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The Birth of the Hospital in the Byzantine Empire by Timothy S. Miller

Medical historians have traditionally claimed that modern hospitals emerged during the latter half of the nineteenth century. Premodern hospitals, according to many scholars, existed mainly as refuges for the desperately poor and sick, providing patients with little or no medical care. Challenging this view in a compelling survey of hospitals in the East Roman Empire, Timothy Miller traces the birth and development of Byzantine xenones, or hospitals, from their emergence in the fourth century to their decline in the fifteenth century, just prior to the Turkish conquest of Constantinople. These sophisticated medical facilities, he concludes, are the true ancestors of modern hospitals. In a new introduction to this edition, Miller describes the growing scholarship on this subject in recent years.

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Review on Explore Byzantium ()

The justly famous hospital of the Pantocrator Monastery is one of the most strikingly modern of all Byzantine institutions. A foundation of the emperor John I Komnenos, the Pantocrator incorporated five wards for inpatients, including a surgical ward and a women's ward, and also maintained an outpatient clinic. Unlike western 'hospitals' the Pantocrator's administration made provision for proper heating, lighting and bed linen, as well as bathing facilities and latrines. Birth of the Hospital cover The Pantocrator's patients were fed a carefully planned vegetarian diet and received pocket money for purchasing additional food or drink. Medical care was supplied by a large and specialised staff of physicians, medical assistants and orderlies.

Although nothing now remains of the hospital buildings, the operation of the hospital is known in detail due to the survival of its Typikon, or founding charter. As Professor Miller notes, there is a tendency in modern scholarship to treat the Pantocrator in isolation - as a 'showpiece' imperial foundation or perhaps as a paradigm, whose ideals were never met in practice. The Pantrocrator's Typikon is discussed in detail by Miller but he is also careful to address evidence from other sources to demonstrate that the Pantocrator Xenon (Hospital) was not unique, but instead was representative of a long and sophisticated tradition of hospital-based medical care in the Byzantine Empire.

The Birth of the Hospital in the Byzantine Empire traces antecedents for Byzantine medical practice back to the classical Greek and Roman world, but identifies hospital-based medical care as a Byzantine innovation, developed from the tradition of maintaining philanthropic houses for the poor and homeless. Unlike the medieval west, where "hospitals" remained hospices of last resort for the destitute, Byzantine xenones were "The chief institutions of the medical profession, employing the leading physicians and accepting some patients who could have afforded to pay." Professor Miller argues that xenones achieved a rank second only to church-building as the mark of a true Christian city and were closely associated with Philanthropia - an ideology of charity and social action which co-existed, sometimes uncomfortably, with the distinctive Byzantine religious desire for withdrawal into the realm of spiritual contemplation.

Professor Miller's depiction of hospital based medical care in the Byzantine Empire is, no doubt, controversial - he mentions one reaction to the first edition of his book which "Labeled as absurd the notion that a society before the twentieth century would have organised its provision of medical care around hospitals." As for myself, I have recently encountered an essay which dismisses the Pantocrator Xenon as a one-off, token effort. Nevertheless, Miller's argument is persuasive and it is supported by an impressively organised array of primary material - some of the detailed accounts, of medical instruments, procedures and, in one case, of a patient's (painful) experience of an operation, are absolutely fascinating.

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Contents

Introduction to the 1997 Edition

Preface to the Original Edition

Ch. 1. Introduction

Ch. 2. The Pantokrator Xenon

Ch. 3. Hospitals and the Ancient World

Ch. 4. Eastern Christianity

Ch. 5. The Fourth Century

Ch. 6. City, Church, and State

Ch. 7. Monasticism

Ch. 8. The Hospital in Action

Ch. 9. Hospitals and Medical Literature

Ch. 10. After 1204

Ch. 11. Epilogue

Notes

Abbreviations and Bibliography

Index

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