The Origin of the Hospital

While recognizing that the current global crisis is largely steeped in a divorce between medicine and ethics, it is important to step back and look at how the medical profession has evolved in history. What gave healthcare the universal appeal as we know today? Why is it that healthcare is looked at by many to be basic human right?

Many in modern-day academia have argued that the medical profession has risen largely due to secular Enlightenment principles. The way this is often emphasized is by highlighting the supposed origin of the modern-day hospital in the second half of the nineteenth century; this was argued by the Swiss medical historian Henry Sigerist and later by the American professor of sociology Paul Starr.

Both Sigerist and Starr maintained that while Christian philanthropy had given birth to hospitals as early as the fourth century A.D., these institutions were nowhere near the sophistication of modern-day hospitals. In 1985, however, historian Timothy Miller put forward a challenge to this notion by suggesting that the origin of the modern-day hospital can be found during the fourth century in what we know today as the Byzantine Empire.

Miller writes:

With their highly specialized medical personnel and their careful rules regarding hygiene, private beds for patients, and proper heating, East Roman hospitals (or xenones, as they were often called in Greek) challenge the accepted image of premodern institutions for the sick—an image of cold, overcrowded, unhealthy places providing little or no medical attention for their patients. Moreover, the existence of these East Roman institutions alters the common notion that the quality of health care drastically declined in all regions during the Middle Ages. A study of Byzantine hospitals will force scholars in many fields to reevaluate their assumptions both about medieval health care and about the possibility that philanthropic agencies can provide the best medical treatment society has to offer.¹

In his book, Miller continues to describe one such hospital called the Pantokrator xenon. He describes how there were beds separated by the nature and degree of sicknesses and wounds. The first section or ordinos, Miller says, was reserved for patients suffering from wounds or fractures; this was the surgical ward. The second section was reserved for patients with eye and intestinal diseases. The third ordinos was reserved for women and the fourth and fifth ordinos were reserved for male patients with various other illnesses. Each bed was assigned to one patient unlike the hospitals of the Latin West.

The ruins of a Byzantine Hospital in Turkey.

As for the staff, Miller writes that two physicians along with trained medical assistants attended each of the five sections in the hospital. The women’s section were attended by trained female physicians. Among these physicians were trained specialists in surgery and medicine. Besides these physicians were priests, laundresses, cooks, cleaners, and many others. As for medicine, Miller writes that the xenon used preparations such as hydrostat, oxymel, and diospolis while prescribing a strict vegetarian diet, which was common practice during that time.

It is important to note that all this did not occur outside the confines of religious activity. Miller writes that spiritual treatment was given as much importance as physical treatment. The reason for this, Miller writes, is because “Eastern Christianity had stressed the close connection between physical and spiritual health.”² It is also important to note that the Byzantine approach was in sharp contrast to the heretical/gnostic position that Christians were to steer clear of secular medicine and rely solely on Jesus.

Some scholars have argued that the Byzantine Empire borrowed these institutions from their Islamic neighbors. Miller states otherwise:

In shaping these institutions of medical care, Byzantine society did not depend on models in contemporary Persian or Islamic society, as some scholars have suggested. Rather, it drew on its own rich traditions of classical Greek medicine. Although Christian bishops surely organized the first hospitals, they readily turned to the students of Galen and Hippocrates for the expertise to make their nosokomeia [hospitals] effective centers of medical care.³

Now, there is also an objection to this point that hospitals may have originated in pre-Christian times as the status of Galen and Hippocrates seem to imply. But Miller says that this was not the case. Certainly huge advances in medicine were made during the pagan times but there was no concern for the general public having access to medical facilities such as the xenones solidify. The concern for public access to medicine, as we will learn from Miller’s statements, was solely a Christian concern.

By the third century, Christians in large cities had organized to aid the poor and needy on a wide scale. They performed some of their most impressive charitable operations on behalf of the sick. When a plague ravaged Alexandria during the reign of the emperor Gallienus (259-68), Bishop Dionysios directed an extensive relief operation, urging his flock, one of the largest in the empire, to remember Christ’s command to visit the sick. In the face of virulent pestilence, the Christians of Alexandria carried out their mission of tending to the plague victims and nursing some back to health. They also fulfilled their obligations toward those slain by the disease, washing and anointing the bodies and burying them in a proper fashion. In his description of the relief effort, Dionysios opposed the behavior of Christians to that of the pagans, who expelled their sick relatives from their homes and left the victims of the plague unburied in the roads because they feared contagion.⁴

The above claims are corroborated by Rodney Stark who highlights the testimony of the pagan Roman Emperor Julian: “The impious Galileans support not only their poor, but ours as well, everyone can see that our people lack aid from us.”⁵ Stark reasoned that this attitude came forth from Jesus’ proclamation about the need to care for “the least of these” in Matthew 25:35-40. He summarizes the difference in Christian and pagan attitudes towards the sick with the following:

And, as we have seen, that is precisely what most concerned Julian as he worked to reverse the rise of Christianity and restore paganism. But for all that he urged pagan priests to match these Christian practices, there was little or no response because there were no doctrinal bases or traditional practices for them to build upon. It was not that Romans knew nothing of charity, but that it was not based on service to the gods. Pagan gods did not punish ethical violations because they imposed no ethical demands—humans offended the gods only through neglect or by violation of ritual standards (MacMullen 1981:58). Since pagan gods required only propitiation and beyond that left human affairs in human hands, a pagan priest could not preach that those lacking in the spirit of charity risked their salvation. Indeed, the pagan gods offered no salvation. They might be bribed to perform various services, but the gods did not provide an escape from mortality. We must keep that in sight as we compare the reactions of Christians and pagans to the shadow of sudden death. Galen lacked belief in life beyond death. The Christians were certain that this life was but prelude. For Galen to have remained in Rome to treat the afflicted would have required bravery far beyond that needed by Christians to do likewise.⁶

It is quite obvious from all the above that a change in attitude towards the sick is historically effective on how medical practices are carried out. We have seen this to be the case with the birth of the hospital once Christianity had become accepted in the civic sphere. Therefore, the question for us today is: Should the medical profession steer clear from religious ethics, particularly Christian ethics? If the medical profession does succeed in severing itself from Christian ethics, what would be the result? Here, it is sufficient that we are left with this brilliant passage from the French anthropologist René Girard.

…in the eighteenth and nineteenth centuries, Westerners made an idol of science and believed in an autonomous scientific spirit of which they were both the inventors and the product. They replaced the ancient myths with those of progress, which might be called the myth of perpetual modern superiority, the myth of a humanity that, through its own instrumentality, gradually became liberated and divine.

The scientific spirit cannot come first. It presupposes the renunciation of a former preference for the magical causality of persecution so well defined by the ethnologists. Instead of natural, distant, and inaccessible causes, humanity has always preferred causes that are significant from a social perspective and permit of corrective intervention-victims. In order to lead men to the patient exploration of natural causes, men must first be turned away from their victims. This can only be done by showing them that from now on persecutors “hate without cause” and without any appreciable result. In order to achieve this miracle, not only among certain exceptional individuals as in Greece, but for entire populations, there is need of the extraordinary combination of intellectual, moral, and religious factors found in the Gospel text. The invention of science is not the reason that there are no longer witch-hunts, but the fact that there are no longer witch-hunts is the reason that science has been invented.⁷