Christ is every poor person: the ‘Hermandad del Refugio’ and transporting the sick in Madrid

Getting ill, either gradually or suddenly, giving birth, having an accident or being the victim of assault could be a point of no return in many towns and cities in the Modern Age (15th to 18th centuries). With no health service worthy of the name, forced to pay medical costs with few or simply no resources, the popular classes were highly dependent on private or institutional charity to overcome such situations. Single mothers, immigrants, people without resources or contacts found it very difficult to get to hospital. It was not just a matter of getting there, but also of gaining admission and receiving some kind of treatment or cure. Aware of this situation, some institutions of the time, like the Refuge in Toledo, justified their function as help for «the poor, abandoned and sick, with no refuge and no one to care for them». Others stated in their norms the difficulties involved in getting the sick to hospital, such as the Caridad de Sevilla, given that:

«[…] there be many poor folk who, due to their ignorance or the gravity of their sickness, know not how to say what afflicts them so it is good that somebody goes with them, somebody who knows what to say to the Doctor».

Ragged, hungry, dirty and impoverished crowds could be found all over the streets and squares of cities and were a serious problem. In this sense, Madrid was not too different from other large European cities. Rather, as a cosmopolitan city, the capital to which people came from many places, it favoured the existence of different hospital institutions, for example those devoted to nationalities: the Italian hospital, the Flemish hospital, The Portuguese hospital, the French hospital or that for the Aragonese. There were also hospitals that only treated women or specialised in certain diseases and ailments like the hospitals of la Pasión, el General, la Corte, los Desamparados, Antón Martín, etc.

One of the institutions which stood out as an aid to the sick in the city was the Hermandad del Refugio y Piedad de Madrid (Sisterhood of the Refuge and Mercy in Madrid), founded in 1618. Although based on a similar institution in Toledo (founded 1610) the Madrid foundation soon outgrew the other and through its three main functions spent its long existence caring for the thousands of poor people in Madrid. The Refuge offered help mainly through the visit, which consisted in handing out alms to the sick with no money, the night round, which sought out poor people in the street and handed out food and relief, and the chairs, which took the poor to hospital using hand-held chairs carried by two men, as the engraving illustrating this Work of the month shows.

Using these hand-held chairs, the Refuge established a system and maximised its use, although such a service had sometimes been (and was) used by other hospitals and charitable institutions from the 16^th century onwards in Madrid, Toledo, Málaga, Córdoba, Valladolid or Medina del Campo. Their example was followed by sister institutions like the Refuges in Zaragoza, Granada or Palermo, and by other, different foundations—with the same goals—like la Venerable Orden Tercera de Madrid, la Santa Caridad de Sevilla or the one in Málaga.

In the early years, the Refuge in Madrid took the sick to hospital by mount, but the considerable increase in poor patients needing transport in the city and the rich donations and alms which the Sisterhood started to receive when it received the support of the nobility, high ecclesiastical hierarchy and the royal family itself, made it possible towards the late 1620s for all transport of the sick to be by chair. For centuries, tens of thousands of patients were carried through the streets of Madrid in these vehicles which, carried by servants of the Sisterhood, took the sick to one of the hospitals in the city. They were eventually also used in fires, collapsed buildings and bullfights, always ready to transport the victims. A large part of the cost of the chairs came from the alms donated by passers-by when they saw them.

The Refuge chairs became an everyday sight in the city. In fact, as (with time) the number of chairs increased to seven or eight, it was normal to see them in a procession from the Sisterhood`s base to the hospitals and then back to the Refuge. More than normal, as we know from the Sisterhood`s records that for hundreds of years this procession was practically every day. During the 17^th century, the chairs worked full time, carrying more and more sick people. In 1630, 1635 and 1636, they transported 787, 529 and 911 patients respectively. 1644-1646 saw no fewer than 1,275, 1,317 and 1,281 and in 1668 and 1676 1,047 and 1,412 respectively.

As part of their strategy to publicise their work, the Refuge took to printing details of the number of poor people they tended to every year. By 1629, they reported that they had transported 703 sick people to hospital:

«[…] who have been found in the streets and elsewhere, utterly without succour, and unable to walk […] having first given them confession, and with certification from the doctors as to which hospital they were from, and that they could be moved without the risk of speeding up their death.»

Most of the sick were taken to the hospital General and to la Pasión (of the 1,268 picked up in1667, 402 and 682, respectively), but they were also taken to others (to Antón Martín, la Corte, the Italian, the Portuguese and los Desamparados—Destitute—, and Buenadicha—Good fortune). At the end of the century, they were still being transported in their hundreds, no fewer than 1,513 in 1692, 571 to the hospital General and 773 to la Pasión. Two women who had given birth in the street were also taken home and another 90 poor people who were not taken to hospital because they could not be moved, all at a cost of 6,035 reales. These hefty figures were much the same during the following century.

Were the motives for the Refuge’s use of chairs merely practical? No. At the time in Spain, they could only be used under licence of the Consejo de Castilla. Their abundance, boosted by bans on carriages in 1578 and 1593, had led the Crown to decree a prohibition of the use of chairs in 1604. Licenses were hard to get, and the ban was strictly enforced. What`s more, other measures were taken in 1594 to control the bearers and their fees, and the growing ceremonial use of sedan chairs by the Queen`s household had made their use a rare privilege to which few people had access.

On the other hand, as the founders reminded Bernardo de Sandoval y Rojas, archbishop of Toledo, asking for his protection, Christ was «one and the same as the Poor», so transporting them to hospital was transporting Christ. Transporting them in chairs perfectly emulated one of the Royal Household`s favourite traditions, the Pietas austriaca, a custom rooted in the Middle Ages according to which the monarchs yielded their vehicle to the Lord when they met Him in the street, as Rudolf of Hapsburg had done, handing his horse to a priest bearing the Viaticum so that he could cross a river. Apart from offering a fast and safe trip to hospital for the sick, chairs were, ultimately, a kind of safeguard which criss-crossed the streets of Madrid full of poor representations of Christ.

Alejandro López Álvarez, Doctor in Modern History from the Universidad Autónoma de Madrid, is a Secondary School teacher in Madrid and has published several works on the use of coaches, carriages and sedan chairs in Modern Spain and on the royal stable of the Austria Dynasty.

Further reading:

William James Callahan, La Santa y Real Hermandad del Refugio y Piedad de Madrid 1618-1832, Madrid, Instituto de Estudios Madrileños, 1980.

López Álvarez A. 2007. Poder, lujo y conflicto en la Corte de los Austrias. Coches, carrozas y sillas de mano, 1550-1700, Polifemo.

López Álvarez A. 2020. Las sillas de mano y los silleteros de la Hermandad del Refugio de Madrid. Caridad, espectáculo y trabajo entre los siglos XVII y XIX, Asociación cultural y científica Iberoamericana ACCI, Madrid.

López Álvarez A., Recio Mir A. 2025. Eamus in refugium pauperum: La colección de Sillas de Manos de la Hermandad del Refugio de Madrid, E-Spania: Revue interdisciplinaire d’études hispaniques médiévales et modernes, 50.

Döberl M. y López Álvarez A., ed. 2020. Tragsessel in europäischen Herrschaftszentren: Vom Spätmittelalter bis Anfang des 18. Jahrhunderts, Viena, Böhlau, 2020, pp. 71-188.