Gary Ferngren, author of Medicine and Health Care in Early Christianity, is Professor of History at Oregon State University. He discusses the ways that Christians have practiced compassion toward the sick since the days of the Early Church. We explore these foundations for Christian health care in this interview.
John Shorb: Your book points out that healing was a part of the idea of Christian philanthropy but that healing was not necessarily, if I have your thesis correct, one of the major pillars of Christianity in the Early Church. I think a lot of people might think, and some scholars would say, that healing is an extraordinary feature of Christianity compared to other religions. In your book, I read a different take on that.
Gary Ferngren: Yes, it is a different take. It has been widely held that Christianity provided a religion of healing like many of the pagan religions of the time. Religion in the Graeco-Roman world had, as one of its chief functions, healing those who would come to a temple specifically for that purpose. In my book, I argued that Christianity was not a healing religion comparable, say, to the healing of Asclepius in the classical world. Christian healing was not stressed as something miraculous or supernatural. The Church basically accepted the same models of medicine accepted by everyone: pagans, Jews and Christians. They all employed doctors. They thought that most disease came by natural means and could be healed by natural means, i.e., medicine. But the real contribution of Christianity was in medical philanthropy, which was lacking in the pagan tradition.
By medical philanthropy, do you mean reaching out to those that had previously not had access to the system?
Yes, there was no system or ideology of philanthropy or charity in health care in the classical world, and by classical world I mean Greece and Rome. The idea that you should offer care to those who were sick or in need as a philanthropic outreach was simply lacking because classical society had no religious or philosophical basis for medical philanthropy. If you got sick in the ancient world, if you had a family to take care of you or some friends, it was done within that context. On the other hand, people who were homeless, who had no support group—and there were a lot of them in the large cities of the Roman Empire at the time Christianity arose—found themselves with no care at all. There were no hospitals or other public or private institutions that administered medical charity. This is where the Christian Church offered a novel contribution. It developed ideas of medical philanthropy which began in the local church and culminated in the creation of the hospital in the 4th century. It introduced something that the classical world very much lacked.
You mentioned the creation of hospitals in the 4th Century. How did they develop?
The first hospital was created about 370 A.D. We can date it almost exactly. But there was a history of medical care that led up to it. I trace three steps in its development.
First, the Early Church from the 1st century on had several orders of ministry, of which deacons were one. The Deacons were specifically intended to care for the social and physical needs of the Church, including those who were sick. They did this by offering not professional medical care, but palliative care to those within the congregation who were ill. This included not just the sick but the poor. The biblical formula is always “widows and orphans”—those who couldn’t look after themselves and had no support structure. They cared chiefly for those who were members of the congregation. And they did this on a regular basis. We know that in the middle of the 3rd century there were about 1,500 widows and distressed people, including the sick, the poor and orphans, in the city of Rome that were taken care of by the churches in Rome. That’s a substantial number. No program like it existed anywhere in the ancient world.
The second step came about because of a plague that broke out in major cities of the Roman Empire in the mid-third century. These plagues were spread in some instances by returning soldiers who brought back a plague from the East, but they affected many of the large cities in the Western Roman Empire, including Alexandria, Carthage and Rome. Large numbers of people died. In Rome, 5,000 people died every day. And there was no municipal assistance. The magistrates of the city had no program for burying the dead or for organizing any kind of acute care. Those ideas were foreign in the classical world. So the Christians undertook the care of the sick, which seemed to them a natural extension of the diaconal ministry to their own congregations.
The third step was the organization of the hospital in about 370. In a sense, the hospital grew out of the monastic movement. Monasteries had arisen in the eastern Mediterranean in the 3rd century, and they maintained philanthropic institutions in many cities. But the hospital was the vision of one man, Basil of Caesarea, who lived in what is today central Turkey. He organized what he called a “poor house,” where the sick poor were taken care of, and it was quite a remarkable institution in that the basileias, as they became known, maintained sections for orphans, for the elderly, for the poor, for lepers—Basil had a special concern for lepers. It was the first hospital in the world. From Caesarea, hospitals spread first throughout the eastern Mediterranean, then to western Europe. They were not large institutions. In some cases they housed just a few dozen patients. Where funds were available, physicians were maintained on staff. And some monks began to study medicine in order to become physicians in the hospitals. But many hospitals did not offer what we would regard as professional medical care. They did, however, offer palliative care.
The sick, especially the poor who had no place to go, could find shelter and at least be given basic treatment, in many cases until they died. These early hospitals had their origins in the Christian concept that human beings were created in the image of God (imago Dei), and hence were of infinite value.
What passages in the Bible were important for people who cared for the sick in the Early Church?
People in the Early Church saw several texts as key. One is Matthew 25 where Jesus says that he will divide the sheep from the goats and one thing he says in Matthew 25:38-40: “‘When was it that we saw you a stranger and welcomed you, or naked and gave you clothing? And when was it that we saw you sick or in prison and visited you?’ And the king will answer them, ‘Truly I tell you, just as you did it to one of the least of these who are members of my family, you did it to me.’” That was taken as a basic model for helping those who were sick and destitute. And probably the most prominent passage in that sense was the parable of the Good Samaritan, which was quoted often in the Early Church by Basil and others. The passage indicated that when people were in need, they were worthy of Christian care and concern.
What did this work look like on the ground? How was it organized?
The organization of medical care often in the 4th and 5th centuries came from bishops. Bishops had concern over the church in their particular dioceses. In the crowded cities of the Roman Empire, there were many destitute and homeless people on the streets and in the baths, where they would seek warmth and hygiene. During times of plague bishops or the monasteries would organize ad hoc care. They saw the need and, in the absence of public or private concern, they tried to fill it as quickly as they could.
There is another kind of care that I also mentioned in my book and it is one that is little noticed in histories of medical philanthropy. There existed a group of lay orders that worked out of the large Christian churches in the Eastern Roman Empire. In several large cities, such as Antioch, groups of lay people within the Church would go out into the streets and to the baths, where they could find the homeless sick, and bring them to churches and give them palliative care. These groups of Christians, called philoponoi or spoudaioi, operated for several centuries in the Byzantine Empire.
At the Church Health Center, our mission is to reclaim the Church’s biblical commitment to care for our bodies and our spirits. The Church has drifted from that commitment, and people are being neglected. So it’s our duty to reclaim this commitment. I’m wondering if Christianity ever really fulfilled that commitment to care for all bodies and spirits in the past.
I am impressed by the way in which Basil the Great, founder of the hospital movement, believed that the gospel called those Christians who had resources to provide for the care of the sick who had none. In the ancient world, the poor and the homeless were everywhere on the streets, because the homeless and the chronically ill were not segregated from ordinary life, as they are today. One saw them frequently in public places, yet the municipal authorities had no program of public relief. They often begged or hoped for some assistance from individuals. Early Christians like Basil took Jesus’ parable of the Good Samaritan as a summons to give aid to those in need of it. Medical philanthropy had its origins in early Christian beneficence before it spread to Muslim and Jewish faith communities. Most hospitals throughout history have been founded as Christian charitable organizations for the assistance of those who were in need. That ministry, to care for bodies and souls, is one that the Church today could well reclaim.