The World’s First Hospital

CATHEDRAL NEWSLETTER - 15 May 2025

Basil the Great. Mosaic, Kiev Hagia Sophia, XI century,

courtesy Wikipedia

Brothers and sisters in Christ, last year, I reflected on the home affordability crisis, and shared an initial theology of housing.

Recently, I have been looking at Christian involvement in addressing homelessness through history. Today I thought I'd share the story of what might have been the world's first hospital, which was a lot more than a hospital, where Christians were at the forefront...

A 4th century case study: Basil the Great’s hospital and poor house

Basil the Great came from a wealthy Christian family, and took a lead in fourth century theology, notably defending the Trinity. He was also an organiser of monastic communities in his native Cappadocia (in modern day Turkey). Shortly after becoming Bishop of Caesarea in 370 A.D., famously, he founded the first hospital in history (at least for which any significant evidence survives). It was known as the Basileaias.

There had been modest Christian guesthouses and soup kitchens earlier in the fourth century in overpopulated city centres in the eastern Mediterranean.

But Basil chose a larger tract of land on the outskirts of Caesarea, partly donated, it seems, by the emperor Valens. The architecture and scope of the Basileaias was extensive, oriented far more significantly in a medical direction.

Its charitable services included outstanding hospital facilities for the sick, a hospice for lepers, a poorhouse for the indigent and elderly, a refuge for abandoned orphans, and a hostel for travellers and the homeless. There was an affiliated monastery and church attached in the precinct.

Basil’s hospital was founded primarily to serve the local poor and destitute (not just the ‘lower class’) whether by feeding, housing or curing them. Basil has himself trained in Hippocratic and Galenic medicine as a young man, and employed professional doctors and nurses, alongside monastics for whom hospital service was one of their standard duties.

In an era where ancient physicians usually rejected chronic and hopeless cases, his leprosarium on site was considered a crowning achievement by his friend, Gregory of Nazianzus. Basil himself served in the leper colony, as an example of treating such sufferers with dignity, and helped destigmatise illness more broadly.

The orphanage section also included children ‘donated’ by families to the monastery for education. The orphans and others children were housed in their own separate wing, provided with all the necessities of life, educated (included in manual crafts so they could make a living when older), and trained in godliness. It appears manual labour was not required of them and discipline was fairly light.

But the concern for hospitality also extended to housing and care of strangers, travellers without shelter on the road, and displaced refugees (for example rural poor hoping for better in the city). There was, of course, no state aid or welfare for any of these people.

Overall, Gregory of Nazianzus praised Basil’s hospital and poor house complex as a wonder greater than the pyramids!

Warmly in Christ,

Sandy Grant
Dean of Sydney

[Reference: From Monastery to Hospital: Christian Monasticism & the Transformation of Health Care in Late Antiquity by Andrew T. Crislip (University of Michigan Press, Ann Arbor) - thanks to John Dickson for the pointer!]