From poorhouse to hospital – a medieval development


Basil (Photo credit: el_finco) Not actually Basil the Great, but the herb, which has been used since ancient times as an anti-inflammatory.

Here’s the next bit of the “hospitals chapter” in Getting Medieval with C S Lewis. It follows from this bit on Lewis, this introductory bit, and this description of the very first proto-hospitals in the earliest Christian church

Basil’s House of Healing

The hospital itself, it is generally agreed, begins to emerge in the fourth century from the compassion of a well-known monk—Basil, now called “the Great.” In setting the scene for this story, historian Timothy S. Miller reminds us that Lewis’s “two-edged” description of the faith (body affirming + spirit affirming) characterized monks as well as laypeople – in a way many moderns find surprising. Mentioning some of the monks’ more severe ascetic practices (for example, the unforgettable Simeon Stylites’ long stretches sitting atop a pole in the desert), Miller admits, “Their lifestyles of severe self-denial may seem to pull against the truth that God made us human beings and called us ‘very good’—bodies and all.”

“But,” continues, Miller, “if monastics really thought of the body as evil, then how is it that some of the greatest strides in the history of healthcare arose within monasticism? Monks cared for the ill in Benedictine monasteries, Franciscan leprosaria, the institutions of the monastic ‘hospitallers,’ the many hospitals of the Augustinians, and so on throughout the history of monasticism.” Basil started it all, and his story “decisively dispels” our “myths of body-hating monks.”[1]

Born around 330 in a wealthy and prestigious Christian family, Basil strayed from the faith as a young man—seeking instead fame and glory in the competitive field of oratory and politics. After a gospel conversion he decided to become a monk, leaving the tempting city to devote himself to prayer and fasting. After touring the then-flourishing desert monasteries in the East, he created a new monastic community in the mountains north of Caesarea.

After a few years, Basil got a vision for a new, urban mode of monasticism, very unlike the desert model. This way would combine the customary ascetic disciplines with service to others—specifically, care for the sick and poor in the thick of the city. Little did he know he was pioneering a way of doing medical care that would blanket the Western as well as Eastern landscape – and would still guide the creation of countless hybrid ascetic/medical communities over a millennium later!

The community that ran his “monastery and philanthropic complex” in Caesarea ministered to the sick and to travelers—effectively creating a hospice setting in which not only physical but spiritual needs were addressed. In particular, they reached out to a despised class, who Basil’s friend Gregory Nazianzen said were “dead before death and have already perished in most parts of their bodies. They are driven from cities, homes, market places, and sources of water, even from their best friends. They are recognized by their names rather than by their bodily appearance”—the lepers.[2]

The inclusion of lepers was a radical step even for Christians of his day. Another radical aspect of Basil’s proto-hospital was its emphasis on medical science as a good gift from God. Greek medicine was associated, in the minds of some Christians, with the cult of the healing god Asclepios. But Basil argued that God gave us the good gift of medical knowledge, and we are to use it. Just as surely as in miraculous cases of divine healing, the ultimate source of medical healing was God himself. So he staffed his institution not only with nurses but also with physicians who studied the fairly sophisticated Galenic tradition of classical medical science. This was the birth of the hospital, which would remain until quite recently a Christian institution.

The hospital’s evolution from Basil to the Crusades

After Basil, Christian institutions of medical philanthropy throve and spread across Christendom, as the newly legal Roman church increasingly took on public functions. In the last decades of the 300s, a wealthy and pious Roman woman, Fabiola, established the first hospitals in her city. In 526, in a foreshadowing of the major role monasticism would play in Western healthcare, Benedict founded his monastery at Monte Cassino and made hospitality to the stranger a linchpin of his influential Rule (which would become the “master rule” of Western monasticism after Charlemagne’s reforms in the 800s). Said chapter 36, quoting the highly influential 25th chapter of Matthew: “‘before all things and above all things . . . special care must be taken of the sick or infirm so that they may be served as if they were Christ in person; for He himself said ‘I was sick and you visited me,’ and ‘what you have done for the least of mine, you have done for me.’”[3]

In the decades and centuries immediately after Basil, most institutions that cared for the sick looked more like poorhouses than modern hospitals: medical care (despite Basil’s example) was rudimentary, the focus was on the indigent who would otherwise be without help – often including long-term tenants, and the church in a region often set aside a percentage of its funds to provide this sort of care.

The 9th and 10th centuries saw a lull in the hospital’s development as unrest and lack of funds led sometimes to the closing or destruction of European hospitals. Nonetheless, the church, led by its bishops and clergy, continued to do what they could for the poor. Meanwhile, Benedictine monks copied and handed down ancient medical manuscripts, developed herbal lore, and experimented with medicines.

Oddly, the next major impetus in the history of the hospital was the Crusades. When the First Crusade took Jerusalem in 1099, one of the first orders of business was to build what would become the “poster hospital” of the age, funded by private donations—largely from Crusaders. In the 12th century, the continued conflicts also birthed orders dedicated to caring for travelers and the ill, including the Hospitallers. By this time, we have accounts from those who visited the Jerusalem hospital describing a complex capable of serving nearly a thousand patients spread across as many as eleven wards. Suitable to the multicultural nature of the city, the hospital welcomed Muslim and Jewish patients too, and fed them chicken in place of pork.

[1] Miller, “Basil’s house of healing: How a fourth-century monk pioneered the hospital,” Christian History Issue 101.

[2] Miller, 14.

[3] Risse, 96.

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