Thursday, February 27, 2020

24 - Book Review: "From Monastery to Hospital: Christian Monasticism and the Transformation of Health Care in Late Antiquity"

From Monastery to Hospital:
Christian Monasticism and the Transformation of Health Care in Late Antiquity

University of Michigan Press, 2005, pp. 235.

By Andrew T Crislip

Reviewed by P E Pormann

Cambridge Journals of Medical History
(2007 Jan 1; 51(1): 130–131)

The quest for the first hospital in history has occupied the minds of many scholars, especially since Timothy S Miller published his controversial book The Birth of the Hospital in the Byzantine Empire in 1985 (reprinted 1997). Crislip's present monograph, based on his doctoral dissertation, contributes to this debate. His main argument runs approximately as follows.

In Late Antiquity, Christian monasticism emerged in Egypt, having two main varieties: “lavra” and “coenobitic”. In the former, monks assembled to live in the same place without subscribing to one central authority or one set of regulations. Conversely, the latter was characterized by a strong uniformity: members of the monastery would abide by the same rules and were integrated into a hierarchical structure. Both types of institutions developed sophisticated medical provisions. Especially in the coenobitic monasteries of St Pachomius (fl. 320) and his successors and imitators, a complex health care system was put into place. If a monk became ill, a “triage officer” would determine where the patient should go, with highly skilled physicians and nurses treating the serious cases. Moreover, the monastic authorities strove to remove the stigma which often attached to disease and disability in the contemporaneous pagan world. When St Basil of Caesarea (d. 379) visited Egypt in the 350s, he was so impressed with these monastic medical provisions that he decided to take Christian charity one step further. He founded a gigantic hospital—comparable to the seven wonders of the ancient world—in his home town of Caesarea in Cappadocia (modern east-central Turkey). It boasted a sophisticated health care system similar to that found in the Egyptian monasteries, but with the difference that free inpatient care, dispensed by professional physicians and nurses, was not mainly restricted to monks, but made available to the general public for the first time. Thus the first hospital, inspired by Egyptian monastic traditions, was born to become a template for the many other hospitals which spread throughout the Eastern Mediterranean and beyond.

This certainly is a good story, but one wonders whether it makes for good history. There are several problems with both the evidence presented here and the general theoretical approach. Crislip often resorts to sweeping generalizations, for instance when contrasting monastic medicine with its pagan counterpart. He claims that “the sick person in Greco-Roman antiquity was ‘less than fully a human being’ ”, and that “ ‘[a]ntiquity offers no evidence of any provision for the care of the crippled’ ” (p. 69), citing secondary sources. Yet the second quotation, taken from an 1956 article, is certainly incorrect (see, for instance, M L Rose's book The Staff of Oedipus: Transforming Disability in Ancient Greece, Ann Arbor, University of Michigan Press, 2003). Likewise, the first statement hardly applies to all the variegated societies and individuals within the classical Graeco-Roman world. Furthermore, like Miller quoted above, Crislip interprets his primary sources in a tendentious manner. For example, the evidence for the presence of physicians in St Basil's hospital largely hinges on half a sentence in one of St Basil's letters where he talks about “iatreuontes”, translated by Crislip as “physicians” and “doctors”, although it can simply mean “those who treat”. In the face of such sparse evidence, he resorts to arguments like the following (p. 116): “There is no contemporary evidence for the architecture of the hospital [founded by St Basil], nor is there any description of the types of medical procedures employed. Nevertheless, since Basil himself as a young man was trained in standard Hippocratic and Galenic medicine we may suppose that a similar standard was employed in his hospital.”

Apart from these generalizations and interpretative liberties, Crislip's approach also lacks theoretical rigour. Following Miller, Crislip attaches great importance to the distinction between “hospices” and “hospitals”, the latter being characterized by the presence of professional physicians. Whether this distinction between caring and curing or the quest for the first hospital thus defined are useful has rightly been questioned by scholars such as Peregrine Horden and Vivian Nutton (none of whose contributions published during the last two decades is cited). Finally, out of a desire to find the present in the past, as it would appear, Crislip frequently employs modern terminology such as the term “triage officer”. The “triage” in the monasteries of Egypt has, however, little to do with that occurring in modern hospitals. In the former, an elder who often was not a physician himself would determine whether the patient was really sick or merely pretending to be so in order to gain remission from the harsh duties and access to better food (and maybe even some wine); he would then decide whether the disease was caused by a demon, therefore requiring exorcism, or by natural causes.

Despite these criticisms, Crislip's book contains some interesting material, for instance, when he quotes from hitherto unpublished Coptic sources. And, like that by Timothy S Miller, it will undoubtedly provoke fruitful scholarly debate.