Medieval monasteries in the history of hospitals

It’s often the “just-right source” that opens up a topic for me, and as I teach it, for my students. In the Resources for Radical Living course, I will be profiling the history of Christian practices of medical healing (that is, not including “faith healing”). An excellent source on this topic just came to me via the wonderful almighty inter-library loan system (thank you Mark Nygaard in the Bethel Seminary library), and I’d like to share a bit of it with y’all. [For more of the story beyond what follows, see here and here.

Guenter B. Risse of the Department of the History of Health Sciences, UC San Francisco, provides fascinating insights into the many stages of medical practice within Christian communities from the earliest years of the church onward in his compendious book Mending Bodies, Saving Souls: A History of Hospitals (Oxford University Press, 1999).

To take just one example: I have seen it said in a number of places that the hospital was a medieval Christian invention. What follows are some excerpts from Risse on health care within medieval monasteries, from chapter 2: “Christian hospitality.” “Invention” is likely too strong a word to use of medieval developments in care of the sick–the Cappadocian father Basil the Great (330 – 379) was setting up something like ancient hospitals in Caesarea to address famine and disease in that city, and there were earlier pagan models that bore some resemblance to what later became hospitals. However, we can see from early on in Benedictine monasteries many of the rudiments of modern hospitals:

“From the start, providing hospitality and healing the sick became key responsibilities of European monasteries, reflective of both the inward and worldly missions they had assumed. As in the East, early Christian welfare in Europe targeted voluntary and structural paupers—there were few distinctions between them—as well as pilgrims. Many were rural peasants, legally free, possibly even owners of small plots who had suffered hard times. As early as Merovingian times [roughly mid-5^th to mid-8^th century], local bishops had been charged with assigning one-fourth of their revenues for the needs of the poor, whose names were kept on special lists, a third in rural parishes. Many were fed, clothed and sheltered in the poorhouse or mansion pauperum adjoining the church. Another frequent recipient of Christian charity was the stranger, a rather broad category that included jobless wanderers or drifters as well as errant knights, devout pilgrims, traveling scholars, and merchants. . . .” (94)

“Most initial Christian charitable institutions in the West were local foundations established by ruling bishops or private individuals in response to particular needs in their respective dioceses. To reform this decentralized and inefficient network, the Church attempted after 800 [Charlemagne’s coronation and the effective beginning of the “Carolingian” period, named after him] to create a European system of social welfare more responsive to the new political conditions created by Charlemagne’s empire. At the synods of Aachen in 816 and 817, the assemblies of abbots espoused a comprehensive program of reform and standardization. The principle of monastic hospitality was strongly reaffirmed, and existing xenodocheia [hostels or lodges developed during the early to mid-4^th century by Christian communities in which the poor were housed and fed; explained in Risse, pp. 81 – 83] or hospitalia were linked to canonical life and cathedral chapters. Bishops remained responsible for administering the funds earmarked for the care of the poor and sick. Monasteries rather than decaying Episcopal cities assumed the greater role in dispensing welfare.” (95)

“Thus, following the fall of the Roman Empire, monasteries gradually became the providers of organized medical care not available elsewhere in Europe for several centuries. Given their organization and location, these institutions were virtual oases of order, piety, and stability in which healing could flourish. To provide these caregiving practices, monasteries also became sites of medical learning between the fifth and tenth centuries, the classic period of so-called monastic medicine. During the Carolingian revival of the 800s, monasteries also emerged as the principal centers for the study and transmission of ancient medical texts. By this time, the earlier intolerance toward lay medical practices had waned in the writings of influential authors such as the Benedictine monk and historian Bede (673 – 735) in England. While disease still was a divine visitation attributable to sin, empirical measures to ameliorate physical suffering could also be sought. . . .” (95)

“Caring for fellow monks was traditional in Christian monastic life. The earliest rule of Pachomius, the Egyptian ascetic (ca. 292 – 348), had proclaimed that ‘if anyone is ill, he must go to the house of the praepositus (prior), if ill, let him be led by the prior into the sickhouse.’ Early monastic rules, including that of St. Benedict, also stressed the care of the infirm and sick monks as one of the important activities of cenobitic life in a monastery. Disabled (in-firmi) members of the monastic community sought exemptions from the austere monastic living conditions and assistance. Chatper 36 of Benedict’s rule proclaimed that ‘before all things and above all things (ante omnia et super omnia) special care must be taken of the sick or infirm so that they may be served as if they were Christ in person; for He himself said “I was sick and you visited me,” and “what you have done for the least of mine, you have done for me.”’ . . . ” (96)

“Monastic hostels played increasingly important roles in providing charitable aid to the poor and needy. Since Benedict had encouraged hospitality for all, monasteries increasingly welcomed guests and separated them according to class. Poor wanderers found shelter in the hospitale pauperum, while the travelking wealthy were received and cared for in better quarters. Further distinctions were attempted between the monasteries’ hospitality and the provision of medical aid at its infirmaries devoted to the monks or nuns living in the institution. Poverty, malnutrition, and exhaustion, however, often led to illness, and hospitality blended with medical attention, prompting transfers to the infirmary or consultations with the infirmarius. . . .” (97)

“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. . . .” (100)

“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. . . .” (103)

Risse then 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. Particularly important (and germane to the last thematic chapter of my Medieval Wisdom for Modern Protestants) was that fact that, as Risse tells us, “one of the most important functions of the Benedictine monastery was the preparation for death, involving sick brethren who failed to recover.” Among other things, Risse notes that “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 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.” (105)

Then Risse notes, again, that healing practices within the monastery were not limited to the monks, but sometimes included poor and sick guests:

“At the hostel, meanwhile, the Benedictine rituals of prayer, rest, food, and the administration of sacraments were also believed to be conducive to the recuperation of exhausted pilgrims, the poor, and sick guests housed in the monastery’s hospitalium.” Risse continues with this perceptive observation: “Resting on straw-covered floors, some of the guests must have felt protected behind the monastery’s walls and reminded of their Christian identity and the redemptive quality of their suffering. Acceptance and understanding were important. At a minimum, these routines would have had a calming and reassuring effect as the visitors socialized with each other and with members of the caring monastic community. Whether they stayed in the infirmary or the hostel, life in the monastery was fostered by a unique therapeutic environment.” (105)

There is so much more in this book, which seems well worth studying for those interested in the history of medicine and in medieval methods of healing. I look forward to learning more from Risse.