In the first half of the twelfth century, the Order of the Hospitallers of St John arose in the Holy Land as the continuation of a fraternity of hospitallers that was already present in Jerusalem in the middle of the eleventh century. This fraternity, founded by merchants from Amalfi, Italy, took care of diseased pilgrims and other western European travellers, even before crusaders made their way to Jerusalem. When in 1099 Godfrey of Bouillon led the crusaders to the successful conquest of Jerusalem from the Moslems, resulting in a terrible massacre, the brothers and sisters hospitallers of St John did their utmost to minister to the numerous wounded. Gratefully, Godfrey of Bouillon bestowed on them a knightly manor and two ovens in Jerusalem.

Although they could not dispose of goods in the Holy Land but rather of possessions in their home countries, mainly Italy and France, this example was soon followed by other knights of the Cross. Thus, the fraternity had to administer possessions scattered across Europe, necessitating the establishing of an organization in order to enjoy the yields. For this purpose a system of tongues (i.e. regions with the same language), priorates, bailiwicks and commanderies was developed, which enabled the payment of dues (responsiones) to the headquarters, primarily in order to manage the large hospital in Jerusalem. After the Crusaders lost the Holy Land in 1291, headquarters including this hospital were transferred first to Cyprus, then to Rhodes and after 1530 to Malta, where they remained till the Napoleonic wars.

The outcome of their organizing activities was the following. The Grand Master was the head of the Order and resided in headquarters. Every member of the Order owed him absolute obedience. In his turn he himself was subjected to the supervision and the decisions of the General Chapter, even though this body consisted of men who again depended on him. This reciprocal principle of obedience was intended to improve the members' discipline and the leadership's decisiveness as well as to create the conditions for a certain democratic involvement. The General Chapter consisted of dignitaries from headquarters, heads of priorates and a number of important bailiwicks who assembled once every five years. These men were called the "grand crosses" after the large white eight-point crosses on their black cloaks. The eight points of the cross referred to the Beatitudes from the Sermon on the Mount (Matthew V, 3-10). After the fifteenth century, when the Order had come to include eight tongues, they also referred to these language fields.

In order to manage the goods in Europe, every tongue was divided into one or more priorates under supervision of a prior. He did not live in headquarters like the Grand Master and the ordinary knights, but in the priorate itself, so that he would be better able to inspect those bailiwicks under him. He resided in one of his camerae priorales, of which, in the case of the Prior of Germany, Heitersheim near Freiburg im Breisgau became the most important one in the sixteenth century. Every prior at that time had five such chambers at his disposal, preceptories from which he obtained a large part of the yields, except for a contribution to the central treasury. Amongst priors, the camerae could vary, but since the fifteenth century, the bailiwick of Utrecht with all its dependent commanderies all over the Netherlands formed one of the five chambers of this prior and was to remain so formally until the end of the eighteenth century.

The hospital fraternity in Jerusalem in the eleventh century was not yet a military order. The exact date of its becoming such an order is not known, but it must have been about 1130. This did not mean that every one of its members from then onwards had to become a knight or had to be born from a gentle or even noble family. On the contrary, there remained a large number of priests, called chaplains, as well, mostly not born from gentle families, who got their own commanderies. So next to bailiwicks for knights every tongue also had bailiwicks for chaplains. In contrast to the knights, who had to serve in headquarters or on the castles or the galleys of the Order, the chaplains were allowed to live on their bailiwick and manage it themselves. This implied that they could put more money and energy into their bailiwick and that their presence had more meaning for the local population. The St. Catherine's Convent, seat of the bailiwick of Utrecht (not to be mistaken for a nunnery), which has always been a chaplain's bailiwick, serves as a good example of this.

Even before the Jerusalem fraternity of hospitallers had been transformed into a religious military order c. 1130, it was most probably already represented in the town of Utrecht in 1122 by a piece of land on which a house with a church and a churchyard could be built, the last of which was baptised the "piteous churchyard": the churchyard of poor strangers. In this place, later sources tell us, the Hospitallers ran a hospital with 24 beds in which sufferers of all diseases were nursed, even those suffering from the plague, with the sole exception of lepers. This remained so even after the Reformation, which took place in the Netherlands c.1580, when the possessions of all religious houses were confiscated by the Protestant rulers in order to serve "pious uses". After the foundation of the Utrecht University in 1636 this hospital was used for demonstrations at the sick-bed by medical professors to their students, so that it became an academic hospital. Although this hospital had to be closed in 1812 due to lack of financial resources, the remnants of its capital together with other pious funds served the building of a new town- and academic hospital in 1822, which in a much enlarged and modernized form and at a different site still exists nowadays.

See for more information: Johanna Maria van Winter, Sources concerning the Hospitallers of St John in the Netherlands, 14th - 18th centuries. Brill Academic Publishers, Leiden - Boston 1998. (Studies in the History of Christian Thought, 80)