By the late medieval period, that is, the 13th-15th centuries, the monastic and city hospitals were often large and highly developed. The largest hospital in medieval England was St. Leonard’s in York, where 200 patients and 18 orphans were supported. St. Leonard’s had the very advanced—and expensive—touch of keeping lamps burning in the wards all night. Long-term patients sometimes wore uniform robes like the monks and nuns, and they participated in maintenance chores if they were able. The orphans formed a school and support staff for the regular hospital. Monks and nuns with practical medical and herbal training made the rounds for patient care.
How was such a large establishment funded in that time? In some cities, tax money directly supported the hospitals. In others, the hospital was granted the revenue rights to something, like ferry tolls or port fees. That was generally a popular medieval way of funding quite a few things. The beneficiary had an interest in overseeing the revenue activity, so it created administration and funding at once.
Hospitals sought private donations actively and aggressively. Leper houses required lepers to beg in public, as long as they kept some distance from the patrons. But most donations came in bequests at a wealthy person’s death. Some donated beds, and others donated houses. Hospitals might receive a farm or just about any other revenue stream that an individual had owned, such as a mill or a forest. Most of these were either sold or managed as an income stream.
When the house was in a good place to expand the hospital, it was retrofitted for a new use. Manor halls with high ceilings became wards with lines of beds along both walls, while private rooms were built at the ends. The same thing was done during the First World War, though as temporary housing, so we can get a sense of what this looked like. The beds that were donated usually went straight into such wards, so probably the beds in a ward were far from uniform.
As hospitals organized in a more advanced way, bequests and endowments were managed by a board, as they are today. Or mismanaged as the case may be. In 1311, the Pope directed that cities should audit their hospitals to make sure the money was going to the right place. Some “hospitals” were caring for few if any patients, and some hospital administrators were living comfortably while the roofs of their institutions were falling in.
After the plague in 1348-50, things got worse. The plague overwhelmed a hospital system that was set up for relatively static needs like old age or blindness. Most hospitals did not distinguish between sick patients and orphans, since both needed care, but the plague exponentially increased the number of orphans. Hospital staff died off with their patients, and endowments were left with nobody to use them. Cities and orders combined failing hospitals and set up new ordinances for their purposes. Typically orphanages, almshouses (for the aging poor) and sick care were now specified. That way, no one institution would be as overwhelmed by a new visitation of the plague, since it could restrict its help to just some sectors of need.