The early followers of the crucified Jesus Christ of Nazareth were convinced of the imminence of his Second Coming, the Day of Judgment, and the resulting end of the “here and now.” Not unexpectedly, such an otherworldly attitude toward the present did not promote concern with man’s mundane physical afflictions—the starting point for any system of medicine.
Origin of Disease and its Treatment
In Judaic thought disease had long been equated with sin’s punishment or with divine disfavor. The early Christian Church did little to discourage popular acceptance of this relationship, and gradually sickness began to be equated with a kind of sin for which the sole appropriate response was to suffer (as Job did) and from which the only possible cure was through Grace, that undeserved and unpredictable intervention of God. This interpretation of the cause and cure of disease was to be fully developed by Gregory of Tours in the sixth century, but it exerted considerable influence before that time. As the end of the world proved less than imminent—and thereby less certain—concern for the problems of everyday life returned. Prime among these, to be sure, were considerations of health and disease.
Among the earliest followers of Christ one found a radically different, though ultimately related, interpretation of divinity and disease which was given considerable development in the Gospels. This was the “Healing Mission of Christ.” In each of the Gospels by Matthew, Mark, John, and Luke (who was himself a physician), many instances of Christ’s acting as a healer were cited in curing the paralytic and lame, the dumb and the blind, the leprous and the febrile. St. Mark’s first reference to Christ’s healing (1:23-27) was to the “tearing out” of an unclean spirit, but it was followed shortly by similar cures of physical complaints. St. John and St. Luke the physician also cited numerous instances in which Christ’s healing of obviously physical infirmities was quite similar to the casting out of devils and other spirits. The modern reader of the Gospels might feel a certain disappointemnt that the writers failed to differentiate among faith healing, exorcism, and miracle, but the “treatment” was the same, whether for physical infirmity, mental instability, or outright death. Throughout, the means of healing were supernatural (what later medieval philosophers would call praeter naturam—beyond nature—by which it was implied that all rules covering the here and now were suspended).
Although at times Christ’s mere presence was sufficient to provide cure, generally more was required. Touching was extremely important, be it Christ’s reaching out or the afflicted’s being able to touch even the hem of his garment. This miraculous aspect of Christ’s nature, at least by the time of the writing of the Gospels, was stressed as one of the strong points in preaching the Christian story. Centuries later, the miraculous attributes of candidates for sainthood were utilized in dual fashion—both “proving” sanctity and making it desirable to revere the saint involved.
In the Gospels a somewhat different exemplar for the Christian virtue of healing is found in Christ’s parable of the Good Samaritan, told in answer to the question: “And who is my neighbor?” This model of the benevolent person performing good works out of compassion for his fellow man has been a strong influence on the development of the concept of “Christian charity,” Its relationship to the treatment of disease helped establish a nexus between the developing Church and concern for the sick.
Development of the Church
The early Christian church, in spite of adversity, not only flourished but saw its character and organization change within a short period after Christ’s death. Originally a minor Judaic sect in the Roman province of Palestine, Christianity was soon given a decidedly Greek and Hellenistic cast by St. Paul. As time passed and the Day of Judgment seemed less, rather than more, imminent, the early Church was less able to rely upon a theology dependent solely on that event, and the Second Coming was given a less certain definition.
The development in the Roman world of an antirational, though practical, system of medicine with a strong overlay of religious mysticism had preceded the influence of Christianity. The increasingly mystical and magical beliefs of the later Empire created fertile ground for the establishment of an otherworldly religion which would overcome feelings of loss of control, security, and dominion as Romans saw their former power slipping ineluctably away, and plague and famine added insult to injury.
The Church itself underwent considerable change as its governance was given an increasingly ordered structure; orthodoxy became a greater concern than preparation for an imminent salvation, especially in the churches of the Eastern Roman Empire, a permanent division after the death of Theodosius in 395, the last ruler of the united Empire. Unlike the pagan religions which tended to abandon those individuals thought to have incurred the disfavor of the gods, the developing Christian church emphasized a need for reenactment of Christ’s healing mission, even if this were done more for the salvation of the caretaker than for the patient. In this way, there was little conflict with the common belief that disease was a reflection of sin. Only the Grace of God could provide a cure, and so those providing care were relieved of that responsibility.
These feelings led to the establishment of numerous kinds of facilities for the care of the diseased and the oppressed: ptochia for the poor; gerontochia for the elderly; xenodochia for strangers; brephotrophia for foundlings; orphanotrophia for orphans; and nosocomia for the sick and downfallen. St. Helena, mother of the Roman emperor Constantine (who, in granting universal religious tolerance, gave Christianity equal footing with other state religions), founded a hospital about 330, the year Constantine moved the capital of the Roman Empire to ancient Byzantium and renamed it Constantinople. In the year 369, St. Basil established a hospital for the sick poor at Caesarea, capital of Cappadocia. A plague hospital was built at Edessa by St. Ephraem (c. 306-373), and, before the year 394, Fabiola, a wealthy Roman matron who later became a pupil of St. Jerome (c. 343-420) in Bethlehem, founded the first Christian public hospital in Europe.
Although these hospitals may have been modeled on the military hospitals of the Roman Empire, there were significant innovations in the Christian institutions. First aid and time for convalescence had been provided in the Roman military hospitals, but since their prime, if not sole, mission was the return to the army of troops capable of resuming battle, extensive treatment or nursing care was never considered. In marked contrast, the Christian hospices were the first ever to be devoted to long-term support of the diseased, poor, and downtrodden. Enthusiasm, charity, and good cheer sustained those in charge, often women of “good birth,” in their provision of the simplest forms of care, hardly ever above the level of nursing support. Nevertheless, Emperor Julian, the Apostate, (331?-363) in attempting to return the Empire to the ancient religion, credited in part these women and their hospitals for the tenacious hold the early Church had on the masses, and he suggested setting up pagan hospitals to serve as counterforce.
The three centuries following Constantine’s recognition of Christianity saw an intense struggle over the development of an orthodoxy which did much to establish for the succeeding millennium the interrelationships of man and God through Church and State. The drastically different solutions of the Eastern and the Western churches created opposing climates of opinion which were directly responsible for differences in both Christian iconography and medical practice. Before the imperial acceptance of Christianity in the fourth century, the areas of strongest Christian influence were in the eastern provinces of Syria, Palestine, and Egypt, the lands of the Bible. Local and even external influences were crucial.
Not without difficulty, the commandment of the Decalogue (Exodus, 20:4) forbidding graven images was put aside and two iconographic styles developed for the portrayal of Christ: the bearded Jesus with shoulder-length hair was derived from portrayals of the Parthian kings, whereas the presentation as beardless young man came directly from that of the Egyptian god Horus. Plotinus (205-270), the founder of neoplatonism, developed a theory whereby a representation of divinity could partake of its divine essence. According to the doctrine of emanation, divine substance flows from the Godhead, or prime principle, into an image, instilling something of the divine power of the figure represented—be it Christ, Mary, or a saint. Therefore, early in the Church’s history, a means of incorporating divine substance into sacred representations for direct and personal use was justified, and the veneration of icons, especially in the Eastern Church, has remained integral to this day. The early tradition of the Healing Mission of Christ and the advantage of utilizing curative miracles in the proselytization of Christianity rapidly led to the creation of numerous icons, at first of Christ, and later of the saints in the act of healing. The doctrine of emanation made these illustrations of even greater value in their becoming instruments of healing themselves. Though never inclined to the veneration of icons, the Western Church nevertheless developed a veneration of relics of saints, deriving ultimately from the Greek tradition of hero worship—as brought to Gaul and Italy by emigrants from Asia Minor.
Other aspects of earlier Oriental religions found in Eastern Christianity were adopted by Western Christians, and some were critical in the ultimate schism of East and West in the year 1054. The cult of Mary developed in Egypt from the Isis-Horus (mother-son) relationship and in Syria where a virgin was said to have given birth to the sun god. Both of these gods were thought to have been born on December 25th, the date early appropriated by the Christian Church for its founder’s birth. Christ assumed not only the birthdate of earlier gods but also many of their attributes, iconographically exemplified in the extensive use of the nimbus, or halo. Soon extended to the saints, this tradition was quickly taken over by the emperors of Byzantium.
As the Roman Empire waned in the West, Christianity was rapidly made crucial to the self-justification of the Eastern Empire—the religio-cultural nexus of Christianity and its claims of universality were essential. Orthodoxy thereby was established, and the earlier tradition of Roman tolerance was abandoned. The predictable conflict of Eastern emperor and Roman pope, however, was to lead inevitably to a schism in Christendom. Even in the East a monolithic church-state orthodoxy could not be maintained for long, and church councils were called both to define and to impose orthodoxy. Irreversible splits were common, and one of them had a special influence on the history of medicine.
In Egypt and Asia Minor, where Artemis, Cybele the Earth Mother, and the mother goddess Atargatis were still being worshiped, it was felt that Mary should be venerated as the Mother of God. Nestorius (d. 451?), Patriarch of Constantinople, objected, saying that Mary was only the mother of the human person of Christ, son of God. However, at the Council of Ephesus in the year 431, his opponents won their case by declaring that Nestorius was denying the true Godhead of Christ since he divided the one Christ into two persons. Nestorius was deposed as patriarch and forced to emigrate with his followers to Antioch, Arabia, and finally Egypt. His cause was also supported in Assyria and Mesopotamia, where at Edessa a medical school was founded, soon to rival the famous center at Alexandria. In 489, however, Bishop Cyril had the Byzantine emperor Zeno condemn the school and expel its heretical founders from the empire. The Nestorians went to Persia and founded the medical school at Gundishapur which flourished for many centuries.
The final institution of the early Eastern Church to have a significant influence upon both Eastern and Western civilization in general and medicine in particular was monasticism. Following the hermitic tradition of withdrawal from worldly society in preparation for the world-to-come, the earliest Christian monks individually had left society to lead an isolated existence of ascetic mysticism in the desert. Monks began to band together, however, under the leadership of Pachomius (d. 348), a hermit who later devised the first set of monastic rules for a cenobitic house.
In the West, things were somewhat different. St. Benedict of Nursia (480-554) knew the Rule of Pachomius, but when he established his own monastery at Monte Cassino, unlike his Eastern brethren, he accentuated a religious community over an anchoritic association of hermits. Intellectually, however, the first Benedictines were of the same bent as the Byzantines, maintaining and copying old manuscripts. It was only the chance association of the early Christian charity hospital and the developing monastic orders that allowed for the monasteries’ assumption of organized medical care in the West for more than five hundred years.