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Following the Footsteps of the Great Physician: Healthcare in the Early Church

Mark’s Gospel records an account of a woman “who had been suffering from hemorrhages for twelve years. She had endured much under many physicians, and had spent all that she had; and she was no better, but rather grew worse” (Mark 5.25-26 NRSV). When she heard about Jesus, however, she pressed through the crowds – “if I just touch his clothes, I will be healed” (Mark 5.28). She was right. The bleeding stopped the instant she touched his cloak and she was delivered from all her suffering.

This woman’s experience under many physicians was common in the ancient world. One of the enduring legacies of the early Church was its reformation of both the delivery of health care and the prevailing popular views of sickness and wellness. The following article outlines the story of this reformation in ancient health care. After a brief overview of health care in the ancient world, I consider three episodes in the development of early Christian health care: 1: the Christian response to the plagues of the third century; 2: the organization and delivery of monastic health care in the fourth century; and 3: the construction of the first hospital, which was part of Basil the Great’s Basileiados, a multifaceted institution that provided medical, social, and educational services.

Health Care in the Ancient World

The family or household was the primary locus of health care in the ancient world.[1] In general, people were not well. Ignorance of basic hygiene meant that people frequently suffered from diarrhoea, dysentery, cholera, gastroenteritis, hepatitis, leptospirosis, and typhoid.[2] Family health care typically took the form of caring, rather than curing. Family members bathed, fed, dressed, and comforted those who were sick in the household.

Outside of family care, there were physicians in antiquity; however, they were not licensed and many so-called physicians were quacks. Even those with medical training practiced with mixed motives. As the second-century physician Galen described the doctors of his day, “some practice the medical art for monetary gain, some because of exemptions granted them by the laws, some from love of their fellow men (dia philanthropian), others again for the fame and honour that attend the profession” (De plac. Hip. et Plat. 9.5.4). [3] Doctors rarely practiced because of philanthropia, love for humanity. Fame and money were the primary motivations, and a doctor’s reputation and income depended on the success of his treatment, which meant he was reluctant to treat severe or chronic illness.

The social stigmatization of sickness is another aspect of ancient health care. Sickness was seen as a consequence of moral weakness. Good health was a mark of both moral virtue and religious piety; sickness was a mark of moral failure and impiety. As the ancients saw it, the peace and stability of the polis depended on the virtue and piety of its citizens. Cicero believed that the success and advance of the Roman Empire was sustained by the piety of the Romans.[4] As long as the Romans maintained their piety, the gods would continue to bless the Empire. Sickness was evidence of impiety, which threatened the peace and stability of the Empire. Thus, people who were severely or chronically ill were stigmatized and ostracized, for the sake of public piety and divine favour.

Given the centrality of the family and the unreliability of physicians, a person without family support, such as a widow, orphan or refugee, was in a desperate situation. The only other options were patronage and philanthropy; however, both the patronage system and ancient philanthropy were a means to social prestige and political advantage. Benevolence to the poor and destitute did not serve these ends. The poor and destitute had little recourse to social aid outside the family. [5] Add to this the social and religious stigmatization of sickness and it becomes clear why the poor and destitute had no access to health care in the ancient world.

The Christian Response to the Plague of Cyprian

The early Christian view of sickness and delivery of health care is illustrated by the Christian response to the Plague of Cyprian in AD 250. This pandemic, which is named after a contemporary bishop of Carthage in North Africa, spread across the Roman Empire and lasted two decades. According to Cyprian’s description, the symptoms included diarrhoea, vomiting, infectious sores in the mouth and eyes, and gangrene of the limbs. [6] The disease was often fatal and many who survived were left crippled, deaf, or blind. While most people abandoned the sick and fled Carthage, Cyprian exhorted Christians to stay and care for victims of the plague, whether fellow Christians or pagans. Cyprian urged the Christians to practice the mercy of Christ by turning the attention of their charity to pagans. [7]

Dionysius, bishop of Alexandria in Egypt, provides another contemporary account of the plague:

Most of our brother-Christians showed unbounded love and loyalty, never sparing themselves and thinking only of one another. Heedless of the danger, they took charge of the sick, attending to their every need and ministering to them in Christ, and with them departed this life serenely happy; for they were infected by others with the disease, drawing on themselves the sickness of their neighbours and cheerfully accepting their pains … The heathens behaved in the very opposite way. At the first onset of the disease, they pushed the sufferers away and fled from their loved ones, throwing them into the roads before they were dead and treating the unburied corpses as dirt. [8]

Dionysius’ account is corroborated by Eusebius’ account of the Christian response to a plague that broke out in AD 312-313:

Alone in the midst of this terrible calamity [the Christians] proved by visible deeds their sympathy and humanity. All day long some continued without rest to tend the dying and bury them; others rounded up the huge number reduced to scarecrows all over the city and distributed loaves to them all, so their praises were sung on every side, and all men glorified the God of the Christians and confessed that they alone were pious and truly religious: did not their actions speak for themselves? (Hist. ecc. 9.8) [9]

The Christian response to the pandemics of the third century was not ad hoc or haphazard. For two hundred years, the church had organized and institutionalized ministry to the poor, the destitute, and the sick. Ambulatory health care was a part of the church’s diaconal ministry. When the plague struck in AD 250, Christians were not only willing to care for the sick, they had organized and trained personnel ready to deliver such care. [10]

Monastic Health Care

The fourth century is one of the most important centuries in church history for two reasons: (1) the distillation and articulation of doctrine and (2) the rise of monasticism. While most monks lived in the desert, some lived in solitude (anchorites), and others lived in community (coenobites). Coenobitic monks lived in monasteries and their communal life was ordered by a set of rules (e.g., Benedict’s Rule). Health care was regulated by monastic rule and provided within the monastery. In fact, most monasteries had an infirmary where monks had access to health care, which, by ancient standards, was second-to-none.

Monasteries had a medical staff, administration, and facilities that provided both inpatient and outpatient care. In terms of personnel, the monasteries were staffed with doctors, nurses, porters, elders, stewards, and lay caregivers. [11] Many monastic doctors were doctors who had renounced their life in the world and entered the monastery. They offered a broad range of medical treatments, from various therapies to the prescription of pharmaceuticals, and even complicated surgery. Prior to the monastery in the fourth century, there were no nurses and no nursing practice in the ancient world. [12] Monastic nurses were charged with feeding, bathing, and providing palliative care for their patients. According to Augustine’s Monastic Rule: “The care of the sick (aegrotantium cura) – whether they are convalescent or suffering from any bodily weakness even if there is no fever – should be entrusted to a particular person so that he may obtain from the storeroom what he sees each one needs” (Reg. 3, 5.8). [13] Whereas the diet of a healthy monk normally comprised bread and water, sick monks were treated to a full menu of comfort foods, such as fresh bread, wine, meat, eggs, anchovies with oil and salt, charlock with oil and salt, raw and cooked vegetables, gruel, various cheeses, honey, stewed plums, and pastries. [14] Elders and stewards served as triage officers, who discerned (diakrisis) what kind of care an ailing monk required. Because the infirmary provided food and comfort otherwise forbidden to monks, elders and stewards had to discern whether a monk was faking an ailment. Thus, the stewards and elders discerned whether the cause of a monk’s malady was physical or spiritual. Penance may be the required remedy. [15]

Monastic health care integrated both spiritual and medical treatment. Basil the Great, bishop of Caesarea (in Cappadocia, modern-day Turkey), represents the early Christian view of medicine when he writes in his Long Rules: “the medical art was given to us by God to relieve the sick” (Reg. fus. 55). [16] Basil argues that the practice of medicine should not be rejected because it is abused by some doctors; rather, he calls on Christians to show the benefits of medicine by its proper use. Even so, he warns against putting the hope of one’s health in the hands of doctors: “we should neither repudiate this art altogether nor does it behoove us to repose all our confidence in it; but, just as in practicing the art of agriculture we pray God for the fruit, and just as we entrust the helm to the pilot in the art of navigation, but implore God that we may end our voyage unharmed by the perils of the sea, so also, when reason allows, we call in the doctor, but we do not leave off hoping in God” (Reg. fus. 55). [17] Medical treatment cannot substitute hope for healing from the Great Physician.

As for spiritual treatment, a whole repertoire of spiritual remedies was tried: prayer, exorcism, laying on of hands, application of holy water and oil, and the sign of the cross. The best physicians were not necessarily those who had medical training. As Athanasius reports in his biography of Antony (one of the early monks): “through him the Lord healed many of those present who suffered from bodily ailments; others he purged of demons, and to Antony he gave grace of speech. Thus he consoled many who mourned, and others hostile to each other he reconciled in friendship, urging everyone to prefer nothing in the world above the love of Christ” (V. Ant. 14). [18] Athanasius explains that God worked through Antony because “the state of his soul was one of purity” (V. Ant. 14). In other words, he prepared for his healing ministry by training in holiness, rather than medicine.

Intercessory prayer was an important part of monastic health care. Again, Athanasius writes concerning Antony: “frequently the Lord heard the prayers he offered on behalf of many people. And Antony was neither boastful when he was heeded, nor disgruntled when he was not; rather, he gave thanks to the Lord always. He encouraged those who suffered to have patience and to know that healing belonged neither to him nor to men at all, but only to God who acts whenever he wishes and for whomever he wills” (V. Ant. 56). [19] The monastic approach to health care integrated both spiritual and medical treatments for sickness. The possibility of miraculous cure did not dissuade monks from learning and applying medical remedies, and the availability of medical remedies did not deter them from praying for divine healing.

Basil the Great and the Basileiados in Caesarea

No one contributed more to the institutionalization of early Christian health care than Basil of Caesarea. The church has bestowed on Basil the epithet magnus (“the Great”), in large part for the significant contribution he made to the theological, ethical, and liturgical life of the church. Shortly after his installation as bishop of Caesarea in AD 370, Basil began work on a network of buildings which came to be known as the Basileiados. Gregory of Nazianzus, Basil’s close friend, called the Basileiados a “new city,” which was more admirable and wonderful than anything else constructed in the ancient world, including the Gates of Thebes, the walls of Babylon, the Pyramids, and the statue of Colossus. [20]

The Basileiados provided facilities and staff to serve the needs of the poor and homeless, strangers and refugees, the elderly and infirm, orphans, and the sick. [21] Doctors and nurses treated the sick and provided palliative care for the elderly and infirm, and teachers educated the orphans; however, it was the ministry to lepers that stood out for Gregory of Nazianzus. He describes the lepers who came to the Basileiados as a “terrible and piteous spectacle of men who are living corpses, whose limbs have died, who were driven away from their cities and homes and public places and fountains, and even from their own loved ones” (Or. 43.63). [22] Basil exhorted Christians not to despise lepers. Despite his own noble ancestry and reputation, he greeted them as brothers and personally bathed and cared for them. Basil’s care for lepers set an example for others:

The effect produced is seen not only in the city, but in the country and beyond. Even the leaders of society have vied with one another in their philanthropy and magnanimity towards [the lepers]. Others have had their cooks, splendid tables, dainties from confectioners, 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. (Or. 43.63) [23]

Gregory’s eulogy for Basil reveals something about the broader impact of early Christian health care: the destigmatization of sickness. The Basileiados not only provided health care, welfare, and education to the poor and destitute, it proved that Christian philanthropia, after three hundred years of charitable service, had changed the popular perception and assumptions of sickness. Even lepers were no longer stigmatized and ostracized, but welcomed and treated as brothers and sisters in Christ.

The success of Basil’s Basileiados depended upon two main resources: monks and money. It was primarily staffed by monks, many of whom, like Basil, had renounced the luxuries of fine cuisine, exquisite carriages, and soft, flowing robes. Gregory of Nazianzus described the Basileiados as “the storehouse of piety, the common treasury of the wealthy, in which the superfluities of their wealth, and even their necessities, are stored, in consequence of [Basil’s] exhortations, freed from the power of the moth, no longer gladdening the eyes of the thief, and escaping both the emulation of envy and the corruption of time” (Or. 43.63). [24] The Basileiados provided free health care, because Basil did not flinch at exhorting the wealthy to generous giving. His extant sermons reveal that he frequently called on them to invest their money in heaven’s treasury, rather than earthly pleasures. [25]

Conclusion

I suspect many readers were not aware of the impact Christianity had on the history of medicine and health care. Before the advance of Christianity, chronic or severe illness was viewed with suspicion and many people shared the experience of the woman in the Gospel account. After spending all their money on physicians, their condition had only worsened. Those without family care had little recourse to health care. The church, however, acted as a surrogate family, which cared for both its own members and those outside the family. It also reformed and regulated the delivery of health care. Visitors to a monastery or the Basileiados received reliable medical treatment. Finally, early Christian delivery of health care integrated both medical and spiritual treatment. Training in medicine also required training in holiness. The early Christian approach to health care called for a diagnosis of body and soul, and prescribed both pharmaceuticals and penance.


[1] Latin: familia, domus; Greek: oikos. The family included biological kin, adopted kin, servants, slaves, apprentices, employees, and boarders. Andrew T. Crislip, “The Monastic Health Care System and the Development of the Hospital in Late Antiquity,” Ph.D. diss. (New Haven, CT: Yale University, 2002), 69; Suzanne Dixon, The Roman Family (Baltimore: Johns Hopkins University Press, 1992), 30.

[2] Gary B. Ferngren, Medicine & Health Care in Early Christianity (Baltimore: John Hopkins University Press, 2009), 116.

[3] Greek text and English translation: On the Doctrines of Hippocrates and Plato (Books VI-IX), ed. and trans. Philipp de Lacy, Corpus Medicorum Graecorum, Bd. V 4, 1, 2 (Berlin: Akademie-Verlag, 2005), 564, 565. Cf. Helen King, “Using the Past: Nursing and the Medical Profession in Ancient Greece,” in Anthropology and Nursing, ed. Pat Holden and Jenny Littlewood (London: Routledge, 1991), 7–24; Ferngren, Medicine & Health Care in Early Christianity, 87–95.

[4] Cicero, De haruspicum responsis 9.19 (Concerning the Response of the Soothsayers 9.19). Bildad the Shuhite represents the pagan view of illness in his response to Job’s suffering (Job 8.1-10).

[5] Ferngren, Medicine & Health Care in Early Christianity, 87.

[6] De mortalitate 14 (On Mortality).

[7] Pontius of Carthage, Vita Cyprianii 9 (Life of Cyprian).

[8] Dionysius’ account given in a letter preserved by Eusebius, Hist. ecc. 7.22 (The History of the Church, trans. G.A. Williamson [London: Penguin, 1989], 237).

[9] The History of the Church, 291.

[10] Ferngren, Medicine & Health Care in Early Christianity, 113–23.

[11] Crislip, The Monastic Health Care System, 25–34.

[12] King, Using the Past: Nursing and the Medical Profession in Ancient Greece, 23.

[13] The Monastic Rules, trans. Agatha Mary and Gerald Bonner (Hyde Park, NY: New City Press, 2004), 119. On the treatment of the sick in other monastic rules, see Pachomius, Praecepta 40-47 (Pachomian Chronicles and Rules, vol. 2 of Pachomian Koinonia, trans. Armand Veilleux [Kalamazoo, Michigan: Cistercian Publications, 1981]) and Basil of Caesarea, Longer Rules (Regulae fusius) 19, 55 and Shorter Rules (Regulae brevior) 155 (The Ascetic Works of Saint Basil, trans. W.K.L. Clarke [London: SPCK, 1925]).

[14] Crislip, “The Monastic Health Care System,” 48–50.

[15] See Basil of Caesarea, Long Rules (Reg. fus.) 55; idem., Shorter Rules (Reg. brev.) 155; cf. The First Greek Life of Pachomius (V. Pach. G1) 52.

[16] Saint Basil: Ascetical Works, ed. and trans. M. Monica Wagner, Fathers of the Church, no.9 (New York: Catholic University of America Press, 1950), 331.

[17] Ibid., 336.

[18] The Life of Antony and the Letter to Marcellinus, trans. Robert C. Gregg, The Classics of Western Spirituality (New York: Paulist Press, 1980), 42.

[19] Ibid., 73.

[20] Oratio 43.63. Oration 43 is a funeral oration for Basil.

[21] Basil, Epp. 94, 150, 174; Gregory of Nazianzus, Or. 43.63; Theodoret, Hist. ecc. 4.16; Sozomon, Hist. ecc. 3.16.

[22] English translation (slightly altered) by Charles Gordon Brown and James Edward Swallow (NPNF2, vol. 7: http://www.ccel.org/ccel/schaff/npnf207.iii.xxvi.html).

[23] Ibid.

[24] Ibid.

[25] See, for example, his sermon In divites (To the Rich).