By Carol Symes, University of Illinois Urbana-Champaign
Incarceration is figured as an invention of modernity. Many historical accounts of the hospital, too, locate this institution’s establishment as a by-product of the early modern state, when secular rulers and benefactors began to interest themselves in public health, supposedly for the first time. But, in fact, both the hospital and the prison emerged during the Middle Ages.
Impact of Christianity
According to the French philosopher Michel Foucault, the prison is a modern invention, born of the Enlightenment’s darker predilection for identifying, surveilling, sequestering, and disciplining the malefactors of society. For the sociologist Norbert Elias, by contrast, the prison is a sign of the ‘civilizing process’ that saw the rejection of barbaric ‘medieval’ practices of vengeance and retaliation, in favor of ‘scientific’ and ‘compassionate’ modes of reform and rehabilitation.
Both the hospital and the prison emerged during the Middle Ages and resulted from some of the same processes: the spread of a legalized Christian religion after the conversion of the emperor Constantine in the early 4th century; the development of new doctrines and regimes of physical and spiritual health; and the need, shared by secular and religious authorities, to establish their legitimacy by regulating the care of the ill, the destitute, or the deviant.
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Pressures of Rapid Urbanization
Hospitals and prisons also responded to the pressures of rapid urbanization and the concurrent economic changes that had occurred after the first millennium. These changes created new forms of geographical and social mobility—for better and for worse. These changes provided new opportunities but also fostered new vulnerabilities and forms of marginality by severing transient individuals from traditional social roles, communities, and kinship networks.
This meant that people who might once have been able to rely on family members or a stable community to care for them in times of sickness often found themselves among strangers, and alone. Similarly, mobile individuals were also targets of suspicion, sometimes making a living through petty crime, but often shunned precisely because they were aliens. There was also a significant overlap between those regarded as mentally ill and those regarded as deviant or outcast. Prisons and hospitals provided different models for dealing with this rootless population.
By the end of the 16th century—that is, by the end of the medieval period—the term hospital could be applied to various places where needy people would be housed, or ‘hosted’, as hospes, a Latin word that means both ‘host’ and ‘guest’.
Imprisonment and Medical Treatments
Although imprisonment is a punishment as old as human society, in antiquity it was almost always a form of temporary detention that ended in corporal punishment or execution; it was not a punishment in itself.
Most ancient legal systems revolve around what the Romans called the lex talionis, ‘law of retaliation’ (literally, ‘law by cuts’) or the rule of ‘an eye for an eye’. Personal injuries were repaid with proportionate counter-injuries, while public crimes resulted in forms of public torture, bodily mutilation, or death. Inability to pay one’s debts resulted in slavery, or the forfeiture of property—including children. Other, more minor, infractions were punished with public humiliation.
At the same time, while occasional or seasonal infirmaries or military field hospitals would have been set up, as the need arose, the treatment of acute or chronic illness in antiquity involved nursing at home; even major operations took place on site. In many parts of the ancient world, temples were very often places of healing overseen by priests with medical knowledge, and there is evidence of rulers patronizing schools for the training of healers; examples are known from India, Sri Lanka, and Persia.
No Real Public Health Care System
Still, rather astonishingly, given their attention to public works and infrastructure, the Romans had no form of public health care—although one could argue that health as well as hygiene in Roman cities was improved by that infrastructure (like public baths, sewage and plumbing systems, and aqueducts) even if there was no institutional provision for the sick and infirm.
In the territories encompassed by the Roman Empire—western Asia, North Africa, and Europe—this began to change under the influence of Christianity and Islam. It is often stated that the Council of Nicaea, the first ecumenical meeting of the newly legitimate Roman Church, provided for the establishment of a hospital in each diocese—that is, in each province overseen by a bishop.
How Religion Influenced Health Care
Although that provision is only included in a later, pseudo-canonical collection preserved in Arabic, there are also Coptic versions of the canons that make similar stipulations. So even if we can’t be sure whether the Council actually ruled on this matter or not, the very fact that all of these different Christian traditions insisted on the importance of subsidized public hospitals is really significant.
Indeed, the Arabic version of this canon makes it clear that the superintendent appointed to provision a given hospital should have the power to require all Christians in the community to support it, according to their individual means, in the much same way that Christians were supposed to support the local clergy with a tithe, or a tenth of their income.
The attachment of a hospital to a cathedral complex, alongside the bishop’s palace and supported by charitable donations, was thus the medieval institutionalization of an ancient practice of seeking healing at temples and sacred shrines, but now with an established endowment.
Common Questions about the Emergence of Prisons and Hospitals in the Middle Ages
Hospitals and prisons emerged during the Middle Ages due to the spread of a legalized Christian religion after the conversion of the emperor Constantine in the early 4th century; the development of new doctrines and regimes of physical and spiritual health; and the need to establish their legitimacy by regulating the care of the ill, the destitute, or the deviant.
In antiquity, imprisonment was almost always a form of temporary detention that ended in corporal punishment or execution; it was not a punishment in itself.
The attachment of a hospital to a cathedral complex, alongside the bishop’s palace and supported by charitable donations, was the medieval institutionalization of the ancient practice of seeking healing at temples and sacred shrines, but now with an established endowment.
