How the Church invented health care

The hospital arose as a Christian institution utterly dependent upon Christian principles.

The foremost expert on the early history of hospitals, Gary Ferngren, Ph.D., made the point most emphatically in his recent historical survey published by Johns Hopkins University. He wrote:

“The hospital was, in origin and conception, a distinctively Christian institution, rooted in Christian concepts of charity and philanthropy. There were no pre-Christian institutions in the ancient world that served the purpose that Christian hospitals were created to serve. … None of the provisions for health care in classical times … resembled hospitals as they developed in the late fourth century.”

It’s not that there was no one practicing medicine. What passed for the medical profession was a riot of different types of practitioner. Many took up some strain of the Hippocratic tradition, but others were herbalists, soothsayers, magicians, or folk healers.

There was no board to certify anyone. There were no medical schools to grant diplomas. Most professional healers simply underwent an apprenticeship with someone more experienced.

Many practitioners made their living by wandering from town to town, perhaps outrunning the public response to their latest failures. Some made their way across continents this way.

From the wisecracks we find in the Bible and other ancient literature, it seems that sick people understood that it was a risky proposition to seek healing. Medicine in the first centuries A.D. was an uncertain and unstable business.

Why? Well, the wandering “medici” (“doctors”) had no roots, no local loyalties, no lasting accountability. They had no institutional form because there was no institutional form available to them.

The Greeks and Romans had temples of Asclepius, where sick people went to pray and offer sacrifice in hope of a cure. Treatment in such places was usually based on the interpretation of dreams dreamt by the sick during a time of incubation in the sanctuary.

While the Asclepian temples may have provided some occasional relief, they were not hospitals. They kept no long-term patients. They offered no extended program of treatment on site.

The nearest approximation of a hospital in classical antiquity was the “valetudinarium” (“hospital”), which was essentially a repair shop for soldiers or slaves.

Both soldiers and slaves represented huge investments for their overseers. Their value was expected to last years and even decades. And so the ancients established places where their human property could be restored to productivity.

As far as we know, the Romans never entertained the idea of providing “valetudinaria” for the wider population. It’s difficult to see how they could have made one profitable or even sustainable.

And yet there was great demand for medical care. Pain, sickness, and discomfort are characteristic of the human condition since the fall of Adam and Eve. And those who suffered went looking, sometimes desperately, for relief.

Such was the world into which the Christ was born. And it was to heal that world that he came.

When asked to verify his own mission, Jesus presented physical cures as evidence: “The blind receive their sight and the lame walk, lepers are cleansed and the deaf hear, and the dead are raised up, and the poor have good news preached to them” (Matthew 11:5).

Healing, then, was an essential part of Jesus’ ministry. It wasn’t something ornamental. In addition to the ailments he mentioned, Jesus also cured dropsy, paralysis, palsy, and hemorrhage.

He cured not only Jews, but also Samaritans, pagan Syro-Phoenicians, and even the occupying Romans.

His cures were unmistakably physical. But John the Evangelist tells us they were “signs” — that is, they stood for something else, something greater. They were signs of a deeper healing — the healing of a wound in the fabric of creation.

Yet they were nonetheless real and true. The blind really did receive their sight. The lame really did walk. And lepers really were cleansed. Neither Jesus nor his disciples would have offered these cures as evidence if they could be easily dismissed and denied.

These cures were, moreover, performed not only by Jesus, but also by his followers, his disciples. In fact, Jesus commanded his disciples to share in his healing ministry. He issued what I like to call “the healing imperative.”

As he sent the 72 out on their first mission, Jesus instructed them to “heal the sick … and say to them, ‘The kingdom of God has come near to you’ ” (Luke 10:9).

Note well that the command to heal precedes the command to proclaim the kingdom. It’s as if physical healing is a necessary step of pre-evangelization. Or perhaps Jesus intended that the kingdom should manifest itself first through deeds of healing, and then simply be confirmed by the disciples’ words of proclamation.

The disciples were faithful to Jesus’ command. They marveled at their success as they returned from that first mission. And that was only the beginning. The book following the Gospels, the Acts of the Apostles — the first history of the early Church — begins by recounting miraculous cures effected by Peter and John.

Paul, in turn, takes up the healing mission of Jesus. On the island of Malta, he heals a man who “lay sick with fever and dysentery” And then, predictably, “the rest of the people on the island who had diseases also came and were cured” (Acts 28:8–9).

The apostles, like Jesus before them, were known for their healing as much as their preaching. They were faithful to the command of Jesus — and the model of Jesus.

Throughout the writings of the early Christians, there is an emphasis on Jesus as a healer. St. Ignatius of Antioch, writing in A.D. 107, spoke of the Lord as a physician.

The early historian Eusebius described Jesus’ ministry with lines taken directly from the pagan physician Hippocrates. He wrote: “A devoted physician, to save the lives of the sick, sees the horrible danger yet touches the infected place, and in treating another man’s troubles brings suffering on himself.”

Christians instinctively responded to Jesus’ healing imperative by dedicating themselves to the practice of medicine. St. Justin Martyr in the second century and Origen in the third both testify that many of their co-religionists were medical doctors.

The historian Ferngren, citing archeology and documentary evidence, concludes that “no other professional group comes close to the number of physicians” in the early Church.

From this we might conclude that doctors were, more than any other professional group, drawn to Christianity. Or perhaps Christians were drawn to medical practice more than to any other kind of work. In any case, the statistics suggest much about the compatibility and similarity between the life of grace and a doctor’s life of service.

There was, however, no distinctively Christian way of doing medicine. Christian practice reflected the variety of methods and theories available at the time. Christians tended to favor the Hippocratic and empirical traditions, which kept the believing doctors at a safe distance from pagan superstitions. Christians in medicine were distinguished only by what they refused to do. The early Christian doctors — like their modern counterparts — took no part in abortion, assisted suicide, cosmetic castration, and infanticide. Nor did they prescribe contraceptive drugs.

They also refused to turn patients away. Because Christian physicians, like Christians generally, believed themselves to be bound by a second imperative. They found in the New Testament a command — and a corresponding duty — to practice unrestricted hospitality.

St. Peter urged his flock: “Practice hospitality ungrudgingly” (1 Peter 4:9). But the most famous formula is this: “Do not neglect to show hospitality to strangers, for thereby some have entertained angels unawares” (Hebrews 13:2).

This second imperative inspired Christian physicians to care not only for their own tribe, but also for “strangers” — and even for their persecutors.

It was, in fact, during the first large-scale Roman persecution that the earliest ancestor of the hospital emerged.

Smallpox devastated the major cities of the empire in the year A.D. 250. At its most deadly phase, it killed thousands of people per day in Rome alone. And it raged intermittently for at least 20 years, claiming the lives of emperors as well as nameless multitudes.

Today we know this pandemic as the Plague of Cyprian, because of the African bishop whose letters describe it most extensively for us.

The disease was a matter of great concern for Cyprian. It was important not only because it was killing Christians — but also because the Roman authorities were blaming the Christians for the spread of the disease. The pagan rulers believed plague had come because the Christians were refusing to offer sacrifice to the old gods.

So the Romans decided to force the issue. They began to demand sacrifice from everyone, and execute those who refused.

Yet, amid this simultaneous epidemic and persecution, the Church inaugurated the first “broad extension” of its medical mission.

Cyprian exhorted his congregation, saying, “There is nothing remarkable in cherishing merely our own people,” he said. “… [We] should love our enemies as well … the good [should be] done to all, not merely to the household of faith.”

So, in the midst of plague, the Christians served even their neighbors who were most un-neighborly. Christian doctors treated not only their co-religionists, but also their pagan persecutors.

This was not a local phenomenon. We possess similar testimonies from Alexandria, Egypt, and elsewhere. The sociologist Rodney Stark noted that the Catholic Church grew at a steady rate of 40 percent per decade during this period, and he believes it was at least partly due to this unprecedented public witness of charity.

The pattern emerged still more clearly in the following century during the epidemic of A.D. 312. By then, the Christians were numerous in every major city, so their efforts were more effective, extensive, and visible.

Eusebius, who was an eyewitness, reports that Christians “rounded up the huge numbers who had been reduced to scarecrows all over the city and distributed loaves to them all.”

Ferngren states most emphatically that, “The only care of the sick and dying during the epidemic of 312-13 was provided by Christian churches.”

It was in the fourth century — as Christians assumed a clear majority in the urban areas — that the institution of the hospital took on a more concrete form.

During a famine in Syria, St. Ephrem the Deacon commandeered public porticoes to set up a 300-bed facility for the treatment of the ill. In A.D. 324, in Egypt, Pachomius established an infirmary in the vast monastery he had founded. In the vicinity of Rome, facilities were founded by Fabiola and Pammachius.

It is interesting to note that many of the hospitals established in the fourth and fifth centuries were founded by women. You will search in vain to find women making similar contributions to the advancement of pagan societies.

Roman and Greek religion offered women no analogous opportunities, no comparable sense of vocational freedom, philanthropic charity, or basic human equality.

With the legalization of Christianity in A.D. 313, hospitals emerged almost immediately as standard features of any city worthy of the title.

The greatest of all was certainly the complex built by St. Basil in Pontian Caesarea. It was so vast that the locals referred to it as “The New City,” and one contemporary observer compared it to the Seven Wonders of the World.

Basil’s Catholic charities included not only a hospital, but also a soup kitchen, poorhouses, a trade school, a hostel for needy travelers, personal care for the elderly, and a hospice for the dying. The staff dispensed food and medical care to all who approached, regardless of their religious affiliation.

What Basil established as something unusual soon became common and essential throughout the Roman world. It was the most visible and concrete manifestation of Christian hospitality, and so, in time, it came to be called a hospital.

Because of their stability, these places became de facto research institutions. For the first time in history, a group of medical professionals were working together, observing various treatments applied to a large number of patients, and then judging their effectiveness. This was a necessary precondition of medical progress.

By the end of the fourth century, most hospitals included some forms of ambulance, paramedic, and pharmaceutical services as well.

How did the hospital happen? No emperor mandated it. No law required it.

Pagan antiquity previously had all the material ingredients for such an institution. The Greeks and Romans had doctors. They had “valetudinaria,” the repair shops for slaves and soldiers. There was ample demand for medical treatment.

And yet neither the Greeks nor the Romans — nor the Chaldeans, nor the Egyptians, nor the Babylonians, nor the Assyrians — ever produced a hospital.

They had the material resources, but they lacked the spiritual resources. They lacked a belief in charity — self-giving love — as a share in the life of God. They lacked the belief in human dignity and universal brotherhood. They were ignorant of the divine command to heal and show hospitality to friends and strangers alike, and even to enemies.

The hospital did not happen in a pre-Christian world. We should wonder, then, whether it can survive long in a post-Christian world.