Between 1991 and 2007, Spitalfields Market in London’s East End was home to one of the capital’s largest- ever archaeological investigations, which uncovered an extraordinary range of finds spanning the Roman period to the late 19th century. These discoveries are now being published in a series of monographs themed by historical period; CA 310 reported on the post-medieval features dating from 1539 to1800, and with the 12th- to 16th-century findings newly published (see ‘Further reading’ on p.35), it is time to explore the medieval part of the site’s history. This is the story of the priory and the hospital of St Mary without Bishopgate, and how ‘St Mary Spital’ cared for London’s sick poor for over 300 years.
The site’s long history of occupation should come as no surprise – it lies on the north-east fringes of what had been the core of London’s Roman and medieval settlement, outside the city walls but alongside a major road: a liminal space, and one that was well suited for organised burial. There, on the east side of Ermine Street (the Roman road running between London and York), lay part of the northern cemetery of Roman London. This burial ground included the exceptionally rich 4th-century burial of a woman dubbed the ‘Spitalfields Lady’, who had been laid to rest in a stone sarcophagus and inner lead coffin, and who was excavated in 1999 amidst a storm of media interest (see CA 162).
Moving forward some 700 years, another burial ground was created on the site: an extramural and extra-parochial cemetery that the Bishop of London founded in what was then open fields, just east of Bishopsgate Street, as the road was then known. Dating evidence for the pre-monastic cemetery comes from radiocarbon dating of the earliest burials (enhanced by Bayesian statistical analysis – see CA 259), and the fact that such large numbers of people, probably c.3,000, were buried there during the 12th century, some in mass graves, suggests that it could have been established as an emergency burial ground intended to cope with an unusual number of deaths that had overwhelmed existing cemeteries. Was this loss of life linked to a single catastrophic event like a famine, such as that recorded in 1124–1126?
The site’s location is also typical of medieval English hospital foundations, and it was here that a group of wealthy London merchants (including Walter Brunus and his wife Roisia) founded the Augustinian hospital and priory of St Mary Spital in 1197. The existing cemetery must have influenced the decision to found the hospital here – London’s first religious house founded by Londoners became a vital part of this commemorative landscape, and the burial ground continued to be used quite intensively, possibly as an interdict (excommunication) cemetery, between 1208 and 1213.
Very few remains of this first hospital foundation have been identified – its main building probably lies in an unexcavated area beneath modern Spital Square – but it was most likely only small, caring and catering for around a dozen or so. It is only from the time that the hospital was refounded in 1235 that we can clearly chart the development of St Mary Spital, and trace how generations of priors, canons, and lay supporters were able to turn a small roadside hospital into a large suburban London monastery.
The priory-cum-hospital expands
St Mary Spital was part of a wave of hospital foundations in the 12th and 13th centuries, and was amongst the largest of those founded or refounded in the 13th century (St Thomas’ Hospital in London was likewise refounded in 1215). The reconstitution of the priory and hospital was perhaps prompted by increasing resources and/or a change in emphasis towards the canons’ spiritual works. Certainly, throughout the 13th century the priory was busy acquiring property in the Bishopsgate suburb, the City of London, and elsewhere, through endowments, bequests, and purchases. This bounty made ambitious expansion possible, and the refounded St Mary Spital was rebuilt on a grand scale. Importantly, it also incorporated the extra-parochial cemetery within the now much enlarged monastic precinct.
This new area comprised about 3ha (7 acres); it was walled on the west side, while the eastern boundary was marked by a large earthen bank and ditch. An inner precinct with a complex of conventual buildings was taking shape, wrapped around the north-west corner of the main cemetery, where some 4,500 Londoners had been buried by this time. The new priory church and infirmary were laid out in a ‘T’-shape, with infirmaries to north and south (one for men and one for women), divided by a central arm forming the church. The scale of these buildings suggests space for 60 inmates, and the sisters who cared for them were accommodated north of the infirmary. To assist in this care, fishponds and a garden – partly for growing plants used medicinally (such as borage and fennel) and as pot-herbs – were created to the east.
Canons and inmates had their own small cemetery adjacent to Bishopsgate, but the main cemetery was used again as an emergency burial ground in the mid-13th century, when around 3,500 people were buried in 200-plus pits; these deaths may have resulted from famines reported in 1252 and again in 1258 – the latter apparently brought on by the fallout and climatic fluctuation caused by a volcanic eruption in that year (CA 270).
Pestilence and prosperity
Between 1280 and 1400, the site underwent a near-continuous programme of construction works – funded by lay supporters including Edward I and rather less regal London citizens – aimed at creating a full suburban monastic house with church, cloister, service and accommodation ranges, and gardens. These improvements included the creation of the first stone cloister to the north of the church in about 1280, a separate new hospital infirmary for sick and elderly laity immediately west of the church, and a new canons’ infirmary to the east.
The main cemetery once again served the wider London community in catastrophic times, with another 1,400 people placed in mass burial pits, probably victims of the famines known to have taken place in the 1310s. Around the 1320s, the prior built a new cemetery chapel, complete with charnel crypt for bones disturbed by grave digging. This crypt remarkably survived to the present day and is preserved in situ below Bishops Square (you can see a 3D digital model at https://skfb.ly/6zMuH). As for structures to house the living, the first of the timber-framed houses that sprang up along the cemetery lane were also built at this time, probably to accommodate servants or corrodians (special pensioner-tenants), or perhaps rent-paying tenants.
The dozen or so canons and around 180 infirmary inmates who inhabited St Mary Spital in the mid-14th century must have been affected by the ‘Black Death’ epidemic of 1348–1349, but no mass graves for this period were identified at the site – probably because a large number of Londoners who succumbed to the plague were buried in the newly created West and East Smithfield emergency cemeteries. Either way, the monastery’s fortunes seem not to have declined beyond repair; the aftermath of the pandemic brought prosperity, and the 1360s and 1370s saw major renovation of its church, adding a Lady chapel and widening the south aisle – a sign of the priory responding to a growing demand for spiritual services in the years following the great pestilence. Wealthy Londoners were prepared to invest in their spiritual salvation, paying for burial in the church and for special chantry masses to speed their souls through Purgatory. Outside, a second cemetery chapel (perhaps for laying-out) may have been built, and a new cross was erected in the centre of the cemetery, where Easter Week sermons were preached.
If demand for spiritual care was on the increase at St Mary Spital, so too was care for the body. During the late 14th century the accommodation for lay sisters was enlarged on the site, and a dedicated pharmacy comprising a single-storey timber-framed building was added to the canons’ infirmary – a clear illustration of active care of the sick and dying, whether canons or, presumably, hospital inmates. We can tell what this care involved, as remarkable archaeological evidence was recovered for the pharmacy wing’s activity in the 14th century and into the 15th century. Inside the building, excavation revealed a large area of hearths, their peat and charcoal fuel, and evidence that copper alloy- and lead-working was carried out here. From pits both inside and outside this building, discarded ceramic and glass distillation vessels were recovered. All the main elements of a distillation unit or still were present: ceramic alembics, cucurbits, aludels, distillation bases, tripods, braziers, and strainers/sieves, plus glass distilling vessels and ceramic crucibles.
At St Mary Spital, the emphasis seems to have been on physical care and herbal and chemical medicine (the domain of the apothecary), rather than surgery. Medieval medicines, applied or swallowed, were prepared using a variety of ingredients, including plants and metals/minerals, and distillation played an important part in such preparations. Residue analysis showed that some vessels from the pharmacy had contained arsenic, copper, and lead, together with mercury. And we know medicinal plants were grown in the prior’s garden adjacent to the canons’ infirmary. All in all, a wonderfully vivid insight into medieval medical treatment.
When we look at individuals buried in the main cemetery, however, we do not know if they were actually treated in the hospital. For example, there were a number of women who had died in or near childbirth. Who among them had been cared for at St Mary Spital, which had a duty to admit pregnant women? Similarly, a woman aged 26-35 was buried with a lead sheet (with brownish hairs, possibly from an animal, on its inner surface) wrapped round her right knee; she had probably worn this when alive, since she had active periostitis on the long bones of both legs; lead was used to treat inflammation, and the soft tissue surrounding the periosteum may have been infected – but was she treated in the hospital?
The spiritual and the secular
By the 15th century, the priory had established distinct but complementary zones: a spiritual core comprising the church and cloister for the canons; the accommodation blocks and service area to the north-west, including a brewhouse, bakehouse and barns; the gardens and orchard to the east and north; the southern cemetery with its chapels and pulpit cross, accessed from Bishopsgate via the cemetery lane; and a large 3¼ acre (1.3ha) field of pasture or meadow, within the precinct boundaries in the south of the priory.
Life in the monastery is revealed by a wealth of finds. The domestic everyday is represented by personal items like dress accessories, alongside food remains and cooking and eating utensils. Meanwhile, the religious life is reflected in various items recovered, including rosary beads, styli, and book fittings, and musical instruments (bone flutes and tuning pegs), as well as in communion sets accompanying a few burials in the main cemetery. Intensive production of medicinal compounds stopped in the early to mid-15th century in the infirmary’s pharmacy wing, which was reconfigured and rebuilt to provide communal space and then individual cells for the canons.
The area in and around the cemetery had become a busy and increasingly secular place. Aside from cemetery visitors and sermon attendees, the five tenements that had been built along the lane in the first half of the 14th century had grown to ten by c.1400; in the 15th century there were at least a dozen timber-framed houses around the burial ground. Tenements were built for letting, and 22 such buildings were documented within the precinct in 1454. The archaeological evidence tells us a little more about who was living in them: rent-paying tenants or priory servants included a coppersmith or bell founder and a blacksmith, both working south of the cemetery. Contemporary records show that living as tenants in the precinct were an apothecary, Richard Hakeby, in the mid-15th century, and a physician, Dr John Smyth, in the early 16th century; they may have assisted in the pharmacy and/or infirmaries as well as treating private clients.
The priory’s economy, however, was in decline (like that of other property owners) and there was little cash to repair buildings in the 15th century. Nonetheless, St Mary Spital was valued as having an annual income of £559 from rents and other assets in 1535, putting it in the richest quartile of all monastic houses in England. About half of this wealth lay in the priory’s urban London ‘property portfolio’. The early 1530s was a profoundly disturbing and challenging time for monastic houses and their religious inhabitants, however. At St Mary Spital, it was a period of frenetic activity and contraction, as the priory leased out tenements and land outside the core needed for the canons and the hospital. Alarmed no doubt by the dissolution of smaller religious houses in 1536, the prior was maximising cash returns and courting supporters.
In 1538, the entire southern precinct was leased to the Guild of St George for gunnery practice; meanwhile, tenants and others had been evicted from this area, and the buildings dismantled. The end came a year later, when the priory was finally surrendered to the Crown in January 1539. The infirmary’s inmates were allowed to live out their lives there, but it did not survive to become a City of London hospital, as St Bartholomew and St Thomas Southwark – both run by a master along secular lines – did.
The story of Spitalfields from the Suppression onwards is an entirely secular one: of courtiers and officials converting and expanding standing buildings into mansions and tenements, of the rapidly expanding suburb from the late 17th century, of immigrant communities, including French Huguenot silk-weavers and garment manufacturers, and the reconstruction of households and their economies (see CA 310).
In stark contrast, for the 300 years before the canons were pensioned off and the physical fabric of the priory leased out, the hospital-monastery of St Mary Spital had tended to the spiritual and bodily needs of its inmates from its position looking out over the countless Londoners buried in the monastic cemetery: the living and the dead side by side in a sacred landscape of care and commemoration.
The main excavation, post-excavation research and analysis, and publication were funded by the Spitalfields Development Group and carried out by MOLA. Thank you to all the many people involved in this project, in particular Nick Holder who collaborated with Susan M Wright to bring this medieval chapter to publication.
Further reading C Harward, N Holder, C Phillpotts, and C Thomas (2019), The medieval priory and hospital of St Mary Spital and the Bishopsgate suburb: excavations at Spitalfields Market, London E1, 1991–2007, MOLA Monograph 59, £32. B Connell, A Gray Jones, R Redfern, and D Walker (2012), A bioarchaeological study of medieval burials on the site of St Mary Spital: excavations at Spitalfields Market, London E1, 1991–2007, MOLA Monograph 60, £28. Available from: www.mola.org.uk/publications.
Susan M Wright is MOLA Managing Editor.