Feminae: Medieval Women and Gender Index

This image depicts nurses caring for the sick at the hôtel-Dieu in Paris. While the artist represents some realistic aspects of the hospital’s sickrooms, the image is an allegory celebrating the virtues to which the nurses aspire in their work with the poor, the sick, and the aged. In this period a hospital, known as a hôtel-Dieu or maison-Dieu (House of God), served many needs including providing a religious house, giving shelter and delivering care to the indigent, the elderly, women ready to give birth and those needing rehabilitation. The hospital in Paris at this time could take in as many as 870 people, though records in December 1482 show 500 men and women receiving care. Most medieval hospitals were staffed by women associated with the Rule of Saint Augustine, as it permitted more flexibility in the structured day for health care, both physical and spiritual. The Fourth Lateran Council had already discussed the equivalence between virtue and physical health. The Augustinian sisters would stay at the hôtel-Dieu in Paris until their expulsion in 1907.

The Augustinian sisters nursed patients back to health—both physical and spiritual (contrition, confession, satisfaction). The largest figures in the image are the professed nuns, who wear the standard black veil, black mantle and blue dress. They managed most of the care and the hospital; older professed nuns were heads of different departments and the prioress, who was one of the two heads of the hospital, was chosen from among them. Here these nuns care for the sick. Since the hospital is like the rational soul, the cardinal virtues, portrayed as the professed nuns, dominate the image. On the left, Prudence holds a ruler in her hand; she cares for the patient Ignorance. Next is Temperance, who holds a bridle or reins, to control and guide desires; she cares for the sick patient Concupiscibility, who needs to have his desires controlled. Fortitude carries a stone tower; she attends to the patient Irritability, who cannot bear to suffer frustration or face dangers. Lastly, Justice, on the far right, carries scales; she cares for the patient Will who has been affected by malice and desires things which are harmful to the body.

In the image, six of the seven patients share beds. While nurses preferred to put a single patient in each bed, regular overcrowding at the Parisian hospital forced two to three to a bed. During a particularly devastating epidemic, healthier patients found themselves lying in bed canopies in order to accommodate all patients. Mattresses were straw or feathers with a sheet and a rough blanket, and linens were washed regularly though not daily. Unlike the depiction here, multiple people sharing a bed were put head-to-tail, so people’s heads were at either end of the bed—not all facing the same direction.

The experienced nuns instruct other women, depicted as smaller and younger. The medium-sized nuns are novices, who had already taken their vows but had not completed apprenticeships. Novices at the hôtel-Dieu wore black veils and mantles but white surplices and dresses, unlike the blue worn by the professed nuns. The smallest figures are "white girls" (les filles blanches), so called because of their completely white clothing (surplice, apron, dress, wimple and veil, coat). These were young women just recruited into the hôtel-Dieu who had not yet taken vows. Most "white girls" came from the bourgeoisie or well-to-do peasantry.

The architecture is quite limited, and the image seems more imagined than realistic in its depiction of the hospital building. Six of the seven interior scenes in the text are set in the same room; the seventh is this one, in a sickroom. One sees only a wall and the bottom of some windows. A table with a blue tablecloth sits at the foot of Irritability’s bed but is disproportionately small. The image has a gently arched top (described as a "basket handle"). The colors are vivid, but the silhouettes are austere and elongated: the sisters and the patients are painted vertically, but the image itself is horizontal. A gilt border surrounds the entire image. The artist is unknown and the images are not associated with any anonymous masters active in Paris at the time. Although many hospital records are illuminated by in-house staff (including the records of the master of the hospital), more than one researcher believes the artist in this case was not on staff at the hôtel-Dieu.

The image is found in a manuscript of Le Livre de vie active de l’Hôtel-Dieu (Book of the Active Life of the Hôtel-Dieu) by Jehan Henry. It is dated to 1482 or 1483. Jehan Henry was a significant figure in Parisian politics in the second half of the fifteenth century. He was probably Norman, of a minor noble family in Ouche. He became a cleric and arrived in Paris some time before 1459, which is the first time hospital records mention him. In the next two decades he became a canon and cantor at the Cathedral of Notre-Dame, a member of the Parlement of Paris, president of the Chambre des Enquêtes, advisor to the king and—most likely due to both his secular and his sacred connections—an overseer of the hôtel-Dieu in the 1470s and again in 1482-83. Henry is depicted in a smaller illumination in the manuscript, as a member of the Notre-Dame chapter with an almuce, a shoulder cape worn by canons, draped over his arm. He kneels as a petitioner before the virtue Mercy, dressed as a nun, who gives him a shoot from the tree of charity and a container of ointment, directing him to live an active life. In the prologue, the text states that Mercy carries this ointment of compassion enclosed in the container of her heart.

In 1482, Henry was selected to head a commission of eight canons to investigate a string of abuses at the hôtel-Dieu and to reform the hospital both administratively and spiritually. The result was Le Livre de vie active, a treatise on theology and morals. The work is not (and was not intended to be) an accurate description of the reality of the hôtel-Dieu but an exhortation to the nuns to strive for the ideals expressed. Henry also sought to show outsiders all that the sisters could do for the poor. The book is dedicated to the hôtel-Dieu’s sub-prioress at the time, Perronnelle Hélène (or Alaine), and an inscription at the end confirms her ownership. Names of successive owners are unknown, except one. The hospital displayed Le Livre until it was confiscated by the state in 1903; it is now housed in the archives of L'Assistance Publique - Hôpitaux de Paris. An inferior but contemporary copy was found in the Ste. Genevieve library in 1923.

The manuscript is bound in parchment; its spine has five ribs. There are 123 leaves, with flyleaves at the beginning and end and numbered pages in ink in the middle. The work was written on vellum, a finer quality material than parchment, with semi-cursive Gothic writing in black and also red ink for chapter titles and sections. There are twelve images. There are also illuminated letters, full-page miniatures, and little narrative masterpieces. The manuscript is well-structured, its images and narration complementing each other.

The emphasis in the High Middle Ages on the active life—actual works of charity and mercy—is the major theme in the Livre de vie active and in the sisters’ work, yet Henry was by no means the only leader urging pious works of mercy. In the wake of papal exhortation, the thirteenth century had seen a wave of religious charitable work. The laity participated regularly, including as donors. Several religious orders, like the Dominicans and the Franciscans, took many of the same monastic vows but continued to work actively within communities. The second wave of medieval hospitals were founded during this time, generally by secular rulers and wealthy bourgeoisie, and were overseen and administered by the Church. Even first wave medieval hospitals originally founded by churchmen, like the hôtel-Dieu (established in the 650s and linked to the cathedral of Notre Dame de Paris), were impacted by this shift.

Despite these high ideals, by the fourteenth century, turmoil had diminished much of the religious fervor (and rigor) of earlier centuries. France in particular suffered. The Avignon papacy and the subsequent Western Schism angered the faithful and spurred calls for reform. Warfare and rebellion repeatedly shattered people’s lives. Nor was healthcare easy at this time. The Black Death hit Paris hard in 1348 and 1349 with Friar Jean de Venette noting that more than 500 dead were carried daily out of the hôtel-Dieu for burial. The plague recurred roughly every decade for the next fifty years, and hospital records indicate other epidemics (including the "big pox") as well. There were periods of famine due to limited land, rudimentary farming technology, and wet and cold weather ruining harvests. In addition, Paris was one of only two northern European cities to boast more than a hundred thousand residents, and war and plague exacerbated problems in meeting the needs of so many people.