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

Accounts of ascetics miraculously curing the sick have captivated audiences both ancient and modern. Now Andrew Crislip turns our attention to a less scrutinized form of ascetic healing: institutional care for the ill. From Monastery to Hospital examines organized health care in late antiquity, arguing that the nearest antecedent to the hospital was the Christian monastery. Crislip meticulously combs Egyptian papyri and monastic texts (including some unpublished texts of Shenoute), Basil's Shorter and Longer Rules, Augustine's rules, and other sources for references to the infirm and their care. He interprets the evidence using social-scientific research models and methods, particularly sociological studies of sickness and hospitals. The book is infused with modern medical terminology such as "inpatient care," "outpatient care," "health care delivery," "providers," etc. Though this language may feel anachronistic, it works to support linguistically the broader argumentative claim that early monasteries conform to the same models of care as hospitals. Crislip's prose is clear and unadorned, geared toward presenting as much social-historical information as possible. Each chapter is divided into several layers of sections and subsections, a format which makes information easily accessible but contributes to a documentary feel to the volume.

The first half of the book describes care for the sick in early monasteries, contextualizing the material with a wealth of background information. There is a brief introduction to monasticism and the book's sources. The first chapter details specific medical practices in coenobia and lavra monasteries, including personnel and practical considerations (e.g., where to house the sick) and treatment procedures. Both types of monasteries provided outpatient care to sick ascetics in their cells. For more intensive inpatient care coenobia built infirmaries while lavra monasteries converted communal church buildings into sick rooms. Crislip convincingly demonstrates that many Egyptian monastics practiced traditional, Egyptian medicine. He also distinguishes between "nonmedical healing," which relies "exclusively on the perceived aid of a divine or quasi-divine agent," and medical treatment (21).

Chapter 2 considers health care as a service which monasteries provided in their roles as "surrogate families." Since the ancient household was the traditional support network for the ill, the ascetic renunciation of family and property necessitated the development of an alternative system to care for sick monastics. The coenobium's typically large population led to the establishment of a separate building for the sick with its own routines, staff, supplies, and kitchen. This infirmary and its dedicated "nursing" staff were coenobitic monasticism's two greatest contributions to premodern health care.

The second half of the book addresses the monastery's role in the historical development of institutional medicine. The use of sociological models is most illuminating in Chapter 3, which argues that a specific social role emerged for the ill. Crislip demonstrates that while Greco-Roman society typically shunned the sick, in monasteries the ill occupied an identifiable social position, known in sociology as the "sick role" (68–69). The sick role exempts the ill from traditional obligations (e.g., monastic work or diet) and imposes "a social obligation to get better" so that the sick can return to their former responsibilities. The ill are expected to seek "officially approved treatment," which in monasteries was strictly regulated since treatment involved privileges such as wine and extra food. As part of the sick role, unless ascetics suffered from a disease of demonic origin, they were not responsible for their disease or their recovery; healing came from care provided by the community, not personal prayer or sheer ascetic will.

The final chapter investigates the origins of hospitals. Crislip outlines the services provided by the Basileias, a charitable institution founded by Basil of Caesarea, attached to a monastery and staffed by monastics. He identifies three fundamental characteristics of hospitals (inpatient care, professionally trained medical staff, and charitable care), all of which the Basileias possessed, making it the first hospital. Using the same criteria, Crislip evaluates...