Hospitals in medieval England gave and received gifts as part of the spiritual economy, engaging in an ongoing process of gift-exchange and reciprocity with the rich, as hospital patrons and benefactors. Those inside the hospital, the poor, infirm, and other unfortunates, also had a role to play, and as recipients of spiritual and bodily aid from the hospital, they could offer prayers of intercession for the houses benefactors, so playing a part in the exchange of gifts. This study of the relationships between those inside and outside the hospital gate offers the opportunity to explore the social history of the medieval English hospital. It also provides a national survey of the English medieval hospital in conjunction with a number of complementary regional and local case studies.