"The birth of the hospital in the Byzantine Empire". By Timothy S. Miller. Essay review.

Dr Miller is a learned and enterprising historian with a fascinating theme. He shows beyond any doubt that the Western hospital tradition goes back to the early Byzantine Empire in the fourth century AD; that, even in its earliest form, the hospital provided for far more than just the treatment of the sick; that by the seventh century, wards in some large metropolitan hospitals were not only divided up between male and female, but even according to specialities, notably surgery and ophthalmology. By 1136, the date of the foundation charter of the Pantokrator hospital at Constantinople, formal teaching was envisaged within the hospital, and three centuries later, students flocked to the hospital lectures of a distinguished doctor and litterateur. The facilities planned for the Pantokrator and a later women's hospital, the Lips, both founded by the ruling family, were lavish and far superior to those of late-medieval hospitals in the West. Even if this were all that could be told about the Byzantine hospital, it would merit the serious attention of all medical historians. But Dr Miller goes further in his reconstruction of the rise and fall of the Byzantine hospital and, still more, in his claims for its significance. On his schema, the hospital, as an institution in which medical treatment was given to the sick by doctors attached to it, first appeared as a result of the Arian theological controversy of the 340s. Basil's hospital of Caesarea (c. 370) was modelled on that of Eustathius of Pontus, which in turn may have been created to rival the healing institutions of another Christian movement, the Anomoians. Orthodox bishops and laymen followed Basil's example in order to win or regain souls for Christ, and by 400, the hospital was commonplace. The next (and most momentous) change was made by Justinian, whoc. 532 abolished the traditional civic physicians and instead appointed them to the staffs of the ecclesiastical hospitals. From then on, the hospital was at the very centre of the provision of health care to the Byzantine community. Its chief physicians-for there was a considerable hierarchy, with promotion based on examination and on experience-were the ablest in the land; they were engaged in teaching their art at the bedside and even in research, for their discoveries of new treatments and drugs can be compared to those of the Paris school of the early 1800s. When economic and military crises rocked …