The medical revolution of the hospital in antiquity
The ancient world did not know of an institution like the hospital – not before Christianity “invented“ it. The process of the establishment of hospitals everywhere happened throughout the 4th and 5th century. Mike Aquilina in his book The Healing Imperative. The Early Church and the Invention of Medicine As We Know It describes for us the features of those ancient hospitals and the medical revolution they brought about:
“By the 400s, hospitals were not just a common feature of the landscape, but in fact were essential to civilization. Before the Christians there had been no such thing as a hospital, but now the world apparently couldn‘t do without them. (…) Hospitals were often independent institutions. In the beginning, many of them were founded by local bishops. But as it became more essential to have a hospital in every city, and as the founders of hospitals were more and more glorified, most of them were founded by rich donors – often as legacies in their wills. (…) In the beginning hospitals cared mostly for the poor, but by the 400s they seem to have been caring for the middle classes, and perhaps some of the rich as well, especially in the East. (…)
Mike Aquilina, The Healing Imperative. The Early Church and the Invention of Medicine As We Know It, Emmaus Road Publishing, p. 156-160
So if you went to one of these hospitals, that were rapidly popping up all over the East, you‘d probably find it a reassuring place. The building would be warm, because it was usually built with a big open hearth as its central feature, and the beds for the patients were arranged to take advantage of the heat. There would be baths attached to keep the patients clean, and for any water therapy the physicians might order. You‘d see icons or religious murals all over the walls because, after all, healing comes ultimately from God, no matter how many physicians have worked to bring it about. There would be an outpatient office, where people who didn‘t need to stay in the hospital could get professional walk-in care. There would also be a dispensary, a pharmacy where drugs were handed out to the general public as they needed them. The staff and physicians had access to every kind of medical tool and whatever special furniture they needed. There would be a separate section for surgery and cautery. (…) Best of all, there‘s no fee. All this medical care, the best the world has to offer, is a public service, brought to you by Christian donors. It really was the best medical care, too. The physicians of the city vied for the few hospital positions available. (…) The nursing staff was made up mostly of volunteer monks in earlier hospitals. But by the 500s, hospitals had grown big enough to hire their own lay nursing staff. (…)
The Christian hospital made classical Greek medicine – scientific medicine – available to a broad population for the first time. Doctors made rounds, examined patients to determine the best treatment, and kept medical records. (…) Physicians had always worked alone. (…) But the hospital brought doctors together in one place. They had to talk to each other. They kept medical records. They wrote stuff down. They made lists of treatments that were known to have worked – lists that belonged to the hospital. (…) Thus, without anyone having planned it, the hospital became centers of medical research. (…) Once physicians started practicing in a hospital setting, modern medicine was the inevitable result.“
Monasticism, Saint Basil the Great, and the hospital
One ingredient that went into the invention of hospitals was the health care system that had been developed in the monastic movement. Saint Pachomius the Great, a disciple of Saint Anthony the Great, in about the year 320 was the first to found a community of brothers that lived in the way of “cenobitic“ monasticism.
“The key trait of Pachomius‘ cenobitic monasticism was centralization. Monks wore a specific habit – in effect, they were in uniform. They were organized into ‘houses‘ of about twenty monks each, and each house had its particular job to do for the whole community – washing, baking, or whatever. The monks all ate in a central dining hall, and they all went to services together in the church.“
Mike Aquilina, The Healing Imperative. The Early Church and the Invention of Medicine As We Know It, Emmaus Road Publishing, p. 113-114
A few years after the founding of his community, Saint Pachomius the Great established a house inside the monastic settlement that was meant to take care of the sick brothers among the monks.
“Pachomius made sure the sick were allowed to be sick, which was practically revolutionary. (…) Not only should those who are disabled be exempt from work, but the other monks should find joy in serving their less able brothers. This was the attitude Pachomius took, and it became the usual attitude in all the monasteries that followed his.“
Mike Aquilina, The Healing Imperative. The Early Church and the Invention of Medicine As We Know It, Emmaus Road Publishing, p. 115-116
From the health care system of the first cenobitic monasteries to the first real hospital it‘s only another link in the chain: Saint Basil the Great. He was born in the year 330, the son of a wealthy family. For his classical education he went to Constantinople and then to Athens, where both he and Saint Gregory of Nazianzus “studied under Libanius, the most famous rhetorician of their time“ (p. 128), a man who also taught Saint John Crysostom. Basil and Gregory became friends, as they lived together throughout their student life. During those years in Athens, Basil studied not only the liberal arts, but also mastered the field of medicine.
After his return to Cappadocia, where he came from, and his conversion and baptism, he became a priest and an auxiliary bishop within a few years. Those were the days of the Arian heresy which Saint Basil the Great, like other great saints of the 4th century, had to fight against, even though the Nicene Creed had already excluded the theological notions of Arianism in 325. But there emerged problems beyond theology, too. And they led to Saint Basil the Great‘s project of building and running a very unique place for the needy in an urban setting:
“In addition to the Arian crisis, there came a social crisis in 368, when a series of natural calamities – including hail storms, floods, and earthquakes – brought famine to Cappadocia. Basil was appalled when some merchants seized the opportunity to grow rich from the scarcity of food, leaving the poor to starve. (…) These social concerns are a recurring theme in Basil‘s homilies and letters, most addressed to groups of monks and nuns. The ideal monk, Basil said, is one whose prayer is augmented by work, but whose work is done ‘so that they may have something to distribute to those in need‘. (…) He imagined charity on a grand scale, an industrial scale, and his vision was concretized – literally – in the construction of what in his lifetime became known as the Basileias, or Basil‘s Place. (…)
Mike Aquilina, The Healing Imperative. The Early Church and the Invention of Medicine As We Know It, Emmaus Road Publishing, p. 134-142
Basil called his foundation a ptocheion – a place for the poor. But it was natural that people should start calling it Basil‘s Place, because it seemed as if no one else could have put it all together. It was great complex of facilities built to serve anyone who needed serving. Basil‘s insititutions included a soup kitchen, poorhouses, a trade school, a hostel for needy travelers, personal care for the elderly, a hospice for the dying, and a hospital. This enormous community, staffed by monks dedicated to the work, really was almost a new city. (…) They dispensed food and medical care to all who approached, regardless of religious affiliation. This was not something added on to their devotions; it was integral to their religious life. This life of prayer mixed with action was Basil‘s ideal for monks and nuns. (…) There was a hostel where the homeless and poor strangers could have a roof over their heads and some decent food. (…) There was an orphanage which took in children who had lost their parents or – just as important – children whose poor parents couldn‘t afford to keep them. (…) There was a place for lepers (…) where the most wretched outcasts in classical society were treated with dignity. There was a trade school where poor men could learn to support themselves, so they wouldn‘t have to depend on Basil‘s Place forever. And finally, there was a hospital. Basil himself tells us that his institution had everything needed for professional care of the sick: physicians, nurses, attendants, and transportation, probably in the form of donkeys.“
Following the model of Basil‘s Place, bishops all over the Eastern part of the Roman Empire began building hospitals. From the historical records it is clear that in the late 5th century, there were hospitals in Jerusalem – as in every city or town of the East. The Western part of the Roman Empire was already in decline and less civilized than the East. But Saint Fabiola, born in 399, a widow and a student of Saint Jerome, founded the first hospital in the city of Rome – and served the patients there with her very own hands. Saint Jerome praises Saint Fabiola‘s work and exhorts his fellow Christians to follow after her:
“The poor wretch whom we despise, whom we cannot so much as look at, and the very sight of whom turns our stomachs, is human like ourselves, is made of the same clay as we are, is formed out of the same elements. All that he suffers we too may suffer. Let us then regard his wounds as though they were our own, and then all our insensibility to another‘s suffering will give way before our pity for ourselves.“
Saint Jerome, quotation from Mike Aquilina, The Healing Imperative. The Early Church and the Invention of Medicine As We Know It, Emmaus Road Publishing, p. 153
