Fresco of the Donation of Constantine, 13th century, Cappella di San Silvestro, Santi Quattro Coronati, Rome.
The fourth century transformed the kinds of institutions the Roman state and its citizens were prepared to build. Christianity carried an obligation to care for the sick, the displaced, and the stranger that had no equivalent in the traditional Roman civic culture. As the new faith moved from toleration to state religion across the fourth century, that obligation began to reshape the institutional landscape of Roman cities. The civic infrastructure of the previous centuries had been organised around temples, baths, theatres, and public games, funded by patrons of considerable means whose generosity was displayed on inscriptions and commemorated in statues. The system served the citizen body as a collective, and it had no institutional provision for those who fell outside its structures.
The Christian institutional landscape that developed across the fourth century introduced precisely these provisions. In the eastern half of the empire, the process began earlier: Basil of Caesarea established a hospital complex outside his city around 369, large enough to be described by contemporaries as a new city in its own right. The model combined medical care with shelter and housing under a single institutional roof. The western half of the empire followed later, and when it did, the initiative often came from individuals of the senatorial class.
In Rome, the first hospital was founded by Fabiola, a Roman matron of the gens Fabia, one of the oldest patrician families of the city. Fabiola had been married twice, and after her second husband’s passing she presented herself before the bishop and the congregation of Rome in the Lateran basilica, wearing penitential garments, and publicly acknowledged what the church considered the irregularity of her second marriage. The act was witnessed by the city and marked her formal reconciliation with the church. She then sold her estates, which were extensive enough to fund the construction and ongoing operation of a hospital, and converted her entire fortune into the institution. She worked in the hospital herself, providing care to those it served.
The kind of institution Fabiola built had no precedent in Roman civic life. The old patronage system had built monuments that bore the patron’s name and served the public as demonstrations of civic standing. Fabiola’s institution served a different purpose and a different population. That redirection of senatorial wealth toward direct care, replicated across the western provinces in the decades that followed, marked the beginning of an institutional tradition that would define the charitable landscape of medieval Europe.
The Fabiola Skirt
Selected Reading
- Stark, Rodney. The Rise of Christianity: How the Obscure, Marginal Jesus Movement Became the Dominant Religious Force in the Western World in a Few Centuries. Princeton: Princeton University Press, 1996.
- Wilken, Robert Louis. The First Thousand Years: A Global History of Christianity. New Haven: Yale University Press, 2012.
- Freeman, Charles. A New History of Early Christianity. New Haven: Yale University Press, 2009.