitals, with some notable exceptions, has tended to be largely (and often unavoidably) regional due to the close ties between charity and politics in this period. Though at its heart a local study of Champagne, The Medieval Economy of Salvation provides a much-needed framework within which to understand the charitable revolution of the twelfth and thirteenth centuries throughout Europe. In a vein similar to Lester K. Little's Religious Poverty and the Profit Economy, Davis's compelling study establishes a clear relationship between expressions of caritative giving and commercialization.