2024 has been proclaimed as the Romanian Orthodox Church’s homage year for the pastoral care of the sick and the commemoration of all the silverless healing saints. To contemporary eyes, this might seem rather strange, since the divorce between science and theology, in this case medical science, is paradigmatic, and the whole question of organized care, so to call it, is the domain of specialized secular medical-social care. But very few people know that the history of organized care, finally concern for the poor, orphans, strangers or the sick, was until recently the prerogative of the church.
Thus, the first testimonies we have are a series of convents and hospitals built in the Middle Ages around monasteries. At Vodița or Smirdeni, Cozia, Dintr-un Lemn Monastery, Sadova or Hurezi, such establishments were organized, especially for the sick poor and the elderly, between the 14th and 17th centuries. In Moldavia, between the 15th and 20th centuries, there were hospitals and hospices in Putna, Neamț, Pătrăuți, Agapia or Dragomirna, Galata or Golia[3].
There is no need to go into details, for example, the Smirdeni’s sickbay already existed with the name of St. Medru together with a xenodochiu for travelers, when Iachint, the first metropolitan of Wallachia (1359), moved his residence to Arges. In the xenodochiu, accommodation and medical assistance was offered especially to travelers. Nicolae Vătămanu cites a deed of gift issued by Vladislav II on July 24, 1542 to the Smirdeni monastery, which attests the presence of the monastery before the old metropolis of Arges [5].
The first hospital in Wallachia is established by Vladislav in 1523 near the Curtea de Argeș Monastery. In Moldavia, Metropolitan Anastasie established two hospitals, one in Dragormina, called “bisericuța bolniță” (1602) and another in Suceava (1619-20)[7].
Finally, closer to us, the Cantacuzino family set up the Colțea hospital at the beginning of the 18th century, Grigorie Ghica II erected the Pantelimon monastery and hospital in 1735, Constantin Mihai Cehan Racoviță founded the St. Spiridon hospital in Iași in 1757, and between 1814-15, the foundations of the Filantropia hospital were laid, all of which, as Ligia Livadă-Cadeschi comments, responded to the biblical commandment of love of neighbor (p.239).[4]
This tradition of organized care was not born out of nowhere. It has a history that goes all the way back to the Church Fathers. Thus, an example of philanthropy is the collection organized by St. Cyprian in 235, when Numibia is attacked by barbarians and many of its inhabitants are taken as slaves. During a famine, St. Pahomias the Great (276-349) distributed the monastery’s wheat to the people[3].
Probably the best known example is the complex of buildings for the care of the poor, strangers and the sick called the Vasiliada, unusual in its scale, diversity of activities and the personnel involved, for the time[3].
St. John Chrysostom also speaks of how organized care functioned in Antioch around 390. Thus, some 3,000 people were supported daily by the church, not to mention the help the church offered to the imprisoned, the sick, the poor, the stranger or the infirm. It is interesting that if only the rich (i.e. about 10% of the population, according to St. Chrysostom’s calculation) were to distribute bread and clothing to the poor (i.e. 10% of the population), there would be no poor in the city, he says[3].
The theology of this morality of caring is undoubtedly biblical in essence, starting from the figure of the poor as a divine protégé in the Old Testament (Jer. 22:21-22; Deut. 15, 7-11; 24, 12-22; 1 Kings 2, 7; Ps. 10, 4; 34, 9; 39, 23; 40, 1; 139, 12, etc.), to become an image of Christ in the New Testament (Matt. 25, 34-40; 2 Cor. 8, 9). “As long as the poor explicitly benefit explicitly from divine protection – comments Prof. Ligia Livadă-Cadeschi – and their mere presence perpetuates the image of the Son of Man on earth […], man’s duty to do justice to them is virtually unlimited” (p.141).[4].
Peter Brown explains, in a series of lectures devoted to the poor and charity, that in the Greco-Roman world, which was divided between the rich and the poor, between those who occupied themselves with philosophical speculation and religion enjoying the charmed world, and the others, who occupied themselves with daily toil (gr. ponos, i.e. drudgery, the curse of labor, etc.),Christianity will break this system of frozen mutual obligations with the notion of “treasure in heaven”:”if you wish to be perfect, go, sell your possessions, give them to the poor, and you will have treasure in heaven; after that come and follow me” (Mt. 19:21). Thus, with this possibility of transferring wealth from earth to heaven – something incomprehensible to pagans like Porphyr, Celsius, Lucian, etc., who saw in this nothing more than a strategy to deprive the rich of their money, which they saw as being thrown into a social abyss, Christianity unites rich and poor, earth and heaven, gold and God, these two incommensurables in the act of charity (almsgiving), transforming the poor from a marginal, inevitably destined to toil daily, into a link between the two worlds. [6]
With the commercial revolution, he says, the modern age will separate the realm of commercial transactions from the realm of religious relations with heaven to the point where it will become impossible to imagine a mechanism by which the two realms can be brought together[6].
How this morality of care will be articulated by the church in the Greco-Roman world is the overarching concern of the Fathers and, for this reason, one of the central novelties of Christianity.
Daniel Caner has shown very well that, with the entry on the scene of the Church in the 4th century, the presence of the poor becomes a public issue, until then almost non-existent in the Greco-Roman world. The poor thus became a living witness both to Adamic sin, understood as greed or hoarding (gr. pleonexia), and to social injustice, i.e. the way in which this wealth is acquired (robbery, deceit, etc.), dividing the world into rich and poor. With the so called “stewardship theory”, the church will challenge the early Byzantine world to translate the divine economy (oikonomia), based on God’s love for mankind, into the human economy. If creation belongs to God, then man is but a mere steward, temporarily placed over his goods[2].
The New Testament, moreover, accompanies this attitude with a series of parables, for example, the parable of the unjust steward or the parable of the man who planted a vine (Lk. 16:1-13; Mt. 21:33-46), presenting man in the position of a steward or worker who disobeys his master by the way he manages things.
By putting the issue in this key, the church paved the way for organized care in the late Greco-Roman world, making it the concern not just of private individuals or NGOs, but of the whole of society, beginning with the emperor. The tradition of danios and endowments by later rulers in Romanian countries, of erecting establishments around monasteries etc., themselves conceiving of themselves as basilicas, echoes these achievements in the Byzantine world.
In short, the road to today’s modern medical systems comes from here. To present them as an achievement of modernity, to which we only became partakers with the entry of the collective West into the saddle in the 19th century and the gradual removal of the church from the picture (who today associates hospitals and health care with the church?), with possibly only primitive and totally inefficient forms of care surviving until now, is naive and obviously untrue.
An excellent summary is given in The Oxford Dictionary of Byzantium[1]:
“Philanthropy (φιλανθρωπία, ‘love of people’) was regarded as an essential divine attribute, which every good Christian was obliged to imitate by serving Christ in the person of the poor, the sick, the aged, the homeless, and the imprisoned. Philanthropy, which embodies the quality of elemosyne (mercy or almsgiving), was thus one of the major virtues expected of saints and kings, the supreme ‘imitators of Christ’. Emperors took every opportunity to characterize and justify their legislation as philanthropic.
The most striking manifestation of philanthropy in Byzantine society was the systematic public provision of social care and hospitalization through a variety of specialized institutions: the hospital (xenon, or, less frequently, nosokomeion), the hospice (xenodocheion), the old people’s home (gerokomeion), the poorhouse (ptochotropheion), the orphanage (orphanotropheion), and the ecclesiastical care center (diakonia). These institutions, like philanthropy itself, had pre-Christian precedents, but were essentially the product of the establishment of Christianity in the 4th-5th centuries and represented a transformation of the model of public benevolence (euergesia) from the ancient ethos of ‘bread and circuses’ to one that emphasized the spiritual salvation of both the giver and the recipient. Although many such institutions were sponsored by the laity, and some of the most important were directly dependent on the emperor, they were all, like monasteries, ecclesiastical establishments. From the 10th century, indeed, all new charitable houses were invariably attached to monastic communities.”
Parish priest Viorel Oprea,
Manea Brutaru Church, Bucharest
Bibliography and notes:
[1] Alexander P. Kazhdan, AliceMary Talbot, Anthony Cutler, Timothy E. Gregory, and Nancy P. Sevcenko (eds), The Oxford Dictionary of Byzantium, Oxford University Press, 1991
[2] Daniel F. Caner, “Christian Ethics of Wealth in the Early Byzantine Empire”, This lecture was delivered by Daniel F. Caner, Associate Professor of History at the University of Connecticut, on February 16, 2015 as part of the “Ethics of Wealth Series”, https://m.youtube.com/watch?v=6JXsK7AXHPU
[3] Ioan Vicovan, „Lucrarea slujitoare a bisericii: modele și repere ale filantropiei Bisericii ortodoxe române în trecut și astăzi”, Dialog teologic 21 (2008)
[4] Ligia Livadă-Cadeschi, De la milă la filantropie: instituții de asistare a săracilor din Țara Românească și Moldova în secolul al XVIII-lea, Cuvântul vieții, 2020
[5] Nicolae Vătămanu, „Contribuții la istoricul bolniței de la Smirdeni și al xenodochiului de la Argeș”, BORom LXXXVI, 1968
[6] Peter Brown, Series: “Treasure in Heaven”: Wealth, Labor and the “Poor Among the Saints”. Christian Giving from Paul to Pachomius, 2012 https://youtu.be/TdzKMhMoPlI?si=0owPrcuyErJZdS1g
[7] Veronica Gonța și Alexandru Gonța, „Mitropolitul Anastasie Crimca, fondatorul celui dintâi spital din Moldova”, MitrMold XXXVIII, 1962