The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter

for the refusal of blood transfusions by Jehovah’s Witnesses), but life lay in the breath. Believing physical cleanliness bespoke spiritual purity, rules were formulated for personal hygiene, social gatherings and sexual intercourse, and prohibitions were issued against eating unclean animals. Though some modern Jewish apologists argue that the dietary bans on pork and shellfish in Leviticus arose from awareness that these foods could pass on diseases such as trichinosis, the fact is that Jewish dietary rituals (kosher food) were principally expressions of precepts about pollution and purification. Nevertheless, cleanliness rites indirectly spurred public health: no well was to be dug near burial or waste ground, water should be boiled before drinking, and waste had to be burned or buried beyond encampments. Judaism also taught the obligation of caring for co-religionists, and by AD 400 Jewish communities were instructed to possess a healer.

      Christians often expressed disdain for Jews as the people of the law, exalting by contrast their faith of the spirit; and this difference is discernible in their distinctive approaches to health. But one must not oversimplify: the New Testament presents many models of healing, secular and sacred alike. ‘Costly physicians’ were condemned, but Luke the Evangelist was himself a physician. In the parable of the good Samaritan, the use of wine as a disinfectant reflects Greek wound treatment, whereas in the Acts of the Apostles healing is portrayed as a matter of faith, involving prayer and the laying-on of hands. When Jesus met a man born blind, he asked who had sinned; and he told the man who suffered from a palsy that his sins were forgiven. Sin was thus assumed to be perhaps a cause of sickness, or at least sin and sickness were similar states; in either case spiritual healing might be requisite. ‘Is any sick among you?’, asked the Apostle James: ‘Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord; and the prayer of faith shall save the sick, and the Lord shall raise him up.’

      Early Christianity exhibits a medley of attitudes towards healing, shaping fluid relations between medicine and the Church. Many old healing practices were dressed up in new Christian garbs; Christian shrines were raised upon the ruins of pagan temples, and the leading healing saints, Cosmas and Damian, were in some respects revampings of the heathen Castor and Pollux.

      Christian theology embraced but modified the radical dualism of some Levantine religious and philosophical sects which elevated the immaterial soul while disparaging the mortal body, commonly viewed as the soul’s prison house. Christianity taught that the spirit was eternal; the flesh was weak, corruptible and fallen. Adam and Eve’s disobedience in Eden had brought disease and death into the world and made nakedness a source of shame. The Desert Fathers and saintly hermits pursued ascetic practices designed to deaden desire and restore the spiritual powers enjoyed by Adam in Eden.

      Such beliefs challenged the classical, Athenian man-centred and polis-oriented ideals of balance and beauty, looking to mortification of the flesh as the release of the spirit. A glorification of suffering associated with release from the throbbing flesh remained a powerful force within Christianity, especially Catholicism. Thérèse Martin, later canonized as Saint Thérèse of Lisieux, died of tuberculosis in 1897, barely out of her teens. ‘God has deigned to make me pass through many types of trials,’ she affirmed in her diary, ‘I am truly happy to suffer.’

      Yet Christianity also taught that man had been created in God’s image in a paradise garden of physical bliss in which disease and death had no part; and it proclaimed the raising up of the bodies of the faithful at the Last Judgment, as prefigured by Christ’s own resurrection. Orthodoxy anathematized the Manichean heresy that viewed the flesh as the Devil’s domain. The human body belonged not to man or Satan but to God, and had to be properly looked after – hence the suicide taboo.

      While suffering and disease could appear as chastisement of the wicked or a trial of those the Lord loved, the Church also developed a healing mission. Was not Luke ‘the beloved physician’? And did not Christ, though he told physicians to heal themselves, give proofs of his own divine powers by acts of healing? Some thirty-five such miracles are recorded in the Bible, and the apostles subsequently exercised healing as ‘a gift of the spirit’. From the start, Christianity won converts among those desperate to be cured; and, like a self-fulfilling prophecy, healing miracles proliferated, often wrought by holy relics like drops of the Virgin’s milk. Sober ecclesiastics condemned this vulgar zeal for healing marvels, presenting Christ as the physician of the soul. Whereas members of his congregation brought infants for baptism hoping the holy water would heal leprosy or blindness, St Augustine (354–430) viewed cures by holy oil, relics or baptism not as a routine health service but as providences. Overall, Church fathers steered a middle course, accepting a role, but a subordinate one, for secular medicine.

      Christianity made its mark through action. Jewish traditions of help and hospitality were extended, and Christ’s instruction to his disciples to care for the sick and needy assumed institutional form through the appointment of deacons charged with distributing alms. By 250 the Church in Rome had developed an elaborate charitable outreach, with wealthy converts providing food and shelter for the poor. After Constantine’s official recognition of Christianity, alms found expression in bricks and mortar. Leontius, bishop of Antioch from 344 to 358, set up hostels in his see; around 360, Bishop Eustathius of Sebasteia built a poorhouse; and St Basil erected outside the walls of Caesarea ‘almost a new city’ for the sick, poor and leprous.

      Similar institutions sprang up somewhat later in the Latin West. A hospital was founded in 390 by Fabiola (d. 399), an affluent Christian convert, who, after two wretched marriages, dedicated her life to charity among Rome’s sick poor. ‘She assembled all the sick from the streets and highways’, wrote her teacher, St Jerome,

      and personally tended the unhappy and impoverished victims of hunger and disease. I have often seen her washing wounds which others – even men – could hardly bear to look at … She founded a hospital and gathered there the sufferers from the streets, and gave them all the attention of a nurse. Need I describe the many woes which can befall a human being: the cut-off noses, lost eyes, mangled feet, leprous arms, swollen bellies, withered thighs, the ailing flesh that is filled up by hungry worms? How often she carried home, on her own shoulders, the dirty and poor who were plagued by epilepsy! How she washed the pus from sores which others could not even behold!

      Greek and Roman paganism had acknowledged no such duties.

      In the East, hospitals (in Greek nosokomeia, places to care for the sick) became large and complex. By the mid sixth century Jerusalem had one with 200 beds, and St Sampson’s in Constantinople was bigger still, with surgical operations being performed and a wing for eye disorders. Edessa had a women’s hospital, and major hospitals at Antioch and Constantinople were divided into male and female wards. By 650, the Pantokrator in Constantinople had a hierarchy of physicians and even teaching facilities, a home for the elderly and, beyond the walls, a leper house. To care for lepers and thus expose oneself to infection was a mark of holiness. Christianity planted the hospital: the well-endowed establishments of the Levant and the scattered houses of the West shared a common religious ethos of charity.

      THE LEGACY OF GALEN

      During a long fallow time of the intellect, some authors passed on the baton of medical learning. Oribasius (325–97), physician to Julian the Apostate, came from a wealthy family in Pergamon in Asia Minor (Galen’s hometown) and studied medicine at Alexandria. Three of his works became influential. The earliest comprised excerpts from the best medical authorities. Its four books described hygiene and diet; the properties of simple drugs and indications for use, and the body – its maladies and treatments from top to toe. What remains of it reveals broad reading and his respect for Galen and Rufus of Ephesus. He also wrote a shorter practical medical compendium for the traveller, and an even briefer summary. He was worried about the state of medicine, bemoaning (in a familiar way) the proliferation of quacks and the want of practical handbooks. Oribasius played an important role as mediator and synthesizer: he preserved excerpts from many authors otherwise lost, created a pattern for later digests, and shaped the package of Galenism that dominated later centuries. Having simplified, synthesized and publicized the master’s writings, his work was rehashed by others in the same mould – Aetius, Alexander of Tralles and Paul of Aegina – before