Saturday, March 22, 2014

French hospital food in the Middle Ages

In 542, at the request of St. Sacerdos, Childebert I founded a hospital at Lyons, the first in France, that was to not only receive pilgrims, but help cure the sick (cura aegrotantium). Unfortunately, no details have survived of its functioning, much less its food. Which is regrettable, since whatever food was served there might fairly be considered the first hospital food in France.

The early idea of a hôpital went beyond receiving the ill. It was, in simplest terms, a place to stay for those who, for whatever reason, had none: pilgrims, traveling clerics, the poor, the sick. Typically such stays were limited in time. Even as the concept evolved, the association between the sick and the poor would remain close, not least because both offered an opportunity for Christians to show their charity. Later records often talk of povres malades, which could mean “the poor sick” but more precisely meant the sick poor. And in practice, those who could afford to receive care at home probably had good reason to avoid the crowded and less than hygienic conditions of period hospitals. While evidence suggests that some people of means did end up there, in general these places were associated with the less fortunate.

In terms of food, what this means is that often it is difficult in this period to distinguish between food for the poor and the sick; in many cases, both probably received the same ration.

Perhaps the earliest glimpse at food given to the sick comes from the 822 rules for Corbie recorded by Irminon. The Picard abbey's hospital received various temporary visitors, including traveling monks, the poor and the sick. For the most part then, the rations outlined would have been provided to all. Hocquet has analyzed the figures in Irminon's document, which are largely in bulk. He estimates that someone lodged at the hospital regularly ate 5.25 pounds of maslin bread, drank 2 cups (.9 liter) of ale and shared a pensa of bacon or cheese, alternately, a muid of vegetables (typically broad beans or peas), sometimes some eel and fresh cheese on fast days, or mutton or veal. There was also an occasional ration of pork. (Hocquet notes: "It is not without interest to note that veal, mutton or horsemeat is a food of the poor, despised by the provenders, whom as we will see ate a great deal of pork...")

This was probably more than many normally ate in the period and certainly substantial, if not particularly luxurious.

Monasteries continued to house the poor and sick in some cases, but increasingly other hospitals were established (widely, though not universally) for this purpose. Typically these were called the House or Hostel of God: the Hôtel Dieu. (“House of God” here is used in the sense of a place of Divine hospitality, not in the sense of “God's residence” as applied to a church.)

Paris' Hôtel Dieu, the earliest and most important Paris hospital, still exists today and is said to descend from Saint-Christopher's hospital, already documented in 829, when a charter from bishop Inchad mentions it. The history of a hospital on that location has been the subject of various dubious conjectures, as for instance that it went back to the time of the Druids or began as a place of refuge under the Merovingians. It may also have been built near a convent then or later, a reasonable hypothesis, since nuns often served in such establishments. It probably faced St. Christopher's tomb.

When the rue Notre Dame was cut through existing buildings in 1184, leading up to what would become Notre Dame Cathedral, St. Christopher's was at least partially destroyed. For a while it is mentioned together with the Hôtel Dieu, but after a time only the Domus Dei parisensis (House of God of Paris) is mentioned. In 1097, St Christopher's was ceded to the chapter that ran the Hôtel Dieu. It had still been, says Husson, more of a hospital in the general sense of a place of hospitality. But subsequently food and/or drink for the sick, especially the pregnant, was noted in various donations to the Hôtel Dieu.

In 1037 Thiphaine la Comine's will set that, on the day of his death, a barrel of wine be given to the invalids lying in at the Hôtel Dieu, "the best there may be" (melius quod habebit). He also left ten pounds for the monks and nuns as well as the sick to have a pittance [that is, a basic meal]. In 1199, Adam, a canon of Noyon, left a donation giving the sick all the foods they wanted and that could be procured on his birthday and, if anything remained, on the following days. In 1244 Etienne Berout set aside 30 pounds for the Hôtel Dieu for a pittance for women lying in. King Jean II (reigned 1350 - 1364) and his son Charles V (reigned 1364 - 1380) granted all confiscated bread and rotisserie products to the hospital. In the early fifteenth century, grocers gave an annual gift of “fine powder”, a mix of different spices. The drapers, on the days of their meetings, sent a loaf of bread, wine and meat to each of the sick, as well as "an entire dish" to the pregnant (though Coyecque notes cautiously "we have... nowhere found that this custom was actually followed"). On Easter, in the fourteenth century, the silversmiths organized a meal with two loaves of bread for each resident, a pottage, two eggs, roast veal and wine (as well as money).

(Note that “pottage” in French is potage, which today is synonymous with soupe, but could be a more substantial dish in earlier eras.)

Meanwhile other hospitals were established around France.

In 1293 Marguerite of Burgundy, Saint Louis' sister-in-law. established a hospital at Tonnere (in Burgundy). The act founding it said that the poor would be lodged in it "and the convalescents fed for seven days and sent off with a shirt, coat and shoes; ... that the [twenty] brothers and sisters... would be charged with giving food and drink to those who were hungry or thirsty... to visit the sick... and must not take their meals until after the sick have been served."

This last stipulation often appears elsewhere as well. A rule for the Hôtel Dieu of Pontoise from the thirteenth century says that meals of the invalids must always precede those of the religious community and the poor are to receive the foods they desire that correspond to the nature of their illness and the community's resources. The same rule says that “the poor must never drink but seated and holding their glass with two hands”, a stipulation also found in Vernon and Lille.

Leon Le Grand, in a lengthy study of Medieval hospital regimens, notes that many Medieval hospital rules were derived from those of Saint-Jean of Jerusalem, which
had as a principle to give the sick everything they asked for, so long as one could procure it and it was not harmful to their health.... Different accounts... show that this article did not remain a dead letter. At Beauvais, for example, during the exercise 1379-1380, most of the finer dishes, such as mutton, fish, crayfish, milk, apples, figs and grapes, tartlets, are noted as having been bought for the sick. At Saint-Nicolas de Troyes, at the Hôtel Dieu of Soissons, they were provided sugar, spices, figs, almonds. At Saint-Julien de Cambrai, in 1361, one notes the purchase of beer, of wine, of white bread, figs, apples, pears, walnuts, cherries and medlars for the same purpose.... At the same hospital, five pittances had been founded for the poor, one of wine and two of fresh water fish. At Abbeville, 60 sous [were given]... to allow the distribution, on the first and second of the Calends of each month, to the sickest people the foods which would give them the most pleasure.
In 1336, at Saint-Germain-en-Laye, the community arranged to distribute the fruits of their vines to "whichever people, pregnant women or sick of the said hospital, want grapes."

Not everybody thought such indulgence was appropriate. The preacher Jacques de Vitry (1160-1170 - 1240) wrote:
Often hospital workers, with a charitable intention, go too far; they go along the sickbeds, asking each and the other what they want to drink and eat; in their ignorance and their simplicity, the poor only consult their taste, ask for wine and meat, even if they have a violent fever, and this too strong meat causes their death... You no more have the right to give them foods contrary to their health than you should leave a sword in the hands of a madman.
Vitry's concern was not unfounded; consider this note on liberated concentration camps: “The liberators' first response was to give the people food. Unfortunately, many died soon after liberation because they ate foods that were too rich for their weakened systems.” (Bartel)

Leon Le Grand also cites the rule of Saint-Jacques du Haut-Pas, in Paris, which mentions poultry, lamb and kid from Easter to Saint Michael's, with pork from young pigs after Saint Michael. “The reason escapes us for which the meat of female animals was always banned, but one understands better that of Lenten food eels, lentils, broad beans, cabbage were excluded, considered too difficult to digest.”

In general, the Church's rules on fasting were eased for the gravely ill. At Aubrac, they were not applied to those in the hospital at all and Innocent VIII (pope 1484 - 1492) excused those in the Hôtel Dieu of Troyes “so that the sick more easily recover their health.”

Le Grand also derives from the statutes of the Hôtel Dieu of Angers an idea of how the sick were served:
At the appointed hour, a bell rang to alert the sisters: at this call all were to go at once, without exception, to serve the poor. Coats and caps were distributed to the sick so that they did not get cold during the meal; then one proceeded to the ablution of the hands; the sisters, a towel around their neck, passed before the beds of the poor and presented the water to them, as was then the custom for all people of distinction before the meal. The pittance, prepared in the kitchen in a large iron pot or in frying pans, was then brought into the hall; the sisters distributed bowls and wooden or tin spoons to the sick, wooden goblets, shared out the food and served it to them, cutting their bread and giving them the help they needed."
Monks too might help with this and of course prayer played a large part, with Holy Water being brought in afterward. This was especially important in order to avoid any invalid who died doing so without the help of religion.

The sick were not always well-behaved. In 1416, the abbey at Charité-sur-Loire implemented new rules, one of which tried to correct an awkward situation: "The sick, who because of their small number were sometimes placed at a single table where they often gave themselves over to pleasantries which could be misinterpreted, would in the future be placed beside the Prior's dais." (Audoin-Rouzeau), Whether larger groups of the sick behaved better in hospitals is uncertain, though it probably helped that they were not typically seated together at a table.

A variety of details survive from other places. In 1327, at the hospital of Bracon (in the Jura), it was set that
the sick lying within the hospital have daily three dishes, that is at lunch a pottage and a plate of meat or fish, or other depending on the day and circumstances, for dinner one such dish as the mistress finds possible
Otherwise, the sick, the poor and women lying in should have whatever it is possible to have, and in the morning before lunch as breakfast should eat just as the mistress sees possible, all the sick and women with child living in a way, both as to food and drink as to other necessities, as the mistress of the said place allows.
In 1395 the “hotel for the sick of Meullen” bought 1000 herring and 20 Paris sous of mustard.

At Saint-Elizabeth de Trèves, the daily fare was plain bread (better on feast days), cabbage, peas, or other seasonal vegetables. On Sundays, Tuesdays and Thursdays, two pieces of meat, on other days eggs, cheese; at Lent, herring.

At Saint-Jean-en-L'Estrée in Arras about a hundred pigs were bought each year between 1313 and 1336; between 1318 and 1324, from 33 to 78 sheep were bought in different years. Somewhat less beef and poultry was bought. Beef was given exceptionally to some invalids; poultry was given to pregnant women, strangely, in Lent. Says Richard, the editor, “gruel, made of oat flour, eggs, peas, and other vegetables, a great deal of milk, wine, beer, verjuice complete this food, to which one could add 'flans' and pastries on certain feast days.” He adds however that the accounts are not very explicit on this point.

At Hesdin, in the same region, pigs were also bought from 1324 to 1336. In the first year, twenty-six were bought at different prices, some to eat "by pieces in winter", seven to sell, three to eat between Easter and Pentecost, six to make bacons, that is, flitches.

Other foods at Hesdin were: a type of ox called bouvet, “an old cow fattened when it no longer gives milk”; rabbits, chickens, geese, snipe, partridge (“rarely”); herring, unidentified fish; eggs; broad beans, peas, beets, borage, cress, parsley, onion, garlic, vegetables mentioned generally as porée; oats for making "ground flour", a gruel for little children; Brie cheese, Beauvois cheese, dry cheese, various spices, ginger, cinnamon, pepper, saffron, cumin, paradise seed, white sugar, rosy sugar, clove, cubeb, mustard, honey, almonds, rice, figs, licorice; salt; vinegar; olive oil; wine, goodale, grape verjuice, apple verjuice, apples, pears, walnuts, cherries, peaches, strawberries, etc.

If indeed all this food went to the sick, they were unusually well treated; the spices alone would have been a great luxury. The Hesdin accounts also include, under equipment, a “mortar to make sauces”, indicating unexpected care in preparing the food. On the other hand, in 1333 the equipment also included a barrel for making gruel, with a funnel and a bucket and a “cauldron for carrying gruel to the sick”. It is not impossible (though not specified) that different ranks of visitor received different rations.

The same hospital had gardens and a rural domain and maintained cows to provide milk for the sick, as well some livestock. It also set out a donation box ("trunk")  specifically to add to the pittance (et fist on chele semaine pitanche as povres d'argent que on avoit pris u tronc del ospital.)

A series of accounts for the Hôtel Dieu of Beauvais survive from the late fourteenth century. Items in the entries from 1379-80 include:
For Nov 23 – Wednesday, half a hundred herring; Saturday, half a hundred herring, one hundred apples, half a hundred eggs and three cheeses
Dec 3 – Saturday, eggs and cheeses
Dec 18 – Friday, 1 quart of herring; Saturday, fish and herring
Jan 15 – Friday, to bake 2 tarts at Robert the pastry-maker's; Saturday, for butter and cheese, apples
Feb 5 – Monday, eggs and cheese; Tuesday, a quarter of veal, spices; Wednesday, one hundred herring; Saturday, a quart of herring
Other items include crayfish, mustard, almonds, chickens, cherries, new broad beans, and oats. Still, if these were all for the hospital, it is not sure if they were always intended for the sick. More explicit references mention mutton, almonds, fish (on Fridays), mussels and crayfish for the sick. Milk is mentioned as well, especially for children. For the feast of Saint-Jean, some foods were reserved for the sick, including sugar, "gruel" bread [?], cherries, apples, figs and grape, butter, crayfish. Accounts for 1377 mention finer meats (veal or mutton), chicken, milk, tartlets and sugar, figs and grapes, and crayfish for the sick.

The community members themselves of course fell sick. At Saint-Gervais de Soissons, between 1447 and 1482, foods are listed for several sick nuns, including quite a bit of sugar and two mentions of claré, a spiced wine like hypocras: “sugar, beverages and other little things”; “mutton, fish, sugar, cherries and other things”; “mutton, fish, cherries, sugar, claré and other things”; “sugar, almonds, white bread and cherries” and green ginger after the illness; “a chopine of claré', sugar, figs, white bread”; and “sugar, almonds, white bread”. Sugar still had some claim to be medicine at this point, but the overall effect here to a modern reader is of treats (and not very healthful treats at that).

A full humoral analysis of all these foods would require a separate study, but fruit in general was regarded with suspicion by doctors of the time, which makes its frequent appearance all the more striking. Aldobrandino of Siena (13th c.) however does write that cherries comfort the stomach and that bitter almonds (though never actually specified in these lists) are better than others for comforting the sick. Otherwise, it is striking that one sees so little soup, for instance.

Lallemand, in a work generally covering the tenth to the sixteenth century, lists various allocations, without specifying the dates. At Gonesse, fresh meat on Sunday, Tuesday and Thursday; bacon on Monday with eggs or cheese in the evening; eggs, Wednesday, Friday and Saturday; with this other foods as available. At the hospital of Séclin in Flanders, accounts mention fresh herring, salted salmon, mussels, small pike, carp, pork, beef, veal, mutton. Eggs, cheese, peas, garlic, spices, vinegar and verjuice were also purchased. At the Hôtel Dieu of Angers, sardines, bleaks, cabatz grapes [from Touraine], and a half-pound of almonds were bought for someone who was "outrageously sick". (One wonders how they felt after eating sardines, grapes and almonds...)

At Metz, Larchey lists:
For each invalid daily three quarters of a loaf and 1 pint of wine "old measure". Item on Monday, Wednesday, Friday and Saturday at dinner each a dish of pottage such as is made in the kitchen of the [sceans ["seated"? established?], that is peas, broad beans and cabbage, according to what the day gives and with this further each a bowl of gruel, which the converts make [sic] in their rooms and further at supper each a dish of cheese bruye [brouet?] made as above.
Item on Sunday, Tuesday and Thursday, each of the said days before the dinner a piece of grilled meat, or a soup of meat when grilled meat is lacking, and they have at dinner each a piece of meat and pottage such as the day provides, and at supper each a sirloin [? alouez/alloyau?] of meat with the pottage.
Item for Lent, each day at breakfast rye puree at dinner peas and saffron puree and at supper a soup of oil and saffron and each day a herring, and Sunday at supper and Monday at dinner a pittance of fish.
(From context this seems to be fifteenth century, though Larchey says only that he took it from the cartulary for the hospital, for which he gives no date.)

Coyecque's work on Paris' Hôtel Dieu in the Middle Ages is probably the most cited work on this subject. Here is his summary of food there:
Outside Lent, the invalids avoided meat one hundred and forty days out of the year, that is three days a week, Wednesday, Friday and Saturday; the one hundred and eighty five other days, they ate meat. Mutton was the basis for all the meals; beef and cow meat were served less frequently; as to veal, lamb or pork, these were only eaten on certain feast days, ten times a year; let us add almond pottage, eggs, salt and fresh water fish, figs, grapes, sugar, gruel, Capendu apples, pears, cheese and tarts; further, each hall received, weekly, three pints of milk. On fast days, eggs and dairy were replaced by herring, barreled (gutted) or smoked, and by onions preserved in walnut oil.
The “gravely ill” were better cared for: they were given better wine than usual; poultry was reserved for them. They were only fed on capons, goslings, poussins or pigeons. If meat disgusted them or was contrary to them, they were given "stew to breathe" [brouet à humer, made with eggs, butter and verjuice] or "meat cullises"; if they wanted a roast, the cook set his spits in motion. On fish days, instead of cod or whiting, they were served a dish of little fried fish."
He asks, rhetorically, “Was one well fed at the Hôtel Dieu?”
The bread, the wine, the meat, were they of good quality? Nothing allows us to deny it; do not forget, besides, that in the Middle Ages as today, the guests of the hospital, for the most part, at least, knew privation by experience, the dry hard piece of bread washed down with a gulp of water, if not complete fasting: an excellent condition for not being difficult and for appreciating the house's pittance...
For the quantity, it is different: each invalid had a choir boy's ration. Was it enough? We would not dare to claim it; some were not of this opinion and asked for a supplement – which they got in return for solid cash.
But, he points out, not everyone could afford this. Still there was always the chance of a rich bequest “for an addition to the pittance”, or a sudden gift of sheep, as well as the leftovers from the community's table.

His description of how this was served differs slightly from that above at Angers:
Two meals a day... were held. When the invalids heard sound, on the clock, the hour of dinner or supper, eleven or six o'clock, rising up on their seats, they held their hands out towards a small table where were found various utensils: an earthen pot where the sister poured the wine ration, a half-setier by meal; a goblet for drinking, a wooden bowl and a spoon, also in wood.
The first official rules for the Hôtel Dieu of Paris are variously dated to between 1217 and 1363. The eighth article states that a sick person must first confess and receive Communion before being admitted (note that this would have excluded Jews, for instance). After the personnel was to take him to his bed and treat him like the master of the house; then to give him every day what he wished to eat, before the brothers were served.

Coyecque's second volume includes some statutes from 1408 “for the Ostel-Dieu and for the good of the poor.” This begins with the reasonable (if perhaps optimistic) order to keep the gravely ill in beds by themselves, without a companion. The next item is a curious mix of French and Latin:
Item that those charged with cooking the meat for the sick, have it properly prepared, so that, when it is presented to the said invalids, eam non abhorreant propter ejus nigredinem aut aliam causam propter quam eciam sani non vellent commedere [they do not shrink from it because of its blackness or other causes such that even healthy they would not want to eat it]
The need for such a stipulation leaves one wondering just how badly prepared the meat might sometimes have been, especially given the limited means of many of the invalids.

The item after this points out that vineyards had been dedicated in Suresnes, Gentilly, Vanve and “other good territories near Paris” to the use of the poor and declares that at least the gravely ill should be served wine from these rather than served wine from the Gastinois and Champagne “as has been done before, by which several paupers, so it appears, have lost their lives.”

Aside from the idea that Champagne was once considered fatal to the sick, a modern reader might be equally surprised to know that at this point the wine of the Paris region was well-regarded, and had been for centuries. The intent here then was that the sick be given very good wine.

In general, much of this fare sounds tasty even today and was probably all the more so to people whose normal diet would typically have been very limited. This is not to suggest that Medieval hospitals were in any way luxurious; the sharing of beds alone would make them unbearable to most of us today. But in terms of food, some might consider crayfish, Brie cheese, almond pottage and tartlets, all washed down with good wine, as tempting alternatives to modern hospital fare.


Dagier,Étienne, Histoire chronologique de l'hôpital général et grand hôtel-Dieu de Lyon 1830

Audoin-Rouzeau, Frédérique, Ossements animaux du Moyen-Âge au Monastère de La Charité-sur-Loire 1986

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