History Matters October 20, 2023
Western Historical Foundations of Medical Science part I: history is the beginning of your data
“Western” - “Western” refers to the Western heritage of social life, religious rituals and be-liefs, philosophical views, governmental systems, artistic expression and traditional cul-tural patterns that emerge from the near east of ancient Mesopotamia before the common era and develops across the Mediterranean into Europe and into the Americas. Western civilization is ear-marked by ancient Greco-Roman culture and philosophy; Western expressions of Christianity in Roman Catholicism, later European Protestantism, and then various sepa-ratist groups (e.g. Puritan) that found their way to the United States; and to some extent Germanic pagan mythological influence.
Greek philosophy, Western/American Christian Branches; Germanic pagan mythology—these three cords of influence are braided together in the 17th -18th during the Enlighten-ment, the Protestant Reformation, and the Romantic movement. Even when the United States be-came “culturally open” to Eastern religious and philosophical influences particularly from the 1960’s until today, much of what is called “eastern” particularly in health has been com-pletely “re-formed” into an American cultural package. If today, an American claims rejec-tion of their own traditional American cultural influences, or is just frankly oblivious to them, this does not alter the fact that they are a cultural child of a Western, particularly American mother.
“Knowledge”- In the ancient Greco-Roman world, it was the philosophers who debated both the meaning and purpose of “knowledge.” While Sophists were skeptical that what we call “knowledge” is no different than personal opinion or a particular tribal belief; it was Plato and Aristotle that argued for the existence of a type of knowledge that is universal, cer-tain, and necessary. This is the beginning of what modern people might call “facts” or “sci-ence”.
“Science” - The word science was not used in the way that most modern people consider it till the 19th century! There was a distinct historical era around the 16th century during a period we look back upon and call “the Scientific Revolution” but this is anachronistic. “Sci-ence” as a concept was, as mentioned, a philosophical idea, and actually called “natural phi-losophy” throughout the history of “European Western civilization.”. There was universal, certain, and necessary knowledge that could be observed, measured, systematized and even tested to offer explanations and predictions about nature and the universe.
Ancient Greek Medicine - “Studying the Natural without the Supernatural”
Ancient healing and medicine, even before the Greek civilization, was “knowledge” given from a pagan god or gods. There was no distinction made between “making a diagnosis” (dia-gnosis) and divination (gnosis). “The way” in which a plant grew or “the way” in which a baby was born was the same “way” in which a person served a god or gods. All knowledg-able “science” was indistinguishable from “religion”. To heal as healer or be healed as a pa-tient was to participate in a religious activity of the divine realm. The healer was a unique individual by inheritance or by the “choosing” by divinity and was often the same person as the tribal priest.
Some people anachronistically “use” the ancient philosophers of the Greco-Roman world who developed the rudiments of statistics, astrophysics, atomic theory, and even medical scientific diagnosis and public health as admirable prototypes of a modern science-minded person of the 21st century who believes “there is no place for religion in science”.
This desire to place science and religion at war does not come from nowhere— it has a his-tory. This memory even if subconscious, is embedded in modern American culture comes directly and indirectly from the “science vs creationism” antagonism that was historically unique to American culture only in the beginnings of the 2oth century. So when some mod-ern people read that some of the ancient Greek philosophers and earliest physicians (e.g. Galen) promoted the idea of studying the natural without the supernatural, they feel a cer-tain kinship to “science” and these “scientists” as they understand those words today. What many modern people wrongly project is that the Greek study of “the natural without the su-pernatural” is not equivalent to a “modern scientific method without a Christian religion.” We fail to understand pagan religions which were the religions of these ancient Greco-Ro-man philosophers.
In pagan mythology, cosmology, and religious practice, the gods were known by the chaos and random foibles of a divine pagan patronage. All worship centered on a sacrificial system in which your “payments” offered little security of the health of you, your family, tribe, city, or royal dynasty. These brilliant ancient Greco-Roman thinkers offered a way of viewing nature and life that was ordered, understood, and even predictable by observation— or we could say “universal, certain, and necessary”.There was a force in and above the world called the Logos, a logical way of knowledge not subject to completely random desires of pagan gods. This was not a different way of thinking about knowledge or “science”as much as it was a different way of thinking about religion in the pagan Roman world. Many philoso-phers questioned pagan religions where humans were slaves to randomness and chaos. Human beings, some believed, could insert order not only into nature, but into a social or-der, and even towards their own individual human body. Observing for repeatable measur-able structure, connected one with a power of order.
This was a paradigm shift in the power to order through knowledge that could be experienced through the senses of a human individual. You could “calculate” the math behind the divine mystery. There was geometry behind god. You could reason with the “logic” behind the Logos. This would become crucial to set the Western stage as Western civilization moves
from a Roman pagan empire to a Holy Roman Empire with Constantinople as her new “Christianized” Rome. While many focus on the political and ecclesial aspects of a “Western Christianized Civilization”, we fail to marvel of how this cultural cataclysm nurtured and synthesized “the study of the natural without the (pagan) supernatural” and of how the Christian God was elevated as the God of order and knowledge through reason.
The Byzantine Hospital
However, the greatest development came not in just the way western humans “thought” about the divine world and how one may “think” about nature, or even think about the hu-man individual—but that philosophical “thought” by itself did not change society. For a so-ciety to change and be “healed/saved”, the thoughts must take on flesh. Healing is thought in action. Good happens only when truth is expressed in beauty. It is in Constantinople in the 4th century that the near eastern Christian monk and bishop, Basil the Great, invents the idea of a hospital, no doubt the most unique of all Christian innovations. Here, the whole world was invited not to a sacrificial temple of pagan worship where one might re-ceive a vision or ecstatic experience from a divine being if it so pleased the gods as was typi-cal of healing temples of Aesculapius and other gnostic movements.
In the Christian hospital, all the sick and suffering were brought to hospitals called xenon's built throughout Constantinople, as were the building of orphanages, poor houses, lodging for foreigners, and houses for the elderly, which abutted these hospitals. These were not the “places for the dying” as one envisions from later Northern European “hospice” places during the Plague in the so-called “middle ages”. This that began with Basil’s xenones . Byz-antine physicians united the teachings of Jesus with the laws of Greek medicine. In the 6th century, we see the xenon as the largest free hospital for the poor developed by Saint Sampson that continued for another 600 years! In the 12th century, our best example of which we have records is the hospital the Pantokrater Xenon which brought in the best physicians, and taught “medical students”, it has divided floors into separate wards by dis-ease, and separated floors by biological sex. They implemented daily baths, regimented di-ets, and heated floors, and even specially designed beds for the elimination of human waste. We have extensive records of their strangely modern medical care as well as how they managed their finances and interfaced with governmental authority. Basil’s 4th cen-tury Byzantine hospital and the development of the hospital is founded upon virtues of helping the poor, orphaned, widowed, sick, suffering, and foreigners which were thor-oughly unique to a Judeo-Christian religious vision of sacrificial living for others as a foun-dation for social order.
This was not just the vision of one brilliant leader, but was the inheritance of a history that required the philosophy of the Greeks, the “medical science” of persons like Hippocrates and Galen, as well as a Christian religious virtue where the “Logos is made flesh” and one’s theological ordering of one’s life comes by caring for your neighbor. This new God of the new empire was not a God who has the face of a powerful and chaotic emperor, but rather the face of a servant who lives an ordered life for the help and healing of the weakest in the community.
It is this history, whether we know it or not, whether we like it or not, that is the historical foundation of professional medical healing in the West. It is no historical coincidence that in the United States in the 2oth century, up until just the past couple of decades, almost every hospital, orphanage, nursing home, charitable housing for the poor, and other health-re-lated charities are all affiliated with a branch of American Christian churches.
What is the Point?
The first point is this : History is the beginning of your data. You cannot understand or even do good medicine wisely without a complete and accurate history. While one (from a west-ern viewpoint) usually thinks of this history as the immediate personal history of the indi-vidual patient, we should know better by now that there is rich “certain and necessary knowledge” to be gathered from the history of family and friends. We should also know by now, that there is even “universal, certain, and necessary knowledge” to be obtained by knowing the history of one’s environment- the air, water, and food quality. The safety, transportation, and relational quality of one’s community. Now more than ever, we have the knowledge, the science, that the social determinants of health are more important than perhaps even individual habits.
And all of these histories: personal, familial, communal, environmental, social, and political —all have histories that made them that way. To “take a complete and accurate medical history” and apply it with the highest wisdom requires the knowledge of medical history. When one does even a cursory investigation of medical history, science, and healing in western culture (and one should do this with the same curiosity, open-mindedness, and skepticism that one encounters scientific data), the conclusion is this : science is braided with religion. Our modern medical system is braided with Western Christian ideas of virtue and charity. When most American patients become sick or are suffering, many are having an existential religious experience— that is not really up to the individual to decide. Even if the individual patient rejects this interpretation of experience, few around him or her will agree. Her en-vironment will make it a religious experience even if she doesn’t.
As healers, even in American hospitals that no longer have nuns, or names with Christian saints and denominations, we must be aware that the culture that put them there is still liv-ing and beating. While we are not at the bedside to promote or sell our own brand of reli-gious belief, we would be foolish to believe that our medical thoughts and therapies are dis-embodied from the flesh of a particular American faith. We would be foolish to deny that most patients who we see are having some form of religious experience be it bad, good, or uncertain. We would be poor scientists if we had not read the studies that most patients de-sire to give their history of what they believe about God, sickness, suffering, and healing. And while few of us (if any) were given any formal training in medical education about the in-terdigitation of medicine and religion, healing and spirituality (and we might even find it pre-sumptuous or imprudent to say much of anything in response to such questions); all of us can be posi-tively aware that these foundations to medical healing are not just old historical writings— they are immediate personal experiences. And with this awareness, we can always be ready to listen. For with the ear, many hearts are healed.