Hospital after the Reformation
In the first half of the sixteenth century,as a consequence of the Reformation,English hospitals were almost abolished in the second half of sixteenth century,many hospitals mushroomed again.All these new hospitals were tremendously different from the traditional medieval hospitals characterized with secularization.
New hospitals were built by citizens’endowments.Authorized by the king,some were built on the grounds of the abandoned hospitals,and some were completely new.The reasons why the citizens were willing to endow the building of the hospitals were as follows:first,there were many vagabonds who threatened the city's order and affected the citizen's living,and the hospital provided a place of refuge and recovery for these people;second,the king authorized the rights to the citizens to administrate the hospitals,which stirred the agitation of the citizens.In 1544,Henry VIII rebuilt St.Bartholomew's Hospital,and authorized the rights of administration to the citizens.When St.Thomas hospital was built,also in 1544,the citizens of London were willing to provide£500.[10]According to statistics,between 1480 and 1660,five royal hospitals in London spent endowments of£141,131.6 d,which took up a big part of the endowments for the disadvantaged,of which,£4,915 was spent on nursing the sick and poor,and£1,500 on the pest-house sick.From 1551 to 1560,endowments by London citizens amounted to£61,279.11 d,but every ten years from 1480 to 1550,the endowments only amount to between£207 to£325.[11]W.K.Jordan,an English historian said,‘they stood unrivalled not only in England but in the whole western world as a well-articulated and munificently supported system of hospitals designed to protect helpless men and women against the most grievous blows of fortune.’[12]Many scholars highly praised the English government's conducting in rebuilding the hospitals,‘It is the first medical relief and the social relief system for the commons which guided by the secular government.’[13]In other parts of England,many hospitals were built.All these hospitals had many secular characteristics,rendering them different from the hospitals in the middle ages.
First,there appeared to be explicit specialization in these hospitals.For example,St.Bartholomew's Hospital and St.Thomas's Hospital were designated specially for the sick and poor,St.Mary was for the mentally ill,and designated as an asylum,Christ Hospital was for orphans to assist with their education and upbringing,and St.Bridewell was designated for delinquents.Besides,in the 15th and 16th centuries,England was at war with its European enemies.The war created wounded soldiers,making St.Bartholomew's Hospital,St.Thomas's Hospital and St.Chathelin's Hospital take the duty of helping the wounded.In addition to the conventional hospitals,pest-houses were built for the poor sick who were caught by the plague in the 15th and 16th centuries,
Healing in its true meaning began in the hospitals.The medieval healing model was facilitated through pray and consoling the sick.This,they believed,helped the body's healing.Cures were performed through religious rituals in the middle ages.Both the sick and the clergy-doctor believed that to die respectfully was more important than to survive a little longer,so to take ablution,and to repent were the primary objectives.In the early modern times,this banal opinion was gradually abandoned.For one reason,in the new hospitals,the clergy were rare,if there were any,their main duties were to perform mass for the dying,and not to participate in the real curing,for this being designated as the professional doctor's duty.There were some contracts between the hospitals and the professional doctors,which showed that doctors received rewards from the government.Connected with this was the stipulation that they should stay in the hospital during their shifts(or indeed overnight)and make rounds for patients regularly.In 1632,doctors in Newcastle would get£40 per year,and the doctors in Ipswich would get£30 per year.[14]The functions of the clergy in hospital were weakening.The fact that the medical function of hospitals in early modern times was strengthened has been recognized by modern scholars.[15]
Second,there were some changes in the organization and administration,and the supervisors of the hospitals had clear duties and rights.For example,in the four royal hospitals in London,[16]the government arranged 66 guardians,of whom,14 were alderman,and 52 were councilman.Their concrete arrangements were as follows:2 aldermen worked as general governors,with the remaining 12 alderman and 52 councilman forming 4 subordinate committees.Every committee had 16 members of guardians who took charge of one hospital:1 alderman dean,and 1 treasurer dealing with financial affairs.Every year,there was an election at St.Mathew's Festival in Christ Hospital or other hospitals to elect the officials.Every guardian's tenure was two years,and the expiration was forbidden.In Christ's hospital,the administration staff included:the dean,whose responsibility was to deal with the official affairs,the treasurer,who took charge of the financial affairs,and 3 almoners,whose responsibility was to supervise the room and board.There were also other staffs including head nurses and nurses.Every guardian had their duties.Neglecting their duty was strictly forbidden,and punished.In October 1593,the treasurer of Christ's Hospital was found to have falsified accounts when the financial affairs were investigated and reported to the dean.By investigating,it was found that the former clerk Wilson should take responsibility for the issue.The dean thought it is very serious,with Wilson subsequently accused of stealing.The dean claimed that Wilson had concealed the whereabouts of significant sum of money.The London court believed the gossip of‘Wilson deceiving is coming’,which meant that in other hospitals,there also was such corruption.On 10th,October,1593,he solicitor of Christ's Hospital was ordered to investigate and calculate the losses.On 14th,October,Wilson confessed,pleading guilty to the charge of embezzlement,and promised to restitute all the goods and money.[17]
Third,providing the required funds was a significant problem.The decline of hospitals in middle ages was largely pertaining to the shortage of funds.After the Reformation,the new hospitals now had many channels to obtain funds.The important sources for hospital funding in the Middle Ages,e.g.endowments,tenement and estate income,were now instable.Now,new hospitals had stable funds,namely the Mandatory taxes,which could ensure the funds in a situation where endowments were scarce,thus ensuring that the hospitals ran smoothly.For example,we can see from the existent records of Christ's Hospital that generally speaking,hospitals could gather money through taxes,rent,bequeath,rent and funeral fees,among which the mandatory taxes were the most important.Mandatory taxes were often used to build hospitals when met with the plague.In 1665,in order to prevent the spread of the plague,the English parliament ordered two parishes,St.Giles and St.Martin's to build pest-houses by levy.The mandatory taxes became the main sources of revenue for the hospital,and it is an example of another difference between the new and medieval hospitals.
Fourth,hospitals began to attach importance to their economic benefits,which embodied a contemporary utilitarian tendency.In the Middle Ages,the sick and poor's medical relief was cost-free,the situations changed.On May 18,1592,the warden of parish Michelle's intention to send two orphans to Christ's Hospital was rejected because the parish did not return the tax owed to the hospital on time.The hospital's dean had said that the two orphans would not be adopted until the parish paid the tax owed.[18]As evidenced by this episode,hospitals would take into account its economic benefits first,with the philanthropic element of Middle Ages now firmly revised.Since cost-free clinics were also stopped,the sick and poor now needed to apply to the government,and show their certificate of personal property to claim relief.The clinical doctor would then estimate the cost of medical care,with the government verifying the amount and paying the amount owed.There was also other financial help,including permission for the sick and poor to beg,and remission of the clinical fees etc.
In conclusion,I hold the opinion that hospitals in the Middle Ages were religious institutions that voluntarily took on important relief functions.In the late medieval period,with changes of the economy,politics and people's opinions,hospitals tended to be more secular.This tendency included two sides:one was the founding of secular hospitals and the expelling of church hospitals;the other was the secularization of the church and secular hospitals.With the degradation of the religious hospitals,its religious functions weakened.In secular society,many alms and pest-houses were built by imitating church hospitals.Although the latter claimed they were guided by the God,their real aims were to realize social order by controlling the vagabonds,and adopting the poor,the sick and orphans.The coexistence of the church hospitals and secular hospitals made the development of hospitals more complex.They needed to adjust,and to find strength—an aspect that would no longer come from the church.After the Reformation,many new hospitals,guided by the secular government and participated by the citizens,were built.These new hospitals were different from the hospitals in the Middle Ages in type,clinical methods,aims and administration etc.