Christian Perfection in Basilian Monastic Hospitals from the Fourth to Sixth Centuries

Abstract

The purpose of Byzantine hospitals—whether primarily curative facilities or caring hospices—has long intrigued scholars. This paper proposes a third perspective on Byzantine hospitals, suggesting that the Basilian monastic hospitals of the fourth to sixth centuries were not merely philanthropic facilities for the sick and destitute but also centers for ascetics’ spiritual growth. Basil of Caesarea incorporated charitable actions by ascetics as essential to achieving Christian perfection within the coenobitic community, developing a theology of compassion that advocated for the purification of harmful passions like anger and pride through the virtue of compassion. In the fifth and sixth centuries, Theodosius the Cenobiarch, who founded a coenobium and hospitals in the Judean Desert, upheld Basil’s idea of the purification of the soul through compassion for the sick. Additionally, the nosokomeion (hospital) of the sixth-century Monastery of Seridos in Gaza emphasized the healing of spiritual diseases through compassion for the sick, as reflected in various epistles. Thus, Basil of Caesarea’s theology of compassion in pursuit of Christian perfection was a foundational element in the emergence and development of hospital spirituality in Christian Late Antiquity.

1. Introduction

Basil, archbishop of Caesarea (330–377 C. E.), established a multi-functional philanthropic institution in 372 on the outskirts of Caesarea, the capital of Cappadocia.1 This institution, so vast in scale that Gregory of Nazianzus referred to it as a “new city” in honor of his friend Basil2, was later known as the Basileias () after its founder.3 According to a 19th-century archaeological survey, the Basileias was situated approximately one to two miles from the capital and contributed to the formation of a new city around it, replacing the older Greco-Roman settlement (Ramsay 1892, p. 464).

The exact nature of the Basileias has been debated among scholars. Hospital–medical history specialists like P. Horden view it as primarily a medical facility, describing it as “the first clearly medicalized Byzantine hospital”. (Horden 2006, p. 69). Similarly, J. Constantelos and T. Miller, while acknowledging its multi-purpose nature, classify it as a hospital or “medical hostel” rather than a hospice (Constantelos 1991, p. 119; Miller 1984, p. 56; 1997, p. 88). In contrast, historians of Late Antiquity, such as Gain, Pouchet, Rousseau, and Holman, regard it as a caring hospice. Gain, for instance, states that “la première fonction de la Basiliade est donc d’offrir l’hospitalité aux voyageurs”, (Gain 1985, p. 279), and others refer to it as a hospice for the poor and sick (Pouchet 1992, pp. 411–12; Rousseau 1994, pp. 139–40; Holman 2001, pp. 74–76).

However, the debate over whether the Basileias was a curative facility or a caring hospice overlooks a crucial aspect: Basil of Caesarea designed this institution within the framework of Christian perfection for ascetics, a spirituality that his successors developed over the next two centuries. Basil considered charitable activities integral to the spiritual progress of ascetics, not merely a separate aspect of monastic life. This spirituality was continued by figures such as Theodosius the Cenobiarch (leader of the coenobitics), John the Prophet, and his disciple Dorotheos of the Monastery of Seridos. This study focuses on this aspect.

First, I explore how Basil of Caesarea related philanthropy to the spiritual progress of ascetics, emphasizing that acts of mercy were essential for achieving Christian perfection. He taught that compassion was a paramount virtue to be cultivated. Our main argument draws on Basil’s Asketikon (Ascetical Works), which provides biblically grounded principles and guidelines for organized community life. The Asketikon, edited at least twice—first as the Small Asketikon (henceforth SA) during his priesthood, and later during his episcopate (370–377)—is central to our analysis.4 Additionally, I examine various features of the Basileias, which served as a hostel for travelers, an almshouse for the poor, and a shelter for the sick.

In the following sections, I investigate the development and transmission of Basil’s hospital spirituality by the monks of fifth- and sixth-century Palestine who embraced the Basilian ethos. Theodosius the Cenobiarch established several hospitals in the Judean Desert in the fifth century, building on Basil’s coenobitic life and the concept of soul purification through compassion for the sick. In the sixth century, at the monastery of Seridos in Gaza, the virtue of compassion continued to be a key aspect of the spiritual progress of ascetics. Although there have been several studies on the hospitals of Theodosius and the monastery of Seridos, the connection between Basil’s “theology of compassion” and “spirituality of hospital” and the monastic hospitals of Palestine has not been thoroughly examined (Constantelos 1991, pp. 120–21; Miller 1997, pp. 132–34; Choi 2020, pp. 185–86).

2. Divine Commandments as Christian Perfection According to Basil of Caesarea

In his Asketikon, Basil of Caesarea presents philanthropic activities as both a preliminary condition for Christian perfection and a common good that a community of ascetics must ensure.5 However, many studies focused on his ascetical ideals have not emphasized this point clearly. For example, Humbertclaude and Amand barely recognized philanthropy or charitable activities as foundational in their analyses of Basil’s ascetical life (Humbertclaude 1932, pp. 64–108; Amand 1949, pp. 86–349).6 Similarly, Morison and Gain ranked hospitality or “charité fraternelle” last compared to other primary monastic virtues, such as poverty, celibacy, prayer, and labor, even though they acknowledged its integration into the monastic vocation (Morison 1912, pp. 22–130; Gain 1985, pp. 123–62). Only recently did M. Dunn appropriately indicate that in Basil’s Asketikon, “the renunciation of wealth for charitable purposes is fundamental to his vision of monasticism” (Dunn 2003, p. 37), though without providing a detailed analysis.

Basil develops the biblical and foundational principles of the coenobium in the Prologue of the Asketikon and its first series of the Longer Responses (henceforth LR).7 Those who desire the Kingdom of Heaven must be “perfect” (Prologue 2 of LR), and Christian perfection depends on adhering to two supreme commandments (entolai): love for God and love for one’s neighbor, according to Matt. 22: 37–40 (LR 1–3; Gribomont 1984, pp. 301–2; Rousseau 1994, pp. 205–6). These two supreme commandments are directly linked with Matthew’s last judgment scene (Matt. 25: 35–45). The legislator of coenobitic life does not separate these two commandments or replace them simply with prayer (theoria) and practice (praxis), as Miller suggests (Miller 1997, p. 120). Instead, Basil views them as so interwoven and indivisible that they cannot be fulfilled independently of each other.

“And he (the Lord) has so joined”, declares Basil, “together these two commandments in every way that the kindness shown our neighbor he refers to himself, I was hungry, he says, and you gave me to eat (Matt. 25: 35), and so on, to which he adds: insofar as you did it even to the least of these brothers of mine, you did it to me (Matt. 25: 40). Consequently, through the first commandment the second is also accomplished, but again, through the second there is (an ascent and a) return to the first, such that if anyone loves the Lord (without doubt) it follows that he also loves his neighbor. For Whoever loves me, says the Lord, will keep my commandments (John 14: 15)”.

(LR 3; Silvas 2005, pp. 172–73)

The connection of the two commandments with Matthew’s last judgment might seem banal, as it seems like a cliché in several later Byzantine typika (charters of monasteries).8 However, this perspective is crucial to Basil’s notion of perfection. It led Basilian communities to be indivisibly united with benevolent works beyond the convent walls, fostering a sense of brotherhood.

The Christological elevation of the poor to Christ and its connection to the two commandments distinguish Basil’s coenobium from the Pachomian monasteries of Egypt. The Pachomian Coptic Lives cite Matthew 25: 35–40 five times, but none of these citations connect the needy and sick with Christ.9 Consequently, the Pachomian Koinonia did not establish charitable institutions like the Basileias throughout its history despite having about 24 monasteries by the end of the 6th century (Nam 2004, pp. 433–61; Nam 2010b). The Pachomian Confederation operated an infirmary solely for its residents and had a separate area for visitors, intended to protect its monks from worldly contamination (Crislip 2005, pp. 11–17).10 Additionally, the Pachomian monks were heavily involved in fluvial transportation and economic activities, which limited their capacity for charitable deeds.11

Second, Basil of Caesarea was convinced of the superiority of communal life over individual asceticism in terms of philanthropic work, as well as in meeting physical needs and fostering self-awareness (LR 7; Gribomont 1984, p. 303). A Christian is “an athlete of Christ’s commandments” and must observe all the commandments given by Christ (Matt. 28: 19–20). Basil asserted, “if they were not all necessary for us to attain the goal, all the commandments would not have been written down, and it would not have been declared necessary that they all be kept” (LR 17.2; Prologue 2). Furthermore, “the commandments are so interdependent that if one is broken, the others are of necessity broken too” (Prologue 2; LR 16.3; Amand 1949, p. 272). In this respect, communal life is superior to solitary life, as “many commandments are more easily fulfilled by many living together, but not at all by one alone” (LR 7.1). A hermit, “in fulfilling one commandment”, usually neglects another; for example, “in visiting the sick” (Matt. 25: 36), he cannot “welcome the stranger” (Matt. 25: 35). In cases involving the distribution of necessities over distances, “the greatest commandment is bypassed, for neither are the hungry fed nor the naked clothed” (LR 7.1; cf. Matt. 25: 35–36). Thus, Basil’s doctrine of observing all commandments, as reflected in the last judgment scene, makes philanthropy a preliminary condition preceding monastic virtues, such as poverty, chastity, labor, and prayer, at least theoretically, in his Asketikon. This vision of Christian perfection explains why the poor relief complex in Caesarea of the fourth century operated with various functions. It is no coincidence that Theodore the Studite emphasized Basil of Caesarea’s teachings on the observation of all commandments in one of his sermons when he revived the tradition of the monastic hospital in the ninth century.12

This perspective of Basil of Caesarea emphasizes religious strictness, suggesting that the degree of perfection may be proportional to the number of commandments accomplished.13 In his teachings on commandments, Basil minimizes any ontological disparity between intention and action, unlike Augustine of Hippo, who grappled with this issue in Book X of Confessiones.14 Basil attempts to resolve this by introducing the notion of the memory of God () (LR 5.3). The memory of God entails a religious and psychological attitude wherein one keeps God’s intention in mind while obeying the commandments, ensuring the purity of action (Amand 1949, pp. 273–74; Gribomont 1984, pp. 302–3; Rousseau 1994, pp. 225–28). It is through the doctrine of the memory of God that Basil provides his ascetics with a religious and psychological basis that can guarantee their purity of action.

Finally, Basil’s concept of Christian perfection encompasses the spiritual progress of nursing monks by restraining harmful passions (pathe). According to Basil’s anthropological framework, passions are categorized into the following three types: natural impulses (e.g., hunger and weariness), forbidden passions (e.g., anger, pride, and avarice), and virtuous passions indicative of virtues, such as compassion, compunction, and humility (LR 8, 17, Shorter Responses = henceforth SR 16, 28, 75). Among these, the second type—destructive to the soul—is synonymous with pleasures, vices, spiritual diseases, and sins (LR 8, 18, 19; SR 28, 160, 229). As the spiritual progress of Christians is proportional to fulfilling more commandments, one has to remove destructive passions to reach perfection.

The founder of Basileias instructed his ascetics to manage the vices of anger or pride and nurture the virtues of compassion and humility by showing kindness to those in need. When questioned about avoiding anger, Basil emphasized that correcting a violation of the Lord’s commandments required not anger, but pity () and compassion (), referencing 2 Cor. 11:29: “Who is made weak, and I am not weak?” (SR 29 = SA 46, SR 182 = SA 191, SR 296, Moralia 70.20). Nursing monks, guided by the bishop of Caesarea, applied these teachings in their acts of charity, enabling them to address their own spiritual ailments while caring for the sick. Philip Rousseau identified this theological inclination as “a theology of compassion” (Rousseau 1994, p. 220, n. 158; Silvas 2005, p. 437, n. 780; Amand 1949, pp. 161–63). Basil of Caesarea’s theology of compassion influenced the monastic hospitals of Theodosius the Cenobiarch and Seridos of Gaza, shaping the core of what we now term the “spirituality of hospital”, a concept further examined below.

3. Functions of the Hospital of Caesarea

Basil employed three distinct terms to denote the Basileias in his Letters (henceforth Ep.) and ascetical works: (Ep. 94), (Ep. 142) or (Ep. 143; 176), and (SR 155, 286).15 These terms were not novel in the 370s. Katagogion, with its literal meaning of “a place of bringing down baggage”, had traditionally denoted an inn since classical Greek periods. Similarly, ptochotropheion was used to signify an inn in the second-century work Oneirocritica of Artemidorus, where it referred to “a shelter for the distribution of food to the poor”.16 Emperor Julian (361–363) utilized the term xenodocheia (hostels) in a letter, urging a pagan priest of Galatia to establish numerous hostels for travelers to counter “the religion of the Galileans” (xenodocheia in this context means “a shelter for strangers”).17 Hence, these terms do not introduce anything groundbreaking regarding the facility’s nature.

Chronologically, prior to the Basileias’s establishment, several shelters must have existed in metropoles and major cities across provinces. Basil of Caesarea sent, around 373, a petition to an accountant of the prefects with the purpose of tax reduction or exemption in favor of a ptochotropheion administered by a monk and chorbishop (chorepiscopus) (Ep. 143). The accountant, presumably a sincere Christian, had supported “one of several ptochotropheia in the city of Amaseia” using his own resources (Ep. 143). Basil also reminded the accountant of his colleague who had promised to favor the ptochotropheia. In another letter from the same period, Basil requested another accountant to visit the ptochotrophia of the region managed by a brother (Ep. 142). Additionally, at various times in the same year, he arranged for the chief of a hospice for the needy to visit an official of prefects in support of the poor (, Ep. 144).18 A monk and chorbishop named Timothy oversaw a monastery and one or several ptochotropheia (Ep. 291).19 These indications led Robert Pouchet to conclude that “les hospices doivent, pour une bonne part, avoir prééxisté à la Basiliade (Basileias)” (Pouchet 1992, p. 305). Benoît Gain shared the opinion that the institution of ptochotropheion was already widespread in the region (Gain 1985, p. 284). Considering these references, several hospices existed in Caesarea, but they were probably overshadowed by the new “shelters” or “inns” (katagogia, plural, Ep. 94) established around 373.20

One of these shelters catered to the hospitality of strangers, travelers, and caravans.21 Basil mentioned in letter 94 that he had the complex constructed for “the strangers and the travelers”.22 Another vital function of the hospice complex was to serve as an almshouse to nourish the poor. When Heraklides visited the ptochotropheion of the “new city” around 373 to obtain spiritual lessons from the archbishop, Basil advised him on the importance of distinguishing genuine paupers from those feigning poverty due to greed (Ep. 150.3.1-31).23 Alongside these functions, the charitable complex of Caesarea included a leprosarium, as implied by Gregory of Nazianzus in his eulogy for Basil.24 This leprosarium was undoubtedly influenced by the example of Eustathius, Basil’s spiritual mentor, who had established one in the 350s as a xenodocheion for those afflicted with leprosy and disabilities.25

References to medical or nursing care have garnered significant attention in modern studies. In letter 94, Basil briefly mentioned “those who need a certain cure because of illness” and the presence of doctors () and nurses () for them in the hospital of Caesarea.26 Basil, who considered medicine as a celestial gift, did not hesitate to utilize it for treating illnesses, as indicated in LR 55. According to Pouchet, a certain Pasinikios, mentioned in Basil’s letter 324, was a young physician who had recently entered into service at a ptochotropheion somewhere within the ecclesiastical territory of the bishop of Caesarea. Gregory of Nazianzus briefly expressed that “disease is the object of study” () concerning the medicine practiced at the hospital of Caesarea.27 The nurses were not salaried employees, as SR 155 suggests that monk nurses served as nursing attendants for the sick inpatients28. This corresponds well to Basil’s teaching that caring for the ill or those in need is considered a prerequisite for Christian perfection, preceding the monastic vocation. Additionally, SR 286 indicates that monks “suffering from bodily illness”, referring to chronically ill members of the brotherhood, could be transferred to a hospice in the region.29 SR 155 and 286 undoubtedly refer to long-term inmates in need of ongoing care and support.

These aspects provide valuable insights into the nursing and medical care provided at the hospice of Caesarea. While the facility offered beds, meals, and nursing care by monk attendants, as well as medical treatment by physicians, the absence of statistical data prevents it from being classified as a hospital in the modern sense. Unlike later examples, such as the seventh-century Sampson xenon or the twelfth-century Pantokrator xenon, which featured surgical facilities and outpatient services, the hospice of Caesarea primarily focused on providing basic care and support to the needy and sick within its walls.30

Nevertheless, medical treatment is not considered an innovation envisioned by the archbishop of Caesarea. According to SR 155, a recalcitrant clientele could be expelled from a hospice by the chief () of xenodocheion.31 There were likely internal (probably religious) regulations in the hospices that patients had to follow. It is possible that the hospices of the region functioned similarly to the “Hôpital Général de Paris” of the seventeenth century. The distribution and sharing of necessities at a distance, as mentioned in LR 7.1, had to concern both the poor and the sick, as illness often led to poverty during those periods. Around 376, in a letter to the bishops of the West (Ep. 243), Basil summarized the activities of ascetics (“the little children” of the church) committed to “visiting of the sick”, consoling the afflicted, aiding those in distress, and supporting various needs, emphasizing their devotion as a means of fostering unity among people.32

In LR 37, Basil once again regulated, not omitting reference to Matt. 25:34–35, that through the corporal labor of ascetics, God may provide sufficiently “for the sick among the brothers (in the world)”.33 In the early 360s, when Basil was asked about the corporal work of monks, his response was that one must labor for the needs of neighbors in the context of Matt. 25: 34–40 (SA 127 = SR 207). In the 370s, he supplemented the rule that one’s own needs are not the goal of one’s work, again referring to the same verse (LR 42.1). One of the indispensable tasks of the hospice of Caesarea was to visit the sick and deliver provisions and necessities. This reorients Miller’s position, which mainly accentuated its medical function (Miller 1984, pp. 55–58; 1997, pp. 85–88).

Basil’s coenobitic movement was designed to serve the paupers based on the last judgment scene (Matt. 25: 35–40) and fulfill as many commandments as possible. After Basil’s death, Gregory of Nazianzus praised his merciful deeds, stating that “he persuaded not to dishonor Christ, the unique head of all people, through inhumanity to the afflicted”.34 However, the Christological connotation of identifying the pauper with Christ was not explicitly emphasized by the archbishop of Caesarea. This hermeneutic was shared by “poor euergetai” of the early Byzantine era, such as Gregory of Nyssa, John Chrysostom, and Severus of Antioch, on the biblical exegesis of the paradox of the Incarnation recapitulated with 2 Corinthians 8:9, as elucidated by P. Brown in Poverty and Leadership in the Later Roman Empire (Brown 2002, pp. 93–110).35 If Basil contributed more to later Byzantine monasticism in this regard than other leaders, it was because he could combine the paradox of the Incarnation with the Christian perfection of ascetics and his theology of compassion through his Asketikon, transmitting them to later generations as an authentic seal of Byzantine coenobitic life.

4. Basilian Hospitals in the Judean Desert of the Fifth and Sixth Centuries

The rise of Palestinian coenobitism was driven by increasing pilgrimage to the Holy Land, which captivated many devout individuals. Some pilgrims from Cappadocia sought to establish themselves in the Holy Places instead of returning home, bringing with them the communal life oriented towards philanthropic spirituality taught by Basil of Caesarea. Representative figures of this movement included Theodosius and possibly Martyrius.

Theodosius the Cenobiarch (423–529) was hailed from Mogariassus in the diocese of Caesarea of Cappadocia. Around 479, he founded a coenobium in the Kidron Valley in the Judean Desert36, which became the largest community in the region and epitomized its coenobitic life. According to Theodore of Petra, the author of Vita Theodosii, Theodosius deeply embraced Basil of Caesarea’s spirituality and relied on his ascetical works to instruct his monks.37 Theodosius took delight in remembering the sayings of Basil, and he constantly had them on his lips.38 The author even portrays Theodosius citing at length some lines from the Prologue of the Asketikon of Basil.39 Theodosius embraced Basil’s concept of fulfilling commandments and linked caring for the sick with his instruction on passions. Theodore encapsulates Theodosius’ theory of perfection and the theology of compassion, both originating from the Asketikon of Basil, as follows:

The care for the sick is the sovereign proof of the love for neighbor. In particular, through it, the passionate part () of our soul is purified.40 For the perfection (), it is not sufficient to nourish the starved, to drink the thirsty, to invite strangers and clothe the naked, but it is necessary to be compassionate () to those people so that one acts not simply a good thing but becomes to be good, and one shows the compassion () not only by hands but also by the soul, manifestly according to the disposition () of the soul. The one who sets forth the love for God not saying “Lord, Lord” but accomplishing the will of the Father in Heavens makes this aspect of the charity visible. He (Theodosius) recognized that the accurate fulfillment of the commandments was the clear sign of the love for God, according to the Lord saying “whoever loves me will keep my commandments”.

(John 14: 15)41

This quotation embodies the fundamental principles of the Basilian coenobium: the concept of perfection, the association of perfection with compassion and disposition, and the assimilation of love for neighbors with caring for the afflicted, and love for God with the fulfillment of commandments. As previously discussed, Basil of Caesarea dissolved the ontological disparity between intention and action through the notion of the disposition (diathesis) of the soul with the memory of God. Undoubtedly, Theodosius was familiar with this teaching, as evidenced by his disciple’s recapitulation of his lessons emphasizing that one’s goodness hinges on the disposition of the soul, not merely on actions. Additionally, Theodosius taught his disciples that the passionate part of the soul could be purified through “being in the state of feeling with the sick” (sympaschein42), echoing Basil of Caesarea’s theory that compassion or humility can temper the vices of anger or pride.

In faithful adherence to the spirituality of Basil of Caesarea, Theodosius established three hospices specializing in healthcare.43 Primarily, he constructed a dwelling () to care for sick monks, likely intended for hermits. He also founded two hospitals for individuals from the secular world: one for the “more learned and august”,44 requiring “medical assistance” () (Usener 1890, p. 40), and the other is reserved “for both the poor and sick”. While the latter was free, the former charged a fee. Notably, the former hospital for the elite reveals an innovative aspect of Theodosius’ charitable endeavors. Theodore reported that his master built an old-age home () within the monastery for elderly or infirm monks. Additionally, Theodosius’ monastery operated a nosokomeion (hospital) in Jericho, essential for pilgrims, donated by a pious and wealthy woman moved by Theodosius’ charitable works (Hirschfeld 1992, p. 199). Furthermore, Theodosius added a wing and church for mentally ill monks, akin to a second monastery within the monastery.45

Within these diverse philanthropic institutions, Theodosius’ monks tended to the sick, needy, and infirm. The author of Vita Theodosii briefly mentioned “different orders of monk-officials” () working in the medical shelters. This led Hirschfeld to suggest that “many monks were employed there as physicians, orderlies, and apothecaries, with full-time jobs, often requiring night duty”. (Hirschfeld 1992, pp. 198–99) In contrast, the author of Life noted that “each order of officials restored the bodies afflicted with diseases by appropriate measures prescribed by Theodosius”.46 Thus, the author portrays Theodosius as a physician. Regardless, monks’ assistance as medical personnel was crucial, given the operation of three hospitals by the monastery, whether laymen also contributed to staffing or not.47 Consequently, Theodosius’ monastery staunchly upheld the Basilian tradition48 of aiding the poor. At its heyday during the Byzantine era, Theodosius’ monastery housed 400 monks across a surface area of 70 m × 100 m (7000 m²).49 The hospice, located outside the southeastern corner of the monastery, approximately measured 30 m × 68 m (2040 m²) and could accommodate a maximum of 100–110 sick and impoverished individuals, as well as pilgrims.

It is probable that the fifth-century coenobitic monastery of Martyrius in the Judean Desert also housed a Basilian hospital. The monastery, fully excavated in the 1980s along with its hospice, predates Martyrius’ appointment to a clerical position in the Church of the Holy Sepulcher in Jerusalem in 474 (Hirschfeld 1992, pp. 42–45). The main complex, covering 67 m × 78 m (5226 m²) in an orthogonal structure, is estimated to have housed a community of 150 to 200 individuals. Adjacent to the main complex, a hospice with a surface area of 1204 m² (28 m × 43 m) was constructed outside the northeast corner (Hirschfeld 1992, pp. 48–49, 78; Magen and Hizmi 1985, pp. 63–64), offering living quarters of approximately 320 m² and accommodating 60–70 travelers and the sick (Hirschfeld 1992, p. 197). A bathing facility was discovered during the excavation of the monastery of Martyrius, which was primarily intended as a medical treatment for ailing monks and pilgrims.50 The attachment of the hospice to the main complex was very similar to the structure of the monastery of Theodosius. Another common characteristic is that the two monasteries were located in proximity to Jerusalem, about 6–7 km from the Holy City, which allowed them to operate hospices and hospitals. Unfortunately, no written sources regarding the hospice of Martyrius have survived.

5. The Hospital of the Monastery of Seridos of Gaza

The sixth-century monastery of Seridos of Gaza vividly shows the active monk-medical staff working in the nosokomeion equipped with outpatient services. Seridos founded a coenobium around 520 in the village of Thabatha, located in the southern part of the city of Gaza (Hirschfeld 2004, p. 76; Bitton-Ashkelony and Kofsky 2000, pp. 51–57). This monastery was surrounded by hermitages and had two spiritual masters who lived in cells isolated from the world, demonstrating that the coenobium incorporated the dual influence of communal life and the Egyptian anchoritic way of life (Bitton-Ashkelony and Kofsky 2000, pp. 52–53). Barsanuphius, one of the two recluses, gave his messages in the form of letters for questions asked through the mediation of Seridos. John the Prophet, the other recluse, joined the community around 525–527 and was soon promoted to recluse but kept in contact with the world, like Barsanuphius, through Dorotheos. A collection of more than 800 epistles of the two hermits, edited in the form of questions and answers following the example of the Asketikon of Basil of Caesarea, comprises a thesaurus of Gazan monasticism (Choi 2020; Barsanuphius and John, Letters—henceforth Letter). As a result of the successful leadership of Seridos and the spiritual cooperation of the two masters, the monastery rapidly grew and was able to establish a xenodocheion, nosokomeion, and church (Letter 570). Over ten epistles, among others that were transmitted to us, are directly related to our theme (Choi 2020, pp. 184–209).

According to the Life of Dositheos, a nursing monk, due to the quantitative growth of the monastery, the two masters decided to construct a nosokomeion to care for ill monks.51 The expenses of the construction were provided by Dorotheos’ younger brother, a native of Antioch, and Dorotheos cared for the sick with several monks.52 The monastery of Seridos was located in the heart of the village of Thabatha (Hirschfeld 2004, p. 77). This geographical feature led the community to open an outpatient service in the nosokomeion for its inhabitants and nearby villagers (Letter 313; 333). The coenobium of Seridos was equipped with a bathing facility for ailing monks and outpatients (Letter 770; Hirschfeld 2004, p. 76; Choi 2020, pp. 190–94). However, the hospital could not afford to supply separate rooms for long-term patients. If necessary, in the case of a foreigner who had fallen ill, a monk’s cell had to be shared with the patient under the consent of the resident (Letter 548).

In addition to the hospital, the monastery operated a xenodocheion that functioned as a hostel for visiting people and caravans.53 The needy could ask for necessities and financial aid (Letter 313, 587). Dorotheos was assigned to serve travelers and caravans as the responsible person (xenodochos) of the hostel.54 Written sources clearly distinguish the xenodocheion welcoming strangers and the nosokomeion caring for the sick.55 It is likely that Dorotheos was simultaneously occupied with the service of xenodochos and nosokomos.56 Thus, as for the overall functions of the nosokomeion and xenodocheion in the Gazan monastery, it looks like “several hospices” (katagogia) administered in the Basileias of Caesarea. According to the archaeological review, the size and splendor of the monastery of Seridos paralleled the monastery of Martyrius, which was one of the largest monasteries in the Judean Desert and could accommodate 60–70 travelers in its living quarters of about 320 m² (Hirschfeld 2004, pp. 48–49, 77–78, 197; Magen and Hizmi 1985, pp. 63–64).

In terms of medical personnel, Dorotheos worked as a physician and head of the hospital.57 He transferred to the coenobitic community his library that contained medical books, which permitted him to increase his knowledge of medicine (Letter 327). Some of his fellow monks labored as hospital staff, while some were even capable of prescribing medications to patients instead of Dorotheos (Letter 316; 334). Dorotheos was frequently consulted by laymen staff (kosmikoi), even during prayers in his cell with regard to hospital matters (Letter 316). Nonetheless, there is no accurate information about the staff of nursing monks, besides ambiguous indications in the Life of Dositheos that Dorotheos cared for the sick with “some other brothers” or “other servants” ().58

The existence of both the medicalized hospice and medical monk staff in the monastery of Seridos shows that it followed the tradition of the monastic hospital of Basil of Caesarea and Theodosius the Cenobiarch. More significantly, John the Prophet regarded the hospital as a place of spiritual battle where Dorotheos could cultivate the virtue of compassion and remove passion. When John was asked by Dorotheos whether silence (hesykia) was more important than merciful workings, John’s reply was clear: silence brings arrogance if one does not reach perfection (Letter 314). John’s position was close to Basil’s view, who defined solitary life as self-pleasing, which is the first and paramount danger to ascetics.59 John the Prophet, citing Matt. 9: 13, “I desire mercy and not sacrifice”, declared firmly that mercy is greater than sacrifice and that Dorotheos would find assistance when he was compassionate () toward someone (Letter 314). However, two extremes must be avoided, and a journey along the middle way should be pursued. Such teachings dominated Dorotheos’ successive inquiries into how to avoid two extremes to journey in the middle way (Letter 315). The response was to preserve “humility in stillness and vigilance in distraction (contact with world)”. Nonetheless, the master did not forget to supplement it with the same precept about compassion offered in the previous response: “It is a good thing to suffer with those who are ill and to contribute to their healing. For, if a doctor receives a reward in caring for the sick, how much more so will someone who suffers as much as possible with one’s neighbor in all things?” Surely, in the reply of John the Prophet, Basil’s doctrine of compassion toward Christian perfection continues to resonate.

In the following letter, the subject of compassion vehemently echoes the virtue of humility. There were different moments when Dorotheos’ prayers were interrupted by his fellow hospital staff knocking on his cell to consult on hospital matters (Letter 316). The recluse replied to Dorotheos’ troubles that “remaining in a cell only renders you useless, for you remain without affliction”, since one can progress to humility only with affliction.60 At the same time, John permitted the petitioner to nominate one monk as a substitute to secure his prayer time; however, this permission was not given without reluctance. When John was closing his letter, he interestingly reiterated the virtue of compassion (), the diathesis (disposition) of the soul on which Theodosius the Cenobiarch insisted following SR 29 of the Asketikon of Basil: “So strive”, John wrote, “if you believe the Apostle, who says: ‘Who is weak, and I am not weak? Who is made to stumble, and I am not indignant?’ (2 Cor. 11: 29). With those who are tormented, we, too, should be tormented, since we, too, are one body with them”. (Letter 316) Though there was a brother who knew how to diagnose patients and prescribe medications in Dorotheos’ stead, the nosokomos was recommended to “simply visit those who are sick” whenever he was not needed in the hospital (Letter 334). In conclusion, John the Prophet firmly established that the virtue of compassion should be cultivated by the hospital workings of ascetics in the context of Basilian and Theodosian spirituality.

Three consecutive Letters (314–316) converge on the common theme of the theology of compassion, that is, the emblem of the Basilian hospital spirituality. John the Prophet used the noun “compassion” (sympatheia) in Letters 315 and 316. In turn, Dorotheos, in Instructions 14.153, written after having later founded his own community, said that a monk who was struggling with concupiscence (epithymia) was cured by sympatheia with which he cared for one suffering from dysentery.61 The term sympatheia, which does not occur in the New Testament, is unfamiliar to the anchorite milieu.62 It must be borne in mind that Basil of Caesarea used the exact term in SR 29, 182, and 296. Moreover, when John gave advice on condescension in the last part of Letter 316 that “with those who are tormented we should be tormented ()”, the rare expression “” which he chose is almost the same as the locution “” (those who are tormented) which Basil of Caesarea used in Moralia 70.20, and on which the issue rests on compassion. These terminological coincidences can be explained by the fact that the library of the monastery of Seridos had a manuscript of the Asketikon of Basil of Caesarea, because Letter 319 states that Dorotheos asked his master about Moralia 2.3; it is known that, according to the manuscript tradition of the Vulgata, the Asketikon was generally transmitted bound, among others, with Moralia and Longer and Shorter Responses (Gribomont 1953, pp. 13–59).

Some letters show Dorotheos struggling strenuously against passion through minute self-examinations. When he found himself falling into vainglory while reading some medical books, he asked for a prescription to get rid of this disease of the soul (Letter 327). John offered this ordinance: “we should not place all our hope in these (medical arts), but only in God who grants death and life”. About 150 years earlier, Basil of Caesarea likewise expressed that “it follows that we must neither avoid the (medical) art completely nor place all our hopes in it”. (LR 55.5) Regarding the vainglory, “the art of medicine”, the recluse said, “does not prevent one from practicing piety; you should regard the practice of medicine in the same manner as the brothers’ manual labor”. This is a brief recall of Basil’s LR 55.1 that compared medical remedies to the arts of agriculture “bestowed on us by God to supply for the infirmity of nature”. (Silvas 2005, p. 265) Once again, John should be recognized as a disciple of the archbishop of Caesarea (cf. Choi 2020, pp. 185–86; Rousseau 1994, p. 220, n. 164).

Nevertheless, Dorotheos was so self-conscious that he found himself enslaved by vainglory because his authority as the head of the nosokomeion unwillingly led him to it (Letter 330). Sometimes, he spoke “with irritation” to the hospital staff or one of the patients when they made mistakes (Letter 331; 333). Even when he apologized to them for his anger, vainglory still followed (Letter 333).63 The confession of Dorotheos overlaps with that of Saint Augustine, who cried that “we can make our very contempt for vainglory (vana gloria) for preening ourselves more vainly still, which proves that what we are congratulating ourselves on is certainly not contempt for vainglory”.64 This is what is lacking in Basil of Caesarea, owing to the theory of the memory of God. Concerning haunting vainglory, Barsanuphius consoled him in his despondency and encouraged him to persevere, saying, “the hand of God is with you… Do not be afraid, and do not concern yourself with anything having to do with the hospital… You only need to pay attention to yourself as much as you can, and God will come to your assistance”. (Letter 330). For the same obsession, Augustine stated that “our hearts are purified by faith”,65 and the consolation of Barsanuphius which stated that “God will come to your assistance” is an Eastern version of Augustine’s maxim.

As for anger, John warned him to “never say anything with irritation” (Letter 333) “but just enough for you to be heard” (Letter 331) “for pride and ‘the pretense to rights’ () hinder our repentance” (Letter 333).66 The spiritual battle against anger continued in Dositheos, a disciple of Dorotheos. Dositheos worked for five years as a full-time orderly (), whose duty was, among others, to make the sick’s beds.67 One day, he became angry with one of the patients, but he was soon aware of what he did and entered the cellar to weep for his sin. The nosokomos, Dorotheos, admonished him to identify the patient with Christ based on Matt. 25:40: “Do not you know that he (the patient) is Christ?”68 Whenever similar incidents occurred, and Dositheos found himself lamenting his own deviations, his master led him to correct them, scolding him for saddening Christ again. These anecdotes reflect a literal interpretation of the bishop of Caesarea in Matt. 25:40, with his teaching on the cure of anger through the virtue of compassion, was inherited by Dorotheos.

6. Conclusions

Basil of Caesarea combined love for God and love for neighbors with the last judgment scene (Matt. 25: 35–40) in his Asketikon. In that scene, the poor and sick are identified with Christ. By doing this, he made caring for the needy and sick a monastic vocation and integrated the charitable workings of ascetics as an essential condition for Christian perfection in monastic life. Therefore, it does not really matter whether their engagements were characterized by poor relief, care for travelers, or medical treatment. However, Basil of Caesarea could not exclude any of them since, in his thoughts, the measure of perfection consisted of performing as many commandments as possible.

In addition, the hospital was a place where nursing monks exercised for their spiritual progress. Referring to 2 Cor. 11: 29, Basil of Caesarea taught in his Asketikon the concept of spiritual therapy: harmful passions such as anger, pride, and avarice could be purified by the virtues of compassion and humility and cultivated by means of condescension to those who were tormented. The theology of compassion of Basil of Caesarea was inherited by Theodosius the Cenobiarch, who erected several hospitals in his coenobium in the Judean Desert in the fifth century.

In the sixth century, the nosokomeion of the monastery of Seridos of Gaza proved to be the successor to the spirituality of Basil of Caesarea. Some questions and answers exchanged between John the Prophet and Dorotheos in the form of letters impressively present the idea of the healing of spiritual diseases through compassion for the sick. The anecdotes of a nursing monk, Dositheos, reflect vivid examples of how Basil of Caesarea’s theology of compassion was applied to the nosokomeion of Gaza. The theology of compassion of Basil of Caesarea in pursuit of Christian perfection is a pivotal point on which the spirituality of hospital emerged and developed in Christian Late Antiquity.