Hector Avalos, Health Care and the Rise of Christianity.

Peabody, MA: Hendrickson Publishers, 1999. Pp. x + 166. Paper, $19.95.

The main thrust of this book is to show that early Christianity was a Jewish sect, which had as one of its primary goals the reformation of the health care systems of stricter forms of Judaism and to address problems found in other health care systems of the Greco-Roman world. It is a book, not about Jesus' healing activities, but about how healing was portrayed and promoted by the early Christian communities. In doing that, the author compares the early Christian health care system to those of the Israelites, Asclepius, Isis, and what he calls the "secular" Greco-Roman" system.

The conclusions, which are summarized in a synposis at the end of the book (p. 119), suggest that the early Christian health care system was different from all other health care systems in a number of regards. First, in the early Christian health care system illness was unrelated to a patient's social or religious status, and this was not so in the other systems. Second, the early Christian system consisted of a simple therapeutic ritual structure compared to the others--it was the only system, in fact, where faith and/or prayer was sufficient for healing. Third, the Christians offered free health care, whereas the other systems were costly. In the fourth place, the location of the patient had no effect on the health care offered in Christianity; mobile consultants overcame the difficulty associated with established shrines. Finally, Avalos identifies no temporal restrictions in the early Christian health care system as compared to other systems.

The argument that part of the missionary program of early Christianity was to provide health care for the sick and the needy (pp. 77, 104) brings a welcome correction to a debate that usually emphasizes teaching and dogma as the main forces in the growth of the movement. Reclaiming this perspective not only brings a balance, but can also be of value for pastors and theologians reflecting about the driving forces in the growth and expansion of Christianity as an important movement in antiquity.

Unfortunately, these insights are overshadowed by a number of problematic issues.

First, despite admitting that the early Christian health care system was not necessarily more efficient than the others (pp. 4, 119), one cannot avoid the impression that the aim of the comparison is not only to show that the early Christian health care system was different, but also that it was superior to all other systems of the time. The notion of "reformation" of health care (Avalos even speculates that the historical Jesus could have had "the reformation of health care as a principal part of his agenda." p. 118), which implies a deliberate attempt to change it, is pushing it too far. This can be seen in some of the conclusions about the uniqueness of early Christian health care that are based on either selective evidence or misrepresentation of some of the facts. For example, Jesus (and the early Christians) were not the only ones in antiquity credited with "healing over a distance" (compare evidence about Hanina ben Dosa and Apollonius of Tyana). It is also true that the early Christians did not require a direct fee for healing, but that does not necessarily translate to "free" health care. The itinerant Jesus followers operated within a system which was based on reciprocal obligations. The fact that their health care service was without direct charge does not mean it was without strings attached.

Second, it is not at all clear what is meant by "the early Christian health care system." On the one hand, selective elements of Jesus' healings are included in the description of the early Christian health care system (e.g., challenging the purity code, p. 70, and healing at a distance, p. 103), but on the other hand, it is claimed that Jesus' healings are not the focus of the book (p. 3). Why bother with the history of research regarding Jesus as healer (pp. 5-11) if this book is not about that topic? A proper analysis of Jesus' healings will have to reckon with at least five types of healing activities ascribed to him (by declaring "lepers" clean, by means of forgiveness of sins, through the faith of someone, by means of magical acts, and by means of exorcisms), while the healing activities of his followers focused on using his name as a powerful source for healing or exorcisms. Will it be possible to maintain the uniqueness of the "early Christian health care system" when either Jesus' healings are totally excluded from or wholly included in the comparison?

Third, given the claim that insights from medical anthropology will be used (and the accusation that other First Testament scholars usually have no formal training in anthropology, p. 9), the most disappointing aspect of the study is the misleading application of the concept "health care system." As the author correctly states (p. 19), a health care system by definition offers a coherent set of resources, institutions, and strategies for dealing with illness. That implies that most societies, modern or ancient, offer a plurality of health care systems. This is something different from saying that each health care system, modern or ancient, offers a plurality of options (p. 19).

This confusion becomes particularly apparent in Avalos' presentationi of the Israelite health care systems (pp. 33-45). Despite the use of the plural ("systems"), it is not at all clear how many systems there were in the Israelite contexts, which elements belonged to which system, or what the features of each system were. In fact, what is presented are lists of the variouis elements found in Israelite literature (for example, a list of the possible therapeutic strategies) but without a clear picture of how the therapeutic strategies, diagnoses of illness, presuppositions about the causes of illness, and specific options available to patients in a specific health care system hangs together to constitute a particular system. In short, there is no picture of the various Israelite systems; there are, instead, lists of components within various systems. A distinction among folk, professional, and self-help systems would already have been useful in keeping apart the specific systems in the Israelite society (something Pilch, e.g., has already pointed out). Such a distinction would, for instance, enable us to see that within Israelite society of the first century, folk healers (like Jesus of Nazareth and Hanina ben Dosa) and a temple dominated health care system can be identified.

Finally, it should be mentioned that a monograph's usefulness is not enhanced by incorrect or misleading presentation of other scholars' viewpoints. The main weight of Pilch's studies on first-century health care systems, for example, is not about Douglas' purity model, as Avalos suggests (p. 9), but about the use of medical anthropology--e.g., Kleinman's model of health care systems as a cross-cultural model--for interpreting first-century illness and healing reports in a proper way.

Pieter F. Craffert
University of South Africa
Pretoria, 0003, South Africa