Mending Bodies, Saving Souls: A History of Hospitals
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.Reviewed by Gary B. Ferngren, Ph.D.Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.