Despite the fact that hospitals for pilgrims and for the poor, sick, and powerless were ubiquitous features of medieval cities, towns, and rural areas, this is one of the first books in English to examine hospitals in medieval Italy. It draws on a variety of unpublished sources—charters, rules and statutes, inventories, and other kinds of administrative records—from almost a dozen archives in northern Italy. Focusing on the northern Italian region of Lombardy from the twelfth through the fifteenth centuries, Brasher argues that hospitals evolved from being religious institutions in the twelfth century, primarily under the jurisdiction of the local bishop, to coming gradually under the authority of lay citizens and confraternities. By the later Middle Ages, Italian hospitals were civic facilities under the purview of civic governments, with many small, independent hospitals closing or being consolidated into large, secularized, municipal, and increasingly medicalized institutions where a trained staff was paid wages.

According to Brasher, a defining feature of medieval hospitals in northern Italy was that they were the products of lay, grassroots activism. They tended to be founded more often by lay individuals and communal groups—neighborhood associations, lay and semi-religious organizations—than by ecclesiastical organizations, and most of the administrative personnel of these hospitals were also members of the laity. Although there were a variety of different administrative models for the oversight of these hospitals, they were relatively autonomous, particularly as ecclesiastical authorities increasingly ceded more control over them, albeit often not willingly.

The central theme running through the book's chapters—on the foundation of hospitals, their management, internal life, jurisdictional disputes, and reform and consolidation—revolves around who exercised power, authority, and jurisdiction over northern Italy's hospitals. As Brasher shows, it was common for members of the laity, ecclesiastical authorities, and communal government leaders to share in the governance, or at least to attempt to do so. The many examples of jurisdictional disputes over the control of hospitals show that shared governance often did not work so well. That these charitable institutions often functioned as pawns in larger political struggles reflects just how deeply hospitals were intertwined in the urban politics of northern Italy of the time. The documentary record, however, may present a somewhat warped picture in terms of the preponderance of jurisdictional disputes. It is significant that ecclesiastical, lay, and civic individuals and groups were even experimenting during this period with the complex arrangements involved in the shared governance of hospitals.

Although Brasher includes some discussion of the relationship between religious culture and the support given to hospitals, the focus of her book is very much on the hospitals as sites of political struggle. She makes a convincing case that hospitals could function as political vehicles, particularly as ways for the laity to express their piety, independent of the church—a point that others, such as Guiliana Albini, whom she frequently cites, have also made. But does the fact that managing or patronizing a hospital could serve as an expression of power and social status for some individuals mean that this was the principal motivation for most of those who made bequests to a hospital or worked in one? Brasher devotes little discussion to the nature of the personal piety of hospital workers and benefactors.

One of the strengths of this book is the light that it sheds on some of the more surprising functions of medieval hospitals. In addition to lodging pilgrims, the sick, and the poor, hospitals frequently mediated communal disputes. Some hospitals even contributed to the building of bridges and roads, another dimension of the civic charity that characterized this region. But hospitals could also be used to advance personal interests, and Brasher uncovers evidence that some of those who worked in hospitals used the institutions to protect their own personal assets. These fascinating examples underscore the expansive roles that medieval hospitals played.

This book would be strengthened by some comparative discussion of hospitals elsewhere in medieval Europe. Doing so would have helped bolster the author's argument that the religious culture and civic life of northern Italian city-states contributed to some of the distinctive features of the hospitals of the region. A greater familiarity with the secondary literature on medieval hospitals and charity elsewhere in Europe might also have given the author pause before drawing some sweeping generalizations about evolutions in medieval hospital practice, which she suggests reflected: a shift from a focus on care of the soul to care of the body; the trend during the late Middle Ages toward the secularization of charitable institutions; and a transition from early medieval caritas (defined here as “a personal obligation to assist those with whom one is in close relation”) to twelfth-century misericordia (defined as “the necessity for assisting the poor and needy for the common good of the community and the social security of all”) (11). This distinction, it should be noted, is later contradicted when misericordia is described as providing “specific assistance” and responding “to very specific needs within their community,” unlike the caritas “of an earlier age” which targeted the “generic ‘poor’” (47). Among the book's more serious factual inaccuracies is its reference to regular canons as “semi-religious” representing “a mix of lay and clerical members,” when by definition these canons were ordained clerics who followed a rule. It cannot accurately be said that the regular canons reflected “the grassroots lay religious movement of the era,” nor that “these canons were not attached in the same way as the traditional monastic orders to the institutional church” (70).

Despite these shortcomings, this book highlights the extent to which medieval hospitals were the products of a particular political and religious environment, in this case the highly urbanized, commercial, and independent city-states of northern Italy.