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Book Review: Health, sickness, medicine and the friars in the thirteenth and fourteenth centuries

This book confronts the now familiar topic of medicine and religion from a practical perspective. It reconstructs the responses to illness of friars in the thirteenth and fourteenth centuries, providing both an account of a neglected aspect of mendicant life, and access to the attitudes of patients—a group ill-represented in the mainstay sources of histories of medieval medicine. Despite the attraction of certain friars to extreme asceticism, Montford argues, the benefit of health for pursuance of the Orders' missions became an increasingly important guiding principle in confronting physical frailties. This opposition, between strict (or, as she puts it, “over-zealous”) observance and following medical advice, continues throughout the book, which outlines how the financial demands of treatment and of providing adequate facilities for the afflicted were weighed against injunctions to a life of poverty. The study traces adherence to medical precepts in a range of different areas, such as the siting of infirmaries and the food given to patients. It documents the therapies employed in the convents, from medicinal simples to surgical techniques, and emphasizes the particular problems these posed for the communities of friars. 
 
The nature of the friars' involvement in the care of the sick changed during the period covered by the book. In the fourteenth century emphasis shifted from domestic provision of nursing and medicines to dependence on secular services. Montford relates this change to the incorporation of university-based medicine into guilds set up to police the occupational boundaries of medical practice. Certainly, healing outside the convents by fratres medici was the subject of successive prohibitions within the Orders, perhaps spurred by worries of scandal, and was in any case increasingly subject to civic legislation. 
 
The book proceeds along straightforward methodological lines. It is focused primarily on the Dominican Order, supplemented occasionally with information concerning the Franciscans, and it juxtaposes writings setting out ideals of mendicant life with records of practice from the convents of S. Domenico and S. Francesco in Bologna. This combined approach directly confronts the problems of the lack of circumstantial detail in the account books and the normative character of the instructional treatises. If there is a complaint to be made here, it concerns the use of Europe as a context when discussing medical issues: national variations are ignored that might have added strength, and certainly nuance, to the arguments presented. If wider attitudes and institutional enforcement are so important to the story of the decline of medical practice, for example, it is surely worthy of note that all the examples provided of Franciscan and Dominican healers working after the ban are English; England, in contrast to the Italian examples pursued at greater length in the book, was without effective regulation or guild control of physic until the sixteenth century. 
 
In general, the book is most impressive when dealing with the practicalities of convent life: the discussion of the surgical procedures employed and the problems associated with them is exemplary. It is less convincing in areas where conceptual issues come to the fore, such as the simplistic treatment of divination, amulets and magical cures; but there is a broader concern. Concepts are taken as givens and set against one another—the study is structured as a fight between medicine and religion in which the behaviour of the friars is the battleground. Theological, philosophical, practical, “medical” and social considerations determine the degree to which the precepts of learned medicine are accepted or followed, but the contents of those precepts do not admit of modification. Despite the rhetoric of demonstrating that patients were “not helpless or passive in the face of disease” (p. 257), this account permits them only the latitude to accept or reject a system constructed by others. Nevertheless, Montford has provided us with a thorough piece of research that carefully deploys the available evidence to paint a new picture of the medical practices to be found in the convents of the medieval friars.