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Moral Sick Notes: Medical Exemptions to Religious Fasting in the Eighteenth-Century Spanish World

Published online by Cambridge University Press:  08 June 2022

George A. Klaeren
George A. Klaeren*
Affiliation:
University of St Andrews
*
*St Mary's College, School of Divinity, University of St Andrews, South St, St Andrews, KY16 9JU. E-mail: gak6@st-andrews.ac.uk.
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Abstract

Eighteenth-century moral theologians in Spain expressed concern that many Catholics were obtaining permission to avoid fasting and abstinence from meat by claiming that they were ill and required medical dispensations. This article examines the theological and medical debate which occurred over a series of treatises and essays in which physicians and moral theologians sought to come to a common understanding of when a Spaniard was infirm enough to be medically excused from fasting and, perhaps more importantly, who had the authority to make this decision. Throughout the eighteenth century in Spain, this responsibility continued to be shared by priests and physicians. The debate highlights the contest for medical authority, mitigated by doubt. It also suggests that any understanding of early modern medical pluralism must include members of the theological community as well as health professionals.

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Type
Research Article
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Studies in Church History , Volume 58: THE CHURCH IN SICKNESS AND IN HEALTH , June 2022 , pp. 173 - 195
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of Ecclesiastical History Society

Introduction: Avoiding Fasting in Eighteenth-Century Spain

It was common knowledge in eighteenth-century Spain that some Catholics would fake an illness in order to avoid the religious obligation of fasting and abstaining from meat, two practices which the church commanded them to observe on specified days throughout the year. The Catholic Church in Spain had traditionally made allowances for those who, for medical reasons, needed to be excused from fasting; but by the eighteenth century, moral theologians had begun to complain that too many individuals were wrongly claiming medical exemption. Indeed, by 1834, this fact had become the source of a familiar phrase that John Collins included in his book of Spanish proverbs for English speakers:

Achaques al Viernes para no ayunar. – ‘Ailments on Friday in order to avoid fasting.’ – Applied to Catholics who pretend indisposition, to be dispensed from abstaining from eating flesh on fasting days; – also to those who find excuses and raise difficulties against doing any thing not agreeable to them.’Footnote 1

Far more than a proverb, medical excuses from fasting were a serious concern for early modern Spaniards. When was it morally permissible to break religious dietary laws on medical grounds? Perhaps more importantly, who had the authority to determine these boundaries and grant permission to be excused from fasting? These questions, which had been raised for centuries, became particularly important for theologians and physicians in the mid-eighteenth century. From 1727 to 1786, at least fourteen different essays or treatises were written defining the parameters of fasting within the Spanish world alone. Many of these were written specifically in response to instructions and changes to the religious practices concerning dietary restrictions in Lent introduced by Clement XII (1730–40), Benedict XIV (1740–58) and Clement XIII (1758–69), changes which were not unanimously enforced or welcomed in Spain.

This article examines the debate over medical exemptions and considerations relating to religious fasting and abstinence from meat in eighteenth-century Spain, focusing on discussions which articulated who had the expertise and authority to verify illnesses and grant dispensations on medical grounds. After summarizing the ‘rules’ of fasting in eighteenth-century Spanish Catholicism and the ways in which a person could receive a dispensation, this article highlights the arguments between theologians, physicians and other intellectuals who sought to determine the cause underlying the abuse of medical exemptions. Two fundamental questions are emphasized: what constituted a sickness worthy of a dispensation, and who had the authority and knowledge to discern such cases? To conclude, this article uses this discussion to demonstrate how the medical and theological communities engaged one another in the early modern Hispanic world, contextualizing these discussions in the broader field of ‘medico-moralism’ and arguing for a more inclusive understanding of medical pluralism which incorporates the impact of theology and religion in determining the parameters of sickness and health in early modernity.

This article helps us to understand better how the church had an active role in defining what constituted ‘sickness’. It helps to elucidate how the church negotiated the meaning and evaluation of both ‘sickness’ and ‘health’. These were shared concepts that were used by the theological and medical communities of early modern Spain. Discussions of moral theology involving fasting necessarily raised questions about health and illness. What is seen in the debate over medical exemptions to fasting is that these ideas, far from being static, were malleable terms which required theologians constantly to engage with, and incorporate knowledge from, medical experts and authorities. Clergy were not only part of discussions about what was considered true ‘sickness’, but were also questioning who had the privilege of determining these concepts in the first place.

The Rules: The Tradition of Fasting and Abstinence from Meat in Early Modern Spain

Fasting and abstinence from meat have a long history of observance both in Christianity and in other religions.Footnote 2 Christian fasting has been linked with several biblical precedents and was advocated by many Church Fathers, including Augustine, Basil, Gregory the Great and Athanasius.Footnote 3 In the medieval and early modern periods, its Catholic proponents included Thomas Aquinas and Fray Luis de Granada.Footnote 4 Religious scholars in the early modern period knew and referenced this tradition to underscore the importance of fasting and abstinence.Footnote 5 One author wrote that while some early Church Fathers believed it possibly a divine law, it was ‘at the very least … a precept of Apostolic canon law and the transgression of it is a moral sin’.Footnote 6 Similarly, Benedict XIV described Lenten fasting as:

among the principal cornerstones of right doctrine. [It was] once sketched for the first time by the Law and the Prophets, somewhat consecrated through the example of Our Lord Jesus Christ, handed down from the Apostles, prescribed everywhere by Sacred canons, and [it is] accepted and observed by all of the Church since its inception.Footnote 7

Rules governing fasting existed in Spain as early as the Council of Toledo in 655; by the eighteenth century, however, the manner and customs of abstinence and fasting had changed significantly from the practice described by the Church Fathers or even by medieval theologians such as Thomas Aquinas.Footnote 8 The basic rules articulated by Spanish catechisms at the end of the seventeenth and beginning of the eighteenth centuries can be summarized in two parts:

  1. 1. Adult Catholics, by command of the church, were expected on given days throughout the liturgical year to practice abstinence from meat. Furthermore, on many of these days of abstinence, Catholics between the ages of 21 and 60 were additionally required to fast.

  2. 2. When fasting, one could drink non-nutritive beverages, but could consume only one meal at midday (around eleven o'clock) and a modest, light meal (refección, collation) later in the evening.Footnote 9

Although these rules remained roughly consistent in Spain throughout the eighteenth century, exceptions abounded. For example, in Spain, abstinence from meat during Lent also extended to abstaining from eggs and dairy products.Footnote 10 However, most Spaniards purchased a special bull known as la bula de la Santa Cruzada (‘the bull of the Holy Crusade’).Footnote 11 These licences were a privilege gifted to Spain to sell in order to raise funds for ‘crusades’ (liberally interpreted) and granted the purchaser certain privileges, including in some cases the permission to eat dairy products, eggs or even meat in certain circumstances during days of fasting and abstinence.Footnote 12 Generally, however, Spaniards were meant to abstain from meat on Fridays and Saturdays throughout the year and supposed to fast for a handful of solemnities and observances throughout the year, as well as before partaking of the eucharist.Footnote 13 By some estimates, days which involved some degree of abstinence or fasting could constitute around one-third of the year for an observant Catholic in the early modern period.Footnote 14 Most debates on the subject, however, focused on the Lenten practices of abstinence and fasting which occurred in the forty-day liturgical season between Ash Wednesday and Easter Sunday. Other observances ranged in duration from a half-day to a few days in a row, but none had as much potential for impacting human health as the forty near-consecutive days of Lenten abstinence and fasting.Footnote 15

Fasting could serve several purposes.Footnote 16 It could be a preparatory practice (as before the eucharist or in Advent), a way of ‘elevating minds’ and intensifying devotion, committing oneself to prayer, an expression of grief or mourning or a practice of mortification and self-sacrifice.Footnote 17 Fasting could also be prescribed as a penitential act in the belief that ‘we mortify [the body] with fasting, which subdues the carnal and luxurious appetites … we deprive ourselves of the delights of the body’.Footnote 18 Fasting was part of the fabric of early modern Spanish society. It was a unitive experience that everyone would have known and experienced, and its impact can be traced socially, culturally and even economically. Scholars have demonstrated, for example, the effect which fasting had in promoting the sale of fish and offal, both of which were permitted on days of abstinence.Footnote 19

It is clear, however, that fasting was also a practice that needed explanation and enforcement. One way to problematize fasting in the early modern period, for example, was to question the definition of ‘food’ or ‘meat’. Were milk, wine or hot chocolate nutritive beverages which could be considered to break fasting? Was smoking tobacco permissible? Did turtles count as ‘meat’ (which was not allowed) or as ‘fish’ (which was)?Footnote 20 These questions were certainly debated, but an equally important and problematic issue concerned the legitimate circumstances in which a person could be excused from fasting, either partially or totally.Footnote 21

According to canon law and most Spanish theologians, there were three exceptions, besides age, which excused someone from fasting, or in some cases from abstaining from meat: piety, labour and infirmity.Footnote 22 Piety allowed those who could not fast and undertake a religious office to be excused, for example, those preaching or confessors. Labour exempted those whose employment required significant physical exertion, such as farm labourers, blacksmiths and soldiers. Both categories were subject to nuanced disputes, but the third category created serious debates.Footnote 23 ‘By illness’, one theologian explained, ‘are excused from fasting those that suffer serious pain that is evidently incompatible with fasting’.Footnote 24 Another stated that ‘by illness, here it is not only understood as those who have a serious illness, but also those with ailments that make the precept notably most difficult’.Footnote 25

These ambiguities in definition created a serious issue for theologians and physicians in the eighteenth century. And indeed, fasting was a serious topic, for, as many theologians pointed out, it was a mortal sin to break a fast without just cause. Moreover, the visibility of breaking a fast made it a useful marker of heterodox (and Protestant) behaviour; Catholics could use fasting as a litmus test in their efforts to counter such non-Catholics.Footnote 26 For example, the Carmelite theologian José Vicente Díaz-Bravo (1708–72) described fasting as ‘the character which distinguishes the Catholic from the enemies of the Cross of Jesus Christ’.Footnote 27 Similarly, the Capuchin moral theologian Jaime de Corella (1657–99) wrote that only ‘nonbelievers, insane people, and children’ ate meat on fasting days, and even in the eighteenth century the Inquisition continued to hear accusations, albeit very rarely, regarding those breaking fasts in conjunction with committing other spiritual abuses.Footnote 28 Scorning the practice of fasting was not meant to be a casual endeavour.

The Problem: The Decline of Fasting in Eighteenth-Century Spain

Spanish Catholics were, therefore, supposed to be regularly observing days of fasting and abstinence from meat, with occasional exceptions in Spanish society being granted for illness and other reasons. In reality, however, this appears to not have been the practice of many Spaniards. Many eighteenth-century writers, both physicians and theologians, complained that almost all Spaniards seemed to be breaking the fast by claiming medical exemptions which were granted to them by priests and doctors. Take, for example, the testimony of Diego de Torres Villarroel (1694–1770), a renowned writer of the Spanish Enlightenment, who described his frustrations in a publication in 1730.Footnote 29

By experience I have seen, it is rare … [that a house] serves fish on the tables on fast days, and in all the eating halls I have seen healthy, fat, and robust people; and they have the nerve to say that Lent was made for fools and Friars. The ailments to avoid fasting are many, but not all are legitimate.Footnote 30

It appears that many Spaniards were avoiding fasting, not by openly rejecting the practice, but by claiming that they should be excused from fasting or abstinence because of illness or infirmity. To be clear, it is difficult to ascertain definitely whether there was an empirical or quantitative decline in the observance of fasting and religious dietary restrictions in eighteenth-century Spain. While there is widespread discussion in works published in this period, it is nevertheless possible that these reflect an unsubstantiated or merely apparent decline which existed more in the discussion of learned authors and printed sources than in reality. However, given the number and the variety of sources which addressed this topic, including writings by local clergy, well-known Spanish intellectuals and religious authorities and papal brevia, it is reasonable to assume that they reflect not only a perceived decline but also a real change in practices of fasting during the eighteenth century. Additional quantitative analysis of the purchasing of bulas Cruzadas could support this thesis. This tension between the regulations for fasting and the actual practice of it may have been exacerbated by the widespread use of the bulas Cruzadas in Spain; one liberty often granted by the bull was the permission to consume dairy products, eggs and even meat during days of fasting and abstinence, provided the holder of the bull had consulted both a medical expert and a spiritual advisor. One reproduction of the bull from the mid-seventeenth century affirmed:

Also conceded to all persons who hold this Bull, [is that] during all the aforementioned year, they can, on the advice of both Physicians, spiritual and corporal, eat meat during Lent, and other times of fasting, and prohibited days for eating meat throughout the year. And that likewise they can eat freely as they wish eggs and things made from milk …Footnote 31

The treasured bulas Cruzadas did not give individuals carte blanche dispensation from dietary restrictions; rather, they required that those seeking such dispensation demonstrate a legitimate medical reason for being excused.Footnote 32 The apparent result was the phenomenon of Friday ailments.

This crisis came to a head in 1741, when Benedict XIV issued two papal brevia on the laxity of fasting in the Catholic world. He lamented in Non ambigimus that ‘the most sacred observance of the Lenten fast has been almost completely eliminated by the excessive ease of dispensing it everywhere in [an] indiscriminate manner for futile and non-urgent motives’.Footnote 33 He urged the clergy to exhort and guide their parishioners to observe the Lenten fast faithfully and emphasized that dispensations should not be given except in cases of ‘legitimate cause’ which had been subjected to ‘the counsel of each of two Physicians’ (utriusque Medici consilio).Footnote 34 The papal language should have been familiar to Spanish readers, because the bulas employed the same phraseology of ‘legitimate cause’ and ‘the counsel of two Physicians’.Footnote 35

Almost immediately, it seems, objections and qualifications were raised in response to this bull, questioning whether it applied to corporate and public dispensations or only to private ones and whether an absolute mandate from the pope had been given. In response, Benedict XIV issued In suprema universalis three months later, which clarified that his commands concerning dispensations applied to every single Catholic.Footnote 36 Here the language was exact and emphatic: to receive a dispensation from fasting, any Catholic would need ‘legitimate cause’, which was granted by ‘the counsel of each of two Physicians’.Footnote 37

The Debate: Doubts about Medical Exemptions to Fasting

However, although the brevia were meant to give clarity, many doubts remained in Spanish society concerning medical exemptions to fasting, evidenced by the number of publications devoted solely to the task of explaining and understanding the bulls, brevia and canons on fasting. Much of this doubt can be attributed to two points: a lack of clear consensus on what constituted an excuse-worthy illness and arguments about who was allowed to determine this. Canon law and moral theologians were not often explicit on what defined illness; likewise, the language of ‘legitimate cause’ was also not explicit. Some categories were clear (pregnant women, for example, were automatically exempt) but because of the subjectivity of experiencing pain and illness and the variety of such experiences, this was left largely to interpretation on a case-by-case basis. ‘Casuist theologians have signalled so many [reasons for dispensation]’, complained Díaz-Bravo, ‘that there is hardly anyone to whom abstinence applies.’Footnote 38 He outlined four categories of medical excuses: supposed causes (supuesta), doubtful causes (dudosa), legitimate causes (legitima) and certain causes (cierto).Footnote 39 The first two, based on hypothetical or potential dangers, were insufficient grounds for receiving a dispensation, while the final category of certain causes applied to those circumstances such as pregnancy in which it was ‘notorious and manifest … of such a manner that no one to this point has doubted [it]’.Footnote 40 The problematic area was the third category, which applied to those health concerns regarding which ‘it is prudently feared that if one does not dispense [a person] from fasting or abstinence … one could occasion some grave harm to the health of the body [of the sick person] … Not all sickness is legitimate cause, but only a notable sickness and that which could be dangerous.’Footnote 41

The instructions mandated the advice of both a spiritual and a corporal physician. But who had the authority to determine cases of ‘legitimate cause’? As Díaz-Bravo noted, ‘Canonists and Physicians travel on contrary paths.’Footnote 42 While, in the past, bishops had been responsible for granting dispensations to parishioners in their dioceses, this task had now been shifted to a cast of figures drawn from both the medical and the theological communities.Footnote 43 In Paris, for example, authority for granting dispensations had been reassigned from priests to physicians in 1657.Footnote 44 In Spain, however, this responsibility continued to be shared by clergy and physicians. Physicians had been added to the list of individuals who could grant a dispensation, but they did not replace parish priests and confessors.

Despite the papal instructions, it seems that there were instances where two experts were not consulted. In some cases, individuals consulted authorities from the medical community, mostly physicians (médicos) and surgeons (cirujanos), while in other cases, individuals sought the advice of authorities from the theological community, priests and confessors. One moral theologian explained, for example, that obvious illnesses (similar to Díaz-Bravo's ‘certain cause’) did not need to be verified by a physician, ‘but when the aforementioned evidence is lacking, one is excused from fasting if a Physician, or lacking one, a Surgeon, a Parish Priest, a Confessor, or a prudent person declares that the sufferer cannot fast without serious detriment to his health’.Footnote 45 While this ranking seems to privilege the medical authorities over the local parish priest, most theologians were clear to assert that it was the right of a confessor or a priest, ‘not having a physician with whom to consult’, to grant dispensations entirely on their own.Footnote 46 In some parts of the Spanish empire, access to a physician or health professional may have been difficult to obtain, but on the Iberian peninsula, this would not have been a logistical concern; other factors could have included a general societal scepticism or disdain for physicians or a reluctance to incur the cost of consulting one.Footnote 47

Nor did an academy-trained and licensed professional physician have to be consulted as the representative for health professionals. Manuel Ezquerro Perez, a chaplain and synodal examiner in Logroño, wrote:

Who is meant by spiritual Physician? … the Confessor approved by the Ordinary … Who is meant by corporal Physician? … One that has been examined and approved by the Royal Protomedicato to cure sick persons, and graduates with licences from the University of Salamanca in the Faculty of Medicine, and where there is no Physician nor is there easy recourse to where there is one, a wise or intelligent man in the art of healing will suffice …Footnote 48

As a chaplain and a confessor in his diocese, Ezquerro may have been safeguarding what he viewed as his own responsibility. His explanation reveals a loose interpretation of ‘physician’; Ezquerro includes practitioners licensed by the protomedicato (a governmental council responsible for overseeing the licensure of medical professionals) and ‘academic’ medical experts, as well as local individuals who had some knowledge of healing and of illnesses.Footnote 49 As the historian María Luz López Terrada has shown, Spanish society was medically pluralist, drawing on non-exclusive resources for health from academic and extra- or para-academic professionals, including pharmacists and apothecarists, university-trained physicians, barbers and surgeons and even local healers who employed magic or religious healing.Footnote 50 The interpretations in theological handbooks of this point indicate that many of these para-professionals were considered capable of providing the expertise required by the ‘corporal physician’.

Some writers argued that the medical community was at fault here for underestimating the seriousness of the theological issues at hand. Benito Jerónimo Feijóo (1676–1764), perhaps the most famous writer of the Spanish Enlightenment, authored at least five different essays which discussed fasting. In one, he complained about ‘[t]he ease of the Physicians in declaring people exempt from the obligation of observing the Lenten abstinence who suffer some habitual indisposition’.Footnote 51 Additionally, some critics argued that the ‘professionals’ from the medical community were actually poorly informed when it came to the science of health and nutrition. Feijóo and others were particularly dismayed that many granting dispensations were doing so based on outdated and incorrect medical theories regarding nutrition which asserted that a vegetarian diet created weakness and a proclivity to become ill. He commented: ‘Those physicians who indifferently [examine] sick people, both actual and habitual, proceed irrationally [when they] excuse the Lenten abstinence. Many are gravely harmed by this dispensation.’Footnote 52 Díaz-Bravo, while arguing that physicians should determine the seriousness of an illness, also cautioned that ‘it is convenient that Physicians should undo the [false] impression that Lenten foods are notably harmful … Although fasting foods may [cause] harm, it is not as much as many physicians think.’Footnote 53 Díaz-Bravo cited the work of Feijóo, Paolo Zacchia and Jorge Baglivo as medical authorities who supported this position.Footnote 54

Likewise, at a meeting of the Royal Academy of Medicine in Seville, Josef Alonso y Saenz, a theologian at the University of Seville, mentioned in one address ‘the defects with which a physician can damage the spiritual good of a sick patient … the excessive liberty with which they usually dispense the obligations of hearing Mass, fasting, and abstaining from eating meat’.Footnote 55 Saenz conceded that the physician's job was made harder by ‘finicky’ patients who exaggerated their ailments, and several other authors also blamed those who consulted physicians and gave false accounts of their illness.Footnote 56 Joaquin Antonio de Eguileta, a chaplain in Madrid, railed against such patients in a sermon for the first Sunday in Lent:

Who does not tremble … upon seeing Lent draw near, knowing that he has to undertake the fast? Who does not seek out the opinions and liberal judgments of Physicians in order to free himself of the obligation of fasting? In the Divine Judgment the truth of these reports will be examined …Footnote 57

Still others during the eighteenth century argued that due to their lack of medical knowledge members of the theological community were at fault for giving dispensations so frequently. In 1751, the criollo physician Joseph Francisco de Malpica Diosdado blamed not only the ‘bad’ religiosity of Mexican Catholics, but also the willingness of priests to grant dispensations out of their general ignorance of the health sciences. ‘[I believed] that on the matter of Fasting and concessions to meat, the Theologians were stricter than the Physicians. Upon verification I found that it is the contrary: both the narrowest and most rigid were the Physicians who wrote on the proposition of Fasting, [rather] than the Theologians.’Footnote 58

Malpica Diosdado outlined nine reasons which he believed were most central to the decline of the practice of fasting, including the relaxed stance of popular Spanish works on moral theology, the work of ‘interloping’ city physicians and the fears that were commonly held about the perils of fasting and abstaining from meat, which, according to Malpica Diosdado, were based on bad science and ignorance.Footnote 59 He not only argued against liberal or casuist moral theology, but also pointed to the culpability of the medical community at all levels, including ‘not only the local healers (curanderos), but also the expert Physicians (Medicos peritos)’.Footnote 60 If a medical opinion was to be given on fasting, he asserted, it should be ‘from the mouth of a Wise, expert, and discreet Professor … not from the mouth of an interloper lacking the necessary science and requisite faculties’.Footnote 61 Malpica Diosdado dedicated the second part of his work to a ‘catalogue of sicknesses … whose dictamina should be consulted along with the experts of the Medical faculty’ when reviewing cases of medical exemption.Footnote 62 Diosdado provided a collation of advice from three medical authorities, including passages on fevers and heart ailments.Footnote 63

Feijóo, who had earlier noted the free hand of physicians, conceded that theologians should recognize that fundamentally medical professionals carried more authority in these discussions because of their ability to understand and define illness:

much more depends on the knowledge of the Physician than on the Theologian. All that the Theologian contributes to the question is only the maxim … which is that one is given dispensation from the fast whose health would be seriously injured by abstinence … All the rest that is needed for the resolution, which is to know: when the abstinence [is], and what [type of] abstinence; to whom, and in which cases does it do serious harm to health, pertains to Medicine and not to Theology. With that it is found much more proportionate for a Physician to decide the doubt, than a Theologian.Footnote 64

The recommendations of Feijóo and Malpica Diosdado indicate a growing awareness that, despite doubt and uncertainty among the medical community, a class of true medical expertise could be recognized in those physicians who had trained in medical science and who followed an established canon of medical authorities. This supports historical arguments that the medical sphere experienced trends of professionalization in the eighteenth century.

Conclusion: Medico-Moralism, Doubt and Authority in a Medically Pluralist Society

Despite the flurry of publications throughout the eighteenth century, the questions surrounding medical dispensations to fasting, namely the definition of a ‘legitimate cause’ and the uncertainty about whose expertise to seek, persisted in Spain.Footnote 65 Although no definitive answer emerged, the discussion reveals that a dialogue was taking place, even if it was sometimes contentious, between two communities: the medical and the theological. The issues of fasting required cooperation between these two groups because the definitions and questions involved knowledge of Catholic theology and apostolic and canon law as well as detailed information about nutrition, illness and the human body. To address the challenges of medical exemptions to religious fasting, eighteenth-century Spanish thinkers realized that it was necessary to approach the subject as an area of overlap area between faith and medicine.

In 1748, in a published exposition on the brevia, Antonio José Rodriguez, who was both a Cistercian monk and a renowned author on medicine, argued that cooperation was needed between medicine and theologians because the subject of fasting belonged to both.Footnote 66

The point is perfectly Moral and perfectly Medical … [for] a just determination, it is necessary [that the] subject is equally instructed in Moral Theology and in Medicine. Neither the Physician, however grand he may be, knows all the nature … of all that is Christian, nor does the Theologian … know what there is in the nature of diets and of illnesses …Footnote 67

Rodriguez suggested that either cooperation was necessary or theologians would need to recognize that the field of medicine represented an area of knowledge which needed to be incorporated into moral theology and studied more thoroughly. Feijóo praised Rodríguez's approach and argued that he embodied the type of scholar who was needed to address such issues, ‘for … he knows the subject matter which a Theologian knows and he knows also that which pertains to the Physician’.Footnote 68

What emerges from this discussion is a more complex way of thinking about how illness was constructed, defined, contested and resolved in the eighteenth-century Spanish world. Fasting represented a tangled nexus of medical and moral-theological interests. As a religious practice, it was asserted to have spiritual impact and significance, but insofar as it involved the human body, it was also governed by medical and anatomical knowledge. It was, as Rodríguez argued, both medical and theological; as such, it was one of many topics in early modern Spain which was included in the category of ‘medico-moralism’, that is, those issues which shared the interests and methodologies of both the theological and the medical communities. While ‘medico-moralism’ may seem to be limited to writings of moral theology, the debates over fasting show that medicine and theology were actively engaging one another and cooperating in the generation of new policies toward fasting and understanding illness, nutrition and anatomy. Two important ramifications of the debate merit special attention: firstly, the impact of doubt and lack of consensus in establishing medical authority; and secondly, the role of religion and of the patient in enriching understandings of medical pluralism.

Firstly, the debates clearly suggest that authority on the matter was negotiated between ‘two Physicians’, that is, between confessors and priests on the one hand and physicians and other medical professionals on the other. While many sources affirmed that the ultimate power of dispensation resided with the church, especially the papacy and the bishops, in most cases the decisions of dispensation were constructed in tandem between the clergy and a medical professional. Several writers also suggested that the opinion and advice of the medical expert gained authority in these questions during the eighteenth century. Feijóo, Rodríguez, Malpica Diosdado and Díaz-Bravo, for example, all emphasized the importance of the clergy consulting learned and professional medical practitioners or undertaking to understand the medical matters themselves. This growing authority is countered, however, by the presence of dissension, a lack of consensus among the medical community, and the reliance by many on outdated (for example, Galenic) medical theories. Uncertainty, so central to the epistemology of Enlightenment Spain, also shaped opinions on the value and verisimilitude of medical knowledge.Footnote 69 These issues contributed to a mistrust and scepticism about the veracity of medical expertise in eighteenth-century Spain and may have allowed for dispensations to be granted in the grey area of doubt.

Secondly, the debate challenges our understanding of early modern Spain as a medically pluralist society. López Terrada has argued that to study the history of medicine in early modern Spain, one needs to employ a comprehensive approach that appreciates the ‘medical pluralism’ which included both academic physicians and ‘unofficial’ health providers. Moreover, she asserts, ‘in order to understand the relationships among the different medical systems that coexist in a society during a certain historical moment, we must take into account not only academic medicine and its professionals, but also society collectively’.Footnote 70 The discussion about medical exemptions to fasting demonstrates that the medical pluralism of Spanish society was indeed complex. First, publications related to fasting show that the requirement to consult a ‘corporal physician’ was freely interpreted to include a wide range of figures in the medical community beyond physicians, including surgeons, barbers and other healers. Second, the case of fasting demonstrates that understanding society ‘collectively’ involves understanding and appreciating the importance of the theological community and of religious ideas in determining the boundaries of illness and health.Footnote 71 In order to understand what it meant to be sick enough to be excused from fasting, more than a physician's definition was needed, although, as has been noted, there is evidence to suggest that professional medical opinion was already gaining epistemic weight during the Spanish Enlightenment.

The fasting debates also highlight the importance of the lay patient as part of the medically pluralist Spanish society. As recent studies in medical anthropology and sociology have indicated, the narratives of those suffering illnesses are valuable sources of experiential knowledge, not least for the way that they reveal differences between expert authority and patient perspective.Footnote 72 In the debate about valid medical excuses for exemption from fasting, a great deal of authority was granted to the person who was claiming to be ill: he or she, after all, was the one who was experiencing the conditions and ailments that were exacerbated by fasting. Even the medical professionals of Spain acknowledged this experiential authority which was the privilege of the patient. Regrettably, recovering the patient ‘voice’ in the discussion of medical exemptions to religious fasting may prove impossible. This article examines sources written by learned authors and by clergy rather than by those individuals seeking medical exemptions to fasting. It nevertheless remains aware of the fact that the layperson played an important role in the process; future research may yield ways of highlighting how individuals seeking dispensation thought about medical exemptions (for example, from sources such as letters).Footnote 73

Torres Villarroel, who was so perturbed by the lack of faithful fasting in Spain, recognized that authority, and therefore culpability, in this matter rested ultimately with the ailing layperson. He wrote that, in the end, the decision to grant a medical dispensation was not given by either a physician or by a priest, but by the individual seeking the dispensation:

They [the Physician and Confessor] do not give this licence; the one who gives it is the one who is suffering an ailment; and thus, he should inform faithfully about his illness, without deleting nor adding circumstances to the gravity of the pain which he suffers, because if he informs sinisterly [with an aim to deceive], the devil will carry him off along with the licence of the Physician and Confessor.Footnote 74

Similarly, the priest and friar Josef Jacobo Gonzalez recommended in a ‘crusade bull sermon’ that ‘in order that the Physician and the sufferer, both of them together, should not perish, the sufferer should inform the Physician entirely truthfully and the Physician should resolve [it] without the least flattery’.Footnote 75 Although the advice of experts was required, these authorities also recognized their reliance on the patient's perspective and the patient's definition of illness and suffering. This suggests that early modern Spanish health professionals recognized that the definition of illness included what philosopher S. Kay Toombs has described as the ‘decisive gap’ between the ‘qualitative immediacy’ of an infirmity as experienced by the patient and the textbook definition of an ailment.Footnote 76 In this way, the patient became an important part of determining health and illness in eighteenth-century Spain.

The controversy over medical exemptions to fasting thus requires historians to understand the relationship between theology and religion and the production of medical knowledge. Discussions about sickness and health in Spain occurred within a historical context in which theological and religious considerations had an important role in determining definitions and establishing accepted traditions. This is especially clear in medico-moral topics which rendered it necessary that the theological and medical communities should cooperate. The decision to seek a ‘sick note’ excusing one from fasting was a perfect example of this: it was not only a medical question, but also a moral question. Fasting, and the ensuing discussion over these ‘moral sick notes’, emphasizes the need to study the realm of medico-moralism and to understand the relationship between theology and the health sciences in Spain and in the early modern Catholic world more broadly.

References

1 Collins, John, A Dictionary of Spanish Proverbs, compiled from the best Authorities in the Spanish Language (London, 1834), 6Google Scholar. The proverb is sometimes presented as ‘Achaques al jueves, para no ayunar el viernes’ (‘Ailments on Thursday in order not to fast on Friday’): Etxabe, Regino, Diccionario de refranes comentado (Madrid, 2012), 23Google Scholar. All translations are my own, unless otherwise noted.

2 Michael Dietler, ‘Feasting and Fasting’, in Timothy Insoll, ed., The Oxford Handbook of the Archaeology of Ritual & Religion (Oxford, 2011), 179–94, at 187–8; Aaron S. Gross, Jody Myers and Jordan D. Rosenblum, eds, Feasting and Fasting: The History and Ethics of Jewish Food (New York, 2020).

3 Among many other verses, see Ps. 35: 13; Joel 2: 12; Matt. 4: 2, 6: 16–18; Acts 13: 2, 14: 23: S. H. Mathews, Christian Fasting: Biblical and Evangelical Perspectives (Lanham, MD, 2015); José Francisco de Malpica Diosdado, Alexipharmaco de la salud, antidoto de la enfermedad, favorable dietetico instrumento de la vida. Dissertacion medico-moral, que trata del ayuno, y accidentes, que escusan de él, y que hacen licito el uso de las carnes á los enfermos, y valetudinarios. En un copioso cathalogo, sacado de tres autores contra el sentir de los hereges, que lo improbaban, y tambien para desterrar los vanos miedos de la opinion vulgar (Mexico, 1751), 39.

4 Malpica Diosdado, Alexipharmaco, 39. See, for example, Thomas Aquinas, Summa Theologica, II–II. q. 147.

5 ‘Desde el principio del mundo se halla en las Escrituras indicado; se figurò en la Ley, y los Profetas; y esta santificado con el exemplo de la Magestad Divina. Solemnizaron su observancia los Apostoles; està notificada por los Sagrados Canones. Los Santos Padres, y Doctores lo observaron, y la Universal Iglesia lo tiene recevido’ (‘From the beginning of the world it has been found indicated in the Scriptures, figured in the Law and the Prophets, and sanctified by the example of the Divine Majesty. The Apostles solemnified its observance; it is notified in the Sacred Canons. The Holy Fathers and Doctors observed it, and the Universal Church has received it’): Joseph [José] Vicente Diaz-Bravo, El ayuno reformado segun practica de la primitiva iglesia, por los cinco breves de Nuestro Santissimo Padre Benedicto XIV. Obra historica, canonico-medica, necessaria à los señores obispos, curas, confessores, medicos, sanos, y enfermos (Pamplona, 1754), 1–2. Quotations are replicated in their original use of accents, although the use of alternative letters and some spelling (such as the long ‘s’, z/c and y/i) have been modernized.

6 ‘Pero á lo menos es precepto de derecho canonico Apostolico. Y la transgression de él, es pecado mortal, como que es en materia grave’: Malpica Diosdado, Alexipharmaco, 39.

7 Translated from the Italian: ‘fra i principali capisaldi della retta dottrina, il digiuno quaresimale. Abbozzato un tempo per la prima volta nella Legge e nei Profeti, quasi consacrato dall'esempio di Nostro Signore Gesù Cristo, tramandato dagli Apostoli, prescritto ovunque dai Sacri canoni, è accolto ed osservato da tutta la Chiesa fin dai suoi primordi’: Benedict XIV, Non ambigimus, Papal Breve, 30 May 1741, Libreria Editrice Vaticana, online at: <https://www.vatican.va/content/benedictus-xiv/it/documents/breve--i-non-ambigimus--i---30-maggio-1741--il-pontefice-ricorda.html>, last accessed 11 January 2022. The Latin text of this document reads: ‘inter præcipua Orthodoxæ disciplinæ capita perpetuò adnumeratum retineri Quadragesimale Jejunium; quod olim in Lege, & Prophetis primitùs adumbratum, ipsius Domini nostri Jesu-Christi exemplo veluti consecratum, ab Apostolis traditum, à Sacris Canonibus ubique præscriptum, & ab universali Ecclesia ab ipso sui primordio retentum, & observatum est’: Manuel Ezquerro Perez, Explicacion de las bulas novissimas de Nuestro S[anctissimo] Padre Benedicto XIV. Sobre el ayuno, complice, y sigilistas; y suplemento al elenco moral de Castropalao, en las materias del ayuno, y penitencia (Madrid, 1758), 196–7.

8 Fasting practices developed regionally, determined by local councils or synods, and were often implemented on a diocesan level. Traditions changed over time; for example, Manuel Villodas, who held a chair of theology at the University of Valladolid in the eighteenth century, wrote that initially the Lenten fast did not start until the Monday following the first Sunday in Lent in order ‘that the tithe of the year is composed of thirty-six days, and not forty’ (‘que el diezmo del año se compone de treinta y seis dias, y no de quarenta’): Manuel Villodas, Analisis de las antiguedades eclesiásticas de España para instruccion de los jovenes. Comprehende los sucesos mas notables de los once siglos primeros, 2nd edn, 2 vols (Valladolid, 1802), 2: 400. Even as far back as the Council of Toledo, however, provisions for excuses from the fast had been made for ‘those with inevitable necessity, illness, or impossibility of age’ (‘los que sin inevitable necesidad, enfermedad ó imposibilidad de la edad’): ibid. 399. Such individuals were instructed by Canon IX of the council to request a dispensation from their bishop: ibid. 399–400.

9 Pedro de Lepe, Catecismo Catholico, en el qual se contiene la explicacion de los principales mysterios de Nuestra Santa Fe Catholica, y las demas cosas, que debe el Christiano saber para su salvacion (Madrid, 1699), 280–1; Rafael Lasala y Locela, Catecismo mayor de la doctrina Christiana, en que se comprehende el menor, y se da una instruccion mas cumplida de las verdades de Nuestra Santa Religion Catolica (Cervera, 1791), 310–11.

10 Lepe, Catecismo, 281. Sources various described cosas de leche, or more often lacticinios.

11 Jose Fernandez Llamazares, Historia de la bula de la Santa Cruzada (Madrid, 1859); Patrick J. O'Banion, ‘For the Defense of the Faith? The Crusading Indulgence in Early Modern Spain’, ARG 101 (2013), 164–85; María Pilar Martínez López-Cano, La iglesia, los fieles y la corona: La bula de la Santa Cruzada en Nueva España, 1574–1660 (Mexico City, 2017).

12 On the popularity of these bulls, see: O'Banion, ‘For the Defense’, 168; ‘An Officer of the United States Navy’ [William Samuel Waithman Ruschenberger], Three Years in the Pacific; Containing Notices of Brazil, Chile, Bolivia, Peru (London, 1835), 1: 209–10. Ruschenberger describes how in post-independence Peru it was still routine for everyone to purchase this licence; furthermore, because these bulas lapsed after two years, they were a ‘lucrative branch of the church revenue’: ibid.

13 For example, fasting was required on the four Fridays of Advent, at the Christmas vigil (on Christmas Eve), on the Ember days and, most importantly, during Lent. Moreover, Catholics were required to observe a pre-eucharistic fast in which they did not eat or drink anything between midnight and the reception of the host the next morning.

14 Regina Grafe, Popish Habits vs. Nutritional Need: Fasting and Fish Consumption in Iberia in the Early Modern Period, University of Oxford Discussion Papers in Economic and Social History 55 (Oxford, 2004), 17. This estimate may be conservative: in the first half of the eighteenth century, the average Spaniard without a bull may have been expected to fast on at least 57 days, and to abstain from meat on approximately 92 additional days, totalling about 41 per cent of the year.

15 ‘Near-consecutive’ because one did not fast on Lenten Sundays (other than the eucharistic fast).

16 For an overview, see Bridget Ann Henisch, Fast and Feast: Food in Medieval Society (University Park, PA, 1976); Caroline Walker Bynum, Holy Feast and Holy Fast: The Religious Significance of Food to Medieval Women (Berkeley, CA, 1987), 34.

17 ‘[M]entem elevas’, found in the preface for Lent. Campbell supports Hillaire Kallendorf's notion that fasting was a ‘preferred method for early modern Spaniards to display their religiosity’: Jodi Campbell, At the First Table: Food and Social Identity in Early Modern Spain (Lincoln, NE, 2017), 137; see also Anon., The Golden Manual: Being a Guide to Catholic Devotion, Public and Private, compiled from Approved Sources (London, 1850), 227.

18 ‘[L]a mortificamos con el ayuno, que sujeta los apetitos carnales y de luxuria: … nos privamos de los deleites del cuerpo’: Lasala y Locela, Catecismo mayor, 405.

19 Grafe, Popish Habits; Campbell, First Table, 37, who describes ‘an uncertain zone between foods that were clearly prohibited on fast days and those that were allowed’. Among these was offal, discussed in Carolyn A. Nadeau, Food Matters: Alonso Quijano's Diet and the Discourse of Food in Early Modern Spain (Toronto, ON, 2016), 106–7.

20 Beth Marie Forrest and April L. Najjaj, ‘Is Sipping Sin Breaking Fast? The Catholic Chocolate Controversy and the Changing World of Early Modern Spain’, Food and Foodways: Explorations in the History and Culture of Human Nourishment 15 (2007), 31–52. See also selected primary sources, including some referenced by Forrest and Najjaj: Antonio de Leon Pinelo, Question Moral si el chocolate quebranta el ayuno eclesiastico. Tratase de otras bebidas i confecciones que se usan en varias provincias (Madrid, 1636); Daniel Concina, Theologia Christiana Dogmatico-Moral, transl. Joseph Sanchez de la Parra, 2 vols (Madrid, 1770), 1: 326; Christoval [Christobal] Nieto de Piña, Discurso Medico Moral. Los que usan leche medicinal deben considerarse entre los dispensados al ayuno eclesiastico (Seville, 1779).

21 Forrest and Najjaj, ‘Sipping Sin?’; David Gentilcore, Food and Health in Early Modern Europe: Diet, Medicine and Society, 1450–1800 (London, 2016); Campbell, First Table; Nadeau, Food Matters.

22 Francisco Larraga, Prontuario de la Teología Moral, ed. Francisco Santos y Grosin (Madrid, 1801), 407.

23 Ibid. 407–8.

24 ‘Por razon de enfermedad se excusan del ayuno los que padecen grave dolencia, que evidentemente es incompatible con el ayuno’: Josef Faustino Cliquet, La flor del moral: esto es lo mas florido, y selecto qué se halla en el jardin ameno, y dilatado campo de la Theologia Moral, 3 vols (Madrid, 1791), 3: 114.

25 ‘Y por enfermedad, aqui no solamente se entienden los que estàn con enfermedad grave, sino con achaques, que hacen notablemente dificultoso el precepto’: Lepe, Catecismo, 286.

26 This was also true outside Spain: Jane K. Wickersham, Rituals of Prosecution: The Roman Inquisition and the Prosecution of Philo-Protestants in Sixteenth-Century Italy (Toronto, ON, 2012), 112.

27 ‘A Observancia sacrosanta del Ayuno, es el caracter, que distingue al Catholico, de los enemigos de la Cruz Jesu-Christo’: Diaz-Bravo, El ayuno reformado, 1; Balbino Velasco Bayón, ‘José Vicente Díaz-Bravo’, in Real Academia de la Historia, Diccionario Biográfico Electrónico, n.d., online at: <http://dbe.rah.es/biografias/22420/jose-vicente-diaz-bravo>, accessed 30 January 2021.

28 ‘A los infieles, à los locos, y à los niños, que no han llegado al uso de la razon, se les puede dàr carne en dia prohibido’: Jayme de Corella, Suma de la theologia moral, 5th edn (Madrid, 1694), 156; Miguel Anxo Pena González, ‘Jaime de Corella’, in Real Academia de la Historia, Diccionario Biográfico Electrónico, n.d., online at: <http://dbe.rah.es/biografias/17513/jaime-de-corella>, accessed 30 January 2021. In 1790, for example, the tribunal in Valencia heard accusations against Luis Cheli, a French widower and hosier; one of Cheli's neighbours claimed that both he and his mother ‘ate meat on Fridays, [that] he did not fast on precepted days, nor did he pray the Mass on half-feast days’ (‘comia de Carne los dias viernes, que no ayunaba los dias de precepto, ni ora misa los dias de media fiesta’): Madrid, Archivo Histórico Nacional, Inquisición 5312, Exp. 121 (1790), Santo Oficio de la Inquisición, Tribunal de Valencia, ‘Proceso de Fe de Luis Cheli y María Cheli’, 18.

29 I. L. McClelland, Diego de Torres Villarroel (Boston, MA, 1976), 13.

30 ‘[P]or experiencia he visto, que es rara la casa de la Corte, y de las Ciudades populosas en que se sirven à las mesas pescados en dias de ayuno; y à todos los comedores los he visto sanos, gordos, y robustos, y tienen por estrivillo decir, que la Quaresma se hizo para los bobos, y los Frailes. Los achaques para no ayunar son muchos; pero no todos son legitimos’: Diego de Torres Villarroel, Vida natural, y catholica: Medicina segura para mantener menos enferma la organizacion del cuerpo, y assegurar al alma la eterna salud (Madrid, 1730), 88.

31 ‘Item concede a todas la personas que tomaren esta Bula, que durante el dicho año, puedan de consejo de ambos Medicos, espiritual, y corporal, comer carne en Quaresma, y otros tiempos de ayunos, y dias prohibidos de comer carne por todo el año. Y que ansimismo pueden libremente a su albedrio comer huevos, y cosas de leche’: Bernabe Gallego de Vera, Explicacion de la bula de la Santa Cruzada. Muy necessaria para confessores, y de grande utilidad, y provecho para todo genero de personas (Madrid, 1652), 28r, 207–8. Gallego de Vera provided the text in both Castilian and Latin; of importance is the phrase ‘de consilio utriusque Medicis’, which Gallego de Vera translated as ‘de consejo de ambos Medicos, espiritual, y corporal’.

32 Claudio Ferlan, Ayuno Eclesiástico (DCH) (The Ecclesiastical Fast (DCH)), Max Planck Institute for European Legal History Research Paper Series No. 2018–09, online at: <https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3260582>, last accessed 11 January 2022, 10.

33 ‘[C]he la sacritissima osservanza del digiuno quaresimale, per l'eccessiva facilità di dispensare ovunque, in modo indiscriminato, per futili e non urgenti motivi, sia stata quasi completamente eliminata’: Benedict XIV, Non ambigimus.

34 ‘[S]ine legitima causa, & de utriusque Medici consilio’: Ezquerro Perez, Explicacion, 199; Benedict XIV, Non ambigimus; cf. the Italian translation of this phrase ‘il consiglio di due medici’ (‘the advice of two physicians’). Similarly, ‘de utriusque Medici consilio’ and ‘dell'uno e dell'altro medico’ in Benedict XIV, In suprema universalis, Papal Breve, 22 August 1741, Libreria Editrice Vaticana, online at: <https://www.vatican.va/content/benedictus-xiv/it/documents/breve--i-in-suprema-universalis---i--22-agosto-1741--nei-giorni-.html>, last accessed 11 January 2022. Compare also ‘giusta motivazione’ and ‘sine legitima causa’.

35 As will be demonstrated, this phrase was interpreted by Spanish authors to mean a spiritual physician (such as a priest or a confessor) and a corporal physician (such as a medical doctor).

36 Benedict XIV, In suprema universalis.

37 See the Latin text of In suprema universalis in Ezquerro Perez: ‘[N]on vero singulis ob legitimam causam, & de utriusque Medici consilio dispensatur’: Ezquerro Perez, Explicacion, 203.

38 ‘Los Theologos Casuistas señalan tantas, que apenas hay sujeto à quien obligue la abstinencia’: Diaz-Bravo, El ayuno reformado, 127.

39 Ibid. 128.

40 ‘[D]e modo, que ninguno hasta aqui ha dudado’: ibid.

41 ‘[S]e teme prudentemente de ella, que si no se dispensa el ayuno, o abstinencia, puede ocasionar algun daño grave à la salud del cuerpo, … No toda enfermedad es causa legitima, sino es la enfermedad notable, y que fuere peligrosa’: ibid. 128, 130.

42 ‘Los Canonistas y Medicos vàn por caminos contrarios’: ibid. 127.

43 Villodas, Analisis, 2: 399.

44 Sydney Watts, ‘Enlightened Fasting: Religious Conviction, Scientific Inquiry, and Medical Knowledge in Early Modern France’, in Ken Albala and Trudy Eden, eds, Food and Faith in Christian Culture (New York, 2011), 105–24, at 111–12.

45 ‘Pero quando falta la dicha evidencia, si el Medico, ò en su defecto el Cirujano, el Pàrroco, el Confesor, ò un varon prudente, declara que el doliente no puede ayunar sin grave detrimento de su salud’: Cliquet, La Flor, 3: 114; see also Larraga, Prontuario, 408.

46 ‘[N]o habiendo médico con quien consultarlo’: Antonio Covian, Manual de curas o breve compendio del ministerio parroquial (Granada, 1815), 36.

47 Bjørn Okholm Skaarup, Anatomy and Anatomists in Early Modern Spain (Farnham, 2015), 214; Barbara Mujica, ‘Healing on the Margins: Ana de San Bartolomé, Convent Nurse’, Early Modern Studies Journal [online journal] 6: Women's Writing / Women's Work in Early Modernity (2014), 128–65, at 137, at: <https://earlymodernstudiesjournal.org/wp-content/uploads/2014/10/5.-Mujica.pdf>, last accessed 11 January 2022.

48 ‘P. Quièn se entiende por Medico espiritual? R. Que el Confessor aprobado por el Ordinario; … P. Quièn se entiende por Medico corporal? R. Que el que està examinado, y aprobado por el Real Protomedicato, para curar enfermos, y los graduados de Licenciados en la Universidad de Salamanca en la Facultad de Medicina; y donde no hubiere Medico, ni es facil el recurso adonde lo hay, bastarà el consejo de varon prudente, è inteligente en el arte de curar’: Ezquerro Perez, Explicacion, 73–4.

49 John Tate Lanning, The Royal Protomedicato: The Regulation of the Medical Profession in the Spanish Empire, ed. John Jay TePaske (Durham, NC, 1985).

50 María Luz López Terrada, ‘Medical Pluralism in the Iberian Kingdoms: The Control of Extra-Academic Practitioners in Valencia’, MH 53, Supplement S29: Health and Medicine in Hapsburg [sic] Spain: Agents, Practices, Representations (2009), 7–25.

51 ‘La facilidad de los Médicos en declarar exentos de la obligación de observar la abstinencia Cuaresmal a los que padecen alguna indispoción habitual’: Benito Jerónimo Feijóo, Teatro crítico universal, vol. 8 (Madrid, 1779; first published 1739), TCU VIII.11§XI¶58, online at: <https://www.filosofia.org/bjf/bjft800.htm>, accessed 17 January 2022. References to Feijóo here include the numbers of the volume, discourse or essay, section and paragraph.

52 ‘[Q]ue proceden irracionalísimamente aquellos Médicos, los cuales indiferentemente a todos los enfermos, ya actuales, ya habituales, excusan de la abstinencia Cuaresmal. A muchísimos dañan gravemente con esa dispensación’: Feijóo, Teatro crítico universal, vol. 7 (Madrid, 1778; first published 1736), TCU.VII.9§VII¶25, online at: <https://www.filosofia.org/bjf/bjft700.htm>, accessed 17 January 2022.

53 ‘[E]s conveniente, que los Medicos se desimpressionen de que son notablemente nocivos los alimentos Quadragesimales; … Aunque dañen los alimentos de ayuno, no es tanto como piensan muchos medicos’: Diaz-Bravo, El ayuno reformado, 130–1.

54 Ibid. 131.

55 ‘[L]os defectos con que el médico puede perjudicar el bien espiritual de los enfermos … Demasiada libertad con que, suelen dispensar en las obligaciones de oir Misa, ayunar, y abstenerse de comer carnes’: Josef Alonso y Saenz, ‘Disertacion Médico-Teológico-Canónico-Legal: De los casos principales en que el Médico es reo en el fuero interno y externo, canónico y civil’, in Memorias Académicas de la Real Sociedad de Medicina, y demas Ciencias de Sevilla, vol. 10 (Seville, 1792), 530–1.

56 Ibid. 531.

57 ‘¿Quién es el que al ver cerca de sí la Quaresma no tiembla, …juzgando que el ayuno le ha de tragar? Quién es el que no busca pareceres de Médicos y opiniones anchas par librarse de la obligacion del ayuno? En el Juicio divino se exâminará la verdad de los informes’: Joaquin Antonio de Eguileta, Sermones para todas las Dominicas del año, 3 vols (Madrid, 1800), 1: 295.

58 ‘[D]e que en materias de Ayuno, y concessiones de carne, eran los Theologos mas estrictos, que los Medicos: y de su averiguacion hallo, que es al contrario: mas estrechos, mas rigidos son uno, û otro Medico, que escribieron de proposito de Ayuno, que los Theologos’: Malpica Diosdado, Alexipharmaco, 8.

59 Ibid.

60 ‘[Q]ue no solo los curanderos, sino los Medicos peritos’: ibid. 14–15.

61 ‘[P]or la boca de un Sabio, perito, y discreto Professor, … No assi de a boca de un intrunso; pues faltandole la ciencia necessaria, y las facultades requisitas’: ibid. 15.

62 ‘Catalogo de enfermedades … cuyos dictamenes deben consultrase con los Peritos de la Facultad Medica’: ibid. 77.

63 Ibid. The three medical authorities included the Cistercian medical-moral scholar Antonio José Rodríguez (1703–77), the papal physician Paolo Zacchia (1584–1659) and Juan Alonso de Los Ruices y de Fontecha (1560–1620), professor of medicine at the Universidad de Alcalá de Henares. Malpica Diosdado also often cited Feijóo: Gema Rivas Gómez-Calcerrada, ‘Antonio José Rodríguez’, in Real Academia de la Historia, Diccionario Biográfico Electrónico, n.d., online at: <http://dbe.rah.es/biografias/19961/antonio-jose-rodriguez>, accessed 31 January 2021; Jacalyn Duffin, ‘Questioning Medicine in Seventeenth-Century Rome: The Consultations of Paolo Zacchia’, Canadian Bulletin of Medical History = Bulletin canadien d'histoire de la médecine 28 (2011), 149–70, at 150–1; Ana María Rodríguez González, ‘Juan Alonso de Los Ruices y de Fontech’, n.d., Lucio Anneo Séneca Instituto de Estudios Clásicos sobre la Sociedad y la Política, online at: <http://portal.uc3m.es/portal/page/portal/inst_lucio_anneo_seneca/bases_datos/bvhe/biblioteca/a_b/juan_alonso_de_los_ruices_y_de_fontecha>, accessed 31 January 2021.

64 ‘[M]ucho más pende del conocimiento Médico, que del Teológico. Todo lo que la Teología contribuye a la cuestión, es únivamente una máxima … esto es, que está dispensado de ayuno aquél, a cuya salud hace grave daño la abstinencia … Todo lo demás que se necesita para la resolución, que es saber, cuándo la abstinencia, y qué abstinencia; a quiénes, y en qué casos hace grave daño a la salud, pertenece a la Medicina, y no a la Teología. Con que se halla mucho más proporcionado para decidir la duda un Médico, que un Teólogo’: Benito Jerónimo Feijóo, Cartas eruditas y curiosas, 5 vols (Madrid, 1777), vol. 1, CE.I.xv.10, online at: <https://www.filosofia.org/bjf/bjfc000.htm#t1>, accessed 17 January 2022.

65 See early nineteenth-century manuals, for example Francisco Echarri, Directorio Moral, Tercera Vez Ilustrado, vol. 2 (Madrid, 1805), 289–323.

66 Gómez-Calcerrada, ‘Antonio José Rodríguez’; Antonio José Rodriguez, Reflexiones theologico-canonico-medicas, sobre el ayuno eclesiastico, que establecen su practica, después de los breves de Nuestro Santissimo Padre Benedicto XIV (Madrid, 1748).

67 ‘Es el punto perfectamente Moral, y perfectamente Medico: por esso para la determinacion justa, es preciso sujeto, que estè igualmente instruìdo en la Theologìa Moral, y en la Medicina. Ni el Medico, por grande que sea, sabe toda la naturaleza, … todo Christiano; ni el Theologo … sabe lo que hay en la naturaleza de los alimentos, de las enfermedades’: Rodriguez, Sobre el ayuno eclesiastico, 251.

68 ‘[Q]ue sabe en la materia lo que sabe el Teólogo, y sabe también lo que pertenece al Médico’: Feijóo, Cartas Eruditas, CE.I.xv.10.

69 Ivy Lilian McClelland, Ideological Hesitancy in Spain 1700–1750 (Liverpool, 1991).

70 López Terrada, ‘Medical Pluralism’, 8.

71 Carolin Schmitz, ‘Barberos, charlatanes y enfermos: La pluralidad médica de la España barroca percibida por el pícaro Estebanillo González’, Dynamis 36 (2016), 143–66.

72 Gareth Williams and Jennie Popay, ‘Lay Knowledge and the Privilege of Experience’, in David Kelleher, Jonathan Gabe and Gareth Williams, eds, Challenging Medicine, 2nd edn (Abingdon, 2006), 122–45, at 122.

73 For a work elevating the patient in the history of Spanish medicine, see Carolin Schmitz, Los enfermos en la España barroca y el pluralismo médico: Espacios, estrategias, y actitudes, Estudios sobre la Ciencia 71 (Madrid, 2018).

74 ‘[Q]ue ellos no dan esta licencia, que el que la da es el que padece el achaque; y así, debe fielmente informar de su enfermedad, sin quitar ni poner circunstancia á la gravedad del daño que padece, porque si informa siniestramente se lo llevará el diablo con la licencia del Médico y el Confesor’: Diego de Torres Villarroel, Tratados físicos, médicos y morales, vida natural y católica: medicina segura para mantener menos enferma la organizacion del cuerpo, y asegurar al alma la eterna salud, vol. 4 (Madrid, 1794), 143.

75 ‘[P]ara que el Medico, y el doliente, ambos juntos, no perezcan, debe el doliente informar al Medico con toda verdad, y resolver el Médico sin la menor lisonja’: Gonzalez, Josef Jacobo, Sermon, que en la publicacion de la bulla de la Santa Cruzada para el año de mil setecientos setenta y seis (Madrid, 1776), 14Google Scholar. ‘Crusade bull sermon’ is O'Banion's term for sermons preached to encourage the purchase of the bulas Cruzadas; ‘For the Defense’, 173.

76 Toombs, S. Kay, The Meaning of Illness: A Phenomenological Account of the Different Perspectives of Physician and Patient (Dordrecht, 1993), 12Google Scholar.