Going to Jerusalem was, for most of the period this site covers, physically dangerous, and the hazards were mostly undramatic ones: bad water, heat, exhaustion, infectious disease and the ordinary accidents of a long journey made on foot and under sail. A traveller who fell ill was by definition far from anyone who knew their history, and frequently from anyone who spoke their language. The buildings raised to meet that problem — guest houses, hospices and infirmaries attached to churches and monastic houses — form a continuous strand of Holy Land building history from the fourth century to the nineteenth. They are also among the worst preserved, which makes them a useful case in how this kind of evidence has to be handled.
A Vocabulary That Does Not Divide Cleanly
Greek writers of late antiquity distinguish several kinds of charitable foundation by name. A xenodocheion was a house for strangers; a nosokomeion a house for the sick; a ptochotropheion served the poor and a gerokomeion the aged. The distinctions are real, but they were not applied consistently, and one foundation often did several of these jobs at once under whichever name its founder preferred. The consequence for a reader of these texts is that the word xenodocheion does not by itself establish that medical care was given at a place, and its absence does not establish that none was. That ambiguity is not a defect in the sources; it reflects institutions which genuinely did not separate shelter from treatment, and it recurs at every period covered below. The vocabulary used across this site is set out in our glossary.
The Earliest Foundations
The institution most often cited as the model is not in the Holy Land at all: the complex Basil of Caesarea established outside his city in Cappadocia in the early 370s, combining shelter, poor relief and the care of the sick. Comparable foundations followed across the eastern provinces, and Jerusalem, which received a rising volume of visitors after the building programme of the 320s and 330s, acquired several.
The best attested is Justinian’s. Procopius, writing in the 550s, records that alongside the Nea church — dedicated in 543, and placed in sequence on our timeline — the emperor provided two houses at Jerusalem: one for the reception of visiting strangers, the other an infirmary for the sick poor. He lists a hospice at Jericho among the same works. That is a textual claim of the ordinary kind, and in this instance excavation has partly met it: when the Nea’s foundations were located in the Jewish Quarter in the 1970s, its vaulted substructures yielded a Greek inscription naming Justinian, confirming both the patron and the scale of the undertaking. The two houses themselves have never been identified on the ground.
The Desert Houses, and Their Hospices at Jericho
The communities of the Judean desert took in travellers as a matter of rule, and here the spade confirms the texts. At Martyrius, east of Jerusalem, excavation in the 1980s uncovered a hostelry of some forty-three by twenty-eight metres outside the north-eastern corner of the monastery, with its own entrance, eight long narrow guest rooms, a chapel and stabling for visitors’ animals; it is estimated to have taken sixty or seventy guests, and the refectory could seat two hundred. A guest range of this kind — set around its own courtyard, reached without passing through the community’s quarters — is the feature by which hospices are identified at other sites, which makes the argument one from plan rather than from finds.
Infirmaries are a different matter. The founders are credited with them freely: Sabas with hospices at Jericho and in Jerusalem, and the Life of Theodosius written by Theodore of Petra with a guest house at his coenobium east of Bethlehem together with separate infirmaries for the sick, for the aged and infirm, and for those who had lost their reason. But no infirmary has been securely identified on the ground at any Judean desert site, including the two excavated completely; the hospital at Mar Saba is known from Cyril of Scythopolis and its position is presumed rather than established. These are hagiographical texts besides, and record what their subjects were praised for, which is not always what stood on the ground. Their architecture is described on our page on the monasteries of the Judean desert.
The most useful correction the evidence offers is geographical. Several houses kept their hospital or hostel not in the wadi at all, but as a dependency down at Jericho. A hospital there was made over to Theodosius; a monk of another community is recorded dying in the hospital of Jericho; and the house of Choziba, which employed a guest-master to receive the traffic arriving continually at its gate, maintained a hostel at Jericho in which its own chronicler Antony was serving as cellarer when the Persians came. The care infrastructure of the desert stood on the road and at the oasis, where travellers actually collected, rather than in the gorges where the monks lived.
The Muristan and the Hospital of Saint John
Immediately south of the Church of the Holy Sepulchre lies a quarter still called the Muristan, from a Persian word for a hospital. The name is worth pausing on, because it does not commemorate the building most readers associate with the site: it records the hospital Saladin established there after 1187, in the compound the Hospitallers had vacated, under a Melkite physician. Three institutions of the same function stood on the same ground under three regimes, and it is the third that named the quarter.
The first was a hospice founded by merchants from Amalfi in about 1070 or the decade following; the traditional dates of 1023 and 1048 come from later tradition rather than from record. Its dedication to Saint John is genuinely disputed — William of Tyre says it honoured John the Almsgiver, patriarch of Alexandria, and was later transferred to John the Baptist, while modern scholarship inclines to the Baptist from the outset, and no date can be given for any change. After 1099 the house expanded quickly under its head Gerard, of whom almost nothing is securely known beyond that he was there through the siege and died on 3 September of some year between 1118 and 1121. The surname under which he usually appears originated in 1730, when an antiquary misread the Latin word tunc, “then”, as a name.
A bull of Pope Paschal II, Pie postulatio voluntatis, dated 15 February 1113 and addressed to Gerard, placed the house under the protection of the Apostolic See, confirmed its possessions and dependent hospitals across the Mediterranean, exempted its revenues from episcopal tithes, and guaranteed the brothers free election of his successors. It did not make the order sovereign and it did not make it military. That change came gradually and later: a constable appears in 1126, the first clear military commitment at Bethgibelin in 1135 or 1136, and brothers-at-arms are formalised only in the 1150s. The rule associated with Raymond du Puy, master from the early 1120s to 1160, contains no military provision at all.
Two Thousand Sick, and What the Number Is Worth
Three twelfth-century witnesses describe the hospital in operation, and they are more careful than they are usually given credit for. John of Würzburg, about 1165, gives the number of sick as two thousand — but says explicitly that he learned it from the serving staff who told him so, not that he counted; he adds that more than fifty were sometimes carried out dead within a day and a night, that they lay in various halls, and that there were women as well as men. Theoderich, a few years later, is more careful still: he records that he could not make out the number of sick by any means, but that he saw the beds exceed a thousand. Both belong to the literature discussed on our page on medieval pilgrim accounts, and both should be read by the method set out there.
The figures are contested, but not baselessly. Some historians treat two thousand as rhetorical inflation; others, working from the hall exposed when the complex was excavated in 2013, calculate a normal capacity of several hundred with something approaching the reported figure possible under pressure, and note a contemporary report of seven hundred and fifty wounded arriving after a battle in 1177 on top of nine hundred already present. No scholar treats two thousand as a verified bed count; the order of magnitude is defensible, and even the location of the infirmary within the compound has been reopened by the recent excavation.
Inside the Hospital
The fullest account comes from an anonymous cleric who had been a patient there. He describes eleven wards in the men’s section, salaried physicians and surgeons making rounds twice a day accompanied by two servants — one carrying flasks for inspecting urine, the other syrups and electuaries — and brethren giving up their own beds and sleeping on the floor when the house was full. Patients were admitted, he says, of every nation, every social condition and both sexes, including Muslims and Jews; lepers, who had their own house outside the north-western wall, were not. The statutes issued under Roger de Moulins in March 1181 by the reckoning then used, 1182 by ours, fill in the domestic detail: four physicians appointed who knew how to judge the qualities of urine and the varieties of illness; beds of convenient length and breadth, each with its own coverlet and its own two sheets; fresh pork or mutton three days a week, with chicken for those who could not eat those meats; sheepskin cloaks and boots for the walk to the privy; and small cradles for the children of women pilgrims born in the house, so that they might lie apart.
The order’s formula for its patients was not merely descriptive. Its rule and its regulations require that the sick be received and served as lords, and the night orderlies were given words to say quietly as they went round: my lords the sick, here is water, from God. Where the institution’s sophistication came from is debated — a Western monastic tradition of hospitality that acquired medical functions, the Byzantine xenon, or the Islamic bimaristan — and the debate is unresolved. So is a plainer question: given how few salaried medical staff there were against the numbers reported, many of those counted as patients were probably tired pilgrims rather than sick ones, and the institution was a hospice quite as much as a hospital.
Care Where It Had Been Built
Set out together, these foundations show one clear pattern: provision clustered at the points where travellers concentrated — the ports, Jerusalem itself, and staging places such as Jericho — and thinned very quickly in between. That is a consequence rather than an oversight. A hospice needs an endowment, a staff and a permanent building, and those follow traffic; it is why even the desert houses put their hospitals down at the oasis instead of keeping them in the wadi. The practical position of a sick traveller was therefore that they received whatever care existed where they happened to be, from whoever happened to be there, and any physician who knew them was months behind.
Distance rather than medical knowledge was the binding constraint. The medieval hospice had no way to close that distance except by building against it, which is precisely why its answer had to take the form of a building — and why the buildings, rather than the practice, are what survive to be studied.
After 1187
The Hospitallers lost Jerusalem in 1187 and the order withdrew by stages to Tyre, Margat and eventually Acre. A tradition transmitted through nineteenth- and twentieth-century writers holds that a small number of brothers were permitted to stay on for a year to nurse those too ill to move; the primary source for it has not been securely identified, and it should be treated as tradition. What is certain is that the function continued on the site under a different name, and that the Crusader hospital building itself stood until an earthquake in 1457 brought it down, after which the surviving rooms were used as stables and market stalls.
Later provision reverted to the communities. Under Ottoman rule the largest new foundation near the shrines, endowed in the 1550s, was a hospice of fifty-five rooms with a soup kitchen feeding several hundred twice a day — and no medical component at all, a reminder of how loosely the categories still sat. Steam navigation from the 1840s multiplied arrivals and forced the issue: quarantine stations were maintained at the ports against plague and later cholera, which reached the region in 1865 and again in 1866, and an international sanitary conference met at Constantinople in 1866 largely because of pilgrim traffic. Purpose-built institutions followed. The Austrian pilgrim hospice inside the walls, its foundation stone laid at the end of 1856 and opened in March 1863, was approved explicitly as a hospice with a small infirmary for pilgrims; the Russian compound north-west of the walls, built between 1860 and 1864, included the first hospital outside the Old City, though unlike its English, German and Jewish contemporaries it was not open to all comers.
The Muristan meanwhile was divided in 1869 by the Sultan Abdülaziz, the eastern portion passing to the Prussian crown prince and the western to the Greek Orthodox Patriarchate. A Lutheran church was raised on the first from 1893 and dedicated on 31 October 1898; a market of some seventy shops was laid out on the second in 1903. The quarter named for a hospital now holds a church and a bazaar, and nothing of the hospital stands above ground.
Principal Foundations at a Glance
| Foundation | Approximate date | Place | Chiefly known from |
|---|---|---|---|
| The complex of Basil of Caesarea | c. 370s | Caesarea, Cappadocia | Basil’s letters and later panegyric; the model most often cited |
| Houses provided by Justinian | Nea dedicated 543 | Jerusalem and Jericho | Procopius; the Nea excavated from the 1970s |
| Hospices credited to Sabas | late 5th–early 6th c. | Jericho and Jerusalem | Cyril of Scythopolis; the site of neither established |
| The infirmaries of Theodosius | early 6th c. | East of Bethlehem | The Life by Theodore of Petra |
| The hostelry at Martyrius | 5th–6th c. | East of Jerusalem | Excavated in the 1980s; the clearest surviving example |
| The Hospital of Saint John | c. 1070–80; recognised 1113 | The Muristan, Jerusalem | Charters; three twelfth-century eyewitnesses; excavated 2013 |
| Saladin’s hospital | after 1187 | The same compound | Arabic sources; the origin of the quarter’s name |
| The Austrian pilgrim hospice | opened 1863 | Inside the walls, Jerusalem | Founded as a hospice with a small infirmary |
What the Evidence Will and Will Not Support
The continuity of the institution is secure. From the fourth century to the nineteenth there was always somewhere in Jerusalem where a traveller who could not go on could be taken in, and the obligation was understood as belonging to the churches and monastic houses rather than to anyone else. Almost everything beyond that is thinner than the literature suggests, and the thinness is not evenly distributed. Guest quarters survive and can be planned, because a hostel is a large building with a distinctive layout; infirmaries do not, because what distinguished a sickroom from any other room was furniture rather than masonry. That asymmetry runs through the whole subject — we can say with some confidence where pilgrims slept, and very little about how they were treated. Capacities come from admiring visitors; internal arrangements come from rules and saints’ lives, both of which describe an intended order rather than a recorded one; and the buildings themselves have generally been demolished, built over, or reduced to substructures. Medical texts recovered from Holy Land libraries, including material brought back from palimpsests by the imaging described under manuscripts, libraries and treasury, tell us what was read rather than what was practised. Readers wanting the wider history of these institutions will find the collections of the History of Medicine Division of the National Library of Medicine a substantial starting point, and the Byzantine scholarship is surveyed among the research resources at Dumbarton Oaks. Several of the sites named here are treated as fabric on our page on the pilgrimage sites of the Holy Land.