Bro. Pius poses with his famous yellow walker. He has been crippled with arthritis
for years, but manages to stay with the flow.
Care of the Sick in the
Rule of Benedict
by Terrence Kardong, O.S.B.
When we look at the care of the sick in the Rule of St. Benedict, we might want to
first ask what it can possibly teach us. Most of us who are of a certain age realize
that medicine hardly resembles health care from our youth. If we have a bit of historical
awareness, we probably realize that medicine has been advancing by tremendous strides
almost from day to day. In comparison with ancient times, for example the time of
St. Benedict in the sixth century, there is a yawning gulf.
Yet most of this progress lies in the realm of science: better chemicals, better
machines and better procedures. But the care of the sick and the weak is not just
technique, it is human wisdom. And human wisdom does not necessarily advance at the
same rate as technical knowledge. In regard to medicine, it could be that the ancients
had insights from which we can still benefit. And so we will look at St. Benedict’s
Chapter 36 on the care of the sick brothers.
Although by our standards, ancient medicine was extremely primitive, there always
were doctors and there was a certain accumulation of medical wisdom among them. We
know this because we still have the writings of Greek and Roman doctors such as Galen.
I might mention also that we have these writings only because they were preserved
by medieval monks in their libraries. These monks were perhaps not as skilled as
the Greeks, but at least they were smart enough to preserve their books. The Arabs
also valued this knowledge and preserved the treatises. Strange to say, medical science
did not advance very much from the time of Christ until the 19th and 20th centuries.
Unbelievable but true.
Medicine among the Christians
What does the Bible say about healing and medicine? When we look at the Jewish Bible,
we don’t find very much, but there is a fine statement in the Book of Sirach that
shows that at least some Jews valued a skilled doctor.
Value doctors, for humanity needs them and God created them. A doctor has wisdom
from God . . . God produces medicine from the earth which the intelligent do not
despise. He (God) gave humans knowledge so as toglorify himself by his wonderful
works. By this means the physician relieves pain, and likewise the mixer of ointments
his pharmacopia, so the works of God do not cease, and help does not vanish from
the face of the earth. My son, when you are sick do not hesitate: pray to God for
he makes well. Cease from doing evil . . . You must also give access to the doctor,
since he is necessary. At some point in time, recovery is in his hands; then he prays
to God that he may grant success to his examination and healing for the maintenance
of life. Whoever sins against his Creator must lay claim to the help of the doctor.
Although this quote is clear enough, it might be well to add that Sirach is a book
written by an aristocrat for aristocrats. In other words, only the wealthy had access
to professional physicians in Jewish society. Secondly, Sirach indicates that sickness
is caused by sin, which is not the opinion of all biblical writers. When we come
to the Christian Bible, we don’t find too much either, but its central figure, Jesus,
is often shown healing people. Certainly he is not a professional physician, but
that does not stop him from taking on the most serious illnesses.
And a great crowd followed him and thronged about him. And there was a woman who
had had a flow of blood for twelve years, and who had suffered much under many physicians,
and had spent all that she had, and was no better but rather grew worse. She had
heard the reports about Jesus, and came up behind him in the crowd and touched his
garment. For she said, “If I touch even his garments, I shall be made well.” And
immediately the hemorrhage ceased; and she felt in her body that she was healed of
her disease. (Mark 5.25-29)
Apparently, the Evangelist Mark does not think much of physicians, but when Luke
copies this text, he drops out the derogatory remarks about them. Some scholars think
Luke himself was a physician. At any rate, Jesus is portrayed as a sympathetic, popular
By and large, it seems that the early Christian Church was true to its Master in
this regard. Even though most of his followers could not miraculously heal the sick
like Jesus could, they could at least tend them to the best of their ability. Sometimes
this went to heroic lengths, we hear from an early historian:
Most of our brothers did not spare themselves and treated each other with heroic
love and goodness; they fearlessly assisted the sick, they carefully nursed and served
them in Christ, they cheerfully died with them . . . sharing the sickness of others,
voluntarily taking on themselves their sorrows . . . it was entirely different with
the pagans. They drove out those who began to get sick . . . they threw half-dead
people into the streets. (Eusebius, Church History, VII 22.7-9)
In his important book, The Rise of Christianity, the sociologist Rodney Stark says
that from what he can tell, Christianity succeeded despite persecution precisely
because it was so much more humane than paganism: It did not just throw people out
into the street. This quote also shows that everyone was terrified of the plague
victims because nobody understood the disease. All the Christians could do was to
offer palliative care. And sometimes they did this in an organized, systematic form.
Some of the bishops, like Basil of Caesarea, ran fairly elaborate hospitals, which
catered especially to those who could pay nothing. Or sometimes wealthy Christians
ran private shelters for the sick-poor. The example of Jesus was powerful in this
We have mentioned that some people thought that sickness was simply a result of sin;
in other words they moralized the issue. There may be a grain of truth in such a
claim, but Jesus himself was skeptical. “As he passed by, he saw a man blind from
his birth, and his disciples asked him, ‘Rabbi, who sinned, this man or his parents,
that he was born blind?’ Jesus answered, ‘It was not that this man sinned, or his
parents, but that the words of God might be made manifest in him.’ ” (John 9:1-3)
Yet this kind of thinking did not and does not easily go away.
Apparently it was still around 400 years later in the Egyptian desert. A famous spiritual
guide named Syncletica gave this advice to her disciples:
Many are the wiles of the devil. If he is not able to disturb the soul by means of
poverty, he suggests riches as an attraction. . . . Overcome by health, he makes
the body ill. . . . Not having been able to seduce it through pleasures, he tries
to overthrow it by involuntary sufferings. He joins to thisvery severe illness to
disturb the faint-hearted in their love of God. But he also destroys the body by
very violent fevers and weighs it down with intolerable thirst. If, being a sinner,
you undergo all things, remind yourself of the punishment to come, the everlasting
fire and the sufferings inflicted by justice, and do not be discouraged here and
now. . . . If you are righteous and fall ill, you will go from strength to strength.
. . . Exult and see who else was treated like that; it is a honor to have the same
sufferings as Paul. (Amma Syncletica 7)
Perhaps we would not all agree that illness is caused by the Devil, but at least
we can agree that it can be an occasion for significant spiritual growth.
very severe illness to disturb the faint-hearted in their love of God. But he also
destroys the body by very violent fevers and weighs it down with intolerable thirst.
If, being a sinner, you undergo all things, remind yourself of the punishment to
come, the everlasting fire and the sufferings inflicted by justice, and do not be
discouraged here and now. . . . If you are righteous and fall ill, you will go from
strength to strength. . . . Exult and see who else was treated like that; it is a
honor to have the same sufferings as Paul. (Amma Syncletica 7)
Perhaps we would not all agree that illness is caused by the Devil, but at least
we can agree that it can be an occasion for significant spiritual growth.
MONKS AND MEDICINE
The early monks had to contend with illness just like anyone else. Sometimes they
claimed that great monastic saints like Antony were not subject to illness, but usually
they were more realistic. People got sick in the monastic colonies and somebody had
to take care of them. Some of these care-givers were more zealous and more skilled
than others, but everybody realized that it was unchristian and inhuman to abandon
others when they got sick. Here is a charming story from the Egyptian Desert:
Three monks wished to hire themselves out as a team of harvesters, but one of them
fell sick and returned to his house. So the other two agreed to take on the work
of the sick brother in the hope that he might aid them with his prayers. When the
pay was distributed, they called the brother to come and get his pay. But he refused,
since he had not worked. But the others swore that the harvest was completed only
by the prayers of the sick brother. (Lives of the Fathers V.17, 20)
Not every early monastic document is sympathetic toward the sick. The Rule
of the Master, for example, displays a rather nasty suspicion of them as fakers and
even goes so far as to make this ugly statement:
Brothers who say they are sick. . . . At meals they should receive only juice, eggs
and warm water, which the really sick can hardly get down. . . . So if they are malingering,
they will at least be driven to rise from bed. . . . Let him at least go into the
oratory with the brothers at the usual time. And if he cannot stand, let him chant
the psalms lying on a mat as if at prayer. But let the brother standing next to him
keep an eye on him so he does not go to sleep. . . . If he will not work, he also
should receive less to eat. When someone claims he is unfit to work, from this one
must assume that he also cannot eat. (Rule of the Master 69.1-2, 9-11, 17)
In fairness to this author, it should be noted that in other chapters he manifests
more tenderness toward the sick, generally exempting them from fasting and heavy
work. In fact, that is the usual teaching of Catholic moral theology: the sick are
exempt from normal discipline. At the other end of the spectrum, we find St. Augustine.
He has a reputation of being a rather hard-nosed moralist, but in regard to the sick
he certainly is quite humane.
If a brother says that he does not feel well, even though he is not noticeably sick,
believe him without hesitation. But if you are not sure whether the treatment he
wishes to have will be of any benefit to him, then consult a doctor about it. . .
. Because bathing may be necessary for good health, the opportunity to visit the
public baths may never be refused. In this matter follow medical advice without grumbling.
Even if a person is unwilling, he shall do what has to be done for the good of his
health, if necessary at the command of the superior. (Augustine, Rule for Monks V.6
Obviously this is a much more sympathetic attitude than that of the Master! Still,
Augustine holds the sick to obedience in that they are not permitted to do whatever
they please. Moreover, here we are dealing with an urban situation where there were
physicians available, as well as public baths. Most early medieval monasteries such
as that of the Master and Benedict were rural and so they had access to neither physicians
nor public baths. But they shared many other issues with Augustine, as we shall see.
When we study Benedict’s text, we will see that he lies somewhere in between these
two extremes. For now, it should be mentioned that he is very interested in preventative
medicine in that he always stresses a balanced, healthy life-style in regard to food
(38-41), clothing (55), sleep (22), work and prayer. Moreover, the medieval monks
were famous for their infirmaries and their pharmacies, as every reader of the Brother
Cadfael novels knows very well. And some scholars would claim that they were an important
bridge from ancient to modern medicine:
The warm and intensive care for the sick that Benedict shows and prescribes produced
a notable series of arrangements for sick care, and created institutes and studies
all aimed at supporting and healing the sick brothers. These enabled Benedictine
monasteries to become centers of health care and medical advancement in the following
centuries. (A. Lentini, La Regola di San Benedetto, 337)
NOTES ON THE TEXT OF RB 36
1.The sick are to be cared for before and above all else, for it is really Christ
who is served in them. 2.He himself said: I was sick and you visited me, and 3.Whatever
you did to one of these little ones, you did to me. 4.For their part, the sick should
keep in mind that they are being served out of respect for God. Therefore they should
not irritate the brothers serving them with excessive demands. 5.Nonetheless, they
should be treated with patience, for in doing so one merits a generous reward. 6.So
the abbot must be very careful that they suffer no neglect whatever.
7.The sick brothers should be provided with a separate room and a server who is God-fearing,
devoted and careful. 8.The sick should be granted the use of baths as often as it
seems useful, but they should be allowed less readily to the healthy, and especially
to the young. 9.The eating of meat should be allowed to the very weak to build up
their strength. When they have recuperated, however, all must abstain from meat in
the accustomed manner.
10.The abbot should be extremely careful that the sick not be neglected either by
the cellarers or the servers. He is responsible for whatever faults the disciples
I. Main Teaching: Sick are to be Treated as Christ (36.1-6)
A. Biblical and Theological Basis of Care of the Sick: Christ is Served in Them (36.1-6;
The central message of this chapter is found in the first half: the care of the sick
is an absolutely primary concern in a Christian monastery. This heavy emphasis is
backed up with a quote from the Last Judgment scene of Matthew 25: if we have treated
the sick well, it will go well with us in the Judgment; if not, we have reason to
be afraid. This was one of the most widely quoted sayings of Jesus in the early Church,
and one can see why. To mistreat a sick person is to mistreat Jesus himself.
We may recall that the sheep and the goats in the Judgment are very surprised to
hear this. Both groups had no idea whatsoever that they were dealing with Jesus himself
all along. They thought they were just dealing with unfortunate, helpless people.
Not so, says Jesus. You were dealing with me in them. The stakes were much higher
than you ever suspected. No doubt this same passage had a good deal to do with the
compassion of the early Christians for the weak, the neglected and the abandoned.
Why did Matthew couch his message in such shocking terms? I think because it is so
counterintuitive. Often, when we encounter the sick, or those in jail or strangers,
we encounter powerless people, people on the margins, people down in their luck.
If our concept of Jesus is one of triumphant power, it is very hard to put the two
together. And he says they are together. Secondly, working with those who are hurting
is difficult and not very glamorous. It takes special motivation. What stronger message
could Jesus send than this?
This is not the only time St. Benedict uses this passage to make that point. In his
chapter on the reception of pilgrims he uses it again: “All guests who arrive should
be received as Christ, for he himself will say, ‘I was a stranger and you took me
in.’ ” Proper respect should be shown to all, “especially fellow monks and pilgrims.”
(RB 53.1-2) But he was not the first one to use it. In discussing the care of the
sick in his hospital, Basil of Caesarea, an earlier monastic writer that Benedict
sometimes quotes, also bases his teaching on the same text of the Last Judgment:
Question: What should be our sentiments when caring for sick brothers?
Answer: As if we were offering service to the Lord himself, who said: “When you
did this to the least of my brothers, you did it to me” (Mt 25:36). It helps to maintain
this attitude in our service if those who receive it are such as deserve it. Therefore,
it is necessary that those in charge be careful that those who are served not be
indulging themselves, but that they be found worthy of the love of God and of Christ.
They should merit the care of the brothers by their patience and the merit of their
lives. Then the thing will be done for the glory of God and the disgrace of the devil,
as it was with holy Job. (Basil, Latin Rule 36)