Medieval attitudes towards sickness and death have received a lot of attention over the last several decades. This interest was initially driven by studies surrounding the plague in the late Middle Ages. But it is a field with a rich tradition of scholarly work. Medieval historians and theologians have looked closely at the development of the sacraments often related to sickness and death, focusing on confession, the reception of the Eucharist, and what came to be referred to as the Last Rites.
In this excellent volume, Thomas Izbicki builds on his long career of work related to the Eucharist, canon law, and the medieval church. His starting point is the Lateran decreeCum infirmitas (1215), and the goal of the book is to study the ways in which medieval priests interacted specifically with the laity in sickness and death by ministering to them via penance or confession, the Eucharist (Viaticum), extreme unction, and the like. His main argument is that while sometimes there are minor variations in the ways in which priests carried out these ministries to the sick and dying, there is a remarkable level of continuity in practice across Europe.
In the first chapter, Izbicki sets the context for this ministry to the sick and dying. He examines the decrees in Lateran IV (1215) that articulate the relationship between sin and physical healing and the clear priority given to spiritual healing. He discusses at some length several passages in the Scriptures--notably the blind man story from John 9 and the directive in James 5 regarding the anointing of a sick man--that highlight the relationship between sin, physical healing, and how some medieval preachers and commentators likewise addressed the hierarchy between sin (spiritual healing) and physical sickness or suffering. Canon law likewise gave priority to the soul over bodily healing. And Izbicki looks at the long tradition, seen in commentaries, summae, and sermons, of identifying Christ as the chief physician of sick souls.
In the second section of chapter one, Izbicki looks at local councils and synods along with their rites and instructions that relate to the sick and dying. He examines specifically the late twelfth- and thirteenth-century statutes of Paris and Rouen and suggests that the Rouen statutes were used in other areas throughout Europe. Pastoral books such as the popular Manipulus curatorum of Guido de Monte Rochen instructed priests on how to minister to the sick and dying. And sermons were always a good way to educate people regarding sins and their consequences, even physical consequences. The laity were to be taught the seven works of mercy, which included visiting the sick, and they were to be taught about extreme unction or last rites, which included penance, the administration of the Eucharist, and the anointing of oil. All this was designed to help the faithful die in a state of grace. Priests used manuals to aid them in this ministry and were held accountable (to the extent possible) by strict disciplinary oversight of bishops or other diocesan representatives. Clergy were also forbidden to receive payment (simony) for the administration of these sacraments.
Chapter two looks at sickbed confession. Izbicki argues that the instructions related to visiting the sick and dying varied (mostly in the details) from diocese to diocese across Europe until the sixteenth-century Council of Trent brought more uniformity. The priest was expected to have a consecrated host and oil, along with the vestments that would be used in this ministry. With some variations, priests were expected to go to the sick person's bedside, hear confession, and administer the Eucharist and extreme unction. Early canon law stipulated that penance and communion, and later, the anointing of the sick were never to be withheld from the Christian facing a grave illness or death. And theologians addressing this topic even extended it to those facing capital punishment and prison.
Medieval pastoral/diocesan manuals, such as the fifteenth-century manual of Toledo or the sixteenth-century manual of Salamanca, provide most of the evidence for how priests were to hear confessions of the faithful. Of particular interest is the discussion of practical problems related to administering confession, such as when a priest was not available or when the sick person was not capable of making a confession either because they were in extremis or facing other mental or physical challenges.
In the third chapter, Izbicki looks at the long history of giving the Eucharist to the sick and dying. Typically, the administration of the Eucharist happened only after confession and was designed to usher the dying person into the next life. There is a discussion of canon law, including the reservation of the consecrated Eucharist and how to carry the host in procession to the sick and dying. The wide range of sources used here is impressive. The sources discuss concerns about such things as the reserved Eucharist falling into the wrong hands, the long journeys sometimes required to take the host to the sick, and even the potential concern over vomiting the host.
Chapter four looks at the anointing of the sick (unction). Again, Izbicki covers a lot of ground in scriptural commentary, canon law, and theology to explain the history of the anointing of the sick and some of the variation related to its practical applications and effects. The chapter includes an extended discussion of Dominican and Franciscan views on anointing. Citing Aquinas and other scholastics along with Franciscan authorities, there was agreement that the primary effect of the sacrament was spiritual healing rather than bodily healing and that children, especially young children under the age of fourteen, facing grave illness did not need anointing. As in the previous chapter, Izbicki documents statutes, visitation records, and other pastoral texts related to instructions for anointing and accountability for priests who failed in their duties.
One of the best chapters is chapter five, which looks specifically at the moment or hour of death. Here, Izbicki discusses a wide range of elements related to the moment of death. Such pastoral provisions included prayers, meditations, readings, and even art, all with the goal of helping people remember the reality of memento mori. The last part of this chapter focuses on burial rites, with particular emphasis on the death of children.
Finally, an epilogue looks beyond the Middle Ages proper to the Reformation and post-Reformation period, and argues that while Protestantism ultimately rejected the sacrament of extreme unction and the decidedly sacramental care for the sick and dying, the Catholic Tridentine reforms continued the traditions and beliefs practiced in the Middle Ages, both in Europe and in the Americas. Although both Protestants and Catholics sought to care for the sick and dying, the distinction between a sacramental (one might argue incarnational) care and a laicized care is perhaps the most significant pastoral change in the Western Christian tradition of caring for the sick and dying--and is one area ripe for future research.
Izbicki's careful attention to scholarly details and his thorough familiarity with the sources and secondary literature on this topic add to the strength of this work. His bibliography includes seventeen pages of manuscript, primary, and secondary sources, an incredible resource for students and scholars in this field. The volume is of high quality, as we have come to expect from Catholic University Press. Students of medieval pastoral care, religion, and church history will welcome this important and readable text.