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

In this important book Andrew Crislip traces the development of early Christian monastic care of the sick, primarily in Egypt. He argues that Egyptian monasticism, while not wholly representative of monasticism everywhere, produced an innovative kind of health care. Much of it was palliative and hygienic, administered by laypersons—but it was also made available in infirmaries, which developed into protohospitals that corresponded to "the best types available outside the monastery" (p. 8). From the beginning, Crislip argues, health care was an integral part of the monastic movement that "fundamentally transformed the health care system of Late Antiquity by providing the template for the late antique hospital, which emerged in the 370s" (p. 8).

Crislip divides the treatment of his subject into four chapters. In chapter 1 he describes the major features of the monastic system of medical care: "health care delivery, medical personnel, methods of treatment, and the specific components of medical healing" (p. 9); those components include diagnostic procedures, therapeutic strategies, and forms of healing that ranged from dietary care to surgery. In chapter 2 he depicts the social and cultural context of monastic health care. He points out that the family (or, more properly speaking, the household) was the focal point in caring for the ill in Graeco-Roman society, which philanthropy and patronage did little to supplement; since entering the monastic life required the renunciation of family and external social ties, it became necessary to create a surrogate family within the walls of the monastery that allowed it to function as a social unit.

Chapter 3 describes the creation of a new sick role, which Crislip believes developed as a result of the monastic health-care system. Within the monastery the sick were exempted from certain obligations like work, communal worship, and even a normal diet. Most importantly, the sick were treated sympathetically and relieved of blame for their illness, although exemptions from ordinary responsibilites often engendered resistance by some monks who "hypervaluated" sickness for its spiritual value. Chapter 4 describes the birth of the hospital, especially the Basileias in Cappadocia, and its constituent parts (the poorhouse, hospice, orphanage, leprosarium, and home for the elderly). Crislip surveys the alleged precursors of the hospital: temples of Asclepius, doctors' clinics, public physicians, and slave and military infirmaries (valetudinaria). He argues that none of them provides a plausible early model for the Christian hospital that emerged in the late fourth century.

Crislip's study exhibits the strengths of his philological and historical approach. It is based on a painstaking examination of monastic rules, epistles, homilies, and lives of monks from late antiquity, as well as a thorough understanding of the social context of Egyptian asceticism and Greek medicine. While Crislip avoids presentism, his adoption of the vocabulary of modern health care may give the unwary reader the impression that he is dealing with concepts that are more highly developed than they were. The book is densely packed, made especially so by extensive annotation and a detailed bibliography. The general reader might be encouraged to skip the notes, but the scholar will find a great deal of important material in them, especially in the Coptic sources that Crislip has mastered.

Few monographic studies of medical care in late antiquity as important as this one have appeared in recent years. It is well researched, judicious in its conclusions, and a model of careful scholarship in a field that abounds in difficulties and pitfalls.