“Our lords the sick”

IMAGINE a reasonably well-off farmer living in twelfth-century Europe. All his life he has heard about the brave crusading knights who rescued Jesus’ tomb from the infidels. Now he is going to Jerusalem to see the tomb himself.

But the journey is long and arduous, the ship crowded and filthy. When he arrives at the Church of the Holy Sepulchre, he is weak, ill, and far from home. He collapses in the street, expecting to die. Instead, a man wearing a religious habit picks him up and brings him to a large, clean hospital just opposite the Holy Sepulchre. There, sleeping in his own bed and fed the finest foods he has ever eaten, he recovers. If he is like most pilgrims, when he returns home he will make a gift of thanksgiving to the Order of the Hospital of Saint John of Jerusalem—the Hospitallers. Pilgrimage from Western Europe to Jerusalem had started long before the Crusades—as early as the fourth century. The top attraction was the Church of the Holy Sepulchre, built by Constantine in 336, and though Muslim conquest of the city in 638 complicated matters, pilgrims continued to pour into the city.

By the eleventh century, housing the great numbers became a problem. A pilgrims’ hostel had been set up for Latin Christians in the late ninth century, but this was probably destroyed in 1009. Later, the Fatimid caliph gave a group of merchants from Amalfi in Italy a plot of land next to the Church of the Holy Sepulchre. There, they lived in their own lodgings, practiced their faith unmolested, and founded a monastery. This was St. Mary of the Latins, staffed with Italian Benedictine monks who provided hospitality to pilgrims visiting the Holy Sepulchre. In time, the brothers also built a hospital for pilgrims.

That small monastic hospital became well known in Western Europe when the armies of the First Crusade besieged the city of Jerusalem in 1099. According to legend, the administrator of the hospital, a man known only as Gerard, stood on the walls of the city and hurled bread down to the starving Christians. The new European Christian rulers of Jerusalem rewarded Gerard and his hospital lavishly. Pilgrims also donated lands and properties in gratitude for the care they received.

In 1113, Pope Pascal II established the brothers of the hospital as the first international religious order, exempt from local lay or ecclesiastical jurisdiction and answerable only to the pope. Gerard was the first master of the new Order. Within 50 years the Hospitallers established an international network to collect men, money, and supplies for their Holy Land mission.

Through the twelfth century, the Hospitaller Order grew and evolved together with the new Latin crusader states in the Holy Land. Like the Templars, the Hospitallers garrisoned castles and sent armed knights into battle to protect the Christian kingdoms. At the same time, as pilgrims continued to pour into Jerusalem, the Hospitallers’ Rule stressed the need to care for the sick in the Jerusalem Hospital.

Master Raymond du Puy (1120–1160) instructed the Hospitallers on “How our Lords the Sick should be received and served.” After a priest gave the Eucharist and heard the patient’s confession, the brothers would carry the sick man to bed and feed him. By 1176, when most people still ground their teeth to stubs on a diet of coarse bread, the Hospitallers set aside the revenues of two villages to feed “our Lords the Poor” bread made with fine white flour, usually reserved for the aristocracy. In 1181 the statutes of the Order stipulated that the patients should have large beds, each with its own coverlet and sheets, cradles for babies born in the hospice, and cloaks and boots for the sick to travel to the latrine.

A massive operation

Contemporary accounts marvel at the sheer size of the Jerusalem hospital complex, which served 900–1000 patients in eleven sex-segrated wards. Among these were foundlings, taken in and supported until they came of age, and Muslim and Jewish patients, who were welcomed and fed chicken instead of pork.

The order employed four physicians to prescribe syrups and cordials for the patients. This does not seem like a large medical staff, and historians speculate on what this reveals about Hospitaller medical practice. Perhaps many who stayed in the hospital were simply weary pilgrims. Other aspects of the hospital’s care are also still mysterious: Does the emphasis on diet show the influence of Eastern medical practices? Or does it simply reflect the Hospitaller rule to treat the sick like lords? Did the hospital employ the Jewish and Muslim physicians that European patients tended to prefer?

When Saladin captured the city in 1187, the Hospitallers had to leave Jerusalem. They operated other hospitals and infirmaries in the Holy Land, and they soon built a new complex in the city of Acre that rivaled the Jerusalem hospital in size. The hospital building in Jerusalem remained a pilgrim’s hospice into the fifteenth century. Today, its site has been built over and we can only imagine what the vast building looked like. It was probably similar to the hospital in Acre, now undergoing excavation after centuries of burial. The brothers built other hospitals, and though they ceased fighting in 1798, they remain Hospitallers to this day. CH

By Theresa M. Vann

[Christian History originally published this article in Christian History Issue #101 in 2011]

Theresa M. Vann is Joseph S. Micallef Curator of the Malta Study Center at the Hill Museum & Manuscript Library, St. John’s University (Minnesota).
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