“A noble thing is philanthropy, and the support of the poor, and the assistance of human weakness…”

So rang the emotional words of Bishop Gregory Nazianzen during the funeral oration delivered for his dear friend Basil of Caesarea in 379. Wishing to remind his audience of Basil’s charity towards the poor, he continued:

Go forth a little way from the city, and behold the new city, the storehouse of piety, the common treasury of the wealthy… where disease is regarded in a religious light, and disaster is thought a blessing, and sympathy is put to the test.

Gregory goes on to mention the Great Wonders of the ancient world: the Pyramids, the Colossus, and the walls of Babylon, but says these pale in comparison to this “new city.” Gregory’s audience would no doubt have recognized his reference to this “city,” but for clarity, he continues:

My subject is the most wonderful of all, the short road to salvation, the easiest ascent to heaven. There is no longer before our eyes that terrible and piteous spectacle of men who are living corpses, the greater part of whose limbs have mortified, driven away from their cities and homes and public places and fountains, aye, and from their own dearest ones, recognizable by their names rather than by their features… no longer the objects of hatred, instead of pity on account of their disease.

We realize that Gregory is speaking of Basil’s hospital, where lepers were treated. Gregory finishes this part of his oration with the moving words:

[Basil] however it was, who took the lead in pressing upon those who were men, that they ought not to despise their fellowmen…Others have had their cooks, and splendid tables, and the devices and dainties of confectioners, and exquisite carriages, and soft, flowing robes; Basil’s care was for the sick, and the relief of their wounds, and the imitation of Christ, by cleansing leprosy, not by a word, but in deed.¹

In this moving eulogy, Gregory has immortalized for posterity what was indeed a milestone in medical history: the Basiliad (also known as the Basileias or Basileiados), the first hospital in history.

The Basiliad derives its name from its founder, the Christian priest (and later bishop) Basil. He is remembered as one of the “Cappadocian Fathers” (along with his brother Gregory of Nyssa and his life-long friend Gregory Nazienzen); the three clergymen were active in Cappadocia (modern-day Turkey), and they have long been regarded as Christian saints in both Catholic and Orthodox traditions.  By AD 369 Basil had already distinguished himself as a holy and capable monk and abbot, and an effective rhetorician and theologian. A continued refrain in his sermons was the exhortation to put Christian teachings into practice, and to always be mindful of the poor. For example, in a sermon on St. Luke’s Gospel, Basil preached:

Why are you wealthy while that other man is poor…are you not a cheater? [T]aking those things which you received for the sake of stewardship, and making them your very own? … The bread which you hold back belongs to the hungry; the coat, which you guard in your locked storage-chests, belongs to the naked; …The silver that you keep hidden in a safe place belongs to the one in need.²

Basil’s charity was put to the test in AD 369, when, in the words of his friend Gregory, “There was a famine, the most severe one ever recorded [in Cappadocia].”¹  Gregory describes how Basil gathered together the poor to feed them; “[He] set before them basins of soup and… meat.”  Based on this information, historians think it likely that Basil had at least a soup kitchen in place by 369.³  But the famine provided the impetus for Basil to undertake a much greater expansion in charitable works.  Seeing the rich hoarding their wealth while the poor died of sickness and starvation, he used the Gospel of Matthew to preach for social reform:

But how do you make use of money? By dressing in expensive clothing? Won’t two yards of tunic suffice you, and the covering of one coat satisfy all your need of clothes?… One bread-loaf is enough to fill a belly…. For it is right… to regard the use of money as a matter of stewardship, not of selfish enjoyment…. What answer shall you make to the judge, you who dress walls, but will not clothe a man; who spruce up horses, and overlook an unfashionable brother; who leave grain to rot, but will not feed the starving; who bury your money and despise the oppressed?…⁴

With these and similar homilies, Basil encouraged the wealthy to support his social projects for the poor. His work has been called a “major social revolution… that challenged directly the hypocrisy, corruption, and uncontrolled self-interest” of fourth-century Ceasarea.³  And this revolution, which included the world’s first hospital, was based on a Christian understanding of charity, of sharing one’s wealth with the poor, particularly during times of crisis.

And what of the hospital itself?  Three of Basil’s letters seem to reference it.  In one such letter, written around 372 to the local governor,³ Basil describes a complex of buildings.  He writes:

…[We have] a magnificently appointed church to God, and round it a dwelling house, one liberally assigned to the bishop, and others underneath, allotted to the officers of the Church in order, the use of both being open to you of the magistracy and your escort.

Here, Basil describes a complex focused around a church, a bishop’s residence, and housing for his clergy (who acted as his staff for much of his charity work).  The complex is apparently large enough that it could house the governor and his entire retinue.  He continues:   …Do we do any harm by building a place of entertainment for strangers, both for those who are on a journey and for those who require medical treatment on account of sickness, and so establishing a means of giving these men the comfort they want, physicians, doctors, means of conveyance, and escort?

Basil has elucidated some of the additional functions of the Basiliad: a house for strangers and travelers, and a site for professional medical treatment.  What seems like a passing reference is indeed monumental: anyone (particularly the poor) can receive medical care from professionals.⁵ He continues:

All these men must learn such occupations as are necessary to life…; they must also have buildings suitable for their employments…We have already…begun providing [building] material.⁶

Here, Basil makes it clear that his impressive social project includes teaching trades to the inhabitants of the Basiliad.  I.e., he is teaching the hungry how to fish, not just doling out fish.  Finally, he makes it clear that the construction of his complex was already well under way by 372 (the date of this letter).

There are two other letters, both dated to 373, that suggest that the hospital was by then operating at full force.  They also help confirm the hospital’s location.  Writing to fellow bishop Amphilochius, Basil writes:

I was lately at Cæsarea, in order to learn what was going on there. I was unwilling to remain in the city itself, and betook myself to the neighbouring hospital (or “poorhouse”) [πτωχοτροφεῖον]…⁷

Basil clearly references that this facility for the sick and poor lies just outside of the city of Caesarea (a city in Asia Minor). Indeed, even when Caesarea itself fell into ruin centuries later, Basil’s neighboring “new city” was still thriving–becoming the modern-day city of Kayseri, Turkey.[8]  Also, one notes that the Greek here for “hospital” (πτωχοτροφεῖον) can signify a facility that tends to the sick or to the poor (or both): Basil’s complex apparently treats the indigent sick.⁹

The existence and function of the Basiliad is confirmed with another letter to Bishop Amphilochius, written in 373: “Come…that you may also honour with your presence the Church of the Hospital (or Poorhouse) [πτωχοτροφεῖον].”¹⁰ Again, Basil’s words confirm that his complex abuts a church, and it tends to the sick-poor.  Also, the fact that Basil is inviting a fellow bishop to visit suggests that his Basiliad is already (or nearly) complete by 373.

We now have sufficient evidence to piece together the history of the Basiliad.  From the dating of the famine, it appears that some facility (at least a soup kitchen of sorts) existed in 369. By 372 it had professional medical personnel; and by 373 it was sufficiently complete that he could invite fellow leaders to visit.  We know that this “new city” housed lepers (based on Gregory’s eulogy)¹¹, as well as other sick, the travelers, and strangers.  It was staffed both by professional physicians, as well as by clergy in the adjoining church (not unlike later Christian hospitals).  And we know, based on Gregory’s reference to the “common treasury of the wealthy”, that the poor were financed by donations from the rich.  Finally, it is possible that the Basiliad also housed orphans, based on Basil’s recommendation for monks to take in orphans;¹² likely these orphans were among those who received tradeschooling.  In sum, the Basiliad was an impressive social endeavor.

But was the Basiliad also novel?  Was it truly the world’s first hospital?  Historians have compared the Basiliad to other, prior institutions which cared for the sick.⁹ For example, the Roman valetudinaria and Asclepian Temples predated the Basiliad and certainly provided care for the sick. But were they truly hospitals?  Per Andrew Crislip, a hospital must have three components: inpatient facilities, professional medical caregivers, and care given for free.¹³ Scattered throughout the empire, the Roman valetudinaria were complexes constructed to treat ill or wounded slaves and soldiers.  These valetudinaria were financed by either wealthy slave owners or Roman legions, to keep the slaves working or soldiers fighting (respectively).⁵  But the facilities did not treat the poor, and they were hardly charitable in nature.  Similarly, the Asclepian temples, dedicated to the Greco-Roman god of healing, are sometimes cited as potential predecessors for the Basiliad.  But the medico-religious services provided in these Asclepian temples were not given for free: sacrifices or donations were expected.¹⁴ Furthermore, the Asclepian temples rarely employed professional physicians.  Finally, they did not accept terminal cases: indeed, a patient dying inside of the hospital would have been seen as a ritual impurity.¹⁵ Thus, even the often-cited healthcare institutions which predated Basil did not perform the same functions that his Basiliad did.  It seems that Basil started a new trend: soon after his death, similar Christian hospitals were sprouting up elsewhere in the Roman empire, and they had became commonplace within one century.⁹ 

For these reasons, historians have argued that “the hospital was, in origin and conception, a distinctively Christian institution.”^{5, 13, 15}

Using primary texts, we have reconstructed the Basiliad, likely the first true hospital in history.  It was constructed with inspiration from Christian social teaching, and with impetus from a famine.  It would become the first in a great number of hospitals across the Roman empire: a major landmark in the history of medicine.

References

1.       Gregory Naziazen. Oration 43. From Nicene and Post-Nicene Fathers, Second Series, vol. 7. Ed. Philip Schaff and Henry Wace. (Buffalo, NY: Christian Literature Publishing Co., 1894.) Trans. Charles G. Browne and James E. Swallow. Available online at www.newadvent.org/fathers.  Accessed 31 January 2015.

2.      Basil of Caesarea. Homilia in illud dictum evangelii secundum Lucam: «Destruam horrea mea, et majora ædificabo:» itemque de avaritia (Homily on the saying of the Gospel According to Luke, “I will pull down my barns and build bigger ones,” and on greed), §7 (PG 31, 276B – 277A). Translated Peter Gilbert, available online https://bekkos.wordpress.com/2009/10/08/st-basil-on-stealing-from-the-poor/. Accessed 31 January 2015.

3.      Philip Rousseau. Basil of Caesarea. Transformation of the Classical Heritage Series, no. 20. California UP: 1998. P137ff.

4.      Basil of Caesarea. Homily to the Rich. Trans. Peter Gilbert. In Migne, JP (PG 31 277C-304C).  Available online: https://bekkos.wordpress.com/st-basils-sermon-to-the-rich/. Accessed 31 January 2015.

5.      Gary Ferngren. Medicine and Health Care in Early Christianity. Baltimore, MD: Johns Hopkins UP, 2009. p124-9.

6.      Basil of Caesarea. Letter 94: To Elias, Governor of the Province. From Nicene and Post-Nicene Fathers, Second Series, vol. 7. Ed. Philip Schaff and Henry Wace. (Buffalo, NY: Christian Literature Publishing Co., 1894.) Trans. Blomfield Jackson.  Available online at www.newadvent.org/fathers.  Accessed 31 January 2015.

7.      Basil of Caesarea.  Letter 150: To Amphilochius, Bishop of Iconium. From Nicene and Post-Nicene Fathers, as above.

8.      Timothy Patitias. “St. Basil’s Philanthropic Program and Modern Microlending Strategies for Economic Self-Actualization,” in Wealth and Poverty in Early Church and Society. Ed. Susan Holman. p267-270.

9.      Timothy Miller. The birth of the hospital in the Byzantine Empire. Baltimore: Johns Hopkins UP: 1997.

10.    Basil of Caesarea.  Letter 176: To Amphilochius, Bishop of Iconium. From Nicene and Post-Nicene Fathers, as no. 6 above.

11.     See Timothy Miller and JW Nesbitt. Walking Corpses: Leprosy in Byzantium and the Medieval West. Cornell UP: 2014.

12.    Basil of Caesarea. Interrogatio XV (PG 31: 952), in Timothy Miller, The Orphans of Byzantium: Child Welfare in the Christian Empire. New York: Catholic UP: 2003, p115.

13.    Andrew Crislip. From Monastery to Hospital: Christian Monasticism and the Transformation of Health Care in Late Antiquity. Ann Arbor: U of Michigan P, 2005, p125.

14.    Guenter B. Risse. Mending Bodies, Saving Souls: A History of Hospitals. Oxford UP: 1999. p.30f.

15.    Gary Ferngren. Medicine and Religion: A Historical Overview. Baltimore, MD: Johns Hopkins UP, 2014. p91-92.

16.    An interesting question, outside the scope of this paper, is whether any of the institutions in ancient Sri Lanka or India (e.g. King Asoka) would qualify as a hospital.  In the least, one can note that there is a paucity of documentation to know exactly what these hospitals looked like.  Similarly outside of the scope of the paper is the question as to whether any other Christian healing institutions (e.g. that of St. Ephraem of Syria, which provided assistance in a plague in 375) might actually have qualified as a hospital, and been constructed prior to the Basiliad (see n.9 above).  Again, paucity of evidence makes this question challenging to answer.

***************************************

Christianity and the Rise of the Hospital in the Ancient World

 Source

Most of us are lucky enough to be within driving distance of a major hospital. It is often the case that we take our medical services for granted. In the Classical era, things were very different. Though the Greeks and Romans made many innovations, they failed to provide any public healthcare. The establishment of the first hospitals was a result of Christianity.

Hospitals Before the Coming of Christianity

Before the Roman Empire converted to Christianity, healthcare was left to the individual and the family. There had been some charitable hospitals in existence in Rome in the 1^st century BC, and even by the 1^st century AD  there were only private hospitals accessible to the rich.

However, there were many temples and sanctuaries to the Greek God of Healing, Asclepius. All over the Roman world there were shrines to the God, called Askleipions. Here sick people went if they needed to find relief from some illness or condition.

View of the Askleipion of Kos, the best preserved instance of a Greek Askleipion.

Many regard these as among the first hospitals because priests would often tend to the sick and comfort them in their illness. There were many facilities for the sick and many of the priests of Asclepius were renowned as healers.  Yet, only believers were allowed to enter these early medical facilities.

There was also the series of military hospitals set up by various Emperors. These were only designed for wounded and ill soldiers and did not provide treatment for the general population.

Christianity and Medicine

The Christian faith was very concerned with religious philanthropy.  That is, it was a creed that encouraged its followers to help those who were unfortunate and needy. It was part of a Christian’s duty to alleviate the sufferings of others. Jesus himself performs several miracles that involve healing, and St. Luke is reported as having been a physician in Antioch.

“Contribute to the needs of God’s people, and practice hospitality.” Romans 12:13

Quadrangle from the Monastery of Great Lavra. Luke the Evangelist. 15th century

In the first centuries of the Christian movement, followers of Jesus were occasionally driven underground and persecuted. The community came to depend on each other. Christians who were physicians would help their fellow believers in times of need. As churches were established some of them were used as informal hospitals. The Christians would often help others during epidemics such as the Antonine Plague.

“Each of us must consider his neighbour and think what is for his good and will build up the common life.” Romans 15:2

The Birth of the Hospital

After the Battle of the Milveian bridge, Christianity gradually became the state religion. This not only brought religious toleration for Christians but also a special status. Soon churches and cathedrals were springing up all over the Empire. They became the centre of communities and the sick often received treatment there.

The first hospitals were built in association with Christian basilicas. They were part of the Churches efforts to help the poor, which was a religious obligation. Local bishops were the driving forces behind these institutions.

Hôtel-Dieu de Paris c. 1500.

The comparatively well patients (on the right) were separated from the very ill (on the left).

There is no agreement on who built the first hospital, but it is claimed that Leontius of Antioch built one between the years 344 to 358. At around the same time, possibly with the support of the Emperor, a deacon was placed in charge of the hospitals in Constantinople. This would suggest that hospitals run by Christians had been established even earlier than the mid-4^th century AD.

These hospitals proved to be very popular with many, especially in urban areas. By the end of the 4^th century there were a vast number of hospitals run by Christians throughout the Empire, but primarily in the Eastern provinces (a reflection of the fact that these provinces were more Christianised and also wealthier). Saints such as Saint Sampson and Basil of Caesarea (Saint Basil the Great), both built hospitals in what is now modern Turkey.

What were these hospitals like?

The majority of these hospitals were staffed by clerics or Christian laypeople, who cared for the sick. Doctors were far and few between, but many were chief physicians. They were deeply influenced by Greek ideas on medicine and by medical thinkers such as Galen and Hippocrates. By modern standards these hospitals were basic and unsanitary.

These early Christian hospitals were mostly reserved for the poor and outsiders such as immigrants, and were concerned with helping the poor die with respect and dignity.  These facilities only offered basic care and succour because of the limited state of medicinal knowledge. Some were bigger, such as the one founded by St Basil of Caesarea. His foundation had an aged isolation unit, wards for sick travelers, and a leprosy house.

Hospitals after the Fall of Rome

After the Fall of the Western Roman Empire, the evolution of the hospital continued. In the West, monasteries provided basic health care to the poor and dying. However, in the Byzantine Empire, the successor state of the Roman Empire in the East, there was a large increase in the number of hospitals.

The Byzantine Emperors bestowed lavish sums on the Church, and this meant that extensive hospitals were built that offered in-patient care and had even departments for those with different afflictions and diseases. These Early Byzantine hospitals would go on to greatly influence the development of medical facilities in the Muslim world.

The word “hospital” has the ability to conjure up different feelings in different people, based on the experiences we’ve had. Yet, I think everyone can and should appreciate the long development of our idea of hospitals as a place where all people can go for care and to be healed.