Of all the sites of interaction between the late medieval clergy and parishioners, none was more personal or viewed as more important in terms of what was at stake (the salvation of souls), than a priest’s care for the sick or dying on their sickbed. It was here that the priest heard confession, administered communion, and anointed the gravely ill with oil, thereby bringing spiritual (and possibly physical) healing. It was hoped that the priest’s ministry would not only bring comfort to the sick but shorten their journey from the earthly world to eternal life. In surveying the ministry to the sick and dying, this book brings together an impressive number and range of sources, including those related to canon law, theology, and ritual.
In chapter 1, “Ministry to the Sick,” Izbicki illustrates the lasting influence of the Fourth Lateran Council’s (1215) canon 22, “Cum infirmitas,” in enjoining priests to visit the sick. “Cum infirmitas” formalized longstanding medieval Christian ideas about the connections between illness and sin, healing and forgiveness, the physical and the spiritual. The canon, which appeared in numerous collections of canons and decretals, prioritized spiritual ministry to the sick over medical treatment. Theologians such as Thomas Aquinas, likewise, argued that the three sacraments – confession, the Eucharist/viaticum, and extreme unction – could cure the sick of the “illness of sin” (p. 16). As Izbicki shows, medieval theologians and canonists frequently described the spiritual ministry to the sick as a form of medical care, rhetorically using metaphors to compare spiritual health and disease to physical health and illness as a way of prioritizing the spiritual.
The foundational element of ministering to the sick and dying was hearing confession, the subject of chapter 2. Pastoral manuals emphasized the importance of priests showing mercy toward the sick, who were only expected to perform any imposed penance if and when they recovered from their illness. It was also recognized that in some cases the dying might not be able to speak, and so canonists and manuals for priests had to determine whether to make various allowances. Could witnesses make confession on behalf of someone dying? If a parish priest was not available to hear a dying person’s confession, could a priest from another parish, or even a layman, do so?
Chapter three examines the administration of the viaticum, the communion given to the sick who were thought to be on their way to the next world. Drawing on manuals for priests, Izbicki details how the viaticum was given to the sick. As he shows, there was a good deal of anxiety within the church that a church’s consecrated Eucharist might not be reserved for the viaticum or might not be refreshed weekly (much was written about the danger of the viaticum being infested with worms). Pastoral manuals described in detail how the viaticum was to be safely stored and carried to the bedridden via processions, with a light carried before the Eucharist, and bells rung to call the attention of the laity, who were expected to venerate the carried host.
During the late Middle Ages, the sacrament of anointing the sick with oil – the subject of the fourth chapter – was thought to originate with the apostles. The scholastic theology of anointing, which frequently cited the Gospel of Mark and the Epistle of James, suggested that the sins of the dying could be remitted through extreme unction. The sacrament was also thought to possibly lead to bodily healing. Episcopal statutes and other pastoral texts often contain detailed instructions for anointing the sick, and visitation records include complaints about holy oil, which had to be blessed by a bishop, not being securely locked or not being refreshed.
Chapter five, on “The Hour of Death,” contains examples from late medieval sources dealing with the “practicalities and preparations for death” (p. 201). In a culture preoccupied with preparing for death, including constant physical reminders of one’s mortality (“memento mori”), priests played an important role in creating the conditions for a good death. Moreover, Izbicki points to one example of a manual for priests, the Urgell manual, which contained an “Ars moriendi” (“Art of Dying Well”), laying out the need for confession, testament-making, prayers for the dead, a crucifix and religious imagery in the sickroom, and spiritual exhortations. At the “hour of death,” priests were expected to deliver a commendation of the soul (“commendatio animae”) that helped the angels in their contest with demons over the dying person’s soul.
Given the impressive range of sources that Izbicki has marshaled, it is disappointing that he does not do more to develop arguments and larger themes. While the book promises to explore the relationship between sickness and sin, for example, this important and complex question is not sufficiently developed. Nor is the clergy’s care of the sick and dying contextualized within a broader discussion of the late medieval pastoral revolution. Many of the examples and texts cited (in some cases, repeated in multiple chapters) call out for greater analysis. What were some of the regional differences (or continuities) in sickbed confessions? To what extent did canonists’ discussions of the viaticum reflect the practical challenges addressed by pastoral manuals and visitation records?
On the positive side, this book brings together for the first time an extraordinary body of source material dealing with the late medieval church’s ministry to the sick and dying. By collecting this material, spanning several centuries and much of Latin Christendom, Izbicki’s work will help future scholars appreciate the energy that went into the late medieval church’s ministry to the sick and dying.
