Invention or evolution in the provision of health care in late Antiquity in the Eastern Roman Empire : the case of the hospital.

摘要

My aim is to discuss the question of whether – and to what extent – the emergence of the hospital in the Eastern Mediterranean is the outcome of the healing tradition of the ancient Greek world rather than of the new values and structures of the Christian society that becomes established in the fourth century AD in the Eastern Roman Empire. I will begin by briefly outlining the situation in the area of medical care in this part of the world up until the fourth century AD, which is the date at which most historians of medicine conventionally place the “birth” of the hospital.1 I will then look at cases of hospitals between the fourth and the middle of the seventh century, in order to determine whether there were new elements that came into play in Late Antiquity in the East with respect to the society’s attitude towards the sick, especially the indigent sick, and its manner of dealing with them. This examination will lead to me to suggest aspects in which there appears to be a predominance of continuity with the Classical past, and others where change ismost noticeable. Earlier historians such as Theodore Meyer-Steineg and Karl Sudhoff have attempted to furnish evidence of the existence in antiquity of institutions to house the sick, but their arguments, according to most present-day scholars, are based on meagre archaeological information and some misinterpretations.2 Although most scholars today concede that the hospital owes its creation both to the ancient Hellenic medical heritage and to the contribution of Christianity, they seem to lean heavily towards the impact of the latter, and firmly place the origins of the hospital in the years immediately following the legalisation of Christianity in theEastern Roman Empire. 1 Sigerist, 1932:82; Miller, 1997:4. 2 Miller, 1997:31. 4 I will argue for the fact that the hospital emerges in the Eastern Roman Empire less suddenly that most scholars claim; that its debt is not quite so heavily weighted in favour of the ideological and socio-economic changes brought about by Christianity and its adoption as a state religion by the emperors, and that the long tradition of medical knowledge, practice and care inherited from Classical Greece constitutes a defining contribution. Whether the hospital was an ideological more than an architectural development may be debated, but I believe that, had this long and valued tradition not existed and, of course, had it not been so easily accepted and adopted thereafter by the Church – for reasons which I suggest are again connected with the nature of ancient Greek medico-philosophical values – the institutions founded in this period would have functioned much more generically as places of hospitality for travellers and pilgrims, or as refuges for the sick, maimed or dying, rather than as places where the restoration of health was a prime consideration. My intent is not to imply that Byzantine medicine was static or to deny that the hospital was a significant evolution from earlier provisions of health care and owed much to the Christian notion of agape. However, I would like to suggest that our own evidence today is still far from conclusive and that there are indications that the hospital was not as revolutionary and novel an institution as might appear to be, but that, while taking shape as a result of the new organisation and values of a Christian society, it had strong roots in resources and customs already in place in the Eastern Mediterranean.