Leper Hospital in St Albans

 

My  writing on Monkybusiness has always tried to bring in our local experience in the great Abbey here in St Albans. When I do this the text goes into Italics. To conclude my series about Monks and Healthcare  I am focusing on leper hospitals in St Albans. There was one for men founded  between 1119-46 (St Julian's) and for women founded 1194 (St Mary de Pre). I shall mainly be concentrating on the former because it lay under the modern church of St Bartholomew where I have worshipped  over 40 years.

It came as a bit of a shock to me to know that as I practice the organ a community of monks may have chanted the Hours here 900 years ago and lepers may be buried very near. This year we are celebrating a mere 60  years !

We know that Abbot Geoffrey de Gorham of St Albans founded a hospital for lepers in the early 12^th century beside the road to London (Watling Street) and the accommodation was on one side of the road with the church on the other. We can get an idea of what the church may have looked like from a contemporary one that survived at Stourbridge near Cambridge.(see below)

Leprosy was all around England at this time. Some saw it as a punishment from God or as a trial to be undergone. It could lead to terrible physical affliction with ulcerations, facial disfiguration, blindness and loss of fingers. It likely covered those with a range of skin complaints like eczema. Consequently such persons should be kept somewhere apart.

Hospices were being set up across England  staffed by monks governed by strict monastic rules, designed as a home with physical and spiritual help to those labelled as lepers. They were funded in a variety of ways. Here in St Albans Abbot Geoffrey arranged for the taxes (known as tithes) from various parishes which owed him allegiance, to be diverted to its support. These were confirmed and adapted by later abbots or Papal bull.

The initial 12^th century rules have been lost so we have to deduce how the place was run from the Deeds of the Abbey and rules issued by the great 14^th century abbots Michael de Mentmore and Thomas de la Mere. Lepers were forbidden to loiter on the road between the hospital buildings and the church. As St Julian’s Hospital was run like a monastery with resident monks, the normal eight offices (services) and Mass would have been celebrated daily starting very early morning. The lepers would have crossed the road to attend Mass and some of the offices, notably vespers and compline. They were forbidden to leave the monastery grounds without permission; to go into the town of St Albans ; to stay away at night or go into the brewery or bake house. There was a shelter facing the road along the side of the road where lepers could converse with one another, but were supposed to  be brief and avoid contact with outsiders. Visitors were allowed to visit a sick person.

St Barts Church today on the site of the church of St Julian's Hospital for lepers. The large road is        Watling Street which separated the hospital buildings from the hospital's church The photo is taken from the site of the hospital buildings ( later the farm)stood. The road would have been much narrower in the Middle Ages. 

They were to wear a special russet coloured tunic with sleeves extending to the hand, a super tunic right down to the ankles and sleeves covering elbows, and a cowl to cover the head. For church they had a black hooded cloak and big boots. All this was to ensure their afflicted parts were well covered. Food was likely monotonous. There would have been some meat , and  fish and 7 loaves of bread a week per person and plenty of beer. St Julians hospital had its own farm, granary, bakery and brewery. It was therefore as self-sufficient as possible, It is not known for sure whether any of the inmates played any part in this work, but what else would they have done all day?

In the mid 14^th century there should have been 6 lepers and a community of 5 priests of good character and a master in charge. The strictness  of the rules suggest that in the past the behaviour of the inmates may have fallen below what was expected. By the 15^th century the prevalence of leprosy had receded and our hospital had less inmates. Early in the 16^th century, there were disputes about the mastership and  it may have ceased to function as a hospital. The domestic buildings and farm were then operated like any other belonging to St Albans Abbey.

After the Reformation and dissolution of the abbey in 1539 it passed to Sir Richard Lee of Sopwell, who obtained much of the former Abbey’s land. . Over the following centuries the hospital buildings were dismantled and rebuilt as St Julians farm, which stood where Tithe Barn Close and Robert Avenue are now. The church was no longer required and was demolished. This open space remained until our Church was built 60 years ago.

St Barts today : 60 years old!

Interior 

Exhibition in our Hall to celebrate 60 years

A nunnery was established by Abbot Warin in 1194 on a site between Watling Street and the river Ver   0.75 miles northwest of St Michael's church.  Nothing remains of it today but the Pre Hotel, which I presume may be near the original site. In 1352 there was a prioress and 8 nuns in the community there. As at St Julian's there would have been a small church with a series of domestic buildings. The prime focus  was on the care of female lepers.  

Healthcare by Monks

 We know that monks looked after their own health (see the last two posts) but how far did they help the sick in their local communities? Monasteries were expected to provide hospitality and help for pilgrims who became ill, but they did not cater for all the local sick. Yet did they provide some accommodation, perhaps for the privileged, or at least health advice? If we include the mendicant orders - the friars - the picture becomes more complex. We know that Augustinian canons often staffed the "hospitals" which were set up by wealthy patrons in our period just like monastic houses.  There were Infirmaries for the public in some cenobitic communities (notably the Cistercians) but there far more establishments of varying size, title and personnel which could loosely be called hospitals. Definitions and boundaries for these are tricky and provision will have varied from area to area and at different times. I hope that the following overview will shed some light on this fascinating area of study.

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We know that Benedictine infirmaries were set up to meet the needs of their own monks In the Rule of St Benedict it is not clear whether there was a duty of care for the sick in general.  Herbal treatment and advice may have been given to local people but the idea of taking in the local sick to use the few valuable infirmary beds is mistaken. In later years wealthy clients may have paid for treatment in separate rooms but this will have been rare.  Provision for the outside sick had to involve separate buildings and separate funding. This begins to look like the modern concept of a hospital.

It might seem logical that hospitals were founded to care for the sick and the physical relief of suffering. Monasteries were more concerned to intercede for the souls of the living and the dead. We must understand that there was a crossover because illness was connected to divine punishment, and hospitals saw  a duty care of the soul as well as the body. In practice there was little if any  difference between a monastic infirmary and a hospital because the care provided likely began with washing the patient, providing clean warm bed with prayers and a round of offices (standard monastic services)performed each day around them.  The environment would appear to us like a church nave with beds and prayers and chanting going on.

Let's consider what  we actually mean by Hospital? The term may have first been used in 1112. Hospes (Latin) means guest or stranger.  The  way they could be founded, their purpose and mode of operation  varied. They can be divided into hospitals for lepers;  short term hospitals for the sick poor resembling hospices for the dying, or for pilgrims who were sick ; and longer term care for the elderly infirm or disabled. There is no agreement on the number of  hospitals from the late 11th century to the mid 16th century. It depends on how they are classified, but  there could have been as many as 1500.Perhaps half of them were directly connected to monasteries, priories or churches. Hospitals could be founded by anyone with money, whether King, Church, nobility, urban corporation, guild and it is not easy to detect who actually founded many of them. A noble might found one in the hope of spending less time in Purgatory. A monastery might choose to become  a patron of one  in order to boost its own reputation.

To give some idea of the spread of involvement by the various monastic orders it has been calculated that in 1146 there were at least 69 hospitals attached or close to a monastic complex.  (15 Benedictine, 2 Trinitarian, 2 Carthusian, 6 Cistercian, 6 Cluniac, 5 friaries, 4 Order of Holy Sepulchre, 24 canonries (Gilbertine, Augustinian, Premonstratensian),2 priory hospitals, 1 Order of St Thomas of Acon and 1 Order of St Lazarus of Jerusalem. These institutions were therefore staffed by a large variety of monks, friars  and nuns. 

Remains of St John's in Canterbury

How did it all start? Archbishop Lanfranc founded St John's Hospital in the 1080s for the infirm, with 30 beds for men and separate section for women. A separate leper hospital, St Nicholas Harbledown, was also founded nearby by Lanfranc  soon after. It is still known locally as the Leper Church. I recently visited this church - see  the photos below 

Other leper hospitals followed all over England built outside towns. 

We have an example of this in St Albans about which there will be a separate post.

The remains of the leper house at Stourbridge

There was a leper house at Stourbridge in Cambridgeshire  built about 1125 which was used by them until the late 13th century. Miraculously the chapel has survived - obviously with restoration but it is pretty much inside and out as the lepers would have known it. The largest Cistercian monasteries sometimes did have an entirely separate Infirmary  built to cater for the external sick.e,g, Rievaulx in Yorkshire, This seems bizarre to me because Cistercian sites were usually very isolated. The sick would have had to travel to them, and it was in the towns that care would have been more necessary. It is unclear how far treatment in these Cistercian lay hospitals went beyond  care and shelter and included real medical  interventions. There were medical men in monks and conversi but Gerald of Wales attacked some of these in the late 12 century for not having appropriate skills and therefore having bad results. From the account rolls at Beaulieu in 1270 we can deduce that inmates of the secular infirmary received daily broth from gruel, beer and small white loaf., meat, mainly mutton, with beans and peas, fish including herring, cod, hake, mackerel and this infirmary cost twice as much to run as the monks' infirmary. It was supported by bequests and donations.

 If they were offshoots of an abbey or priory the hospitals would invariably be situated outside the main monastery campus.  This was particularly true of Cistercian foundations. This was the case at  Fountains Abbey in Yorkshire and Zwettl in Austria.. The lay infirmary at Tintern Abbey in Monmouthshire was a mile away.  Zwettl in 1218 could cope with 30 needy infirm. Beaulieu in 1270 gave food and shelter at night for 16 poor men.

 Whereas the Rule of St Benedict tied Benedictine monks down to a specific closed place , the Mendicant Orders were different. Their role was more hands on with the local community. So far in these posts I have hardly mentioned these Orders so it is time to briefly explain what they were about. Their main trademarks were poverty, ability to travel around, and live in urban areas in order to preach, evangelise and help the poor. They are often called friars, not monks, and usually did not answer to an abbot nor necessarily stay in one location. The four great Mendicant Orders were the Franciscans (often called Grey friars and founded 1209), the Dominicans (often called Black friars  and founded 1215), the Augustinians (Austin friars founded in early 13th century) and Carmelites (White friars founded early 13th century). At first their houses were small but as they received donations, bequests, and sponsorship their buildings began to get larger and larger in towns. As for their attitude to public health it was their duty to visit the sick, especially the poor sick in their homes. Some Franciscans were physicians and treated their own members and some secular patients in the early 13th century and later on they may have acted as apothecaries.St Francis had conspicuously helped lepers as part of charity to the poor. Dominicans never considered physical care of the sick as part of their duty although there is some evidence that they treated secular patients in their infirmaries. How far the treatment in Mendicant infirmaries went beyond a clean warm bed and spiritual comfort is impossible to define.

Hospitals were founded to provide help for sick pilgrims or just accommodation for the night. The Maison Dieu at Ospringe, on the outskirts of Faversham, Kent, commissioned by King Henry III in 1234, was for travellers to the Continent to stay overnight, with chapel and food and bed for the night. The provision was both material and spiritual by Canons of the Order of the Holy Cross (or Crosiers founded in Belgium in 1210). The surviving building on the old A2  is only a small part of the original foundation. See plan below where it is to the bottom left and off the picture. The main buildings including the chapel and the Camera Regis where a King might stay are  on the other side of the road and have completely disappeared. A Master and 3 Augustinian brethren would have staffed the hospital (or hostel) providing spiritual and some physical care. Endowments by wealthy benefactors helped to support the work. However the demands of Kings and other nobles with large retinues meant that demands exceeded what was available, and along with incompetent stewardship of resources, the facility struggled during the later Middle Ages.

Maison Dieu at Ospringe Kent

Hospital buildings for the laity tended to follow the monastic pattern with the best drainage systems around and availability of water and toilets. Examples of these separate Major  Hospital buildings included St Mary Spital in London, St Leonard's at York and   Holy Trinity Soutra in Scotland. All three were run by Augustinian canons.  St Mary Spital was on the site of the present Spitalfields Market in central London. It grew to 180 beds staffed by 12 lay brothers or sisters. For  the interesting full story see  here.

Conjectural view of St Mary Spital 

Hospital of St Cross at Winchester

The hospital of St Cross at Winchester still survives  today. The design of these mimiced to a large extent a normal abbey.  with double quadrangle housing chapel and clergy in one and hospital in the other.

Hospitals seemed to have taken in both men and women and could be tended by men and women staff (monastic or lay) . St Mary Chichester gives a good impression of what a standard Infirmary would have looked like.  

Plan of St Mary Chichester

Interior view of St Mary Chichester 

To accommodate both men and women the layout would have required alteration. The Infirmary at St John the Baptist and St John the Evangelist at Sherbourne had a double decker arrangement with women on the top deck and  men below. The women would have still been  able to see Mass below without being seen from below. St Mary Spital in London may have been two storey too.

It appears that the number of hospitals declined later in the 14th century after  the Black Death. Many surviving hospitals were small, perhaps meant for 12 inmates,   and few had over 100 beds. Some cities had large numbers  : London 35, including 9 for lepers, York had 35, Bristol 16, Norwich 15, Exeter 10 and Canterbury 9.  but some of these were likely to have been like a hospice for 2 or 3 people.

What happened at the Dissolution of the monasteries? Perhaps half of the existng hospitals were closed following the King's audit in 1535 because they were run by monasteries or appeared to be like monasteries and fell into the category of having income of less than £200 a year. By 1540 the monasteries had disappeared through a piecemeal procedure of surrender and threat. Notably St Leonard's of York had also gone. More followed through the later 1540s as the King moved against collegiate churches and chantries. The great monastic and hospital foundations in and around the City of London emptied out and many became ruins by the reign of Queen Elizabeth.

                                                  Some sources

Ayliffe, W. St Bartholomew's Hospital and the origin of London Hospitals.  (2008)

Bottomley, F. Abbey explorer’s guide (Otley, 1995)

Braun, H. English abbeys {London, 1971)

Clark, J.G. Benedictines in the Middle Ages (Woodridge, 2011)

Clark, J.G. and Preest, D. eds. Deeds of the Abbots of St Albans (Boydell Press, 2019)

Crossley, F.H. The English abbey 3^rd ed, (London,1949)

Evans, J. The Romanesque architecture of the Order of Cluny (Cambridge, 1938)

Furniss, D.A. The Monastic contribution to medieval medical care. Journal of Royal College of Practitioners,  15  1968, 244-250. 

Harvey, B. Living and dying in England 110-1540 the monastic experience. (Oxford, 1993)

Kerr, J. Life in the Medieval cloister (London, 2009)

Knowles, D. Religious Orders in England vol 1-3 (Cambridge, 2008)

Leroux-Dhuys, J-F.  Cistercian abbeys : history and architecture (Cologne, 1998)

McAleavey, T. Life in a Medieval abbey  (London, 1995)

Mahood, H. The liminality of care : caring for the sick and needy on the boundaries of monasteries. (University of Reading, 2015) 

Mountford, A. Health, sickness, medicine and the friars in the 13 th and 14th centuries. (Abingdon, 2004)

Parry, A. ed. Rule of St Benedict (Leominster, 1990)

Rosewell, R The Medieval monastery (Oxford, 2011)

Whittock Life in the Middle Ages (2009)

Williams, D.H. The Cistercians in the early Middle Ages (1998)

Health Care for Monks 2 the Treatment

 How did monks get into the Infirmary for treatment? Rules varied according to local practice. It was a wise Infirmarian who ensured that he had beds in reserve. A system to control entry would be desirable. Westminster had what they called "outside of the choir" patients (perhaps blood-letting patients)who were like day visitors, using the miserichord and parlour and then other "in patients" who were there night and day, often for 2-4 days. In the 14th century any monks at St Augustine's Canterbury who were deemed ill enough could be  supplied with a fat capon, wine and candles and spend 8 days in the Infirmary. I hope this was not abused! 

Discipline was slightly more  relaxed once inside the Infirmary: for example clothing regulations. Talking was allowed but silence was demanded after the office of Compline. Examples have been found of "old stagers" causing dissention by with their  constant reminiscing  "Licentious games were forbidden". It is easy to imagine that as monastic discipline declined, a spell in the Infirmary became an attractive option. The seven Offices of the day were supposedly said in the Infirmary so these will have started at dawn It looks as though hospitals still remember this as patients are awakened at 6.00 and get tea and then have a two hour wait before breakfast!

The Miserichord  (dining room)would serve meat but most crucially there was choice and diet could match individual requirements. Apparently at Westminster  some individual dietary requirements had to receive permission from the Abbot or Prior. There was a case where the patient declined to drink beer and the prior substituted wine. The accounts show 10 shillings spent on wine.

We must remember that illness was often seen as Divine judgment and a way for the soul to be purified through individual suffering. (This idea did not go down too well after the Black Death of 1349) Individuals would seek religious cures. This was still the background for the work of the Infirmary. Patients would be party to the continuing round of Offices in the Infirmary and this was part of the treatment. 

What sort ailments might have been common? Early rising and vigils in a freezing church and austere way of life could have led to mental and physical collapse. The harsh diet could lead to stomach problems. The Cluniacs got back trouble from too much manhandling of heavy bells. Also the demands of the liturgy with the excessive amount of chanting  contributed to congestion and coughs. The vigils took their toll too with the poor lighting and dust leading to eye problems. The great Abbot Peter the Venerable suffered from catarrh which affected his voice and prevented him from preaching. 

Research from records kept by the Infirmarer at Westminster 1383-1417 found liver complaints, possibly from large intake of ale and hyperostosis (too much growth of bone tissue) maybe connected to obesity. Also a lot of treatment of disease in the shinbone (morbus in tibia) which were probably varicose ulcers. These could have worsened with the constant standing for Offices, and also the dietary lack of vitamin C. From figures in Barbara Harvey's survey of Westminster Abbey 1375-1529  some 40% per year  of the monks were admitted to the Infirmary  during the year and most were not there for more than 8 nights. This is not including day patients. She thinks this shows resilience bearing in mind the lifestyle and hazards of the day.

Infirmaries had to cater for a variety of  serious illnesses and diseases. Leprosy was a common problem and we shall return to this in a later post about public health care. Caring for such diseases was   a factor in the drive to compartmentalise the large infirmary halls.

The next stage was to work out a physical cure if this were necessary. The Infirmarian would be advised by a physician who was "hired" for a fee  to make visits. He would make the diagnosis and recommend medicines or other measures. The medicines might be supplied by an apothecary from outside, particularly for complex or time-consuming recipes. He might supply cordials which he had made up, or Lozenges and pills. In some cases  he might use items from the herb garden in the monastery.The Infirmarian and his assistant may also have dispensed medicines, using their herb garden. If surgery was needed a surgeon would be brought in. Usual operations were for fractures, wounds, ulcers etc. but were rarely abdominal. There were no real anaesthetics. The surgeons were paid for each operation. All these persons were seen as channels for divine healing. 

It seems that the actual operation of health care  varied across the various monasteries. The Synod of Clermont in 1095 had forbidden medical activity by clergy, but this was not the end of that story. The ability to have physician, surgeon and apothecary all easily available  would obviously be very different in Fountains Abbey as opposed to Westminster. Practices also developed during our period. (1066-1539)

 In the 11th century monasteries had been the only place for medical learning in western Europe. A school of medicine seems to have grown up at Salerno in southern Italy in the 9th and 10th centuries coming to flower by the end of the 12th. The Regimen Sanitatis Salernitanum or Salernitan Rule of Health may have originated from the 12th or 13th century. Written in rhymed verse it is likely to be founded upon the teaching employed in the Salerno school. There was a succession of monk physicians emanating from Salerno and other medical universities., like Montpellier, Bologna  and Paris.

 Abbot Baldwin of Bury St Edmunds was the consultant physician for King William I and Bishop Arfust of Norwich also was treated by him for an eye injury..St Albans had a family of physicians trained at Salerno. Warin was the head of these and was later to become Prior and Abbot. (1183-95). His successor John de Cella (1195-1214)was also a physician. Some monasteries  had their own physician and these individuals were greatly prized.

Herbal medicine was very important. Back in the ninth century Walafrid  Strabo (809-49) from the Rheichenau island on Lake Constance in southern Germany  had described 23 herbs which could be used. Monks were seldom physicians, but the use of herbal medicine by monks was widespread. Ancient practice by other civilisations could be called upon and the work of Hippocrates (460-377 BC) and Dioscorides (40-90 AD) was  crucial. Monastic gardens were developed in Italy from the 6th century. Herbal sections became separate so that particular plants could be chosen for recipes. In our period (1066-1539) a monastery was not complete without a herb garden.

Books about the use of herbs  were written. The Regimen Sanitatis Salernitanum mentioned earlier for example. St Hildegard of Bingen (1098-1190) described 250 plant species for their healing and nutitional value.   This was broken down into 28 for a basic medical kit : galgant alpinia, horseradish, cinnamon, summer savory, basil, mugwort, garlic, nutmeg, mustard, gentian, cloves, hyssop, ginger, dill, bay leaf, lovage, garden orache, peppermint, pepper, parsley, nettle, watercress, sage, chives and tansy.  Headaches and aching joints could be eased by sweet smelling herbs like rose, lavender and sage. Fever could be reduced using coriander. Stomach pains could be treated with wormwood, mint and balm. Mint was used to treat venom and wounds. 

I recommend you look at this post by Dr. Christopher Monk on his blog  Blogum scribum which details this in detail brilliantly.

The photos below show myself as the Infirmarian in our Medieval Munchies weekend 18-19 September 2021 at St Albans Cathedral.It was great fun.  I seem to look rather like the mad librarian monk in the film "Name of the Rose"!

                                                  Some sources

Bottomley, F. Abbey explorer’s guide (Otley, 1995)

Braun, H. English abbeys {London, 1971)

Clark, J.G. Benedictines in the Middle Ages (Woodridge, 2011)

Clark, J.G. and Preest, D. eds. Deeds of the Abbots of St Albans (Boydell Press, 2019)

Crossley, F.H. The English abbey 3^rd ed, (London,1949)

Evans, J. The Romanesque architecture of the Order of Cluny (Cambridge, 1938)

Harvey, B. Living and dying in England 110-1540 the monastic experience. (Oxford, 1993)

Kerr, J. Life in the Medieval cloister (London, 2009)

Knowles, D. ReligiousOrders in England vol 1-3 (Cambridge, 2008)

Leroux-Dhuys, J-F.  Cistercian abbeys : history and architecture (Cologne, 1998)

McAleavey, T. Life in a Medieval abbey  (London, 1995)

Mountford, A. Health, sickness, medicine and the friars in the 13 th and 14th centuries. (Abingdon, 2004)

Parry, A. ed. Rule of St Benedict (Leominster, 1990)

Rosewell, R The Medieval monastery (Oxford, 2011)

Williams, D.H. The Cistercians in the early Middle Ages (1998)

Health Care for Monks 1 : the Setting

Monks had illnesses and grew old like all of us. The Rule of St Benedict (Ch.36) made clear provision : "For the  sick brethren a separate room must be provided..." and "the eating of meat  should be allowed to the sick who are in a weak condition..." Hence monasteries provided an Infirmary (sometimes called the  Farmery.)We will look at the usual layout, mode of operation and the kind of complaints and treatments provided for the patients. As usual I will refer to St Albans Abbey practice where possible. Health care for others will be considered in a later post.

The Infirmary has been described as a mini monastery within a monastery. They tended to be on the eastern side of the monastery because Greek writings had suggested this orientation would be more healthy than facing north or south with clear dry air freshened  by winds from the north or east. This was the theory anyway. The Infirmary was regarded as separate possibly because of the link  between illness and sin as well as for practical considerations of hygiene. 

Thetford Priory in Norfolk (above) is a good example. Infirmaries had their own dormitory (a Great Hall rather like the Refectory except lower in height)) for sleeping, own kitchen to provide different food and a chapel for the regular offices  (the seven Offices of the day)to be held. Infirmaries were most often sited to the southeast of the main cloister. 

 

An existing example can be seen at  Ourscamp in northern France and is now used as the chapel of a monastery of the Roman Catholic Congregation of the Servants of Jesus and Mary.

Former Infirmary building at Ourscamp, France

 Rows of beds would be set up inside and sometimes there was an altar at the east end. Sometimes there was a separate chapel. There would be a kitchen and dining room (miserichord) and a room to house the Infirmarer, who was in charge of the complex. There might even be a small cloister which would provide shelter when moving among the buildings and  could also be used for the patients to exercise.  Infirmaries often had to be extended or rebuilt to cope with demand or changing use.

The great Abbey of Cluny in Burgundy ended with a great Infirmary (the large hall in the foreground of the engraving  below) 165ft by 78 ft. There were 4 rooms each with 8 beds in cubicles, and a separate room for footwasking or bleeding.

 The Infirmary at  Bermondsey Abbey in south London had three stages of growth, all dependent on a large drain to the nearby Thames. The final great hall there was 28 metres by 16 metres with four small attached rooms. By the 15th century separate rooms were being created and this might involve the partitioning of the great hall. This happened at Fountains Abbey in Yorkshire with numerous small private rooms. Some had separate fireplaces. 

At Kirkstall in Yorkshire an extra floor was inserted over the aisles of the hall, like a mezzanine floor,  to provide more accommodation. The separate refectory for the sick inmates of the infirmary was increasingly used by all the monks on a rota basis and was the miserichord. 

The Infirmary  ( Farmery) Hall no 11 in plan below)at Lewes (Cluniac) had aisles and  a chapel with chancel (nos 13 and 14).

Lewes

St Albans had an Infirmary with chapel and cloister from at least the time of Paul de Caen (1077-93). This was rebuilt by Geoffrey de Gorham (1119-46) with Infirmary Hall and Chapel at the east end. Rebuilding work occurred under John de Marines and finally around 1425 by  John of Wheathampstead. Apparently if a monk could not fulfil all the monastic liturgical activity but were not sick enough for the Infirmary there was provision for him in a room called an oriel .Lack of archaeological excavation does not enable us to get a clear picture of what these buildings were like. We do know that separate chambers or cubicles were formed in the Great Hall in the 14th century.

The operation of the Infirmary was overseen by the Infirmarer, who was a monk. Until the 12th century this implied that he was some kind of medical practitioner. This changed and he was more likely to be a literary man, perhaps previously a Precentor. (organiser of the music and librarian). It seems as though at this time one major post qualified a monk for another. This reminds me of how ministers are shunted around in our British Government system. Chancellors become Foreign Ministers and so on. At Westminster John De Mordon became Infirmarer in 1357 after being precenter. The Infirmarer would have at least one assistant, probably a lay brother. 

We should beware of thinking that the Infirmary area was always separate and cut off. This may originally have been the case in the 11th century. It will likely have remained the quietest part of the monastery, but increasingly the space was under pressure not only for the sick, but for separate rooms for visitors, and older retired  monks. At Westminster a society wedding used their Infirmary in 1405 ; rooms were used by the Prince of Wales during a visit and Humphrey Duke of Gloucester may have used the Infirmary chapel as his own private chapel 1430-1.

                                                            Some sources

Bottomley, F. Abbey explorer’s guide (Otley, 1995)

Braun, H. English abbeys {London, 1971)

Clark, J.G. Benedictines in the Middle Ages (Woodridge, 2011)

Clark, J.G. and Preest, D. eds. Deeds of the Abbots of St Albans (Boydell Press, 2019)

Crossley, F.H. The English abbey 3^rd ed, (London,1949)

Evans, J. The Romanesque architecture of the Order of Cluny (Cambridge, 1938)

Freeman, M. St Albans, a history. (Lancaster, 2008)

Kerr, J. Life in the Medieval cloister (London, 2009)

Knowles, D. ReligiousOrders in England vol 1-3 (Cambridge, 2008)

Leroux-Dhuys, J-F.  Cistercian abbeys : history and architecture (Cologne, 1998)

McAleavey, T. Life in a Medieval abbey  (London, 1995)

Mountford, A. Health, sickness, medicine and the friars in the 13 

th and 14th centuries. (Abingdon, 2004)

Parry, A. ed. Rule of St Benedict (Leominster, 1990)

Rosewell, R The Medieval monastery (Oxford, 2011)

Williams, D.H. The Cistercians in the early Middle Ages (1998)

 

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