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Hospitaller Services in the Kingdom of Jerusalem Library

Lecture author Onlineby © ESCMID C. Savona-Ventura Chr isti anit y ad opt ed as th e nati onal religion of Roman Empire –– 312 AD312ADAD Library Jerusalem became a magnet for pilgrims. Lecture First surviving pilgrim account by Christianauthor of Bordeaux dated 333 AD OnlinePilgrimsby required the establishment© of “refuge houses” in the Holy City.

Emperor Constantine Constantine 306-337ESCMID AD DlDevelopmen tfhitllit of hospitaller services

Establishment of pilgrim refuge Libraryhouses – Xenodochium Establishment of hospitals HitlHospitale – gues tht house Lectureor host el Infirmorum – infirmary to treat sick EblihEstablishment of fhi hospiauthorces –– Onlineby Nosokomion © Establishment of charity houses Leppprosaria – care of lepppers ESCMIDGerokomaria – care of the elderly

Blessed Gerald in the Jerusalem Xenodochium EtblihEstablishmen t o f xenodhidhidochium

603 AD Pope GregoryLibrary the Great requests Abbot Probus to set up a XENODOCHIUM in JerusalemLecture. Named: Santa Maria Latina Mentionedauthor by St . Antoninus of Piacenza Onlinewho duringby his pilgrimage fell sick and was© received into this refuge house.

Pope Gregory the Great 540ESCMID-604 AD AD StMiLtiSanta Maria Latina xenodhidhidochium 1023 AD: Re-established b y Merchants of AmalfiLibrary after negotiations with Mustesaph , caliph of Egypt. Placed under the direction of the BenedictineLecture Order Set up a xenodochium for women dedicated to author Santa Maria Magdalene . Medieval merchants in the Levant OnlineSet upby a xenodochium for non- Amalfian© men dedicated to St . John the Almoner, Patriarch of Alexandria 608-616 AD. ESCMID Entrusted to lay brothers 1082 AD: visited by John, Archbishop of Amalfi. Establishment of leprosarialeprosaria ~370 AD: leprosarium set up at Ptolemais [now Acre] by St. Basil the Great, Bishop of Cesarea. Library ~400 AD: leprosarium established in Jerusalem by Empress Eu dox ia [383-408]. Lecture Placed under the direction of the Basilian Order author By 6th century, lepersOnline were travelling to the Holy Landby to bath in the River Jordan and© the Siloam Pool – both believed to have 14th century view of a leper miraculous healing powers. (Ms., Wellcome Institute Library, London) ~808ESCMID AD: housed 15 lepers Services: 1099 Basilian Monks Benedictine Monks caring for lepers giving refuge to pilgrims Library

Lecture author St. Lazarus OnlineSt.by John the Almoner St. Mary Latin St. Maryygyg Magdelene Leprosarium outside gates © of Jerusalem in vicinity of Xenodochium complex within gates of St. Stephen’s Gate Jerusalem in vicinity of Holy Sepulchre ESCMID under management of Gérard and Agnes The Crusades 638 AD: Jerusalem capitulates to Caliph Omar bringing end to Christian Library dominance. Some decrease in number of pilgrims but flow increased again at turn of Lecture millennium. 1078: Jerusalem capturedauthor by Seljuks Online Seljuk maltreatment ofby Christians © Prompts First Crusade led bGdfbyESCMID Godfrey d dBe Bouill on who captures Jerusalem in 1099. 1099: All hospitaller services in Jerusalem placed under the direction of Gérard. 1st decade: re-organized into a religious Order underLibrary the prottifStJhthBtittection of St. John the Baptist Adopted the Augustinian rule 1101Lecture: Roger I o f Sic ily donates money for “the Hospital for the feeble and other sick”. 1102:author Saewulf wrote “Without the gate of Onlinethe Holy Sepulchre, to the south, is the church of bySt. Mary, called the Latin……Near which is the © Hospital, where is a celebrated monastery founded Gérard greeting Godfrey de Bouillon in honour of St. John the Baptist.” 18th century painting by A. Favray, Museum of Fine arts, Malta The Order formallyyg recognized b ypy Pope ESCMID Paschall II in 1113. Paschal the Bishop, servant of the servants of God, to his venerable son Gérard, founder and provost of the Xenodochium of Jerusalem, and to his lawful successors forever. Services: 12thth centuryyy St. John the Almoner St. Mary Latin St. Lazarus St. Mary Magdelene Library 1099 Fratres Hospitalarii under provost Gérard adopted Augustinian Rule Lecture author Order of OnlineOrder of Hospitale Santa Maria Order of St. John the Baptist St. Lazarusby est. ~1124 Templar knights Papal Bull: 1113 Papal Bull:© ~1118 OdOrder of fT Teut oni c est. 11181118est. knights; est. 1198 •Refuge to pilgrims •Care of lepers •Care of German •Protection of •Medical care ~1136 •Military role ~1234 pilgrims pilgrims •MilitaryESCMID role ~1131 •Military role •Charitable activities Raymond du Puy ? Roger Boyant Originally set up by Hugues de Payen German philanthropist [1120-~1158] [1118-1131] [~1119-1136] ~1143 Raymond du Puy e..sce Lazari Library

e..g maria magdalena Lecture author Onlineby © hospitale ESCMID

militia templi

Map of Jerusalem ~1130 Cambridge Bibl. Municipale, ms 466, fol.1 Order of St. John

• Gérard [died 1118] succeeded by Raymond du Puy – Re-organised Order to include a Military role. – Emphasized Medical Care in conjunction toLibrary giving hospice to pilgr ims [Chap ter ~ 1125/53].

""How Our Lords the Sick Should be Received andSd Served ddSd. AdithtObdiAnd in that Obedience in wLecturehi hihthch the Master and the Chapter of the Hospital shall permit when the sick man shall come there, let him be received thus: author •• Let him partake of the HolyOnline Sacramentby , first havinggg confessed his sins to the pp,riest, and •• afterwards let him be carried© to bed, and and •• there as if he were a Lord, each day before the brethrenESCMID go to eat, let him be refreshed with foodfood charitably according to the ability of the House…." • Pope Innocent II in circular letter Quam Amabilis Deo dated 20th February 1131 emphasises triple role of the Order Library How pleasing to God and highly revered the Xenodocheum of Jerusalem is, what pleasant and valuable accommodation it offers to the poor pilgrims, those have experienced sufficiently, who driven by internal piety, visit the Holy City JerusalemLecture and the Sepulchre of the Lord enduring the dangers at sea and the dangers at land... . There (in the hospital of Jerusalem) the poor andauthor miserable are being convalesced. The Sick Onlineare being administered a thousand kinds of services of charity. Those whoby are harmed by manifold constrains and dangers are getting b ack there© the ir o ld vi gour and i n ord er t o enabl e them to visit the places, which were sanctified by the life of our Lord Jesus Christ on earth, the brethren of this house always prepared to risk theirESCMID life for their brothers (the pilgrims) undertake to protect the pilgrims from the attacks of the infidels on their way to and fro through squires and animals used for riding which are very specially selected for this purpose...... •• 1163: Rabbi Benjamin of Tudela wrote that –– “There are at Jerusalem two hospitals, which support four hundred knights, and afford shelter to the sick; these are provided with every thing they may want, both during life and in death; the second is called the hospital of Solomon” [referring to the infirmary of the Templar knights] Library •• 1187: Theodorich visiting Jerusalem before the Order's exppyulsion from the city wrote: –– “Here on the south side of the church,Lecture stands the Church and Hospital of St. John the Baptist. As for this, no one can credibly tell another how beautiful its buildings are, how abundantlyauthor it is supplied with rooms and beds, and other materialsOnline for the use of poor and sick people, how rich it is in the means of refreshingby the poor, and how devotedly it labors tototo maintain the needy , unless© he has had the opportunity of seeing it with his own eyes. Indeed, we passed through this palace, and were unable by any means to discover the number of sick people lying there;ESCMID but we saw that the beds numbered more than one thousand…..."…..." •• 1182: Statutes of Master Roggger des Moulins –– “…..that for the sick in the hospital there should bebe engaged four wise doctors who are qualified to examine urineLibrary and to diagnose diff eren t disease an d are a ble to administer appropriate medicines.” –– “…..that in everyLecture ward and place in the Hospital, nine serjeantsauthor should be kept at their serviceserviceOnline, whoby should wash their feet gently, and change© their sheets, and make their beds and administer to the weak necessary and ESCMIDstrengthening food….” •• 1182: Statutes of Master Roger des Moulins –– “…..the“…..the beds of the sick should be made as long and as broad as is most convenient to reposerepose, and thatthat, each bed should be covered with its own coverlet and eachLibrary bed should have its own special sheets .” –– “…..“…..each of the sick should have a clock of sheepskin and Lecture boots for going to and coming from the latrines, and cap of wool.” –– “…..…..…..little cradles author should be made for the babiesOnline of women pilgrims born in the HouseHouse, soby that they may lie separate, and that the baby© in its own bed may be in no danger from the restlessness of its mother.” ESCMID–– “Adllth“… And all the children ab and oned b y th ei r fathers and mothers, the Hospital is accustomed to receive and nourish HospitaleHospitale for German knights •• Early history not clear Jacques de Vitry [written 1611] “…many Teutons and Almayns who went to pilgrimage could not speak the tongue of the city, so the divine clemencyLibrary inspired an honourable and religious Teuton , who dwelt in the city with his w ife, to wife, to build a hospice at his own cost, wherein he might entertain poor and sick Teutons …For a long time, in great poverty, he ministered to the sick and needy .” Definitely extant as a subsidiaryLecture to Order of St. John by 11431143 1143: Pope Celestine II author In letter to RaymondOnline du Puyby refers to a subsidiary German itale hospppitale in Jerusalem©

1160: John of Wurzburg –– “On the way down the same street, which goes to the gate by which ESCMIDone reaches the temple, and on the right, is a cross street with a long portico. In this street is a hospital with a church, which has been newly built in honour of Saint Mary, and is called the House ofHouseofof the Germans.”.” Order of St. Lazarus Early history not clear Gérard [di ed 1118] suppose dly succee de d by Boyant Roger who previously servedLibrary as Rector of the Hospital of Saint John

Definitelyyy extant as an entitLecturey by 1130 ~1130: “~1130: “A dwelling of lepers” situated between Tancred’sauthor Tower and St. Stephen’sOnline Gate mentioned in Work on Geography.by ~1130: e sce Lazar© i noted on map of Jerusalem. ESCMID~1135: Armenian monk granted a cistern to “domui leprosorum Sancti LazariLazari”””. Number of donations refer to the Church and Convent of the Sick of St. Lazarus situated outside the walls of Jerusalem 1142: Act of donation of land in JerusalemLibrary to byyy King Fulk of Anjou refers to ““ecclesie Sancti Lazari et conventui infirmorum, qui miseli vocantttur”””. Lecture

DllfitthDual role fits the clitloister-likauthore appearance depictionOnlineby in the 1130 map of Jerusalem© 12th century seal used in Jerusalem which shows on ESCMIDone side the mitred abbot and on the opposite side shows a leper holding a clapper. Jerusalem Domus leprosarum

The leprosarium was run by a master assisted by nursing brothers and sisters . Originally the magistro conventui Sancti Lazari infirmorum de Jerusalem was supposed to be a milesLibrary leprosus. In 1253, Pope Innocent IV was requested by the brothers to alter previous rule stating that the chosen master was to be any healthy knight from amongst Lecture the brothers of the house since all the leper knights of the house of St. Lazarus were killed in the Battle of Gaza inauthor 1244. Fratre magistro domusOnline leprosum 1153: Bartholomeo by 1154: Hicteri © 1155: Hugonis de Sancto Paulo 1166abetus4: Lambertus 1169:ESCMID Gérard de Montclar 11851185--86:86: Bernardi

12281228--34: Gualterus de Novo Castello Leper colony with attending monk 12341234--54:54: Rainaldus de Floriaco (Exhibit – The London Dungeons) Leprosy affected all classes of Medieval society and the Domus leprosarum cared for all who sought shelter therethere.. Library Livre au Roi ~1200: required any knight or sergeant with leprosy to join the convent of St. LectureLazarus where it is established that pppppeople with such illness shouldauthor bebe. His wife wasOnline to enter a convent and all pppppropertiesby should devolve to their heirs.© ESCMID Templar Rule: Leprous knights were obliged to live apart from the communityygppy though supported by Order. After ~1260 “When it befalls any brother that, by the will of Our lord, he contracts leprosy and the thingLibrary is proven, the worthfhhhldhy men of the house should adihhidmonish him andkhid ask him to request permission to leave the house and go to Saint Lazarus, and take the habit of a brother of Saint Lazarus.” Knight continued to be supportedLecture by his parent Order. author OnlineHospitaller Statutes ~1260:by “if in any country there be a ©Brother who is a leper, he may not wear the Habit from that time forward, and may not come among ESCMID the Brethren, but he should be provided with food and clothing”.”. “It“Itsoso happppppened that onceoncewhenwhen he was ppygpyglayingp g withwith somesomeotherothernoble boys ……,,theythey began pinchingpinchingoneone anotheranother…………Baldwin bore the pain altogether too patiently,patiently, asas ifif hehe diddid notnot feelfeel itit.. …….... AtAt firstfirst II thoughtthought that this happened because of his endurance, not becausebecauseofof insensitivityinsensitivity..…….... At last I discovered Librarythat aboutabout halfhalf ofof hishis rightright handhand andand armarm werewere numbnumb,, soso thatthat he did notnotfeelfeel pinchespinchesororevenevenbitesbitesthere. there.………… Physicians werewereconsultedconsulted and prescribed repeated fomentations, anoitiitiintings, an ddd even poiiisonous dddrugsLecturettto iiimprove hihihissconconditiditidition, btbtbutb t in vainvain..For,For,as we later understood more fully as time passed, and as wewemademade moremorecomprehensivecomprehensive observations, this waswasthethe beginning of an incurableincurablediseasedisease..………….... For asauthor hehebeganbegantoto reachreachthetheage of Onlinepubertypubertyitby it became apparent that he was sufferinggg from that most terrible disease,,, leprosyleprosy.© .EachEachday he grew more illill.. TheThe extremities andandthethe face wereweremostmostaffected ESCMID ……..””

13th century depiction of Baldwin IV’s leprosy diagnosis [Ms. H.Y.Thompson 12, fol.152r, BL, London] Domus leprosarum presently nonnon-- existentexistentexistent –– excavations revealed only an arched portal and some cut steps leading to moat. Two posterns suggest thatthatthat building may have extended further along walls to incorporate a female hospital near David’s Gates, a cemetery Library east ofSf St. S tephen’s G ate and the Pool of St. Ladre.. 1187 Ernoul: describes Salah al--Din’sDin s assault of Jerusalem stating that the Lecture assault was directed between the hospital for male lepers near St . author Stephen’s Gate and thatOnline of women lepers behind David’s Gate. by 1187 Theoderich of Wurzburg:© “Whoever makes the circuit of the city walls,,g beginning the j ourney at the Tower ESCMIDof David, will find at the western angle of the city the church and National Geographic dwellings of the lepers , which are handsome and kept in good order.”.” Order of Temple knights

1120: Founded by a group of knights led by Hugh de Payns and his relative Godfrey de Saint-Omer. Main aim: to protect pilgrims from brigands andLibrary Muslin raids. Given old Temple as headquarters site by King Baldwin IIBaldwin II OiOrigi nall y att ach ed dt to th e canonsLecture of fthH the Hol y SepulchreSepulchre 1129: recognized and confirmed authora Military Order by Pope Honorius IIOnline. by Adop tdted© ch ar itblitable acti tiitivities Provided food for poor ESCMID Set up some hostels to house poor Medical activities directed for the sick of the OrderOrder • La Régle du Temple • given by the Council of Troyes, 1129 – 61. Let sick brothers be given consideration and care and be served according to the saying of the evangelist and Jesus Christ: Infirmus fui et visitastis me.Library That is to say: 'I was sick and you visited me'; and let this not be forgotten. For those brothers who are wretched should be treated quietly and with care, for which service, carried out without hesitation, you will gain the Lecturekingdom of heaven . – Therefore we command the Infirmarianauthor to studiously and faithfullyOnline provide those things which are necessaryby to the various sikbick bro thers, suchtflhbidh as© mea t, flesh, birds and all other foods which bring good healthESCMID, according to the means and the ability of the house. The Christians dominion of Jerusalem came to an end after the Christian forces were driven out by Sultan Sal a din i n O ct ob er 1187 . The surviving knightsLibrary of the Military Orders after the Battle of Hatim were beheaded at the express orders of Saladin because in the words of the Arab chroniclerLecture Ibn al-Athir “they were the fiercest of all the Frankishauthor warriors.” Onlineby Bibliothèque Nationale FR. 5594 Fol. 197, © Sebastian Mamerot, Les Passages fait Outremer, vers 1490 WtWESCMIDestern response withithl launchi ng of the Third Crusade to retake Jerusalem [1189-1192]. 14th century Les Livres du Graunt, BL Ms Roy. 19DI, f.107 Third Crusade: 1189 --91 Siege of Acre Crusaders besieged the Muslim garrison at Acre. Saladin surrounded the city and the Crusader forces ––““A Siege within a Siege”” Library

The prolonged conflict with multimulti--European involvement Lectureplaced particular stresses of the besiegers. authorRidhdlRequired the development of Onlineby dedicated field hospital © services for different armies. ESCMID Orders established new base in Acre

Library

Hospitale sc Thomas Domus militia ecc. Sancti lazari Lecture

Source: • Lib. Secretorum Fidelium Crucis en bas, c.1285 Hospitale sc John •Detail of buildings from copy of Matthew Paris : BL, London ms.Roy.14.C .VII, fol 4v Order of Teutonic knights During the Siege, German contingent established an improvised field hospital made of wood from dismantled ships and sail canvas. Library After end of siege built the Opitale des Alemans nearnearnear St. Nicholas Gate. Run by the BrothersLecture of St. Mary under leadership of Sibrand [1190[1190--1192]1192] 1199: Con firmeauthor d a reli gi ous O rd er b y Pope OnlineInnocentby III with first master Heinrich I WalpotWalpot© StatutesStatutes::--“in the principal house, which is the head of the order, doctors are to be employed as the finances of the house allow and as the ESCMID numbers of the sick require” Order of St Thomas of Acco During the Siege, William, a chaplain from Middlesex. Dedicated himself to nursing the sick and burying the dead. Library After end of siege built the hospitale of St . ThomasThomas.. Community followed the monastic rule of St. Augustan Lecture Under protection of English king. Militarized by Peterauthor of Roche, the Bishop of Winchester,Online duringby the Fifth Crusade 12171217--12211221 1236: Pope© Gregory IX accorded confirmation to the OrderOrder Regulations similar to those of the Teutonic Order. ESCMID

Tombstone: Peter de Roche 1238 Winchester Cathedral Order of St . Lazarus Before 1234: Order of St. Lazarus assumed a militaryyy role in addition to its care for lepers 1234: Pope Gregory IX appealedLibrary for aid to help the Order pay off its debts contracted in “defence of the Holy Land”. 1244: Participated in Battle of Gaza where almost Lectureall the brothers of the Order either fell in battle or were thrust unto captivity 1250: Parauthor tic ipa te d in Ba ttle a t a l--MldMensura led Onlineby King Louis IX 1253:by Participated in the Syygrian Campaign led ©by King Louis IX •• Maintained their medical traditions. –– 1234:ESCMID Land donation charter drawn up by Petrus, archbishop of Caesarea, in favour of the domus leprosarum tototo sustentationem leprosorum et aliorum ibidem deo servitientium.. Order of St. John

Built extensive hospital complex in Acre 1262: ChapterChapter--GeneralGeneral under Master Hugh Revel …decreed that the Brother of the InfirmaryLibrary …. should visit the beds of the sick brethren who lie in the infirmary……And at all times at which the doctor shall visit the sick brethren, the b roth er of th e I nfi rmary sh Lectureould go with hi m, …… author Onlineby © ESCMID Very little of the Medieval Sacra Infermeria survives in Acre

Library

Lecture author Online Excavations at the Acre Hospital: courtyard,by sewage pit; pit; and and warehouses warehouses © ESCMID The Siege of Acre In April 1291, the Saracen army under the l ead ershi p of S ult an Kh alid l aid siege to Acre. Library The fi ve milit ary re ligi ous O rd ers j oi ned forces under the control of William de BjMtfthTlBeaujeu, Master of the Temple. Lecture The last Latin stronghold in the Holy LdflltthSLand fell to the Saracen onsl aught author on the 14th May 1291. Onlineby © The Chri sti an garri son was made up of ab out 14000 infantry and 700 knights, of whom more than a half belonged to the Orders. ESCMID Or der o f the T empl e ~240 kn ig hts Order of Saint John ~140 knights Order of St. Lazarus 25 knights Order of Teutonics 15 knights Order of St. Thomas 10 knights Order of St. John Acre ÆÆ Cyprus ÆÆ RhodesRhodes Capture of Rhodes [1311] gave the Order an independent state. Had land holdinggpps in various parts of Europe. Order of the Temple Acre ÆÆ CyprusCyprus Library Suppresse d b y P ope i n 1312 . Ha d land h oldi ngs i n vari ous parts of Europe Order of St. Lazarus Acre ÆÆ Cyprus ÆÆ FranceFrance Lecture Had moved Magisterial seat to Boigny in 1255; had land holdings in southern Italy, England, author Switzerland, Hungary. Order of TeutonicOnline knights Acre ÆÆ Prussia by Created an independent© state in 1225 mounting crusade against Poland & Lithuania Order of St. Thomas ESCMIDAcre ÆÆ Cyprus ÆÆ England [~1370] Dissolved by King Henry VIII in 1540