Fitting right into the modern Monty Python stereotype of medieval people as backward, ignorant, and superstitious is the assumption that especially the monks of the Middle Ages sought only supernatural explanations for things. Understanding that up to the 12th century, healthcare took place almost exclusively in the monasteries, we jump to the logical conclusion: such care couldn’t possibly have attended to the physical causes of illness. Didn’t those monks just believe that illness was caused either by demons or by the sins of the sick person? There’s a germ of truth here (pun intended), but the reality was quite different. That’s the subject of the next section of the hospitals chapter in my Getting Medieval with C S Lewis.
The distinctly monastic flavor of healthcare during the Middle Ages – even when it was provided by lay orders like the Hospitallers – deserves a bit more probing. From the beginning, monasteries in the West took Benedict’s cue and made caring not only for ill monks but also for needy travelers one of their primary tasks. The “stranger” was always an object of monastic charity. This “rather broad category,” says medical historian Gunter Risse, included “jobless wanderers or drifters as well as errant knights, devout pilgrims, traveling scholars, and merchants. . . .” Monastic care for the stranger and the ill was formalized in the 800s during Charlemagne’s reforms, as assemblies of abbots (leaders of monasteries) gathered to reform and standardize that aspect of monastic life. At that time many of the scattered church-sponsored hostels (xenodocheia) across the Holy Roman Empire were given “regula”—quasi-monastic rules, and “monasteries . . . assumed the greater role in dispensing welfare.”
Organized, ubiquitous, stable, pious: the monasteries of the West became sites of care and of medical learning. “Benedict’s original rule ordered that ‘for these sick brethren let there be assigned a special room and an attendant who is God-fearing, diligent, and solicitous.’ This monk or nun attending the sick—the infirmarius was usually selected because of personality and practical healing skills. The latter were acquired informally through experience, as well as through consultation of texts, medical manuscripts, and herbals available in the monastery’s library or elsewhere. . . . The infirmarius usually talked with patients and asked questions, checked on the food, compounded medicinal herbs, and comforted those in need. . . .”
“A rudimentary practice of surgery (‘touching and cutting’) at the monastic infirmary was usually linked to the management of trauma, including lacerations, dislocations, and fractures. Although these were daily occurrences, the infirmarius may not have always been comfortable practicing surgery on his brothers, for it was always a source of considerable pain, bleeding, and infection. Complicated wounds or injuries may have forced some monks to request the services of more experienced local bonesetters or even barber surgeons. . . .” Risse notes other popular healing practices of the Middle Ages that were integrated into the monastic medical routine, including herbology, bathing (not otherwise common!), preventive bloodletting, and diagnostic examination of pulse, urine, stool, and blood.
The mention of some of these “backward” medieval medical practices may raise another stereotype many have in their heads about the Middle Ages. Just as some still believe the fabrication that medieval people believed in a flat earth, some assume that medievals did not know, and were not interested in, the physical causes of illness. Instead, the story goes, they assumed all illness came from devilish or demonic sources, or, a variant, from some hidden sin in the sick person.
To be fair, this impression can seem to be supported by some misleading evidence in the sources themselves. They certainly did, in an ultimate sense, understand illness as having a spiritual dimension. In fact, most medievals would have said that illness originates in at least the permissive will of God. Gregory the Great, for example, viewed illness and other causes of suffering as a particularly strong instance of God communicating with us through the natural realm (see “creation chapter.”) Here as in so many areas, Lewis agreed with the medieval theologians: “We can ignore even pleasure. But pain insists upon being attended to. God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains: it is his megaphone to rouse a deaf world.”
Sin, too, played a role in illness for medieval thinkers. The fallenness of the world, originating in human sin, was in a general sense considered the source of illness (as of all dysfunction in our world). But medieval sources only very rarely mention a sick person’s particular sins or even their general sinfulness as the cause of their illness.
Demonic activity, too, might be seen as playing a role—particularly in mental illness. But even here, “mental and spiritual illnesses were attributed as much to overwork, overeating, and overindulgence in sexual activity as to climatic conditions, magic spells, and demonic possession.” Medievals were not blind to the natural causality of depression and other mental troubles. Both priests and physicians might help a troubled person, and we often find in medieval texts an acute awareness that a spiritual explanation of these psychological illnesses was not enough. The 11th-century Bishop Fulbert of Chartres, for instance, wrote that “it is a physician’s duty to offer those who are suffering from depression, insanity, or any other illness what he has learned in the exercise of his art.”
A further confusion arises from the medieval tendency—identified by Lewis and noted in other chapters of this book—to swing back and forth rapidly in their thinking between the natural and the spiritual level of reality: “pigs to angels” and back again. This held true in their explanations for the causes of things. They perceived and affirmed many levels of causality, and they were comfortable shifting back and forth between these levels depending on the audience and occasion of their writings:
“ultimate and proximate causality may be spoken of in the same breath without any distinction being made, and an intermediate (usually demonic) causality mingled in with the former two. Any one of the three may be mentioned as the cause of a particular condition, and taken by the modern reader as the author’s perceived sole cause, whereas the choice of that cause was simply determined by the author’s desire to emphasize one, with no intention of making it appear exclusive. This applies not only to considerations of madness but also, indeed even more so, to sickness generally.”
We know that demons, though a popular causality in accounts of illness, were by no means considered to be the cause of all illness. “As a general rule,” says Darrell Amundsen, “when early medieval sources mentioned direct demonic involvement, which they frequently did, the condition was clearly regarded as possession, whether accompanied by sickness or not.” Furthermore, many venerated saints experienced frequent and terrible illness – indeed “seemed to gain a high degree of sanctity through their sicknesses”—a fact inconsistent in medieval thinking with demonic causality.
So, medievals understood illness to have multiple causes, natural and spiritual, and they almost never pointed to an individual’s sins as one of those causes. Where the spiritual dimension of illness came most to the fore in monastic healthcare was in preparing a patient for death. Risse explains what that looked like: “Periodic visits to the sick by members continued. Some brethren remained with the dying inmate throughout the day and night, praying and reading from the Scriptures by candlelight. The point of this vigil was to ensure ‘proper passing’; nobody should be left to die alone. If death became imminent, the whole monastic community was summoned and the monks congregated around the sick on both sides of the bed [wonderful detail] alternately to pray and sing, using music to ‘unbind’ the pain and thus provide the departing with spiritual nourishment for the journey to the beyond. Death was usually announced by the clapping of boards or ringing of bells, with burial in the monastic cemetery after elaborate funeral ceremonies. The deceased monk’s name and date of death were inscribed in a memorial book, and he was henceforth included in all intercessionary prayers.”
 Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (Oxford University Press, 1999), 94.
 Risse, 100.
 Risse, 103.
 Lewis, Problem of Pain.
 Amundsen, 187, quoting Jerome Kroll.
 Fulbert quoted in Amundsen, 187.
 Amundsen, 186 – 7.
 (Risse, 105)
- From poorhouse to hospital – a medieval development (gratefultothedead.wordpress.com)