Mending Bodies, Saving Souls: A History of Hospitals
Oxford University Press, 1999
By chronicling the transformation of hospitals from houses of mercy to tools of confinement, from dwellings of rehabilitation to spaces for clinical teaching and research, from rooms for birthing and dying to institutions of science and technology, this book provides a historical approach to understanding today's hospitals. The story is told in a dozen episodes which illustrate hospitals in particular times and places, covering important themes and developments in the history of medicine and therapeutics, from ancient Greece to the era of AIDS. This book furnishes a unique insight into the world of meanings and emotions associated with hospital life and patienthood b y including narratives by both patients and caregivers. By conceiving of hospitals as houses of order capable of taming the chaos associated with suffering, illness, and death, we can better understand the significance of their ritualized routines and rules. From their beginnings, hospitals were places of spiritual and physical recovery. They should continue to respond to all human needs. As traditional testimonials to human empathy and benevolence, hospitals must endure as spaces of healing.
TABLE OF CONTENTS
Preface
Introduction
Framework for a history of hospitals
Hospital narratives and case histories
1. Pre-Christian Healing Places
Dreaming of Asclepius: Ancient Greek Temple Healing
A divine summons to Pergamon
Asclepius and his cult
Temple healing: Ideology and patronage
Staging temple rituals
Aristides’ healing dreams
Collective Care of Soldiers and Slaves: Roman Valetudinaria
A young warrior becomes ill
Building a new professional army
Valetudinaria: Ideology and mission
Valetudinaria: Organization and staff
Soldiers and their care
Asclepieion and Valetudinarium: Confluence of the Sacred and Secular
2. Christian Hospitality: Shelters and Infirmaries
Early Christianity: A New Vision of the Sick
Edessa: famine, epidemics, and strangers
Christianity: Constructing a mission of healing
Christian welfare: Rise of the xenodocheion
“Slash and burn”: Caring for the sick
Healing at St. Gall: The Golden Age of Benedictine Monasticism
The abbot of St. Gall takes a fall
Benedict’s monasteries: Ora et Labora
Monastic caring spaces: Infirmary and hostel
Healing in monasteries: A community approach
The Twilight of Western Monastic Supremacy
3. Church and Laity: Partnership in Hospital Care
The Pantocrator Xenon of Constantinople
Tales of a feverish poet
Post-Justinian Byzantium: Society, medicine and xenones
Islam’s bimaristan and Christianity’s Pantocrator xenon
Theodoros Prodromos and life in the hospital
“Our Patients, Our Lords”: The Care of Pilgrims in Jerusalem
A pilgrimage to Jerusalem
Jerusalem and the Hospital of St. John: Mission and patronage
Feudal loyalty: Caring for “Our Lords the Sick”
St. John’s Hospital: Model for the world
Hospital Agendas in Peril: Corruption and Early Medicalization
4. Hospitals as Segregation and Confinement Tools: Leprosy and Plague
Leper Houses
A fateful second opinion
Views of leprosy and the construction of stigma
Locus of confinement: Anatomy of leper houses
Institutional rituals
Pesthouses or Lazarettos
Trastevere: Rome’s early plague spot
Framing and fighting plague: Pestilence and public health
Lazarettos: Makeshift isolation, cleansing and treatment
From Asclepius to San Bartholomeo: Purification rites
Framework for early medicalization
Welfare and Hospitals in Early Modern Europe
5. Enlightenment: Medicalization of the Hospital
Edinburgh, 1750-1800
Wanted: A letter of recommendation
Age of Enlightenment: Edinburgh and its infirmary
Hospital patients and their management
House of teaching: Clinical instruction and research
Vienna, 1750-1800
Seeking care: A tailor’s fate
Joseph II and Vienna’s Allgemeines Krankenhaus
Johann Peter Frank: Hospital director and Brunonian practitioner
Clinicum practicum: The patient as teacher
6. Human Bodies Revealed: Hospitals in Post Revolutionary Paris
A former soldier seeks rest
Ancien Régime: Paris and its hospitals
Hospital reform: The fate of France’s “curing machines.’
Bedside and autopsy table: New approaches to disease
Physical diagnosis: Laennec and the stethoscope
Life at the Necker Hospital
Parisian hospitals: teaching and research
The patient’s body: Centerpiece of medical learning
7. Modern Surgery in Hospitals: Development of Anesthesia and Antisepsis
America: Warren and Anesthesia
Living in a voluntary American hospital
Philanthropy in Boston: The Massachusetts General Hospital
Management of pain: A professional goal
First amputation under ether anesthesia, 1846
The significance of ether anesthesia
Scotland: Lister and Antisepsis
From the Shetlands to Victorian Edinburgh
Hospitalism and the “new” nursing
Lister and the antiseptic system of surgery
Infirmary life: An eyewitness account
Providing aseptic surgery: A new role for hospitals
8. The Limits of Medical Science:
Hospitals in Fin-de-Siècle Europe and America
Typhoid Fever and Johns Hopkins Hospital, Baltimore, 1891
A bartender with fever
Hopkins and Billings: Genesis and gestation of a new hospital
Osler, physicians, and nurses
Life in the hospital: The healing power of water
Science and religion: partners in healing
Cholera and Eppendorf General Hospital, Hamburg, 1892
A frightful collapse
Eppendorf General Hospital: Model for the world?
Cholera and hospital caregivers
Back to water: Managing cholera at the Eppendorf Hospital
Aftermath
9. Main Street’s Civic Pride:
The American General Hospital as Professional Workshop
An automobile accident in 1930
“A public undertaking”: American hospitals after 1900
Madison, Wisconsin, and its general hospital
Who pays? “Hospital-hotels” face the Depression
A new national epidemic: Automobile accidents
Efficiency versus humanity: Hospital life at MGH
The road to financial health
10. Hospitals at the Crossroads:
Government, Society and Catholicism in America, 1950-1975
A sudden heart attack
Serving the community: Buffalo and Mercy Hospital
Catholic hospitals: “The fairest flowers of missionary endeavor’
Hospital life at Mercy Hospital, 1954
Another heart attack
The impact of Medicare
Catholic hospitals: Identity crisis and ethical guidelines
Wired for survival: Life in Mercy’s CCU
“Moving forward under God”
11. Hospitals as Biomedical Showcases:
Academic Health Centers and Organ Transplantation
Searching for a donor
From teaching hospitals to academic health centers
Quest for excellence: Moffitt Hospital and UCSF
Renal transplantation: Scientific, clinical, and professional contours
World class: Transplantation at UCSF
“Rebirth” at Moffitt Hospital
Making transplantation routine
12. Caring for the Incurable:
AIDS at San Francisco General Hospital
An early AIDS portrait: “Warren”
San Francisco General Hospital: Tradition and evolution
Framing AIDS in the early 1980s: Lifestyle, cancer or infection?
Who “owns” AIDS in San Francisco? Planning Ward 5 B
Gay pride: Patients’ rights and responsibilities
The art of nursing: Life in Ward 5 B
Managing death and dying
The lessons of AIDS
Conclusion
Towards the Next Millennium: The Future of Hospitals as Healing Spaces
Evolution of hospitals: A Profile
The new American spirituality
Consumerism in medicine
New managerial and financial imperatives
Hospitals and the humanity of institutional care
Index
REVIEWS
From The New England Journal of Medicine, November 4, 1999
“Since the publication of his award-winning Hospital Life in Enlightenment Scotland (New York: Cambridge University Press, 1986), Guenter Risse has been recognized as a leading historian of hospitals. Mending Bodies, Saving Souls is a worthy successor to Risse’s earlier study. It is a well-researched work of amazing breadth. And it asks all the right questions.
”The generic hospital,” writes Risse, “is an abstraction. In reality, there are only particular hospitals, each with its unique name, patrons and mission, buildings, staff, and patients.” Risse describes his approach as “episodic, a series of portraits” of particular hospitals (or, in some cases, prehospitals), “loosely arranged in chronological order but also strategically chosen to cover important themes in the history of medicine and therapeutics.” Each chapter focuses on a single patient who sought treatment in one of the many celebrated hospitals described in the book. Some patients were distinguished figures, such as the second-century Roman orator Aelius Aristides, and others were persons whose stories are known to us today only through the accident of historical preservation, such as Grette Thielen, a German housewife who was examined for leprosy in 1492. These accounts provide fascinating vignettes of the experiences of individual hospital patients over a period of nearly two millennia.
Risse describes not merely the social history of medicine but also the history of an entire culture. His sweep is vast and impressive. He traces the evolution of the hospital from its initial role as a house of mercy, refuge, and dying in late Christian antiquity through its role as a house of rehabilitation at the time of the Renaissance, of cure in the 18th century, of teaching and research in the 19th century, of surgery after 1850, of science in the early 20th century, and of high technology in the late 20th century. Risse explores the ideology of each institution he surveys, as well as the staff, the architecture, the treatment administered, and (where appropriate) the culture of dying. These themes and others are discussed against the backdrop of the “master text” — the political and cultural history that situates each hospital in time and place. So that the reader can appreciate the infirmary of the monastery of St. Gall in 10th-century Switzerland, for example, Risse narrates the origin and development of the monastic movement. Theories of disease and therapeutic practices are discussed extensively. For centuries, many of the procedures used in European hospitals presupposed the validity of humoral pathology, which Risse describes so that the reader can understand the seemingly bizarre treatments administered to patients in ancient and medieval hospitals. Finally, he enriches his account of modern American hospitals by making extensive use of personal narratives (e.g., the story of Warren J., a patient with AIDS).
In addition to the broad sweep of the book, one is impressed by the author’s familiarity with the recent literature in many specialized fields. There are occasional errors (e.g., the statement that the New Testament does not appear to sanction the use of medicines), which reflect Risse’s reliance on specialists who are themselves mistaken. But even in areas that are far from his field of special competence, one is struck again and again by his mastery of the evidence, his subordination of detail to the major themes of the narrative, and his sympathetic understanding of modes of thought that are either outdated or currently unfashionable. Chapter 4 (“Hospitals as Segregation and Confinement Tools”), for example, provides an excellent discussion of the special role of leprosy in medieval society, the rapid spread of syphilis in the early 16th century, and the plague that afflicted Rome in 1656-1657. Among the subjects that Risse covers in each case are contemporary ideas of contagion, public health measures, religious explanations of epidemic disease, and the development of institutions (pesthouses and lazarettos) that were built to house the sick.
The changes in hospital care over time have been immense, from the simple early Christian shelters, which provided “great spiritual solace but minimal physical comforts,” to the complex institutions of the late 20th century, which “have reversed this emphasis and now focus primarily on individual physical rehabilitation in more fragmented and depersonalized environments.” Yet hospitals are in trouble today. In a concluding chapter, Risse points out that they face numerous pressures from consumerism in medicine, new managerial and financial imperatives, and growing complaints by patients about the lack of personal attention. “If current trends continue,” he predicts, “more than a third of all existing American hospitals will either close or merge during the next decades.”
Risse has written a superb book that is likely to become the authoritative one-volume history of hospitals. If a knowledge of medical history provides health care professionals with a broad view that informs their understanding of present trends, there can be few hospital staff members who will not benefit from reading this book. It will give them a balanced perspective from which to approach the challenges facing hospitals in our own time.”
“Mending Bodies, Saving Souls presents an ambitious and meticulously documented history of institutional care of the sick. Risse tells the story of the institution by recounting the case histories of 19 hospitals from antiquity to the present, through the eyes of both a historian and clinician.”
“The questions raised by Guenter Risse’s history of the hospital are those we must confront if we are to salvage our public hospital systems in the 21st century.”
“Mending Bodies, Saving Souls is an astonishing achievement, and the author’s coverage over space and time is awe-inspiring.”
“Risse’s book has already achieved the status of a standard, and it surely will reach the status of a classic which it well deserves.”
“Risse has been highly successful in dealing with this complex subject. His text brings together a treasure trove of fascinating material, skillfully organized and frequently poignant in its impact.”
“Mending Bodies, Saving Souls is a tour de force which matches considerable intellectual and historiographic ambition with humane and punctilious scholarship. The imaginative emphasis on the experiential dimension of hospital care makes this erudite and compelling study memorable and often moving.”
“The presentation of hospitals in the ancient and modern world is a perfect synthesis. Risse has given us a global social and cultural history of the Western medical tradition.”
“This is an extraordinary, ambitious book that seeks to integrate an enormous literature. It succeeds on many levels.”
“Superb, monumental study of the history of hospitals. Mending Bodies, Saving Souls tells how over the centuries, human compassion slowly brought about those institutions in which most of us will eventually end our days.”
“Carefully documented and replete with important detail, this book will be the standard reference for the ‘long history’ of the Western hospital.”