Monasticism and Medicine: From Morals to Money and Back

John Sprague

Writer’s comment: This assignment ended up being a lot of fun. The class was my first real history course, and I wasn’t completely sure what Professor Cadden wanted. But medieval history has always fascinated me, and I was working at a medical school, so I added my religious studies interest, incorporated a dash of Philosophy… and Voila! Unfortunately, there wasn’t a place in the paper to talk about knights and damsels in distress.
—John Sprague

Instructor’s comment: In History of Medieval and Renaissance Medicine (HIS 139A), students travel far from the galaxy of modern Western medicine. To be good historians, they must find ways to discuss and write about people in the past: other cultures have ways of looking at health and disease that make sense but they do not necessarily correspond to our ways. The course’s first writing assignment dealt with health advice on love and sex written by a monk. There John Sprague found the problem he would address in his final paper: why and how would the clergy be involved in the care of the body? A good problem is essential to a good history paper but it is not sufficient. John did resourceful research, formulated a thesis about the changing circumstances, and wrote and rewrote and rewrote.
—Joan Cadden, Department of History

Today, if we consider the healthy spirit and the healthy body we have to examine not only two different objects, but two different jurisdictions. The presupposition is that the body and its spirit are distinct and, therefore, treated separately. Religious institutions generally see to the health of the spirit, leaving the body to the physicians and their hospitals. This distinction is blurred, however, in early medieval medicine in which the care of the body and of the soul worked together behind cloister walls. The practice of monastic medicine was widespread and ideally revolved around the belief that medical treatment was inextricably tied to the care of both soul and body. Care of the soul was given such importance that people sought physical health to ensure the health of the soul. Then, in the twelfth century, a series of Ecumenical Councils of the Church, specifically the Second Lateran Council of 1139, banned “monks and canons regular” from practicing medicine “with a view to temporal gain,” creating a distinction between care for the body and care for the soul that remains today (Tanner 198).
         In this paper, I will investigate the relationship between medicine and monasticism with reference to the changes decreed by the Second Lateran Council. First, I will examine the role of medicine in monastic life prior to the twelfth century, when, as the practice of medicine became a secular profession, the nature of what it meant to care for someone’s health changed, even for the monk-practitioner. Medicine could now be practiced outside of the obligation of Christian duty—it could be practiced for money. It was the cleric’s role in medicine outside the confines of charitable Christian duty with which the Church took issue. I will argue that the Council did not forbid monks to practice medicine as such—rather, their decrees were meant to re-establish the practice of medicine as a religious endeavor—and that although secular medicine became more distinct from the monastery, the original ideal of brethren caring for their own health remained a fundamental part of the monastic community throughout the remaining years of the Middle Ages and well into the Renaissance.
         The monastic medical tradition has its roots deep in the fundamental doctrines of the Christian faith and served a very specific role in the monastic community. Indeed, Christianity could be said to be a “healing” faith, with its central notion of the Blood of Christ as “curing” us of our sins, and the abundance of stories about miracle cures performed by the Saints and their relics. Christ himself successfully treated leprosy, blindness, and crippling handicaps, not to mention the fact that he cured death, the final aim of medicine. Cassiodorus, a Roman statesman in the sixth century, glorifies the monastic doctor in his Institutes, saying, “I salute you, distinguished brothers, who with sedulous care look after the health of the human body . . . you help the sick with genuine zeal.” He then advises the other brethren to “learn, therefore, the properties of herbs and perform the compounding of drugs punctiliously” and to examine the Herb Book of Dioscordes and the works of Hippocrates, Galen and Aurelius (Sharpe 16-17). St. Benedict of Nursia instructs those in his Rule that “before all things and above all things care is to be had of the sick, that he be served in very deed as Christ Himself. . . . And let the sick themselves remember that they are served for the honour of God” (Sharpe 17). St. Benedict’s edict explicitly points out that the care of the body is designed to function in the larger context of the “healthy” soul. The Christian faith served well as a vehicle for the propagation of medical inquiry and practice since it related to a Deity who had a vested interest in the human race, going even so far as to create the human body and later to assume a human likeness in the Incarnation of Christ. This intimate connection between the Divine and the body marks a sharp contrast to the attitude of the pagan faiths of the time, whose pantheon of divinities exhibited only a secondary interest in the affairs of man (Jacobs 89). This intimate connection of the body, and its well-being, with the proper worship of God defines the monastic relation to medicine throughout Medieval Europe.
         The importance of systematic health care in the monastic area can be seen in the design of the monasteries themselves. St. Benedict suggests that “a cell be set apart by itself for the sick brethren, and one who is God-fearing, diligent and careful, be appointed to serve them” (Sharpe 17). In the ninth century, the monastery of St. Gall in present day Switzerland followed St. Benedict’s suggestion and turned its cell for “sick brethren” into a crucial component of the design of the complex: part of the complex was set aside for the House of the Physicians, a medicinal herb garden, and the House for Bloodletting, in addition to the large Monk’s Infirmary (Horn and Bonn 178). Moreover, the facilities for sick brethren and the laity were separate—infirmary, chapel, and all. As the manuscript plan presented by Walter Horn and Ernst Bonn shows, the medical buildings were not built as an afterthought but carefully integrated into the whole design of the monastery, with the physician’s house being adjacent to the bloodletting house, the garden, and the infirmary, and all being directly next to the kitchens. The “critically ill” were kept in the actual living quarters of the physician, and the House for Bloodletting contained the usual main fireplace along with one in each corner in order to be sure the patients were kept warm in their weakened state, which illustrates forethought in the design, and suggests that the practice of phlebotomy was an integral aspect of the monastic regimen. The plan illustrates the herb garden as having sixteen different medicinal plants which along with the regular vegetable garden and orchards of the monastery would be able to supply any poultice, purge, or infusion the physician might need (181-82).
         The Benedictine monastery at Monte Cassio was no doubt in good hands after Constantine the African joined its members in the eleventh century, bringing with him the practices and theories of the Arabic medical traditions. There he translated into Latin, often for the first time, volumes of Arabic medicine. No doubt much of this new knowledge influenced the blossoming lay medical community of near-by Salerno, but much of his writing probably dealt specifically with the concerns of his monastic brethren. In his Viaticum, for instance, Constantine discusses an illness which he quotes his source, Rufus, as calling “the burden of eros” (Wack 189). Rufus simply recommends sexual intercourse as the effective treatment, even if it is with “those he does not love” (189). Constantine, however, describes the same disease as being caused by the “contemplation of beauty” (189), which is a malady of the soul, and which therefore must be treated quite differently, namely with wine, poetry, music, conversation, and walking with good friends (191). These last treatments are, of course, much more acceptable to those whose vocation will not allow them to take Rufus’ advice—Constantine’s view of the malady and the treatment he prescribes is just what one might expect from a monk who is looking after the health of his monastic community.
         But monasteries were not exclusively concerned with the health of their own. They also had some intimate connections with the laity, serving and being served by lay people. For example, the Directives from the Abbot Adalhord for the Abbey of Cormie list three physicians; two of them were laymen (Horn and Bonn 181). We see, then, that monastic medicine had already begun to associate with the laity, which possibly helped contribute to the problems the Ecumenical Council’s decrees sought to rectify.
         Undoubtedly, one of the most significant contributions of the monastic community to the field of medical knowledge was its role in copying manuscripts. Physicians were trained primarily through Latin texts and, in a culture where few people could read or write, the monks served as propagators of knowledge. Siraisi tells us that “in the twelfth century, monastic libraries built up medical collections that served to train monk-practitioners and were also an important source of ideas about human physical nature for theological and philosophical writers” (50). Siraisi also provides an illustration of a medical text of the mid-twelfth century by a Benedictine monk at the Abbey of Prüfening which shows the physiological systems of the arteries, veins, bones, and muscles (92-93).
         Monks, then, were privy to much of the current medical theory. That the monastery at St. Gall had devoted an entire building to the practice of phlebotomy shows that the monk-practitioners were not afraid to use the most current and aggressive medical theories. Constantine, in fact, added some of his own books to the number of medical texts translated into Latin, which places medicine, at least in some respects, at the forefront of monastic thought. Throughout Europe, the Benedictines established monastic libraries at Oxford, Cambridge, and Winchester in England, Tours in France, and Fulda in Germany (Riesman 19).
         There were many other influences, though, that began to distance the monasteries from the medical field. The first and ultimately the most important was the beginning of medical faculties at universities. With this new development came the broadening of learned medical practice into the secular world, and the fundamentally different role of medicine as concerned only with the health of the body without any further appeal to the health of the soul. In addition, the growing autonomy of cathedral schools, although administered by the clergy, also had a strong secular influence on the subjects taught and the purpose of education. These schools exhibited a strong intellectual freedom from the monasteries and included the study of medicine in a larger curriculum of arithmetic, astronomy, astrology, mechanics, geometry, and music—all of which served to further establish medicine as a scientific endeavor rather than a religious one (25).
         Cities were also growing in the twelfth century and with them a commercial atmosphere where, as Minkowski points out, the “increasing demands of a growing population for monastic and conventual medical services inevitably encroached on clerical spiritual responsibilities” (84). The same cities came with market economies wherein services, medical and otherwise, could be supplied for a fee, which, of course, conflicted with the monastic vows of poverty. It is in the twelfth century, then, that monasteries experienced some real conflict between their roles as caregivers of the soul and the body—in the practice of medicine there was now an arena where ambitious and well-educated monks could use their knowledge for personal financial gain. With a more concentrated laity who were able to pay for their medical care and with monks willing to be paid, the Second Lateran Council of 1139 found it necessary to take action. The ninth canon of the Council’s edicts of 1139 states:

Moreover, the evil and detestable practice has grown, so we understand, whereby monks and canons regular, after receiving the habit and making their profession, are leading civil law and medicine with a view to temporal gain, in scornful disregard of the rules of their blessed teachers Benedict and Augustine. In fact, burning with the fire of avarice, they make themselves the advocates of suits. . . . There are also those who, neglecting the care of souls, completely ignore their state in life, promise health in return for hateful money and make themselves healers of human bodies. And since an immodest eye manifests an immodest heart, religion ought to have nothing to do with those things of which virtue is ashamed to speak. Therefore, we forbid by apostolic authority this practice to continue, so that the monastic order and the order of canons may be preserved without stain in a state of life pleasing to God, in accord with their holy purpose. Furthermore, bishops, abbots and priors who consent to and fail to correct such an outrageous practice are to be deprived of their own honors and kept from the thresholds of the church (Tanner 198-199).

         This canon illustrates a specific concern of the Church but it does not simply prohibit the practice of medicine by the members of a monastic community. Rather it is a prohibition against the practice outside a spiritual context. The Council objects when, after “receiving the habit and making their profession,” the monks or clerics use medical knowledge for “temporal gain,” that is, they “promise health in return for hateful money.” The primary objection, then, is that medical treatment is used for a worldly end, whether it be a monetary one or one that recognizes the health of the earthly body as an end and not as a means to a healthy immortal soul.
         From this evidence it is therefore possible to reconstruct what role medicine must have come to play in at least some monastic communities. The edicts of St. Benedict dictate that the health of the monastic community was to be a primary concern and that great steps should be taken to see that a monastery was equipped to do just that. Then, in The Plan of St. Gall, Bonn and Horn find that the laity played a part in monastic medicine, sometimes as physicians, and more often as serfs and workmen assigned to the monastery, and thus as patients (181). Considering the growth of the cities and commerce, the filtering of knowledge into the laity through cathedral schools and the burgeoning universities, and the specific nature of the Second Lateran Council’s objection, it is reasonable to conclude that the monk-practitioners must have expanded their practice of healing bodies into the community but left the healing of souls at the monastery gates while taking their purses with them. After all, the decree forbids “this practice” to continue so as to preserve the monastic order “without stain in a state of life pleasing to God, in accord with their holy purpose” where “this practice” is specifically practicing medicine and law “with a view to temporal gain.”
         There is certainly no doubt that, from the twelfth century on, the field of medicine found itself more in the secular world than ever before. This can be seen as a consequence of two factors. On one side the Church attempted to withdraw its physicians from the arena of secular medicine, and on the other side the universities educated medici to replace them. The growing prominence of the medical faculties at the Universities of Bologna, Montpellier, and Paris (later on, at the University of Padua) brought the study of ancient medical texts by literate students out from under the watchful eye of the monastery.
         Along with this shift from sanctified to secular came a new role for medicine. Whereas before, medicine was practiced within the context of a healthy body as a means for a healthy soul, and within the context of Christian charity, now the practice of medicine was concerned with the health of the body in its own right. Patients could judge for themselves the benefits of medical treatment; they either felt better or they felt worse. In a world where medical treatments were sometimes fatal, a need for some standardization and quality control developed, and this standardization took the form of a university education. King Alfons IV el Benigne in 1329 decreed that in order for a physician to be allowed to practice in the city of Valencia, he must have “followed the art of medicine for at least four years in a studium generale” (Garcia-Ballester et al., 60). Thus, through a combination of Church decrees and secular standardization, it appears that the practice of medicine was effectively removed from the Church.
         Despite the continuing “secularization” of medicine, however, the Church still seems to have remained committed to the practice of medicine within certain bounds. Likewise, the society at large, even while regulating the practice of medicine through secular restrictions, still allowed and even accommodated the monastic role in medicine. The Valencia Decrees, mentioned above as defining a legitimate physician as one who attended a university, still did not apply to monastic practitioners. In December of 1334, a certain Jacme Lama was accused of practicing medicine without a license under said decrees. The prosecutor made lengthy arguments to prove that Lama was acting as a physician in every way but without carrying the required license and therefore should be fined. Lama, in his defense, did not deny the practice of medicine without a license, but cited instead that he was a “tonsured cleric . . . [and therefore] not in [the law’s] jurisdiction” (66). Jacme Lama was then acquitted.
         Even within the monastic culture, medicine remained an important part of Christian duty. As I have shown above, the purpose of the Council’s decrees was not to remove medicine from religion but to draw it back into the confines of Christian charity, that is, to prohibit the monks from making a living at it and to make sure they concentrated on the souls of the ill, not their money. Well into the fifteenth century we see that many religious orders still saw fit to practice medicine, both as a means of sanctifying the actions of the practitioner and as a means of maintaining the spiritual health of the ill through the health of their body. In 1497 the Oratory of Divine Love (a predominantly lay association) stated:

because it would be of little value to be brothers unless one performed the duty of brothers one to another . . . whenever any one of our brothers is infirm, let the visitors, or one of them, graciously visit said brother and help him, above all spiritually . . . providing doctor and medicines, and above all let them arrange for confession and communion as they would for themselves . . . and finally let them with all diligence try to help him, above all spiritually in that extreme pass (Olin 18-21).

         The Oratory of Divine Love was founded by a prominent layman, Ettore Vernazza, and had as its purpose “the personal sanctification of its members through the faithful practice of their religious devotions and through works of charity benevolence” where part of the “satisfaction” was the healing of others (Olin 18). Although not a monastic confraternity, the Oratory of Divine Love illustrates the notion of seeing to the health of the body as a means to a healthy soul within the bounds of benevolence and charity lived on beyond the Second Lateran Council’s decrees. The close association between this order and the healing arts is demonstrated in the inspiration of Vernazza, St. Catherine of Genoa, who “without intermission led a most intense spiritual life combined with unwearying activity on behalf of the sick and sad” (Butler 289).
         In the 1516 De officio episcopi, Gasparo Contarini lists, among the duties of a Bishop of the Church, caring “for the members of his household when they are ill, and let him provide for their welfare in a way that takes account neither of expense nor of inconvenience” (Olin 101). Contarini goes on to explain how Pietro Barozzi, a Bishop in Padua, illustrated remarkable interest in the medical well-being of his order’s members, even taking part in the consultations of doctors—“indeed he did this in every case, so that he neglected neither the last nor the lowliest. A charity that must be highly praised, and an action truly worthy of a Bishop” (101).
         The Capuchin Constitution of 1536, in which the new Franciscan monastic order attempts to return to the original ideals set forth by St. Francis of Assisi, lists two medical requirements of the Order. “To relieve the wants of the sick, as reason dictates, the Rule commands, and fraternal charity requires, we ordain that when any Friar falls sick, the Father Guardian shall immediately appoint a Friar qualified to attend to him in all his needs” and also that “since they who are detached from this world find it sweet, just and charitable to die for the love of Him Who died for us on the Cross, we ordain that during a plague the Friars shall succour the afflicted according to the regulation of their Vicars. The Vicars, however, shall always have the eye of prudent charity open to such occasions” (Olin 168). Here the emphasis is on the piety of the practitioner of medicine, possibly because most of the patients would be part of the monastic community anyway. In all of these examples we see that the treatment of the ill was a primary concern of the religious and monastic communities, and they make explicit (possibly to avoid any conflict with the Lateran decrees) that any healing must take place under the “eye of prudent charity.”
         A number of abbeys in England had layouts similar to that of St. Gall. The plans of Bardney Abbey in Lincolnshire show that the infirmary, built in the thirteenth century, had its own chapel (Horn and Bonn 342); Castle Acre Priory in Norfolk had an infirmary built in the twelfth through the fourteenth centuries, over 300 years after the main buildings were constructed (346); and the Kirkstall and Fountain’s Abbeys had infirmaries both built in the thirteenth century. Fountain’s Abbey even had separate facilities for both brethren and lay people (350, 352). Thus, not only were the monastic and religious orders carrying on the theory that medical healing must be made available to their brethren, but they were building their monasteries so as to accommodate it. The practice of medicine is closely associated with money; where one exists the other is never far behind, either entering the pockets of the physician or leaving the hand of the patient. Even in the fifteenth century Geoffrey Chaucer was well aware of this skepticism when describing the physician along for the ride to Canterbury:

He did not read the Bible very much.
. . . Yet he was rather close as to his expenses
And kept the gold he won in pestilences.
Gold Stimulates the Heart, or so we’re told.
He therefore had a special love of gold. (Chaucer 37)

No doubt one of the primary aims of the Second Lateran Council of 1139 was to distance the monastic practice of medicine from avarice. It simply did not look good for medically trained monks to be out in the community healing people but with little or no concern for the health of their patient’s souls, or for the piety of their own. So while it might appear that the Lateran Council’s decrees of 1139 effectively prohibited the practice of medicine by monastic communities, since from the twelfth century on, medical texts, knowledge, and practice were no longer controlled by the Church, the evidence shows that throughout the Middle Ages and the Renaissance, medicine remained an important part of the monastic community, seen both in the specific instructions given to monks and the physical plans of their monasteries. The Second Lateran Council, then, must be read as an attempt by the Church to control any entrepreneurial clerics who might have taken their medical knowledge into the community for reasons other than those of “prudent charity.”

Works Cited

Butler, Alban. Lives of Saints. Ed. Michael Walsh. Kent: Burns and Oats, 1991.

Chaucer, Geoffrey. The Canterbury Tales. Trans. Nevill Coghill. Baltimore: Penguin, 1952.

Garcia-Ballester, Luis, et al. “Medical Licensing and Learning in Fourteenth-Century Valencia.” Transactions of the American Philosophical Society. Philadelphia: American Philosophical Society, 1989.

Horn, Walter, and Ernst Bonn. The Plan of St. Gall: A Study of the Architecture and Economy of, and Life in a Paradigmatic Carolignian Monastery. Berkeley: Univer-sity of California Press, 1979.

Jacob, Joseph M. Doctors and Rules: A Sociology of Professional Values. London: Routledge, 1988. Minkowski, William. “Physician Motives in Banning Medieval Traditional Healers.” Women and Health. Binghamton, New York: Haworth Press, 1994. 83-94.

Neuburger, Max. History of Medicine. London: Oxford University Press, 1910.

Olin, John C. The Catholic Reformation: Savonarola to Ignatius Loyola. New York: Harper and Row, 1969.

Riesman, David. The Story of Medicine in the Middle Ages. New York: Paul B. Hoeber, 1935.

Sharpe, William D. “Isidore of Seville: The Medical Writings.” Transactions of the American Philosophical Society. Philadelphia: The American Philosophical Society, 1964.

Siraisi, Nancy G. Medieval and Early Renaissance Medicine: An Introduction to Knowledge and Practice. Chicago: University of Chicago Press, 1990.

Tanner, Norman P., ed. Decrees of the Ecumenical Councils. Washington D.C.: Georgetown University Press, 1990.

Wack, Mary Francis, ed. Lovesickness in the Middle Ages: The Viaticum and its Commentaries. Philadelphia: University of Pennsylvania Press, 1990.