Ii HOSPICE TO HOSPITAL IN TIIE NEAR EAST:

AN INSTANCE OF CONTINUilY AND CHANGE

IN IATE ANTIQUI1Y
Nigel Allan

• A great instirutioo, if it is to suivive the passage of time, must display

• continuity while being subject to change. This fact of life is well attested
by the emergence of the hospital in the Near East. The hospital developed
out of a situation of great change, yet it displays a strong thread of conti-
nuity.
The Byzantine Empire began with COnstantine the Great's establish-
ment of his capital in COnstantinople in A.D. 330.1 However, COnstantine's
dream on the eve of the battle of Milvian Bridge in 312, in which he was
guaranteed victory through the sign of the Cross, and his subsequent con-
version to Christianity mark the opening of the Christian epoch in the his-
tory of the Roman Empire. 2 On becoming sole emperor in 324, he
transferred the imperial capital from Italy 10 the East, and cho.se Byzantium
because it was an excellent center of communication with a fine harbor.
Since it had never been a major city, it could be "re-established" as a Chris-
tian metropolis and given a new name, "the city of Constantine.''3 Yet,
although Christianity became the faith of the imperial house, apan from a
shon interval during the reign of Julian the Apostate (r. A.D. 361-63), and
although by the end of the fourth century, it was the only religion permit•
ted, the old dispensation of pagan worship and custom suivived for several
centuries and 10 some extent was even assimilated by the new.◄ It was in
this period of change and continuity that the essence of the hospital may be
found in the late Roman Empire.
The rise in population, particularly in Syria and Palestine, and the lack
of sufficient land to suppon families in rural areas, especially the families of
younger sons, forced many 10 seek their fonune in the cities, where, with-
out the skills necessary 10 avail themselves of the limited opponunities pro-
vided by ancient industry and commerce, they found themselves dependent

1 The olf,cW daie Is 11 May 330.

'Socra!fs.E.cclesiasna,I Hislory, bk. 1, chap. z, rev. with no<es by Andrew C. Zenos(Oxlord: Parker: New
Yori<, OUisdan Lirerarure Go., 1691), p. 2, in Niame and Post-Niame Fall:,er, (hereafter, NPNf), 2d set., YOI. 2.
• Ibid, bk. 1. ct,,p. 26, pp. 20-21.
'Henry M. Gw.iddn and Jame,; P. Whill\e)', eds, n,, Gambritfe< Media,al History, planned by J. II- Bury, 8
""15. (c.ambridse: cambridgc U~rsi\y Pres., 1911-36), I: 16-19.

446

Bull. Hlsl. Med, 1990, 64: 446- 462

Hospice to Hospital in the Near East 447

upon the philanthropy of others. 5 Here the church filled a vacuum left by
the impoverishment of local municipal government, assuming this responsi-
bility in obedience to Christ's command to give meat and drink to the
hungry and thirsty, to entertain the stranger, to clothe the naked, and to visit
the sick and the prisoner.6
The earliest evidence regarding the care of the poor in a Christian con-
text comes from the Acts of the Apostles, where it is recorded that in
response to a request for famine relief from Judaea, the disciples in
Antioch, who were first called Christians there, sent "every man according
to his ability ... relief unto the brethren which dwelt in Judaea.''7 Later, in
the fourth century, the church in Syria organized relief programs around
:xenodocheta, hostels reserved for the poor. By the reign of Julian, Christian
communities throughout the East had established institutions to accommo-
date and feed the poor.8 Xenodocbeion is a composite word comprising
two elements, xenos, a traveler or person from outside the municipality or
beyond the monastic cloister, and docheion, a recep<acle or place of recep-
tion; in other words, a place where a stranger may stay-an inn or a hos-
pice. By the early fourth century, the term xenodocheion had come to
designate asylums for the poor, possibly accommodating those driven into
the metropolis in search of the charitable agency of the church.
Although the development of the xenodocheion- from a guest house
to an institution that also served as an asylum for !he poor, and later to a
place where the sick received the practical application of medical skill-
was contemporaneous wilh the rise of Christianity, the whole concept of
medical care was inherited from the pre-ChriStian age of classical Greece.
The practice of medicine in classical Greece dates back co the preclassical
age of Homer,9 and lhroughouc its long history, it maintained the apparent
structure of a great family tradition. When Asklepios emerged as the deity of
healing, myth wove him into the chain of knowledge that passed from one
generation to successive ones. 10 Even after !he conversion of Constantine,
the Asklepian cult, with its mirarulous rures, continued to flourish through-
out much of the fourth century, finally to be extinguished by Theodosius I

'E,-etyne Patbgean, Paw.mo! -,;que "pau,rete wclale a Jl>,zance, ,r..7° si«ks (Pans, Mouton,
19n), discusses (on pp. 1$6- 80) lhe inabUJcy o( lhe lly7.arulne economy ,o cope wim incr-..d unskiUed
rural labo< and (oo pp. 301 - 40) me groMh oflhe rural population.
'So Mao. 25:31 - 46. All Biblical ciaiom rerer 10 the Audlorizcd (!Ong James) vcrs;on
7 Aas I b26 - 3Q
• ~ P -, pp, 188-95, maintains "1al thelJe new institutionS ooeloped before lhe end of me
fooru, century. For an outline o( the early de-'Clopmeru o( me hospi131, ,,e Mduel W. Dols's recent anicle
'The origins of me Islamic ho,pil:ll, myth and reaU~•," Bull HiSI. .lfed., 19fl'7, 61, 367-90. esp. 370-73.
9H<:ruy E. Sigerw., A Hislory ofMedicine, 2 vols. ( Ox&:,rd and New York: Oxford Un!VerSil)• Press, 1961). 2,
16-43,,.,...,.,, tha< the Iliad, me~•. and the Homerie hymns mlJS< be consulted With cautloo. The
Uter.11\U'C on Homeric medicine iS considet,ble, a, shown by Sigerl<t, 11/SICJr)\ pp. 35- 36.
•• AIX(J<(ljng 10 lege,id. ASl<lepiOS had atn0<18 his duldten tly&ela. the goddess of heallll, and M>chaon and
Podalirius, ,wo 500$ nc<ed ro, their medic3I sl<ill; and he was also an anre;1or of liippocrales, See Emnu J.
Edelsre;n and Ludwig Edelstein, Asckpius, A O:J/leaion and J,,,,,,,,,_, <f lbe T"'1in>:>mes, 2 vols. (Balti·
more Johns HopkiflS Pres<, 1945). 1, 60- 107.
448 NIGELAIUN

(r. AD. 379- 95), who outlawed all pagan practices and shrines 11 Its survival
during the time of Christianity's rise to power is n()( altogether surprising,
for Asklepios, more than any ()(her of the deities of ancient Greece, resem-
bles Christ Born of a mortal mother, Coronis, by the agency of the god
Apollo, he performed many miracles of healing, including the restoration of
the dead to life. 2.eus, either for fear of men becoming immortal by the
agency of Asklepios or at the complaint of Hades, slew him with his thun-
derbolt. 12 Although these similarities to Christ made Asklepios suspea in
the view of Christian apologists both in the East and the West, 13 a synthesis
or continuity would seem apparent in the metaphorical use of the physician
by the Fathers of the Greek Church to describe Christ.14 NO( only was the
metaphor of the physician used by Christian theologians of the East to
describe Christ and his ministers, but al.so the apostles Peter and Paul, as
well as the Hebrew prophets, were claimed to have practiced the therapy of
the soul. This imagery underwent further development, particularly among
the Cappadocian Fathers, who conceived of the bishop as a healer of souls.
Gregory of Nazianzus compared Saint Basil's work as bishop of Caesarea to
that of a physician, describing him as applying soothing or harsh words as
required to cure sinful souls, just as physicians apply sweet and biner medi-
cines in their remedies.ts By the fifth century, the image of the bishop as a
spiritual physician had become commonplace throughout the East.
With regard to this healing role of the bishop, an interesting thread of
continuity and syncretism With the cla~ical age can perhaps be traced. Dur-
ing the fifth and sixth centuries, liturgical symbols were introduced which
further strengthened the image of the bishop as a healer of souls. It was
during this period that bishops began to carry a stiff of office to denote
their episcopal authority and their suppon of the spiritually and physically
ill.16 In the Byzantine Empire, however, the bishop's rbabdas, or crozier,

"A H. M. )Ones, 7be l.aM!r Roman Empin!, 284-602, As«ial and E«>nomic Sun'!)\ 2 vols. ( Qxfo<d, Basil
Bladto,•e ll, 1!173), t, 167- 69. In 385, Theodosius renewed the prohibirioo ablood sacrifice. In 391, all paean
aaM1Jes v.-ere forbidden in Rome. The prolubltloo was mended to i18)1l(, aoo in the foUowing year, all fonns
a paean """'1ip were outlawed throual,oor the empire. See Noel Q. Kins. n., Eny,e,or 11!eodo,ius and~
- . , of <JJristianity (l.oodoo, SCM Press. 1961), pp. 71-86.
,., Ni<holao G. L. Hammond and How-dld H. S,;ullard, eds., 71,e (),ford ClasTicoJ C>iai(J,ray, 2d ed. (Oxlo<d
Clarendon Press. 1970), pp. 129-30.
"See FMsreln -1 Edelstein, ~ 2, 132-38. See also, e.g., St Jerome, 71,e Life of St. Hlli:rlon, in
Prlnclpal Wcris of St..,,,.,,_, trans. W. H. Fremar<Jc, G. Lewis, and W. G. Manley ( Oxford Parl<er; Nev.·
Yorlc avtswo Urerarure Co., 1893), pp. 307- ll
14
Adolf Yon Harnack. In Die g,i«bisd)e ~ d,s '~ " Terrullian's, ~ -aus der
il/leslen ~ (l.elpzls, J. C. Hlruichs, 1892), pp. 89- 111, in Texte und /Jnlmu<hungen zur
Gesd>id1te dw a/ldJristlicbm /Jll!ran,r, vol 8, pt 4, shows th:11 Christ at first was...., as a physician and as
sudl was compared ro Asklepios, and iUustr.iles ro v.'h:il men< in early Chnstmdom !he Gospel ..,.. preached
as the medicine of the ,oul aod Christ wa., ,ecn as a physician.
"St. Grqpy of Nazianzus, In laud,m Basi/ii ~ chapo. 40, 81, i n ~ " " " " ' ronJ>ltrr,s. ed.
.J;l<ques-Paul Mil!J,e. Sril:r g,aeca ( hereaner, Migne l'G'). YOI. 36 (Pam, 1858), ools. 549, 604.
14 The first wiequM>CII refeaeuc• ro ahe 0'0/ZkT as a Ururgkal lnltrumeru occurs in the r,,,ruy..,.,,,,.J,
= d the Council a Toledo, held in ~3. whJch ..,,. convoked by SI. lsldore of Se\itle. SI. Isidore of Seville
regarded the episcopal crook as a marl< of the bishop's ruling autll<xit)' and a symbol ofhls role as supponer
of the infumltles of the weak See St. I s ~ D e ~ c:ffe;iis. bk. 2, dl:op, 5, sec. 12 in PatroJogiae
cursus complen,s, ed. Jacques-Paul Migne, S<ries !anna (hcrc:lfter, Mijplc Pl,), ,'OI. 83 ( Paris. 1862), cols.
783- 84,
Hospice to Hospital in the Near East 449

also came to represent the bishop's duty to heal the spiritual ills of his flock
and to guide them without injury.17 It seems po5sible that a pagan symbol
was intricately bound up with a Christian one, that is, that the Asklepian
rhabdos was merged with the Juda~hristian serpent, which was also an
Asklepian attribute, to represent the Judaeo-Christian deity's care of the sick
and His healing power. An interesting form of crozier is the aux decussala,
or Greek T, the arms of the cross often so twisted as to represent two
serpents opposed. This, known as the crocla, was borne by abbots and
bishops of the Eastern rite and refers in its origins to Matthew 10: 16, where
the disciples are exhorted 10 be "as wise as serpents." However, the cross
that forms the basis of this crozier originally held the crucified Christ, the
lifting of whose body Saint John compares co Moses· raising of the serpent
in the wilderness, to heal the recalcitrant children of Israel of the poisonous
bites of serpents that God had sent as a punishment.18 This points to the
importance attached to the local bishop's role as a spiritual healer-a phy-
sician of souls and a benefactor of the physically ill. By the syncretism of
one of the ancient symbols of classical Greek medicine with Christian sym-
bolism, the Christian pastor with his staff reveals elements of classical Greek
medicine in Byzantine and Eastern Christianity.
This syncretism of classical antiquity with Eastern Christendom can be
detected in the greatest of the Fathers of the Greek Church, Saint Basil,
bishop of Caesarea. Son of an aristocratic landowner in PontuS, versed in
classical learning, including medicine, which he had studied with much suc-
cess in Athens, he was the epitome of Hellenism in Christian form, the
cultured man of his day. 19 It is of particular interest that Saint Basil is cred-
ited with founding in Caesarea during his episcopacy a large philanthropic
institution, which he placed in the care of a mona5tic community. In accord-
ance with Saint Basil's establishment of the New Testament as the basic rule
of his monasteries, his monks, in obedience to this rule, served the poor
and provided shelter for the homeless.20 According to Sozomen, the fifth-
century church historian, Saint Basil's institution was the most celebrated of
its kind, while Saint Gregory of Nazianzus implied that Saint Basil's founda-
tion, which he refers to as kaine polis, "a new city," was a multipurpose
institution that, besides providing care for the sick and poor, also

17 In Si. lgll:llius's life of Nieephl)nl$, an.ilbi<hop of C<lnll3ntinople, he u5'S the word mabda& Wilh refer-
ence 10 die spirirual care ar,d ""1fare pro,.,ided bj• a blShop. See S< lgnallU'l, Vila S. /l'fcR/X!Orl, ed Charles de
Booe, in M<xp,orl an:bl,plsuJpl ConltanlmopolllanJ opuscukl h/slorial (Lelpz18: B. G. Teubner, 1880), p. 156;
aoo}an Schouten, 7be Rod and Sepe,u ofMtkpios,~mbol ofMedidtie (Am9.eroam and New Yori<: Elsevier.
1967). p. 12;.
18John 3:H, 15. Cf. Num. 21:4- 9.

"St, G"'iOI)' of Nazianzus, fn io,,dem JJatilii ~ (hap. 23 and e,;p. clup. 63, cols. S26-2i, 578-79.
His b<ochi:r, St. G"'iOI)' ol Nyssa, a friend of the ph)'Sici3n EuS13111ius, was anodier ll,,e example of Oirisliln
Hellenism, and bolh he and Si. ll:,sil were revered as Fathers of the Greek a,urm See St. Gregory of Nyssa,
On the Holy Trim!)> and Godbet2d of the Holy Splrll, """'· William Moore and Henry A Wilson (Oxford:
Parker; New Yor"' Oui,iian Llter31ure Co., 1893), pp. 326- 30, in NPNF, 2d ser., ,o[. S.
., s,,, Emmanuel A de Mendie!a, '1.e .-y,i- renob4tique basWen compare au S)'S<OO>e renobitique
pacMmlen," fla'UI! de /'btstol,e des religions, 1957, 152: 43 . ...
450 NIGELALL\N

provided rooms for lepers, travelers, and others. He described It as a

storehouse of piety where disease is regarded in a religious light and sym-
pathy put to the test.21 Another source claims that in response to the
wretched position of lepers, Saint Basil established a leprosarium in Cae-
sarea, and an appeal was made to wealthy citizens for the means to suppon
it so that not only lepers but also others suffering from various infirmities
could find shelter and comfon there. 22 This charitable work not only
enhanced the church's reputation but also gained popular suppon for its
leaders. It is notewonhy that it was when Saint Basil was assistant In charge
of charities in Caesarea that he won the popular suppon with which he
achieved his election to the episcopal throne in A.D. 370. 23 Soon after, sev-
eral similar institutions were established in Constantinople by Saint John
Chryso&om, who, when elected as patriarch, followed the example of Saint
Basil; within twenty years of Saint Basil's death in 379, monks worked as
nurses under SaintJohn Chrysostom's episcopacy.24
Perhaps an even more significant example of continuity between the
medical tradition of classical Greece and that of Eastern Christendom was
the application of the former by the latter, thus ensuring the preservation of
well-established practices and skills in a changed situation. Physicians work-
ing in the xenodocheia of Byzantium, where the sick were cared for, were
conscious of their classical inheritance and saw no break in the continuity
from paganism to Chri:,,ianity. A nosokomos, or hospital administrator, \\-TIO
was in charge of the xenon25 that formed pan of the celebrated Pantokrator
monastery founded by John 11 Komnenos in the twelfth century, could claim
that Galen, a pagan, was the teacher of his profession and contemporaneous
with Christ, thus connecting Galen with the new dispensation.26 As early as
the founh century, Oribasius of Pergamon ( c. A.D. 320-400), physician to
Julian the Apostate and generally regarded as the first Byzantine physician,
summarized in his corpus of medical v.Titings the work of the physicians of
ancient Greece, from Hippocrates to the second century of the Christian

21 St. Grego,y of Na:zianzuS, In laudem Ba,i/u ""'II'U. ct,,p. 63, cols-. 577- ?9. See also Demetrloo J. Con,
star<elos, Byranllne Pbllanlbropy and ScdaJ Welfwe ( New 8runswidc, New .l<t's<',> Rutgers University Press,
191,a), pp. 154- 58.
"Vila S, G,-egcri tbeokigi. In Mlgne PG, vol 35 (Paris, 18;7), cols- 273-74; 311d Consr.welos. Byzatmn,,
PbilDn1iJroW, p. 155.
"St. Basil, R.egulaefa,im - inletro!J3UO 55.4, In Mlgne, PG, ,'OI. 31 (P3ris. 1885), ools 1049-50. 0:
St. Gregory of Naiianzus, fn /aude,n Basil•_,;. chap. 28, cols. 533- 36. Simii.tly, rtoo foUQl\>ed an aaernpt
10 remo,.e from epiSOOpal offioe St. Jolvl Cluyoostom, whose philanthropic repwuon ..-.... much apprecl:lled
bl ConslanlinOple. Sozomen, &x·te,;a,;na,J History, hie 8, chap. 18., mo. Otester D. Hanranfi (Oxford: Parlcer;
New York: Christian Liter:1rure Co., 1891), pp. 410-11, in NPNF. 2d scr., vol 2.
"Palladlus, Pa/Jadif dfak>gus de v/Ja S. J<>anniS Q,ryso,;tr,n,;, ed Paul R Coleman,Norton (cambrldge:
cambrldge Un!VerSliy Press, 1928), p. 32.
"The nosokomos ...., generally chooen from among lhe leading ph)sicians. 8y the tv,-elfth ocmury, _,,,,,
""1er lhan xmodocbeiott desig,lated an ""3llllshment for lhe care of lhe $iek. See Tu:not!,y S. Miller, 71,e
Binb of tbe Ho,pila/ in the B.)ozmuine Errplre ( BallimOre, 111aryland:johns Hopkins University Press, 1985), pp.
28- 29. See also Dols, "Ongins of the lsbtnlc hospkal," p. 371.
>l loaniS T ~ F/)NuJae, epistula SI. ed. Pruus AM. Leone ().eipzlg: aG. Teubner, 1972), p. 121.
Hospice 10 Hospital in the Ne2t East 451

era, selecting much of his material from Galen's writings.27 The writings of
Oribasius are of panicular significance because they date from the time
when the practice of medicine in centers dedicated to the care of the sick
was in its very infancy in the Byzantine Empire. From the fifth to the seventh
centuries, the medical curriculum at Alexandria was centered on these writ-
ings.28 With the rise of the Islamic empire, the writings of Galen were trans-
lated into Arabic, studied, commented on, and admired 10 the extent lhat
some have survived only in Arabic translation.
Apart from being known as the founder of a great charitable institution
in Caesarea, Saint Basil is celebrated as a theologian and a liturgical innova-
tor. His revised liturgy, which became the established rite at Constantinople,
still remains today as one of the principal liturgies of the Greek Onhodox
Church. This liturgical development was part of an extensive and strong
current of cultural influences that spread from Cappadocia to Byzantium
and then passed through the oriental church to Asia. The metropolis of the
Syriac-speaking church of the area, Edessa, in Mesopotamia, known today as
al-Rul:ia, in southeastern Turkey, became the center from which the Cappa-
docian renaissance of learning radiated. 29 Mesopotamia had been ruled by
Alexander's Seleucid successors and eventually became a frontier area of
the Eastern Roman Empire, with Edessa the chief city in the vicinity. Here,
the native dynasty of the Osrhoeni ruled until Edessa v.,as declared a Roman
colony in A.D. 214.30 As in other cities of the Ea.stern Roman Empire, institu•
tional struetures from the Hellenistic period survived into the Christian era.
The sons of the leading citizens of Edessa pursued the heritage of classical
Greece at Antioch, which was celebrated as a center of Helleniscic learn-
ing. ~1 Yet, although the fabric of Mesopotamian society v,,as Greek, and the
upper echelons were to some extent of Greek blood, Mesopotamia was an
area fought over by Byzantium and Persia, an area whose people were
Semitic in language and did not have an overriding commitment to Con-
stantinople.32
Against this social and theological background, the theme of the
Cbristus medicus is found as deeply rooted in Syriac patristic literature as in

"See o.u,...., d'Ori/Ja!;e, ,rans. IJk:o C. Bussa...icer and Q-.arles Daremberg, 6 vols. ( Paris: lmprimerie
nallorude, B;ullitn:, 1851-76), I, =iii-xxxviL
"a. A. z_ Jiicand;u, "An xtemp<ed ~ o n or lhe late Alexandrian mediral curriculum.' Med. Hist.,
1976, 20, 235-58, esp. 241.
"See De I.><.)' E. 01.d,y, I/ow Gm>lt Sde,,ce Passed to d>e Ambs (London, Roodooge & Kegan Pml, 1949),
p.50.
'°A.H. M.JOl>eS, 7be Odes oflbe FAstem Roma,1 /mlinces, 2d ed., rev. Michael Avi-Yonah et al (An>Slet-
dam, Adolf M. Haldcen, 1983), pp. 21$- 21.
"E.g., Ludlv\ Manyr (d. A.D. 311), havi.-« fi..,. 5'\ldied in fale$-sa. cominued hiS srudies a, the more dlstin-
gulshed school of Antioch. See E.R Hayes, L'erol;, d'Ede$se (Pari$, Les Pres.ses modemes, 1930), p. 123. Euse-
bius (d. before ..o. 359), who d0clinod the see of Alexandria a'1d "'"nrually became bishop of Emesa, first
studied the Scripcwes and "'3S !hen insuuaed in G1'e<k ll1erarure b\' a master who li\-ed in Edessa. From
there he procceded 10 lhe school of AntiOCh before his ele.-adon ,o <he episcopate. So Socralc,, Ea:Je,ia,tiw/
History, bk. 2, chap. 9. p. 39.
"See)Ooes, <---of/be Ea<t,m Roma,1 Pm,inces, pp, 215- 23.
452 NJGl!l.AUAN

Greek. 1be account of the introduction of Christianity to Edessa involves a

healing miracle commissioned by Christ, in which the city's ruler was
healed,33 and it iS noteworthy that in the later Syriac acoount of the fourth
century known as the "Doctrine of Addai,"34 Jesus is described 00< as the
"good Saviour" of Eusebius's Greek account but as the good physician.
'Asyd, "physician," is the tide most frequently used in Syriac literature to
describe Christ, and medicine iS often referred to by Saint Ephraim, the
greatest of the Fathers of the Syriac Church, in this context. Like the Fathers
of the Greek Church, Saint Ephraim also regarded the patriarchs and the
prophets-such as Abraham, Moses,Joseph, and Samuel-as "physicians."
He considered the world to be sick, unable to be healed of its malady, and
he spoke of Christ as the physician who, taking pity, heals us through hiS
own body and blood with the medicine of life. 35
The influence of the Cappadocian church on Mesop0<amia may also be
reflected in the legends surrounding Saint Ephraim, who, hearing of Saint
Basil's fame, traveled to Caesarea to meet the bishop. It is therefore 00<
without significance that Saint Ephraim established in Edes.5a around A.O.
370 a charitable center similar to that founded by Saint Basil. Saint
Ephraim's institution was set up to help famine victims who had sought
refuge in the city and were asking for assistance from the church. 1be funds
were provided by wealthy citizens, who made over their donations to Saint
Ephraim as the only trustworthy member of the community. The Greek
word xenodocheion is used in the Syriac text to describe this institution,
which appears to have been a hospice. Like other similar esrablishments in
the B)'W)tine Empire, it was supported by various forms of charity.'° The
charitable institution founded by Saint Basil was supported by a gift, com-
prising the income from several villages, from the Emperor Valens him-
self,37 while at least one of the xenodocheia established by Saint John

"The earlies< accoont of !his imponan< ""'"" is recorded by Euseblus In his OJurdJ HlsJory, bk. I, chap.
13, ed. Anhur c. Mct.iffen (Olclord Parl<er; Nev-· Yori<, Christian Literature Co., 1800), pp. 100- 102, in NPNF,
I!,$., ,'()I. J.
" For the Syriac aocowu, ..,. 7"e Doarirte of Adda; tbe ,v,o,,Je, U'>RS, and ed. ~ Phillips (London,
8. C. Teubncr, 1876). Reubens Ow.ii, HistOire d'Edesse (IJ,fa) (1892; reprint, Am5'erdam, Philo Press, 1975),
pp. 90. 91, plaoes the ev~UzatiOn ol F.dessa in me n,i(ldle cl the tllird century, before the eviden«o bad
on lhe arcniveS or F.dessa uoed by EusebiU> in his aooowu wa, troUISI.Med &om Syriac into Creek. For > fuU
dlsa&loo ol the d3!ing of the letter of Jesus, s,e Judah B. Segal, &feM, '"Tbe Blessed Cay" (o.foc'd Claren-
don Press, 1970), pp. 62-81.
"S<. l:phtalm, O>rmlna Nlsibena, ed. and uaru. Edmund Bed<, 2 ,'Ols. in 4 (LouV3in, - du CSCO,
1961 - 63), In CopusSaponm, Ori,ianorum Cri!nlallum (hereurer, CS'CO). vol 219, Saj,fclres,\}ri (here-
after, Sy,),,,,1, 93, pp. 100- 103. On the use oC ~,; In reference to Christ. see Rollen Murray, .l),mboo of
Q,un;b and Kin{Jdom: A Study In Early~ Trr>dlnon (London and New Yono Oimbrid(!t University Press,
1975), pp. 199-200.
"S<. SimeOl'l Srylilc:s, Vie> georgiennes de S . S.)'l'ffll Slyli#! l'anden er de S. E{bt,m, ed. and U'>RS. Gerard
Garioe (louvain, Se<rewial du CSCO, 1957), in CS<X>, ,,:,I. 172,lbenca 8, p. 79. Sec also Solomen, Ecc--
ca/ Hi!lory, bk. 3, chap. 16, pp. 295- 97.
"See Batrutdbe!alll) 'Atb~HISJO/reecdisiastfqu,!, pc. I, ed. and U'3nS. franQ)iS N2u ("'Af finnin·Dide<,
1932), In fasc 2, p. 300, in P<Jll'Ologfa Orienlalis, vol. 23: 3lso Louis Duchesne, Fbf)· H/slcry of the (,bristian
Onrcb, from Its Foundation to the End of tbe Ff/lb Cmluty, l'JlglJsll lt3llS. of 41h ed, 3 ,ool,s. ().ondon, John
MUIT3)', 1909- 24), 2: 315.
Hospice to Hospital in the Near East 453

Chrysostom in the wake of Caesarea was supponed by the income deducted

from an overindulgent biShop's expense account.38
Some fifty years after the xenodocheion of Saint Ephraim, we have the
first evidence of permanent xenodocheia in Edessa. These were established
by Bishop Rabbula not simply as ho5pices for the poor but also as hoopitals
for the sick, where they were looked after by a properly organized staff. It
would appear that the funding was generous, for according to the bishop's
biographer, the food was so good that even thooe accustomed to being well
fed enjoyed the hospital diet. This indicates that nat only the poor but also
thooe accustomed to a reasonable standard of living sought the care of the
xenodocheion. There were two separate establishments, one for men and
the other for women, supervised by monks appointed by the bishop. Every
effon was made to ensure clean beds and sheets, to attend to the comfort of
the patients, and to provide the care of an efficient and God-fearing staff of
men and women. 39 In about A.O. 460, Bishop Nona, who is described in
the Syriac text of Joshua the Stylite as xenodocbos, "one who receives
strangers," established a xenodocheion for poor invalids outside Edessa's
Beth Shemesh gare. 40 Later, during the great famine of 500-501, the two
stewards of the great church of Edessa, one being the church treasurer, the
other in charge of church estates, set up a xenodocheion adjacent to the
church, where those dying of starvation could find refuge.41
Although Bishop Nona established within his xenodocheion a shrine
for the two martyr saints Cosma.s and Damian, it seems that there were also
two separate shrines devoted to these saints in Edessa, each containing the
relics of the martyr to whom it was dedicated. 42 Again, we can trace in the
miraculous cures effected by these two saints a thread of continuity with the
pre-Christian age. According to popular belief, these saints were willing to
effect their cures without a fee, a practice that earned them the epithet
anargyroi ("without money"). By the sixth century, many cities, even some
in outlying parts of the Byzantine Empire, such as Edessa, had specific
churches and shrines dedicated to these two saints.43 The Asklepian temples
that had been so popular in antiquity for their rures by incubation ( sleeping

"Palladius, DiaJogµs de wa S joannis a,ry,,;.ro,,,;, p. 32.

,. Aphm:es, ~ Sd:,,iften der , , , _ , ~ ApbrMJeS, Rabu/a$ und Jsaalt V. - -
"""'· Gust1v Bid<dl (Kempcen, Gemuny, J. Ro.<sel'schen, 1874), pp. 205-6.
., See 71,e O:,ronicle q jC6butJ lbt Stylite Co,,y,oseri In .l}ruc, AD. 507, chaps. 41, 42, ll2llS. WUIJam Wfi#,.
(Cambridge, Cambridge Unh-emty Press, 1882), pp. 31-32, esp. p.32.
"fl;,id. See >!so Duv21, H;,,c)lre d'&Jes,e, p. 176; and B. H. C, (,;cl "Sele<ti<lm from the Sj'liac no. I - Toe
Ovonicle ol f.dessa,' ,. }. Sa<red l.lt., 1864, n.s., 5, 28- 4S, "'here che dlfficuky of che Syriac CCXI is noced on
p.43.
"Seg,I, EideM, pp. 184, 250-51, considers le possible lhac che shrine of St. Coomas was siawed near che
·v.t11 olJoo" by lhe Hamn Gate, in MUCh 7.a,,gi, the Turkish ronqueror, In 1164, bathed w cure Ills gouc. ct.
Alben Abouna, u:w., ~ auaals d>ronla>n ad annum OJristi 1234 pmin,ln$ II (l.ouvain, Secretaria
du CSCO, 1974), p. 102 In C5CO, rol. 3S4, .I),'( vol. 154,
"Miller, 8H q tbe Ho,pllal, pp. 63- 66, oompar<S Asldepioo, pauon god o( _ . phys-.ian,, wuh
Cosmas and Daml211, patro0 sainlS ol Christian medicine, and describe$ the d ose relationship between
shrines dedicated co che anargyroi, and xenodocheia
454 NIGELAUAN

in the temple) were supplanted not by Christian hospitals but by the cult of
the anargyroi, which performed miracles in exaaly the same way as the
Asklepian cult had done. 44 The patient retired to a special church where the
saint's relics were deposited; while the patient slept, the saint would appear
in a dream and recommend treatment. 4~ The image of the martyr saint
reposing in peace as victor over the protracted suffering of martyrdom was
frequently associated with the cure of illnes.s, and with the healing proc-
ess.""
Saint Ephraim had come to Eclessa as a refugee in A.O. 363, after the
defeat of the Byzantines by the Persians, and the ceding of Nisibis. Before
his deparrure, he had directed the distinguished school at Nisibis, but it was
with reluctance that he took charge of the school that appears to have
existed in Edessa at this time.47 Under its new director, the school achieved
great distinction and became known as the School of the Persians, since
many of its teachers and students had come from Persia, especially Nisibis
and the vicinity. Their knowledge of Greek and the many manuscripts they
possessed enabled these refugee academics to create in Eclessa a major
academy for the preservation, transmission, and dissemination of learning.
It is from about this time that we have the first evidence of the passage of
Hellenistic learning into Semitic Mesopotamia: translations of Greek works
into Syriac. A British Library manuseript dated toward the end of A.O. 4 I I
contains Syriac translations of Eusebius's 7beophania and Martyrs in Pales-
tine, 48 while a Leningrad manuscript copied in 462 contains a Syriac version
of Eusebius's Ecclesiastical History.49 What survives, however, can only be a
residuum of the Greek works in Syriac translation that were extant in
Edessa at this time, for we know that Syriac-speaking Christians prized Aris-
totle's works, especially the treatises on logic ( called, collectively, the
Organon ), of which the most frequently read were the Caregories, De inter-
pretatione, and the first book of Prior Analytics. They also studied the Eisa-

"Byzamlwn Itself had several churches dedicaled 10 S<. Cosmas and St. Damian in wtuch the praaice of
inrubauon Ooorislied. See Schooten, Rod and s,,pe,u c f ~ pp. 72, 73; also Mary H.amilton, l•icuba·
lion; or, tbe Ctn of Disea,;e it1 Pawzn Temples and 0 , , - . Cbtld>e; (St. Andrews. Soodand, W, C. Hender·
,on; London, Simpkin, Mmtwl, Hamilton, Kent, J906), pp. IJO, 119-27.
"Geo<J!C P. Badger, 7be lW$)riQn$ and Tbelr RfluaJs .. . , 2 ,-01$. (L<lndon, J06eph Mast..,, 1852). I, 326,

"'See Peter BC'OMl, 1be Cull of be_

des<libes how e,,cn in the nine!eenzh <'enlWJ' the Sid<, especially lhO<e su!l'ering !rom sldn di,order$, spcru
the nigju by the Bir E),ilp (well ol Joo) dooe 10 lhe shrine of St. Coomas 10 effect a cure.
,rs Rise and Funalon In Latin 01rlstfanJly (London, SCM Press:
O\i<ago, Unlvel,l~• ol O\i<ago Press, 1981 ), pp. 79- 80.
"See Hayes, Li/oole d"Etlesse, pp. 124- 42.
"William WrlSht, comp., Ciltalogue ofS)ri<>c Manu,aipts in the BritifJJ Museum. 3 ,'ols. (London; British
Musewn, 1870- 72), 2: 632., no. 726, pcs. 3 and 4 [Add 121501 For editions or lhese Syriac versions, see
Eusd>ius, On the 1btcpbania; or, Div/ne Man;/e!1ation of OUr U.-d and SaviourJesu, ~ ed. Samud Lee
(Londoo, Socic<y (or the Publicalion ol Onerual TcxlS, 1842); and idem, Hioflo,y cf lbe Mfl1yro in Palestine, ed.
and uan,, William Cweton (Loodon and Edlollwgh: WilliamS & No<g:ate, J86l).
.. Foe Ille S)"l'iae version ol EIISeblus's - Hlslo,y, see tl1e edltlon by WWlam Wl'i/t< and Nonnan
Md.ean (carnbrldge: Clmllridge Unlversi<y Press, 1898}, also Wlllwn H. P. Hlw:h, An Nbum ofDRted S)ri<>c
Manuscript.s (Bos,oo, Massachusetts: American Aademy ol Ans & Sciences., l946), p. 54,
Hospice to Hospital in the Near East 455

goge, which is an introduction to the categories written by Poiphyry (A.O.

233-c. 301). The high esteem in which the Organon wa5 held is witnessed
by the medieval Syriac chronicler who wrote concerning it, "Without [this I
book of logic it is not possible to reach an undel'SWlding of the Scrip-
tures."~
According co 'Alxfisho, writing in the fourteenth century, "Hiba, Klimi
and PrObi translated into Syriac the books of Theodore of Mopsuestia and
the writings of Aristotle. "51 Evidence of the translating aaivities of Hiba ( d.
A.O. 457), who was director of the School of the Persians and, later, bishop
of Edessa, and who bore the epithet metargernana, "the translator," sur-
vives in Theodore's work in Syriac translation52 for use in Edessa, and an
early tranSlation of the Etsagoge has been attributed 10 him. 53 Kumi's trans-
lations cannO( now be identified. Proba is thought to have belonged to the
sixth century, and since he is described in several manuscripts as "priest,"
"archdeacon," and "archlater [arcbiaJros]" of Antioch, he would seem to
have little connection with Edessa's School of the Persians. 54 However, it is
quite clear that by the fifth century, the translating process was already well
established in Edessa, providing Greek works to those whose language was
Syriac, and in consequence bringing Hellenistic learning a step nearer to
the world of Islam. Because of the liberal establishment of hospitals in
Ed~ it is not difficult to conceive that Greek medical works would have been
included in this translating aaivily, both for use in hospitals and for teaching.
The reference co Proba as an archiacros is interesting. This is a Greek
word used in Syriac to denote a public physician, but its exact significance
requires examination. In its most primitive sense, the word archialros refers
to the ruler's personal physician; it is found mentioned in d<x:uments from
Ptolemaic Egypt.5S It appears, however, that beginning in the second century
of the Christian era, the term arcbiatroi came co be used of civic physicians,
whose role was in many respectS a continuation of that of the earlier demo-
sfot fa/rot, the public physicians, who were generally employed by a city

"Jean-B3pdsle Chabot, ed., a.,,,.-, ad annum Cbrisll 1234 pentnens (1916; reprir<, Louv:>in, L Our•
becq, 1953), p. 105, in =· ,(II. 81, S}n; ,ol. 'lo. Tr:insbtion by Sel>3suan Brock on p. 2S ~ "From Ant>g<>-
olsm ro AssimU.uon: 5\'liac Anlrudes ro Greek Leaming" In &1S1 of B)za,ut,,m, S.)na and ...,,,_ In lb<!
- Period. ed Nina G. Gmoian, Thomas F. M>dlews, and Roben w. Thomson. Dwnbanon Qaks
Symposium, 1980 (Washir@Jon, D.C.: Dumbanon Q.ilcs, 1982), pp. 17-34.
SI Badger, 1be Neslorlans, ,,:,1. 2, Appendix A, "Index of Biblieal and Ecclesustieal wntingS . . . by Mar Alxl
Yeshua .. . A.O. 1298," pp. 'lol-79. Translation by fl4ler on p.369.
"See Wriglo, comp.• ~ qf-\)riacMa,~ 1, 107- 8, oo. 161 (Jx 5, sec. 3)1Add. 12138t and 2:
644, no. 729 (Jx. 12, sec. e) (Add. 14597[ ·
"See Amoo Baumswk. /lrlslolles bei den S.)""" vom 5. !>is 8 JdJrfJundene, S.)m:ve Te\'le b e r ~
ube,-,,rz und unlmUd!I (Leipzis: B.G. Te.t>ner, 1900: reprtm, Aalen: Sdencla Verlag, I~). pp. 133- 48. The
Eisagog, ,erved as a clear e,cpa,idoo of Arat0<eli>n logic and as such eluddated the 1enninology used In the
v.O<ks of Theodore ~ Mopsuesda and Diodore of T:m;us, standard thoologiCII wori<s of lhe Syriac church.
"Brock, "From AntogOOism ro Assimibtioo," esp. p. 26. The di1oo.ol<y of his date is rocognized by WiWam
Wrish<, ASbort Hisl<Jry o/S)riac l.ila'tllUTe (London: A & C. Blad<, 1894), i:p. 64-65,
"SO Vrvian Nuaon, "Archialri and the mcdic>l prolessiOo in antiqui~•." POJ)eT> Bril. S<bwl Rome, 1977, 45,
191-226, esp. 193-98
456 NIGELAUAN

council for their medical skills in exchange for a fee or various privileges. 56
The increase in the number of archiatroi v.ithin the municipality reflects an
increasing stability and recognition of the medical profession, contempora-
neous with a movement away from granting physicians citizenship and
other privileges and toward granting them exemption from local taXation
and liturgies. In faa, immunity from iaxation is specifically mentioned by
Galen as an incentive for some to become physicians.57 However, this
benevolent anirude toward medicine and education was impeded by the
Roman emperor Antoninus Pius (r. A.O. 138- 61), who restricted the
number of physicians to ten in major cities, seven in provincial cities, and
five in country towns in an effort to reduce overly lavish public expendi-
tures. 58 As a result, those designated by the term archiatroi would be
included among the ranks of medical officers exempt from tax. By the time
of Constantine, therefore, archiatroi were municipal physicians holding
public appointments and receiving a salary, but exempt from tax. They pro-
vided the best medical care available and were free to charge a fee, which
they might scale down according to the patient's means or even-for the
very poor -waive, but this w.is at their discretion.S9 According to a law
iSsued by Constantine on 27 September 333, recorded in the Theodosian
Code of 438,60 and reissued in the Justinian Code of 534,61 all physicians,
including archiatroi, had a particular duty to train new recruits to the medi-
cal profession. This demonstrates the continuity of the importance attac:hed
since pre-Christian times to the duty of transmitting professional medical
knowledge and practical skills.
Procopius, in his Anecdota, states that Justinian canceled the pa}ments
of anrumae to both the public physicians and the teachers of the liberal
arts, a right which had been given to these two classes by Constantine, had
been endorsed by Theodosius in his code, and was also confirmed by Jus-
tinian in his code.62 It has been argued that as a result, the archiatroi
became part of the evolving hospital establishment, in which the best medi-
cal service was provided, and where medical students were taught.63 How-

"t.ouis CtJhn.Haft, 71;,e Public ~ q - c,...,. (Nonhampton, Mllssach11Se1tS: Smith Ccllege.

Dept of His<o<y, 1956), pp. ~7-44, 70, que,tions !hi> assumption becru,e of <he lack of adequa<e "'i<l<:ncc
and oonfinco lhe privileges of lhe tlemcsi<>i iatrOi IO guararueed re,ideoo, M\hin a t'.(,mmunily and (Jfticial
endorsemen of their qualificac:k:,ns tO praaiee 9.-.J\in that communiry.
"See ()ale,\ ~ omnia, ed. C. G. Kiihn, 20 ,,o1s, in 22 (Leip-.dg. 1821-33; repnn~ Hildeshdm, Ger·
many, Georg Olms, 1965i 5, 751.
'"See w. William<, "Aruoolnus Plus 3lld lhe rowol d pro.•indal embos.sies," Hlstorla, 1967, 16, 470-83,
wkh regard 10 AruoolJUJS Piu.< reducing ="'8"'1 dvtc expendlrures for arnboss3don 10 lhe emperor.
"See Danel W. Amundsen, "Visigothk medkal ieglsla<loo," Bu/I. Hist. M<d., 1971, 45, 553- 69, esp. n. JS,
where this point Is discussed wilh reference oo <he Codex Thoodosianus, on whldl It ls based.
"'1becdosian Code, bit 13, tide 3. sec. 3 in 1he 1boo,-an Code and Novels and tbe SimlOrldian Const/,
IUlions, trans. Clyde Pharr (Princesoo, New )er,ey, Prinmon Uni\-ersity Press, l~Z), p. 388,
"Codex 1u,r;,,;a,,,,,. bk. JO, tnlc 53, sec. 6, in co,pus iuris aw,, od. ""11 Kroeger, 4th (5tc«otyp<d) ed.
(Berlin, Weidmann, 1878), vol 2, p. 422.
"Procopio.<, An,aJoto, 26.5; ed. and uans. Henry 8. o....ing (London, William Heinemann, 1935), pp.
302- 3.
,.MJIJer, 8il'1b cf lbe Ho,pikll, pp. 48- 49, 157-58.
H05pice to Hospital in the Ne2r East 457

ever, it is noteworthy that in 552 Justinian r~'tored to those two classes in

the recently reconquered city of Rome the same allowances of annonae that
he himself had given in the early pan. of his reign. It could be said that
Justinian was trying to Ingratiate himself in Rome With this legislation, but
this argument is weakened by the further confirmation of the provisions for
civic physicians in the BasiUca of Leo VI.64 lllere seems to be no doubt that
archiatroi taught pupils, as was customary in ancient Greek medical prac-
tice. The continuity of this tradition is witnessed by the biographer of Saint
Theodore of Sykion, who claimed that the saint always knew how to cure
the sick because he had been a prize student of Christ, the true archiatros. 65
As a result of the withdrawal of the annonae recorded by Procopius, medi-
cal teaching may have moved into the hospital as the latter developed from
a mere hospice, but the restoration of the annonae indieates that there was
no compulsion either by circumstance or law for this development to have
occurred. Medical instruction would therefore have taken place wherever
convenient-the hospital being an obvious venue, but the physician's home
or some other place being equally suitable.
Returning to Prooa, it seems possible that he could have functioned as
archiatr05 in the hospital built by Justinian in A.O. 541,66 which suilS the
sixth-century date attributed 10 him.67 In consequence, although evidence is
lacking, it is not improbable that, in addition to philosophical works, he may
also have translated works of classical Greek medicine for instruetion and
application either in the hospital or elsewhere in Antioch. We are, however,
on firmer ground with Sergius of Ra's al-'ayn in Mesopotamia, where he too
held the position of archiatros. Having studied medicine and philosophy at
Alexandria, he used his facility with Greek to prepare Syriac translations of
the leading authorities studied there. 68 Many of these tranSlations were well
known and still in circulation in the ninth century, as l:{unayn ibn lsf:iaq

64 See Vivian Nlllton, essay ,eviev,· ()( 8inb of lb, Hosp/IOI, ill' Miller, Med. J/i$t., 1986, 30: 218- 21.
"Vie de 1heodore de SJ"166n. sec. 25, parL 145, 146, ed. Andre Je•n l'esrugi~. 2 ,'Ols. ( Brussels: Socl<!te
des BolwiW51c:s, 1970). AnaJet;ta IJo/Jandianu Su/J$idia Hagie~ no. 48: vol. 1, pp. 11~115 (Greek
,exi) and vol. 2, pp. 118-20 ( tr.anSl:Mion and oommeruat)•).
'"Procopius, De aedfj1cl6. bk. 2, chap. 10, sec. 25: ifl q,..,,, omnia, ed. Jacob Haury, 4 vols. (Leipzig: B. G.
Teuboer, 1964), 4: 80.
61See Brock, "From Arnag.oolsm co MSimiladon.," p. ·26,
'"Es-. British Ubraty Sj'liac ms. no. 987 IAdd. 146581. a seventh-century manUSCTipc that oonwns most <:i
Sergius's labors a., transla,or and includes • translatK>n <:i Porphyry's Ei:iag08e :mn1)uted IO tun. ro&,."'1 ill'
the Tabula PorJJb>rii and the Caleg<>riue of Aris<Otle, also aruibuted 10 him: and 30 cxherv.ise Wlkno9.n
tr<atise :iddressed 10 Theodore, On lbe O>U$eS <.f !bl! (Jnl,e,se llaXJrding IO tbe Vieu< of Aristotle, Sbou.WIIJ
How ft ls a Spl:,e,,; and Sergiu,'s ()W11 ue.itL,e oo logic, also addres.<ed 10 Theodore. Peri KDsmou ("On the
Universe"), • pseud<>AtiSt0telian tre:nise u-a,,si.red by Sergiu.<, "11Jch ls also round in this manusc:rip<. is
regarded a., a ma5terpieoe of the iranslacor·s an. See Wrlgh<, comp., caralogue of 5Jri.<Jc . • ~ , ,
1156-57. BritiSh Libr3JY S)'t'iac°"· no. 100! (Add. 14661 I contains books 6- 8 of Galen's treatise De simp/i·
awn medicamenJorum ,emp,rameruis acJacu/tanbus, tr.lllS. Sergius. See Wtigh<. oomp .. Catalogue <.fSJ""'
,
. ~ 3: 1187. See also Victor Rys.sel, iJbe,, den texrkritisdJen Wenb der S)"isd>e,1 /AJWseezungen p
<bist:ber Klassilter, 21/0ls. (LelpZlg: L Femau, 1880- 81). l: 4- 18: 2: 10-29, with special relerence iothe Syri3<
iranslacion of Perl Kosmo,,
458 NIGELAUAN

anests in his Risa/a, where he describes several of them unfavorably.69 It

seems unnecessary for Sergius to have cranslated medical works into Syriac,
because he was acquainted with Greek, and could thus refer to them in
their original language and apply their remedies to his patients. In view of
the teaching role of the archiatrOS, however, it is plausible that he may have
translated these works int◊ the vernacular to make them available to pupils
and physicians in the locality who did not understand Greek Ar. the same
time, if such medical instruction did take place, it may have included medi-
cine indigenous to Mesopotamia, as witnessed in the closing section of the
Syriac Book of Medicines. 70 Astrological and astronomical works were also
translated by Sergius but as far a5 can be ascertained, these subjeets,
although relevant to medicine, do not appear to have been taught in the
schools of Syriac-speaking Mesopotarnia 71 We do not know of, nor have we
any evidence of, an institution of medical care in Ra's al-'ayn, although it is
noteworthy that Constantinople, even in this border area of the empire, was
regarded as the metropolis to which Sergius went on ecclesiastical business
and where he subsequently died in 536. It is probable therefore that the
pattern of medical care and teaching that existed in Constantinople was also
followed in Ra's al-'ayn.
Further evidence pertaining to medical instruction may, however, be
deduced from the statutes relating to the celebrated school of Nisibis. The
school Saint Ephraim had directed at Nisibis continued a shadowy existence
after the capture of the city by the Persians in A.O. 363.72 However, it revived
following the closing of the School of the Persians in Eclessa by Emperor
2.eno in 489,73 and in consequence, many returned to Nisibis to pursue a
Nestorian Christology regarded as unorthodox in Constantinople and sup-
pressed by the imperial government
The School of Nisibis came to be regarded as the successor to the
School of the Persians and experienced a renaissance under its direetor,

"See lft""4"l ibn l,baq iiber die ,yrisdJerl W1d arab/sdxm GaJen-iibers,,:zungen, ed. and irans, Goohelf
Bcrgsm,sscr (Leipzig F. A. Brocl<haus, 1925), pp. 4-10, 12- 14, 30-31 (Mlbi«cx,, pp. 6-11, 16- 17, 37- 38):
see :also Max ~le)-e,:ho(. "New 6gJ11 on f:iuoa;o ibn lsJ:,llq and his perio<~" lsiS, 1926, & 685-724.
'° E'""" A. W. 8udge, ed., SJnan At""°"!)\ Palbok)~• c,nd n,,,,,peunc:,; or, "Tbe 8cck <(Medicine$,•· 2
vols. (Londoo: Oxford Unh..,,.;cy Pres.s_ 1913). vol 1, UlU'()O.l<tic.>o, e,p. pp. 553-601, ,,ol 2, EngjiSh tr.tnslation
and Index, e,p, pp, 656- 714.
n See Wristu, oomp., Clllak>g,,e ofS)rla<. MatlUSCrlp<s, 3: 1156- 58, no. 987 [Add 14658], esp., e.g., sec. 7,
On lbe Causes of the ~ ltcccrdmg to the VtCWS ofAristak Showing How It Is a Spbwe. and sec. 12, On
lbe J\alon or lr(luena, of the Moon At:rording to the Vieus of""'°7.,,,,,,.
"See Haye:;, L'erol,e d'~. pp. 124-25.}ean•Baptiste Chaooc, "L"~e de Nlslbe, son hlslolre, ses sia,
nus," Journal A!ianq,w, 1896, 9th ser., 8, 46, n. 2, refers to the School or Bishop Jaoob, which St, Fj)hraJm
direaed, being destro,-.d by the Persians in 363.
"He su,pc:oed it of harboring the Ncoro<ian hcre,y. The death of Hibo in 457 is lllken I)!•some soutces 10
mark the end of the S<hool of Ed<:ssa.., utik:h time, acoording lO M~i~:izeld in the OJronkk ofArlJ,/, Narsai
and hls oolleagues were e,cpelled. See Die <J,ronik """ Arl>e/a, = l',eler Kawerau (LOuv.lin: E. Pectcr>.
1985), in aco. v-ol. 468. S)ri '"'1. 200, pp. 95-96. See :also 1be $lalutes of the Sd,ccl efNiSibis, ed. and=
Mhur v = (Stoddlolm: EsrooJan The-ological Sode,y in Exile, 1961), pp. 15-17, In Pope,s of the &:,nian
1beologfcal ~ in Exile, vol. 12, where various oplnloru; reg;,tdlng the oomplicated quesdon of the exaa
date of the dosing of the School of the Persians are S<ated,
Hospice to Hospital In the Near East 459

Narsai, who, before his flight from Edessa, had been direaor of the school
there. The statutes issued by Narsai in A.O. 4% and revised by ):lenana in 590
provide a bird's-eye view of the school's organization and reflea the struc-
ture of the school in Edessa which the School of Nisibis succeeded. From
the revised statutes of 590, it is interesting to note that studerus who studied
theology were forbidden to reside with physicians, since "books of the craft
of the world should not be read with books of holiness in one light"74
Moreover, tho.5e anending the school who occupied themselves with medi-
cine were not allowed to continue their theology courses until they ceased
their medical activities and supplied the authorities with a good reference. 7S
We also know from the statutes of 4% that when one of the community fell
ill, it was the duty of the occupants of his cell to look after him. 76 This
arrangement became formalized in the revised statutes of 590, by which
time an infirmary had been established, with an anendant; if the anendant
fuiled in his duty, he was punished with a fine that was contributed to the
infirmary funds. 77 This infirmary, therefore, had developed as a private
monastic establishment anached to the school, for the use of students and
staff.
No medical instruction took place either as pan of the school curricu-
lum or in the infirmary; in fact, it was expressly forbidden. In view of the
high regard in which physicians were held by the schismatic Nestorian
church, as shown by the fact that they participated with the clergy in Bagh-
dad in the election of the patriarch, the regulation seems extraordinary. 78
However, the prohibition itself tells us that medical instruction did indeed
take place in Nisibis, and the most obvious location for it, in accordance
with the statute, was apparently in the homes of the physicians or in a hospi-
tal apan from the theological college. This would seem 10 be the correct
interpretation of the account ( recorded in the anonymous Chronicle of
Seert)79 of the life of Babai the Elder, who lived in the early seventh century.
In the chronicle it is stated that Babai srudied medical books at the hospital
-the word bimaristan is used-of Nisibis and stayed at the school for
theological instruction. He thus anained over a period of fifteen years a

"Voooos, Slatules. surure 19 cl A.O. 590, pp. 100- 101. This u-anslatioo cl !he su1u1e ;s quoted Ill' Dols,
"Origins cl lhe Islamic hospiral," p. 375, Olabo<, 1.'ecole de Nisibe;' p. 78. rranslares more eleg;imly, "parce
qu'il ne coovient pas. esc,il dk, d'ro.Jdler )es lf'tTes des sciences humaioes en Jl'.W?me temps que les li'.Tes
salnts".
1'Viiol><,s, StalWes, SUIUIC 20 o( A.0, 590, p. IOI.
,. ,bid., ''"""· 11 or A.O. 496, p. 80.
11 Ibid., ""'1J!O I of A.O. 590, pp. 92-93.
" SeeJames A. Mcrugomery, 11'3nS. ar,d annooll(ll', The Hlsta,;i•ofYabal/ob Ill, Ne!itOrlan Patriar<b, and <f
His Vicar, B a r ~ Mongol - to/be,_, Couns al lbe Etld of lbe Tbi1'teenlh CRnJu,y ( New
Yori<: Columbia Un~..,.i~, Press, 1927), p. 43. Dols, "Origins of the Islamic ho<pJc~; · p. 37S, SlJ!!ll"SIS N chis
negative ,1ew of medical stUdy arose. because, as a pocentiaJ~· pre!Ugious and lucrative career. medicine
would ctm.· srudems av,-ay from the snody of rheology, which .,,.. !he purpose cl the School of Nisibis.
"Wriaen in Arabic during the lemh or ele..,.eOOl cenruries and based on an earlier Syriac ,~ion. See
Histon Nesrcdenne (O:,ron;qu,, de S</e,T), pc. z. ed. ,lc1dai Scher (Paris, f'irmin-Didoc. 1919), f.1><. 4, pp.
530-31, in PQITO/ogia OrietuoJis, lo'OI. 13,
460 NIG£LAUAN

thorough education, the medical pan of which, to satisfy the statutes, would
have been undertaken at a different time from the theological. It is interest-
ing, however, that it was while reading in the bimaristan that he had a
dream in which he was ordered to the convent of Mount Izla, where, as
abbot, he was encrusted with inspecting convents and eliminating heresy
from them. Had he given his consent, he would have been elected Calho-
licos at the synod held following the murder of Khosrau ll in 628. 80 This
again illustrates that at an early stage those with medical training were
highly esteemed in the Nestorian church.
Since the &atutes of Nisibis were originally drawn up by a director of
the School of the Persians in Edessa, they accordingly reflect the situation as
it had existed there. It therefore follov.'S that medical education would have
been forbidden within the School of the Persians but would have been
carried out in some of the many hospitals established in Edessa or in the
homes of physicians. The latter doubtless were accorded the municipal sala-
ries and the taX exemptions that were granted to physicians and teachers of
the liberal ans in the rest of the Roman Empire.81
Zachariah of Mitylene, writing in AD. 569 of events between 553 and
556, refers to the establishment of a xenodocheion by the king of Persia on
the advice of Christian physicians attached to the coun. 82 This was evidently
an innovation hitheno unknown in Persia, but like the hospitals of Saint
Basil ofCaesarea and of Bishop Rabbula ofEdessa, it too was endowed-in
this instance from the royal treasury, the endowment being one hundred
mules, fifty camels laden with provisions, tv.•elve physicians, and whatever
else was required. The narrative breaks off abruptly, but in the previous
paragraph it is noted that the king of Persia had abstained from eating the
meat and blood of unclean animals ever since the time that Tribonian
anended the coun, originally as a captive. Trihonian is described as the
archiatros, and the word is used here in its primitive sense to describe him
as coun physician, although it is quite possible that he may have advised on
the con&ruction of the xenodocheion, obviously a Chri&ian inStitution bor-
rowed from the Eastern Roman Empire. It appears that the hospital, first
developed as a Christian inStitution, gained ground in Persia immediately
before and after the rise of Islam, for in a lener that can be dated to AD. 790,
Timothy, the Syriac patriarch from 780 till 823,83 states that he had built a
xenodocheion, which he defines and equates with the Islamic term bi1nar-

., Ballol the Elder composed over eighty theological "'°'ks· some of "11Jch are recorded by 'AbdishO; see
~ . N ~ 2, 370.
., Medldne was cenahlly caugllt 31 Alexandria until the severuh renrury. AilllO<J8h we have ,., knowledge
of ho6pltals !here, k ls feaslble lhac they existed, and Iha! lhey may """ had lacllJties for medical ttaining. See
lskandar, ''Late A!e,oindnan medlcu curriculum,- p. 236.
"'71:>e S)ri>c OJronide Knoun as 1baJ o{Zacbarid> o/Milylene, trans. FredetickJ. Hamilton and Emes1 W.
Broolcs (London, Melhucn, 1899), pp. 331-32.
"Tunothy was an influential figure a1 eowt and in !he dlurch. duri~ whose rule lhe Neslorian Olurcll
extended as far as India 5ee Alpl,onse Mingana, ''The early Spread or Olri&ianity in India," Bull. Jolm R)'lands
Libmry, 1926, IO, ~-68.
Hospice 10 Hospital in the Near East 461

iStiin, at al-Mada'in,M or Ctesophon/Seleucia. As the letter is addressed to his

friend Sergius, who was subsequently appointed metropolitan of Elam, also
known as Khuzistan, Timothy's use of the more familiar Persian term may
have been necessary to define the Syro-Greek xenodocheion.
The Christian monopoly of the medical profession, which includes the
hospital, continued into the Islamic period, and it is significant that the Is-
lamic theologian al-JaJ:ii+, writing in the ninth century, could relate in refer-
ence to a BaghdAd physician whose practice was going badly that his failure
was due to his being a Moslem instead of a Christian and speaking Arabic
instead of the language of GondesMpur.85
With regard to medical teaching, an amusing account wrinen by Ibn abi
U~aybi'a in the thirteenth century is of interest He relates how l:{unayn ibn
Isf:iaq greatly irritated Yuf:ianna ibn Masawayh when teaching medical stu-
dents in his council room by trying to display his knowledge of the ques-
tions he asked. When Ibn Masawayh's patience finally broke, he ordered
l:{unayn out of his house, "so he was taken out of his house" ffa-ukbrija min
darih I which shows that medical instruction in eighth-<:entury Baghdad still
took place in the physician's home. 86 With regard to Rhazes, the same
author quotes 'Ubayd All.Th ibn Ji braii of the new bimamtan eStablished by
'A<;lud al-Dawla in Baghdad. Among the physicians appointed, one in partic-
ular, 'Ali ibn Ibr.lhim ibn Bukkas, taught medicine in the birnaristan. He
also describes Rhazes sitting in his council room with his pupils, with !heir
pupils sitting further away and yet other pupils further away again; and he
explains the system of medical consultation.87 The word used here for "his
council room," ft majlisihi, derived from the Arabic root jls, "to sit," can
denote "his conference room" or "his presence." Due to the size of the
class, it seems more probable for this teaching to have taken place in the
lecture hall of the birnaristim.
Eventually the bimaristan became a completely Islamic inStitution as
the Christian minority declined in importance within the Islamic empire.
However, an element of continuity from the pre-Christian to !he Christian to
the Moslem periods can perhaps be traced in the Asklepian rhabdos. The

"See "I.es lettres du P.luiatche N.,.o,icn TimocMc I," ed. Raphael J. Bidzo•id, $n,di e Te,:i, 1956. UJ7,
35- 36; also Dols, "Origins olthe Islamic ho,pital," p. 379.
"" has =Ji· been me lashion 10 dowTigr.lde me imponance of Gondesh!pur, bu, de,,ly ilS Signifi-
cance as a center of Ovistian medical practice and $tUd)' W3$ recognized See Le litre de$ au:n1s par Abet.,
Olbma,, Amv "'1 /JOhr al-l>jdxz de Ba>m (.l'.Jult> al Bukl,al<I(, ed. Gerlof van Vlolen (Leiden, E.J. Still, 1900).
pp. 10')-10.
°'Yusuf ;t,n Ibrahim i$ qu<lled by lbn abi U!')'bi'a as having ob.se,ved Hunayn lbn lshaq reoding Galen"s
De ,eau ;n Greek and S)Tiac and !hen lrritlling lbn ~lisaw.lyh with que"10M. He e,q,lalns how lbn Ml<a,
Myh, coming from Goode<hapor, haled 10 see a man bn!d 10 trade in f;llr.l intrude imo me medical profes-
sion, and caun<ed 1:funayn aroirolngly. See lbn a/Ji Usaybi'a, ed. A\•gus< Muller, 2 ''Ols. (1884; reprint,
Farnborough, England, Gregg lnlemalional Publisher.;, 1972), 1, 18~.
"Ibid., p. 310. The palleru described his .-ymp1oms 10 lhe f,r,o pup;I he enc<)Unter<d, v.t.o, if he d;d no<
know me """'""'"' rcquirod. would rd,:,- the .,.,- 10 anc.-.her group. If !hey in rum ....,.. uruible 10
diagno5e or treat the ~T.J'4Xoms, the patiem werv. to their tnent~ ~•ho, if lhey too were wuble 10 treat him
or her satisbclocily, referred lhe palier< 10 Rliazes him<elf.
462 NIGELAUAN

latter was syncretized into the Christian Byzantine Empire in the form of the
bishop's crozier, and it survived well into the Islamic period lbn Burian (d.
A.O. 1066), himself a physician and a Nestorian priest, when visiting Antioch
in 1049, then under Byzantine control,118 n0ted that the city's hospital was
directly under the patriarch's control89
The history of the hospital in the Near East reveals a thread of continuity
that can be traced from classical antiquity through the Christian period into
the world of Islam, but this continuity was accompanied by continuing
change, exemplified by the assimilation of new ideas in the light of new
experience, and by changed circumstances, which transformed the hospice
or asylum for the poor into the hospital. Essential characteriStics for a suc-
cessful institution are both stability and change, a radical conservatism.
These were characteristics which the hospital, or the bimaristan, of medi-
eval Islam inherited from its precursor and which it maintained, ensuring it~
survival until modern times as a celebrated Islamic institution.

"AnliOCh MS 13ken by the Arabs in 638, fell inlo d1e lwlds d d1e By7anllneS c. 969, and MS capcured b)·
the Seljuks in 1083.
"Joseph Sd\3dn and Max Meyerhol, 1beM ~~ - Ion 8uJlan of BafJ,-
dad and lbn Rid:aln of Coro, A Cctrlrlbutloo IV lbe Hlsro,y of G<-eelo Learning amor,g tbe J\mbs. f&'pdan
Unlverslly, Farull)' of Aro Publlcatlon no- 13 (Cairo, 1937), pp. 55-56,