Mending Bodies, Saving Souls: A History of Hospitals [Hardcover]

Guenter B. Risse (Author)

Book Description

Publication Date: April 15, 1999 | ISBN-10: 0195055233 | ISBN-13: 978-0195055238 | Edition: 1

By chronicling the transformations of hospitals from houses of mercy to tools of confinement, from dwellings of rehabilitation to spaces for clinical teaching and research, from rooms for birthing and dying to institutions of science and technology, this book provides a historical approach to understanding of today's hospitals. The story is told in a dozen episodes which illustrate hospitals in particular times and places, covering important themes and developments in the history of medicine and therapeutics, from ancient Greece to the era of AIDS. This book furnishes a unique insight into the world of meanings and emotions associated with hospital life and patienthood by including narratives by both patients and care givers. By conceiving of hospitals as houses of order capable of taming the chaos associated with suffering, illness, and death, we can better understand the significance of their ritualized routines and rules. From their beginnings, hospitals were places of spiritual and physical recovery. They should continue to respond to all human needs. As traditional testimonials to human empathy and benevolence, hospitals must endure as spaces of healing.

Editorial Reviews

From The New England Journal of Medicine

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.

Review

"The author takes his readers from Greek and Roman times through the pangs of suffering in the early Christian era, the surge of the Enlightenment as exemplified by Edinburgh, Vienna, and Paris, to surgeons such as Warren and Lister and the modern research giants of municipal mercy. Just to review this immense background of our ere is a great treat; Dr. Risse's abundant research and sophisticated interpretation makes this book an intellectual triumph."--Francis D. Moore, MD, Moseley Professor of Surgery, Emeritus, Harvard Medical School

"Dr. Risse brings the patient, pilgrim to the "foreign land" of hospitals, to the center of this magnificent, poignant history of medicine. Telling the experiences of actual patients, doctors, and others in hospitals at different times and in different places, Risse brings the hospital to life, vividly, as a place of rituals where some human beings struggle to live; others do the best they can in the face of available medical knowledge and often dangerous social conditions. A remarkable, moving, humane book -- a major contribution to the history of medicine, and highly recommended for the general reader."--Rosemary A. Stevens, Stanley I. Sheerr Endowed Term Professor in Arts and Sciences, University of Pennsylvania

See all Editorial Reviews

Product Details

• Hardcover: 716 pages
• Publisher: Oxford University Press, USA; 1 edition (April 15, 1999)
• Language: English
• ISBN-10: 0195055233
• ISBN-13: 978-0195055238
• Product Dimensions: 9.6 x 6.7 x 1.7 inches
• Shipping Weight: 2.6 pounds (View shipping rates and policies)
• Average Customer Review: 4.7 out of 5 stars  See all reviews (3 customer reviews)
• Amazon Best Sellers Rank: #1,306,130 in Books (See Top 100 in Books)

More About the Author

Guenter B. Risse (1932-) is a historian of science and medicine. Born in Buenos Aires, Argentina to German immigrants, he received his M.D. degree from the University of Buenos Aires School of Medicine before coming to the United States to complete and internship and training in internal medicine. After obtaining his American citizenship, he obtained a Ph.D. degree in history at the University of Chicago in 1971. Since then he has held academic appointments at the University of Minnesota, University of Wisconsin-Madison, and the University of California, San Francisco and Berkeley. He is currently professor emeritus at the University of California and Affiliate Professor in the Department of Bioethics and Humanities at the University of Washington in Seattle. The American Association for the History of Medicine awarded him the 1988 Willian H. Welch Medal for his book Hospital Life in Enlightenment Scotland and in 2005 its Lifetime Achievement Award. His most popular work Mending Bodies, Saving Souls: A History of Hospitals narrates the transformation of Western hospitals from houses of mercy to institutions of science and technology. Such a "master narrative" rests on a dozen episodes featuring patients admitted to prominent hospitals, their suffering and adaptation to institutional life and its often cumbersome routines. The last chapters spotlight a number of contemporary hospitals in which the author was able to make rounds, as well as interview patients and their caregivers.The final essay features the AIDS Ward at San Francisco General Hospital during the early 1980s, an unforgettable and very emotional experience. The book ends with an epitaph, a remark by one of the nurses: "Upon a time there was a disease called AIDS and these rooms were filled with people who were loved by people with love."

Customer Reviews

Most Helpful Customer Reviews

9 of 9 people found the following review helpful:

4.0 out of 5 stars A compassionate, informative history of medicine, hospitals., May 12, 1999

By A Customer

This review is from: Mending Bodies, Saving Souls: A History of Hospitals (Hardcover)

Hospitalitas, the Latin root for our word hospital, implies a relationship, a sharing between the visitor and caregiver. In his new book, Mending Bodies, Saving Souls, medically trained historian Guenter B. Risse traces the evolution of hospitals from their early mission as humble houses of mercy to the role of some today as arenas of nearly miraculous technical feats. Throughout the book Risse suggests that today's emphasis on diagnostic techniques and surgical specialties often overshadows and even undermines the capacity for compassionate caregiving. Risse, MD, PhD, is professor and chair of history of health sciences at the University of California San Francisco. He was trained as a medical doctor in Peronist Argentina and earned a doctorate in history at the University of Chicago. He brings both spheres of knowledge to his ambitious project. The chapters provide a series of portraits at the threshold of different medical milestones - the discovery of the stethoscope and its role in diagnosing tuberculosis; the emergence of autopsies to help pinpoint causes of disease and bring the possibility of preventing them; the first amputation under general anesthesia; the early use of antisepsis at the Royal Infirmary in Edinburgh; the modern development of organ transplant surgery and post-operative care; and the very real drama played out on the first AIDS ward in the early 1980s. After sketching their origins in Byzantium, Risse portrays hospitals in the Middle Ages as houses of refuge and dying, where moral and spiritual concerns prevailed and where caregivers were expected to fast and do penance. The house of mercy gave way during the Renaissance to the house of rehabilitation, borne by the conviction that the sick or wounded might be healed, not merely cared for. As scientific understanding grew, the house of rehabilitation became the house of cure. In our time, Risse writes, the top hospitals focus on teaching and research, where the newest, boldest techniques are developed and proven. They have become houses of science -- a long journey from their origin as houses of mercy and refuge. He wonders if the technical gains in the "medicosurgical" era can't allow more room for the proven gifts of more compassionate caregiving. As the book reaches the present day, Risse offers a chapter chronicling the superb skill, insight and persistence of the pioneers in the field of organ transplantation. He follows three young women as they prepare for and recover from kidney transplants. In an environment where the extraordinary life-saving skill of surgeons is prominent, mutual support among the three patients turns out to be invaluable to help them cope with pre-operative anxiety and difficult recoveries. One can't separate personal, emotional support from the healing experience, Risse seems to be saying. The book's final chapter relates the shifting treatment strategies and innovative caregiving employed in the country's first hospital ward dedicated to treating AIDS patients, the UCSF-affiliated San Francisco General Hospital Medical Center's now legendary Ward 5B. The AIDS ward history is offered as hopeful evidence of the capacity for deeply compassionate care in a modern hospital setting. At a time when the pace of medical understanding of the disease was slow and erratic, the SFGHMC ward focused on keeping patients informed and comfortable, and meeting their emotional and social needs. Some of the patients were suffering advanced stages of the disease, and loneliness and fear could be devastating additional burdens. The ward offered weekly informational sessions for patients and placed an emphasis on primary caregiving, privacy and psychological counseling. The staff was about half gay and lesbian, and many were strong advocates for patient education and advocacy in the face of such a bewildering and often overwhelming disease. As Risse documents it, the spirit of the ward was extremely positive and uniquely supportive. One patient is quoted as saying, "`I know how the pioneers must have felt fearing what was ahead of them. My bed is like a covered wagon and we are all on a wagon train helping each other in a time of need.'" This recent demonstration of strong commitment and compassionate caregiving in a modern hospital has served as a model for hospice development and for ever-increasing patient involvement in decisions about their own care. But perhaps most important, Risse suggests, Ward 5B is a modern testament to the capacity for health workers to provide loving and knowing care, and the capacity for the institution to reconnect with hospitalitas, infusing the modern, technically sophisticated hospital with the healing powers of touch, compassion and deep caring.

4 of 4 people found the following review helpful:

5.0 out of 5 stars Mending Bodies, Saving Souls, June 1, 2003

By 

Jack D. McCarthy, MD (Albuquerque, NM USA) - See all my reviews

This review is from: Mending Bodies, Saving Souls: A History of Hospitals (Hardcover)

Beautifully produced thick book with marvelous details and engrossing flow of information. Thinking of the labor expended in writing such a encommpassing volume leaves me in awe of the superb quality of the author's scholarship.There are over 1000 references, many in languages other than English. Since a history of hospitals cannot be separated from the history of medicine, obviously some overlap occurrs, which is welcome. I recommend this book for the serious reader.

2 of 2 people found the following review helpful:

5.0 out of 5 stars Want to know why hospitals are the way they are?, August 20, 2008

By 

Rebecca Emmons "frog_buddha" (Stillwater, OK) - See all my reviews
(REAL NAME)   

Amazon Verified Purchase

This review is from: Mending Bodies, Saving Souls: A History of Hospitals (Hardcover)

I used this book as a source for a research paper on French hospitals in the 17th and 18th centuries. I often got caught up in the other time periods, though, because there was so much to learn. The author covers a lot of ground, in terms of the shifting role of hospitals over time and geography. He includes the training of medical professionals, the involvement of religious personnel and organizations, dietary and daily regimens, diagnosis and treatments, the effects of politics, economics, religion, education, and so forth on how hospitals operated and were viewed. I bought this book for my mother-in-law (a retired RN and nursing instructor) as a Mother's Day gift, and she loves it. I want a copy for myself, because it helped me understand why hospitals are the way they are today, and to appreciate just what we do have available.