As a glance at his bibliography would demonstrate, Adam Davis's study of the hospitals of thirteenth-century Champagne follows in a long and rich scholarly tradition focused upon the endowment of medieval hospitals as social litmus test. Davis himself traces this tradition to the work of Peter Brown and Sharon Farmer on the ‘poor’ and excluded. A social category supposedly invented by the fourth-century Christian episcopate, the poor were rendered both more vulnerable and more visible by the ‘commercial revolution’ of the high Middle Ages. As the rich grew appreciably richer, and the rest were left flailing ever more distantly in their wake, so the poor became the target of mingled pity and suspicion. Lester K. Little's Religious poverty and the profit economy (1978) long ago traced an economy of salvation in which, in an increasingly commercialised Europe after the year 1000, Christ's mercy to the outcast served as a model for a more personal association with paupers and the marginalised, exemplified most famously in the life of St Francis of Assisi. Pursuing an alternative and more sinister theme, oddly neglected by Davis, R. I. Moore's Formation of a persecuting society (1987) sought to define both sickness and poverty as instances of the deviant ‘other’, deliberately excluded from the mainstream by those twelfth-century elites that founded hospitals and leprosaria not so much for charitable ends, but as instruments of socio-economic dominance. Amongst the more recent authorities, François-Olivier Touati, Carole Rawcliffe, Peregrine Horden and Elma Brenner (in her study of the hospitals of medieval Rouen) have taught us not only of the therapeutic impulses imported to western medicine, not least through Islamic influence filtered via Byzantium, but of the role that medicalisation afforded women, several centuries before Florence Nightingale and the horrors of the Crimea. In what ways does Davis advance this debate, or his evidence drawn from Champagne, and more specifically from the archives of the hospital at Provins, challenge the models established by Touati's Sens, Rawcliffe's Norwich or Brenner's Rouen? Certainly, Davis demonstrates that charity was itself frequently described using a commercialised vocabulary of profit and potential loss. As in Norwich or Rouen, a clear distinction was drawn between the permanent exclusion of lepers and the more temporary care on offer from the hospitals of Provins. As in Norwich or Rouen, hospitals came to replace monasteries as the chief object of local charity, fully integrated within a locally defined sense of ‘community’. Gift giving was not indiscriminate, but often carefully calculated and meticulously documented in what was often the language of commercial reciprocity: the promise of eternal reward in exchange for gifts bestowed by the living. Likewise, just as in Jacques Le Goff's formulation ‘church time’ merged into ‘merchants’ time’, so particular moments in the medieval life cycle might provoke particular charitable impulses: on embarkation for crusade, in expiation of usury, and especially as proof of deathbed repentance from sin. Financial accounts, surviving from Troyes from c.1300, allow us insight into the number, gender and social standing of those cared for, or working in hospitals. As elsewhere, caution had to be exercised to avoid over-loading a hospital with in-patients or resident pensioners. Hospital staff were predominantly female and, despite being in many cases attached to foundations themselves (by contrast to their English equivalents) bound by the Augustinian rule, only ‘semi-regular’, vowed to chastity but not to the renunciation of personal wealth. Here, the collection of statutes and foundation charters published by Léon Le Grand as long ago as 1901 continues to prove of particular utility, not least, with pre-echoes of Oliver Twist and the Andover Work House, in documenting an anxiety to provide both against the over-indulgence of inmates and the misappropriation of funds by hospital guardians. There is no lack of picaresque or forensic detail, for instance with the calculation of the average purchase price of rents (a surprisingly low yield of one thirty-sixth of the price of rents purchased at Provins in 1217, p. 180), or the Christmas carousing and sausage-eating of the choir-boys and younger canons of the Hôtel Dieu at Reims, censoriously reported in 1322 (pp. 239–40). For the rest, however, this remains a study that broadens rather than in any way overturning the norms and expectations established by previous enquiry. On occasion, there is misunderstanding (of the economic significance of felling entire woods, for instance, p. 176), a failure to account for local circumstance (as, for instance, with the swampy and altogether unhealthy situation of the great hospital at Tonnerre, here [p. 266] proclaimed a model of aristocratic forethought), or an over-emphatic assertion of originality (as throughout, in the suggestion that somehow historians have failed to recognise the degree of discrimination exercised in charitable giving). On the finer details of the ‘moral economy’, one might have anticipated at least a reference to Rosalind Faith's 2019 monograph, as perhaps also to John Baldwin's masterly account of the dilemma faced by the canons of Paris in accepting for Notre-Dame a stained glass window gifted by the city's guild of prostitutes. In a study supposedly focused on a single town and its hospitals, there is surprisingly little on Provins and rather more on other instances, not just Champenois but more generally French. Even so, as the work of a historian deeply engaged with local archives and the broader picture to which they contribute, this is a book that commands both admiration and respect. To what extent did the pursuit of salvation, newly commercialised in the twelfth and thirteenth centuries, mirror the dilemma of modern health-care systems (or for that matter universities) supposedly ‘not-for-profit’, in reality obliged to operate in ruthlessly competitive ‘free’ markets? How to distinguish selfless beneficence from the egotistical pursuit of earthly fame or posthumous reward? These remain questions not just for the social elites of thirteenth-century Champagne but for the Leona Helmsleys or Bill Gateses of our own equally troubled times.
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