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Hospital Density and Distribution II
Modelling Leper-House Density for South-West England
Gauging the scale of relief available in medieval England from hospitals is hindered by the absence of direct evidence concerning their number and location. The twelfth and thirteenth centuries - the period of major expansion in scale and scope of institutional relief - is particularly intractable. Most hospitals were poor (and poorly documented) and hospitals as a group were not recorded systematically. The South-West serves as a good example of the complexities and the potential for modelling hospital density. In the medieval period the diocese is known to have had nineteen leper-houses (map 1). Critical for modelling is a unique source - a list of payments to the lepers of 40 places in the diocese of Exeter recorded in the executors' account of the will of Thomas Bitton (d.1307), bishop of Exeter. The list was researched in detail by Orme and Webster (1995) and what follows owes a heavy debt to their work. At issue is the degree to which the list should be regarded as indicative of the number of leper-houses in the diocese in 1307. The first problem to be dealt with is whether all the payments represent leper-houses or whether some of them represent lepers living in non-institutional contexts.
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Since Bitton's will has failed to survive it is not immediately apparent what was meant by the account's stock phrase 'to the lepers of...' which preceded each place-name and payment. In wills the phrase was often used to signify a leper-house in the same way that nunneries or houses of canons might be referred to as the nuns or canons of a particular place. The absence of other documentary evidence for leper-houses at 23 of the 40 places listed in the account led Orme and Webster to argue that only some of the payments represent leper-houses.
Analysing the Bitton list by urban or rural status of the place-names, the size of payment and independent evidence for the existence of a leper-house raises some intriguing possibilities. Of the 23 places which lack independent evidence for the existence of a leper-house, 9 places (marked '?' map 2) were indistinguishable in terms of payment size and the predominantly urban status of their location from the 17 places which did have independent evidence for a leper-house (marked 'LH' map 2). Given the capacity of such institutions to fail to leave an enduring trace in the documentary record, these 9 places could also represent leper-houses. The 14 remaining places are distinguished from the previous group by having smaller payments (6-119d) and more heterogeneous locations. This group includes some places whose characteristics render it hard to conceive them being anything but lepers living in non-institutional contexts (Map 2).
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The number of 'missing' houses does not end there. The executors who compiled the Bitton account are unlikely to have included every leper-house in the diocese given the geographically restricted nature of the list. Some measure of its shortfall comes from mapping the distribution of the payments in relation to the distribution of towns within the diocese of Exeter. This shows that twenty-eight towns lay well beyond the area encompassed by the Bitton list in terms of the payments themselves and the journeys undertaken by the individuals who distributed the payments where these can be reconstructed (Map 3 continuous geographical sequences 1 & 2). That some of these towns had leper-houses is confirmed in two instances by the documented occurrence of leper-houses (Map 3 points A-B). A further 7 houses can be allocated to this area, if 1 in 3 of the 28 towns had a leper-house. This would mean that the total for the diocese could be as high as 35 houses.
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A note of caution needs to be struck at the end of this unashamedly speculative exercise. If the dramatic difference between the known (19) and projected number (35) of leper-houses for Cornwall and Devon bears any relationship to historical reality, it is unlikely to have been as great for most other counties. Cornwall and Devon are poorly represented among the sorts of regional and national sources on which knowledge of the existence of so many leper-houses is dependant. Both counties were also predisposed to have considerable numbers of leper-houses because they had among the highest density of towns in England. For many counties, especially those in the Midlands and the South-East, our knowledge of the numbers of leper-houses and other sorts of hospitals, though incomplete is likely to be far more representative.
Short Bibliography
- Accounts of the Executors of Richard Bishop of London 1303 and the Executors of Thomas Bishop of Exeter 1310, ed. W. H. Hale and H.T. Ellacombe, Camden Society, new ser., 10, London, 1874.
- Holdsworth, C. J. 'From 1050 to 1307'. In N. Orme (ed.), Unity and variety : A History of the Church in Devon and Cornwall, Exeter Studies in History, 29, Exeter, 1991, 23-51.
- Kain, R. and W. Ravenhill, A Historical Atlas of the South-West, Exeter, 1999.
- Orme, N. and M. Webster, The English Hospital 1070-1570, New Haven, CT, 1995.