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A DEFENSE OF THE CAROLINGIAN “DEFENSE OF MEDICINE”: INTRODUCTION, TRANSLATION, AND NOTES

Published online by Cambridge University Press:  20 November 2020

JOEL L. GAMBLE*
Affiliation:
University of Oxford / University of Toronto

Abstract

The “Defense of Medicine” prefaces the Codex Bambergensis Medicinalis 1, a Carolingian collection of medical texts. Some scholars have dismissed the Defense as an incoherent patchwork of quotations. Yet, missing from the literature is an adequate assessment of the Defense's arguments. This present study includes the first English translation accompanied by a complete source commentary, a prerequisite for valid content analysis. When read systematically and with attention to the author's use of sources, the Defense is limpid and cogent. Its first purpose is to defend the compatibility of Christian faith and secular medicine. Key propositions include the following: God made nature good, so the natural sciences are reconcilable with divine learning; scripture respects medicine; God expects the sick to avail of physicians and deserves honor for healings done through physicians. Counter-arguments used by the Defense's opponents, who rejected medicine on principle, can also be reconstructed from the text. Two further purposes of the Defense have hitherto been explored insufficiently. After justifying medicine, the Defense addresses sick patients. It encourages them that illness can be spiritually healthful, an instrument for curing their souls. The Defense then addresses caregivers. It tells them why they should succor the sick, even the poor: not for gain or fame, but in imitation of Christ and as if treating Christ himself, whose image the sick bear. The Defense thus contributes to the history of ideas on medicine, health, sickness, and the ethics of altruistic care.

Type
Research Article
Copyright
Copyright © Fordham University 2020

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Footnotes

I am grateful to Nathan Gamble, Dennis Ngien, Claude Eilers, Darrel Amundsen, and Alister McGrath for their support with this project, Klaus D. Fischer for kindly sending me some valuable notes, and the reviewers and editor at Traditio for their many fruitful suggestions.

References

1 Defense, ed. Stoll, 48: “COGOR RESPONDERE HIS QVI ME INANITER HVNC DICUNT LIBRVM SCRIPSISSE DICENTES PARVM IN EO VERVM ESSE conscriptum.”

2 Its modern history begins with Sudhoff, who gave it its present title. See Sudhoff, Karl, “Eine Verteidigung der Heilkunde aus den Zeiten der ‘Mönchsmedizin’,” Archiv für Geschichte der Medizin 7 (1913): 223–37Google Scholar. From Sudhoff until Stoll and Keil's publications in the late 1980s, the Defense is sometimes referred to simply as the “Bamberg manuscript.” See, for example, MacKinney, Loren C., “Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals,” Bulletin of the History of Medicine 26 (1952): 131Google ScholarPubMed. It has been described as “an often poorly written patchwork of Biblical and patristic quotations.” See Horden, Peregrine, “What's Wrong with Early Medieval Medicine?,” Social History of Medicine 13 (2009): 525, at 17Google Scholar. Fischer reasonably admits that “[t]he line of reasoning of this relatively long piece [the “Defense of Medicine”] . . . is not always clear to me.” See Fischer, Klaus D., “Das Lorscher Arzneibuch im Widerstreit der Meinungen,” Medizinhistorisches Journal 45 (2010): 165–88, at 178Google Scholar. In contrast, Keil noted the Defense's “distinct skillful structuring” and “systematic argument.” See Keil, Gundolf, “Klostermedizin im frühen Mittelalter dokumentiert am Lorscher Arzneibuch von etwa 790,” in Geistliche Aspekte mittelalterlicher Naturlehre (Wiesbaden, 1993), 2324Google Scholar. Sigerist also commended the Defense in his survey of medieval medical literature: Sigerist, Henry E., “The Latin Medical Literature of the Early Middle Ages,” Journal of the History of Medicine and Allied Sciences 24 (1958): 127–46, at 143–44CrossRefGoogle Scholar. Leja recently recognized its “mastery of Christian doctrine” and nuanced argumentation. See Leja, Meg, “The Sacred Art: Medicine in the Carolingian Renaissance,” Viator 47 (2016): 134, at 12CrossRefGoogle Scholar.

3 Fischer, “Das Lorscher Arzneibuch.” The manuscript is available online at: https://nbnresolving.org/urn:nbn:de:bvb:22-dtl-0000003730 (accessed 23 July 2020). For a critical edition of the codex, see Defense, ed. Stoll. Readers are welcome to compare the present translation with that of Wallis, Faith, “A Monastic Defense of Medicine against Rigorist Critics: The Lorsch Leechbook,” in Medieval Medicine: A Reader (Toronto, 2010), 8493Google Scholar.

4 For a general background to Lorsch, see McKitterick, Rosamond, The Carolingians and the Written Word (Cambridge, 1989), 185–91CrossRefGoogle Scholar.

5 Fischer, “Das Lorscher Arzneibuch,” ably reviews the state of the evidence. In this paper, I shall simply refer to “the author” and “the Defense.”

6 Sudhoff, “Eine Verteidigung der Heilkunde.”

7 The reference to Bede, identified in the translation below, is possibly from De tropis et schematibus (ca. 710). See n. 146 below.

8 Fischer, “Das Lorscher Arzneibuch” (n. 2 above), 187. Fischer discusses some of the more interesting recipes and summarizes the codex's contents. See also Defense, ed. Stoll, 11–42; Everett, Nicholas, “The Manuscript Evidence for Pharmacy in the Early Middle Ages,” in Writing the Early Medieval West, ed. Screen, Elina and West, Charles (Cambridge, 2018), 115–130 at 126–27Google Scholar; and Touwaide, Alain, “Pharmacy,” in Handbook of Medieval Studies: Terms–Methods–Trends, ed. Classen, Albrecht (Berlin, 2010), 2:1079–81Google Scholar.

9 Defense, ed. Stoll, 58: “nullus terrenam debet spernere medicinam.”

10 This method is common to early medieval writers. As Ponesse describes the approach of Smaragdus of Mihiel, an early ninth-century monastic scholar, “To walk in the footsteps of the Fathers was not to imitate or blindly transcribe their words. Contradictory teachings had to be reconciled.” See Ponesse, Matthew, “Standing Distant From the Fathers: Smaragdus of Saint-Mihiel and the Reception of Early Medieval Learning,” Traditio 67 (2012): 7199, at 99CrossRefGoogle Scholar.

11 MacKinney, “Medical Ethics and Etiquette” (n. 2 above), 29.

12 Defense, ed. Stoll, 60–62: “Ipso in die iudicii dicente: Infirmus fui et uisitastis me et quamdiu fecistis uni de his minimis, mihi fecistis. Igitur nolite negligere Christum uisitare . . . Ideo discite pauperibus misereri, ut et dominus uestri quandoque misereatur . . . In die iudicii cum his, qui in dextris erunt, audire meremini: Venite benedicti patris mei . . .”

13 Abigail Firey, “‘For I was Hungry and You Fed Me’: Social Justice and Economic Thought in the Latin Patristic and Medieval Christian Traditions,” in Ancient and Medieval Economic Ideas and Concepts of Social Justice, ed. Todd Lowry and Robert P. Gordon (Leiden, 1998), 333–70, at 336–37. For the concept of “reward in heaven” among late Roman Christians in general, see also Brown, Peter, Through the Eye of a Needle: Wealth, the Fall of Rome, and the Making of Christianity in the West, 350–550 AD (Princeton, 2012), 8486Google Scholar.

14 Defense, ed. Stoll, 62: “Hos ergo legite et quemadmodum dixerint, medicamina conficite et ita languentibus subuenite a Christo mercedem recepturi . . .”

15 Ferngren, Gary, Medicine and Healthcare in Early Christianity (Baltimore, 2009), 86Google Scholar.

16 For the relevance of a philosophical/theological basis of medical ethics, see Pellegrino, Edmund D. and Thomasma, David C., Helping and Healing: Religious Commitment in Healthcare (Georgetown, 1997)Google Scholar. More generally, the historian of philosophy Alasdair MacIntyre argues that ethical precepts always emerge from and are understood in the context of “traditions” (with their historical, cultural, philosophical and other content). See MacIntyre, Alasdair, After Virtue: A Study in Moral Theory (Notre Dame, IN, 2007)Google Scholar.

17 MacKinney, “Medical Ethics and Etiquette” (n. 2 above), 2. See also Galvão-Sobrinho, Carlos, “Hippocratic Ideals, Medical Ethics, and the Practice of Medicine in the Early Middle Ages: The Legacy of the Hippocratic Oath,” Journal of the History of Medicine 51 (1996): 438455, at 444Google ScholarPubMed.

18 Keil, “Klostermedizin” (n. 2 above), 24; and Leja, “The Sacred Art” (n. 2 above), 12.

19 Defense, ed. Stoll, 50, quoting Isid. Sent. 3.3.4, 201: “Tribus enim ex causis infirmitates accidunt corpori, id est ex peccato, ex temptatione, ex intemperantia passionum; sed huic tantum nouissimae humana potest medicina succurrere, illis autem sola pietas diuinae misericordiae. Uerumtamen . . .” See n. 151 below.

20 Keil, “Klostermedizin” (n. 2 above), 24.

21 Horden, “What's Wrong with Early Medieval Medicine?” (n. 2 above), 18. Amundsen, commenting specifically on deontological texts from the early Middle Ages, agrees: “The identity of the authors and the intended audience of these treatises is unknown.” See Darrel W. Amundsen, “Caring and Curing in the Medieval Catholic Tradition,” in idem, Medicine, Society, and Faith in the Ancient and Medieval Worlds (Baltimore, 1996), 175–221, at 194. Galvão-Sobrinho also concurs: “Hippocratic Ideals,” 444.

22 Fischer, “Das Lorscher Arzneibuch” (n. 2 above), 187.

23 Fischer, “Das Lorscher Arzneibuch” (n. 2 above).

24 Klaus D. Fischer, “Heavenly Medicine vs. Earthly Medicine in the Preface to Germany's Oldest Medical Book (ca. 800),” an unpublished talk presented at the Institute for Advanced Study, Princeton, in 2009. Fischer refers to the Defense's seven-fold division of “physics” (the natural sciences), which ultimately derives from Isidore's Differentiae II. Bischoff has argued that Isidore's classification was independently taken up by Alcuin (who became an influential figure at the Carolingian court) and the Anonymus ad Cuimnanum, a grammatical work possibly originating at Bobbio in the early eighth century. See Bernhard Bischoff, “Eine verschollene Einteilung der Wissenschaften,” in idem, Mittelalterliche Studien (Stuttgart, 1966), 1:273–88; and Expossitio Latinitatis (Anonymus ad Cuimnanum), ed. Bernhard Bischoff and Bengt Löfstedt, CCL 133D (Turnhout, 1992), xxii. Note, however, that the Defense's quotations correspond directly to the Differentiae II and only loosely to the Anonymus ad Cuimnanum; the Defense's author must have had access to the Differentiae II itself. For references, see nn. 143–44, 146–48, and 150 below.

25 Leja, “The Sacred Art” (n. 2 above), 11, also referencing the sevenfold division of physics with its definition of medicine (see previous note).

26 Leja, “The Sacred Art” (n. 2 above), 1–3.

27 Leja, “The Sacred Art” (n. 2 above), 24.

28 Defense, ed. Stoll, 60–62: “Scire debetis . . . quia in pauperioribus magis Christus uisitatur, diuitum quippe habundantia ipsa sibi uisitationem exigit medicorum . . . Visitate ergo quos pauperes aspicitis et quos foris cernitis dispectos saeculi, intus arbitramini amicos dei ad uisitandum. Namque pigri cur estis, quando hoc, quod iacenti in terra porrigitis, sedenti in caelo datis.” The latter portion borrows almost verbatim from Greg. Hom. Evang. 40.12, 410: “Honorate quos pauperes cernitis, et quos foris conspicitis despectos saeculi, intus arbitramini amicos Dei . . . Ad tribuendum ergo pigri cur estis, quando hoc quod iacenti in terra porrigitis sedenti in caelo datis?” The Defense adapts Gregory's exhortation, directed to Christians in general, into an imperative for medical caregivers: Honorate becomes Visitate, while ad tribuendum becomes ad visitandum.

29 Early medieval monastic rules tended to use “poor” and “little ones” in a metaphorical way to refer to sick members of the monastery. See Kardong, Terrence, Benedict's Rule: A Translation and Commentary (Collegeville, 1996), 303Google Scholar.

30 Smaragdi Abbatis Expositio in Regulam S. Benedicti, ed. Alfredus Spannagel and Pius Engelbert, Corpus Consuetudinum Monasticarum 8 (Siegburg: 1974), 323–28; English translation: Smaragdus of Saint-Mihiel, Commentary on the Rule of Saint Benedict (Kalamazoo, MI, 2007), 516–24Google Scholar. For examples from early monastic rules, see Clark, James G., The Benedictines in the Middle Ages (Woodbridge, 2011), 182–85Google Scholar; and Kardong, Terrence, “Concordia Regularum 65: On the Care of the Sick,” American Benedictine Review 53 (2006): 320–38Google Scholar. Overall, uncertainty surrounds how religious institutions actually engaged in charity in the early Middle Ages, especially compared to subsequent centuries. See Brodman, James, Charity and Religion in Medieval Europe (Washington, 2009), 5388Google Scholar.

31 Leja, “The Sacred Art” (n. 2 above), 30.

32 See n. 1, above.

33 Fischer, “Heavenly Medicine vs. Earthly Medicine” (n. 24 above).

34 Vivian Nutton, “Medicine in Late Antiquity and the Early Middle Ages,” in The Western Medical Tradition: 800 BC to AD 1800, ed. Lawrence I. Conrad et al. (Cambridge, 1995): 1:71–87, at 75.

35 Nutton, “Medicine in Late Antiquity,” 75.

36 Darrel W. Amundsen, “Body, Soul, and Physician,” in idem, Medicine, Society, and Faith (n. 21 above), 1–29, at 8.

37 Amundsen, Darrel W. and Ferngren, Gary B., “Medicine and Religion: Early Christianity Through the Middle Ages,” in Health/Medicine and the Faith Traditions: An Inquiry into Religion and Medicine, ed. Martin, Marty E. and Vaux, Kenneth L. (Philadelphia, 1982): 93–132, at 100Google Scholar.

38 Amundsen, “Caring and Curing” (n. 21 above), 193–94; and Flint, Valerie J., “The Early Medieval ‘Medicus’, the Saint — and the Enchanter,” Social History of Medicine 2 (1989): 127–45CrossRefGoogle ScholarPubMed.

39 Amundsen, “Caring and Curing” (n. 21 above), 193–94; Nutton, “Medicine in Late Antiquity” (n. 34 above), 313; and Flint, “The Early Medieval ‘Medicus’,” 135. See also David C. Lindberg, The Beginnings of Western Science, 2nd ed. (Chicago, 2007), 325: “The denigrating accounts of conventional medicine that appear in the saints’ lives served an obvious polemical function — namely, to authenticate and magnify the power of the saint in question by demonstrating how he or she had healing abilities that transcended those of the secular healer.”

40 Wallis takes a similar view of the text, seeing it as a response to those in its monastic milieu who rejected “secular medicine.” See Wallis, Faith, “The Experience of the Book: Manuscripts, Texts, and the Role of Epistemology in Early Medieval Medicine,” in Knowledge and the Scholarly Medical Traditions, ed. Bates, Don (Cambridge, 1995), 101–26, at 124Google Scholar. By contrast, the Defense does not mention the “pagan healing shrines” that Fischer proposes as the “real enemy.”

41 Defense, ed. Stoll, 52: “Sed solent aliqui dicere: Quam necessitatem habemus a medicis curari, qui sollicitudinem nostram in ipsum proicimus, cui cura de nobis constat esse? Numquid non sine medicamentis nos potest sanos permittere consisti, qui solo sermone uniuersa ualet restaurare.”

42 The earliest Latin manuscripts of Agatha's vita (BHL 133–38) date to the eighth century: AASS Feb. I (Paris, 1863), 602–604. The liturgical antiphon quoted in the Defense appears in a late ninth-century antiphoner. See John A Emerson, Albi, Bibliothèque Municipale Rochegude, Manuscript 44: A Complete Ninth-Century Gradual and Antiphoner from Southern France, ed. Lila Collamore (Ottawa, 2002), 182 (no. 480). The antiphon is catalogued as Cantus ID 003733: http://cantusindex.org/id/003733 (accessed 24 July 2020).

43 Defense, ed. Stoll, 56: “Sed non ideo humana refutanda medicina, sed cum gratiarum actione in labore utenda, quia nemo debet carnem suam in eo, quod condita est, odio habere, sed in eo, quod facilis est ad peccandum, ei frenum delectationis non relaxare. Licet Paulus diceret: ‘Carnis curam ne feceritis,’ quia statim adiecit: ‘in desideriis.’”

44 Nutton, “Medicine in Late Antiquity and the Early Middle Ages” (n. 34 above), 76–77.

45 Crislip, Andrew, Thorns in the Flesh: Illness and Sanctity in Late Ancient Christianity (Philadelphia, 2012), 167–71CrossRefGoogle Scholar.

46 See n. 19, above.

47 See n. 1, above.

48 Fischer, “Das Lorscher Arzneibuch” (n. 2 above), 178.

49 Defense, ed. Stoll, 48: “magis considerabam necessitatem indigentium quam reprehensionem aduersum me bacchantium.”

50 Defense, ed. Stoll, 48: “Respondebo eis non meis sed sacrarum scripturarum uerbis.”

51 Note, for example, the rhyme and rhythm of “eis non meis” and the alliteration “sed sacrarum scripturarum.” The author may have been familiar with Bede's work on rhetoric, De tropis et schematibus (see n. 146 below).

52 Defense, ed. Stoll, 48: “non est respuenda humana penitus medicina, cum eam constet diuinis non esse incognitam libris.”

53 Claudio Leonardi, “Aspects of Old Testament Interpretation in the Church from the Seventh to the Tenth Century,” in Hebrew Bible / Old Testament: The History of Its Interpretation I/2: The Middle Ages, ed. Magne Sæbø (Göttingen, 2000), 180–95, at 183–84.

54 Isidore, Mysticorum expositiones sacramentorum seu quaestiones in vetus testamentum, PL 83.809: “Lector non nostra leget sed veterum releget.”

55 Leonardi, “Aspects of Old Testament Interpretation,” 183–84.

56 As reviewed by McCulloh, J., “Hrabanus Maurus’ Martyrology: The Method of Composition,” Sacris Erudiri 23 (1978–79): 417–61, at 457–59CrossRefGoogle Scholar. For a charge of “plagiarism,” see, for example, Raby, F. J. E., A History of Christian-Latin Poetry: From the Beginnings to the Close of the Middle Ages (Oxford, 1953), 179–83Google Scholar. For a reassessment, see Mary Garrison, “Alcuin, Carmen ix and Hrabanus, Ad Bonosum: A Teacher and his Pupil Write Consolation,” in Poetry and Philosophy in the Middle Ages: A Festschrift for Peter Dronke, ed. John Marenbon and Peter Dronke (Brill, 2001), 63–78, at 70–71.

57 McCulloh, “Hrabanus Maurus’ Martyrology,” 457; and Paxton, Frederick S., “Curing Bodies—Curing Souls: Hrabanus Maurus, Medical Education, and the Clergy in Ninth-Century Francia,” Journal of the History of Medicine and Allied Sciences 50 (1995): 230–52 at 231–32CrossRefGoogle ScholarPubMed.

58 Horden, “What's Wrong with Early Medieval Medicine?” (n. 2 above), 17.

59 Sigerist, “The Latin Medical Literature of the Early Middle Ages” (n. 2 above), 141.

60 McCulloh, “Hrabanus Maurus’ Martyrology,” 459.

61 As Petersen remarks, “No reader of Gregory's works can fail to be struck by his immense and detailed knowledge of the subject matter of the Bible and by the way it permeates his thought and writing.” See Petersen, Joan, The Dialogues of Gregory the Great in their Late Antique Cultural Background (Toronto, 1984), 25Google Scholar. Demacopoulos further notes that Gregory's “asceticizing hermeneutic” enables the “primary goal of his didactic practice, which is to lead his audience to a moral and practical application of the biblical text.” See Demacopoulos, George, Gregory the Great: Ascetic, Pastor, and First Man of Rome (Notre Dame, IN, 2015), 22CrossRefGoogle Scholar. See also Markus, R. A., Gregory the Great and His World (Cambridge, 1997), 4045CrossRefGoogle Scholar; and Moorhead, John, Gregory the Great (Abingdon, 2005), 1825CrossRefGoogle Scholar.

62 Gregory, Hom. Evang. 40.1, 394. For the Defense's reference to this homily, see nn. 181–82, below. Its author cites three of Gregory's writings: the Dialogues, the Homilies on the Gospels, and Homilies on Ezekiel. No references to Moralia in Iob, Gregory's longest exegetical work, have been detected. Still, the Moralia exerted an indirect influence through Isidore's derivative work, the Sententiae, quoted extensively in the Defense. See Stephan Kessler, “Gregory the Great: A Figure of Tradition and Transition in Church Exegesis,” in Hebrew Bible / Old Testament: The History of Its Interpretation, Volume I: From the Beginnings to the Middle Ages (Until 1300) (Göttingen, 2000), 2:135–47, at 140; Scott DeGregorio, “Gregory's Exegesis: Old and New Ways of Approaching the Scriptural Text,” in A Companion to Gregory the Great, ed. Bronwen Neil and Matthew J. Dal Santo (Leiden, 2013), 269–90; and Evans, G. R., The Thought of Gregory the Great (Cambridge, 1986), 87–96 and 147CrossRefGoogle Scholar.

63 Gregory's legacy to Latin Europe was as the “premier master of the allegorical sense”: DeGregorio, “Gregory's Exegesis,” 290. See similar assessments by Markus, Gregory the Great, 45–49; and Moorhead, Gregory the Great, 18–25.

64 Leonardi, “Aspects of Old Testament Interpretation” (n. 53 above), 182. See Isidore of Seville: On the Nature of Things, trans. Calvin B. Kendall and Faith Wallis (Liverpool, 2016), 8; and Sharpe, William D., “Isidore of Seville: The Medical Writings. An English Translation with an Introduction and Commentary,” Transactions of the American Philosophical Society 54 (1964): 175, at 19CrossRefGoogle Scholar.

65 The author of the Defense may possibly have known and utilized a companion work to the In Vetus Testamentum, which Isidore himself tells us that he wrote “according to the literal sense” (iuxta litteram). See PL 83.208B; and Leonardi, “Aspects of Old Testament Interpretation” (n. 53 above), 183–84. Regrettably this hypothesis is impossible to resolve, for this commentary has been lost to history.

66 Defense, ed. Stoll, 48: “Tui, inquid, sunt caeli et tua est terra.”

67 Defense, ed. Stoll, 48: “. . . procul dubio cuncta bona sunt . . . Neque enim deus omnipotens, quod etiam infideles fatentur verum, cui summa potestas, cum summum bonum sit, ullo modo sineret mali aliquid esse in operibus suis.”

68 Defense, ed. Stoll, 48: “Quorum tamen sapientia atque doctrina, quia a domino data, imitanda esse uidetur dicente domino in euangelio: Omnia, quae dicunt, facite . . .”

69 Defense, ed. Stoll, 48: “Quando in scriptis eorum aliquid utile sumitur, quasi aurum, quod sepe contigit, in sterquilinio repperitur, sicut quidam uir dei interrogatus, cur gentilem legeret, ostendit dicens: aurum in sterquilinio quaero.” The “man of God” is Cassiodorus. See Cass. Instit. 1.1.8, 22. Cassiodorus's metaphor of gleaning gold from dung, which he places in the mouth of Virgil, enjoyed enduring use in Christian literature, eventually becoming part of the humanistic expansion of the Life of Virgil (the Donatus auctus). See Folliet, Georges, “La fortune du dit de Virgil ‘Aurum colligere de stercore’ dans la littérature chrétienne,” Sacris erudiri 41 (2002): 3153CrossRefGoogle Scholar; and Wilson-Okamure, David, Virgil in the Renaissance (Cambridge, 2010), 122–23CrossRefGoogle Scholar. Leja finds the Defense here implicitly using the Augustinian distinction between use and enjoyment. See Leja, “The Sacred Art,” (n. 2 above), 6, with reference to Augustine, De doctrina christiana 1.7–10, ed. and trans. R. P. H. Green (Oxford, 1997), 14–22. Certainly the Defense's argument is resonant with Augustine (see n. 76 below), but the influence seems indirect, through the other authors quoted.

70 Gregory, Dialogues 2, prol.: “ . . . eum, quem quasi in ingressum mundi posuerat, retraxit pedem, ne si quid de scientia eius adtingeret, ipse quoque postmodum in inmane praecipitium totus iret. Despectis itaque litterarum studiis . . . sanctae conuersationis habitum quaesiuit . . . Recessit igitur scienter nescius et sapienter indoctus.” ed. Adalbert de Vogüé, in Grégoire le Grand, Dialogorum libri IV, SC 260 (Paris, 1980), 2:126; trans. Kardong, Terrence G., in The Life of Saint Benedict by Gregory the Great: Translation and Commentary (Collegeville, 2009), 1Google Scholar.

71 As with Isidore, though in far more limited contexts, Gregory seemed to operate based on a different, more permissive, principle than a cursory reading of his comments against secular learning would suggest. See John Moorhead, “Gregory's Literary Inheritance,” in A Companion to Gregory the Great (n. 62 above), 247–67; and Markus, Gregory the Great (n. 61 above), 34–45.

72 Anlezark, Daniel, “Gregory the Great: Reader, Writer and Read,” Studies in Church History 48 (2012): 1234CrossRefGoogle Scholar. Anlezark argues that Gregory passed on to later generations the attitude that Christians should detach themselves from worldly knowledge and its literature.

73 Faith Wallis, “Isidore of Seville and Science,” in A Companion to Isidore of Seville, ed. Andrew Fear and Jamie Wood (Leiden, 2020), 182–221, at 214–15: “By his practice of compilation, Isidore also quietly, even surreptitiously, persuaded his readers that Christian truth and classical science could collaborate in shaping a new model of erudition.” See also Sharpe, “Isidore of Seville” (n. 64 above), 7; and the introduction to The Etymologies of Isidore of Seville, trans. Stephen A. Barney et al. (Cambridge, 2006), 7, 13–14 and 16.

74 Isid. Sent. 3.13.11, 238.

75 Isid. Sent. 3.13.6, 237: “Omnis saecularis doctrina spumantibus uerbis resonans, ac se per eloquentiae tumorem adtollens, per doctrinam simplicem et humilem christianam euacuata est, sicut scriptum est (1 Cor. 1:20) . . .” See the introduction to Cazier's edition in CCL 111, liv–lvi; and Irvine, Martin, The Making of Textual Culture: ‘Grammatica’ and Literary Theory 350–1100 (Cambridge, 1994), 219–20Google Scholar.

76 See, for example, Cass. Instit. 1.28.3–1.28.7, 70–71; the extended passage on medicine quoted in the Defense follows three chapters later, ed. Stoll, 60 (see nn. 180 and 183 below).

77 Book 2 of the Differences (known variously as Inter Deum, De differentiis rerum, or simply Differentiae II) explores distinctions between entities and is strongly doctrinal in character. It was likely conceived and originally circulated separately from Book 1 (Inter caelum, De differentiis verborum, or Differentiae I), a grammatical work which explores distinctions between similar words, and which the Defence does not cite. Both were composed around 600. See José Carracedo Fraga, “Isidore of Seville as a Grammarian,” in A Companion to Isidore, 228–35.

78 Weisheipl, James A., “Classification of the Sciences in Medieval Thought,” Mediaeval Studies 27 (1965): 5490, at 58–60CrossRefGoogle Scholar; and Hicks, Andrew J., Composing the World: Harmony in the Medieval Platonic Cosmos (Oxford, 2017), 7074CrossRefGoogle Scholar.

79 Defense, ed. Stoll, 48, quoting Isid. Diff. II 38.25–27, 99: “E quibus quidem quaedam religioni conueniunt, quaedam uero longe modis omnibus aliena sunt.”

80 The homoeoteleuton and assonance are difficult to recreate in translation: “In quibus omnibus, secundum litteram, dumtaxat animadvertere possumus quod ad obducendam cicatricem uulnerum resina probatur esse idonea, et ad macularum squalorem reformandum nitrum herbaque borith sunt praevalida.” See Defense, ed. Stoll, 50. The order of the gerundive purpose clauses is varied for emphatic effect, creating parallel, balanced phrases: gerundive + accusative + genitive, then genitive + accusative + gerundive. Note also how the author highlights his use of the fundamental literal sense of scripture, secundum litteram.

81 Scientia is not found in any entry of the Brepol “Vetus Latina Database” for 1 Corinthians 12:28; most variants have gratia (grace), donationes, or dona (gifts) of healing.

82 Defense, ed. Stoll, 50: “Medicina est scientia curationum,” quoting Isid. Diff. II 38.24, 99.

83 Weisheipl, “Classification of the Sciences” (n. 78 above), 54. Harrison likewise highlights this interior dimension of scientia in the pre-modern period. See Harrison, Peter, The Territories of Science and Religion (Chicago, 2015), 1116CrossRefGoogle Scholar.

84 Wallis, “Isidore of Seville and Science” (n. 73 above), 187.

85 Defense, ed. Stoll, 50: “Nec inmerito donum esse spiritus sancti dicitur, per quam homo ad opus bonum exercendum reparatur.”

86 For an overview of Isidore's considerable influence in medieval Europe, see Mark L. Tizzoni, “Isidore of Seville's Early Influence and Dissemination (636–711),” in A Companion to Isidore (n. 73 above), 397–419.

87 Isid. Sent. 3.3.4, 201 (see n. 19 above). In the translation below, I avoid translating causae (“reasons”) as “causes,” because to contemporary readers “causes” has too many connotations of modern science, in terms of efficient, mechanical causation. The Defense's meaning is more ambiguous. For the historical shifts in causal understandings, see Harrison, The Territories of Science and Religion, 68–81.

88 The “medicine” was fish gall. Today this may seem less medicine and more magic, but from the perspective of the ancient Near East, fish gall would have been an accepted treatment for trachoma (which plausibly was Tobit's condition). See Moore, Carey A., Tobit: A New Translation with Introduction and Commentary (New York, 1996), 202Google Scholar.

89 For an analogous perspective in the Salernitan period, consider Hugh of St. Victor's remarks on food: Hugo de Sancto Uictore, Didascalicon de studio legendi, ed. Charles H. Buttimer (Washington, 1939), 43–44.

90 Defense, ed. Stoll, 50: “aut solacia aut medicina humana non est refutanda.”

91 Defense, ed. Stoll, 52: “Quam necessitatem habemus a medicis curari, qui sollicitudinem nostram in ipsum proicimus, cui cura de nobis constat esse? Numquid non sine medicamentis nos potest sanos permittere consisti, qui solo sermone uniuersa ualet restaurare.”

92 Defense, ed. Stoll, 52: “necesse est, ut eius uerbis fidem accomodent, quem eorum curam habere non diffidunt. Dicit enim: Non egent sani medico, sed male habentes.”

93 See n. 42 above.

94 Crislip, Thorns in the Flesh (n. 45 above), 168.

95 Defense, ed. Stoll, 52: “Scire etenim debent, quia nullus quamlibet iustus homo hanc praesentem uitam euadere potuit sine flagello.”

96 Defense, ed. Stoll, 52: “qui etiam uoce dominica ita laudatur, ut nullum habuisse in terra similem diceretur (Job 1:8), ulcere pessimo percussus esse ita ut testa saniem fluentem et uermium scatentem globum raderet narratur (Job 2:8).”

97 Defense, ed. Stoll, 52: “Sed et Paulus apostolus infirmitatem se carnis habere s‘pius manifestat, cum dicit: Quando infirmor, tunc potens sum (2 Cor. 12:10); et rursum: Libenter, inquid, gloriabor in infirmitatibus meis, ut inhabitet in me uirtus Christi (2 Cor. 12:9).” The Defense is not novel in this approach to illness, as Crislip has shown in his study of asceticism. See Crislip, Thorns in the Flesh (n. 45 above), 147–59.

98 Defense, ed. Stoll, 52: “O quam optabilis tribulatio carnis, quae virtutem habitare facit in homine Redemptoris!”

99 Defense, ed. Stoll, 52: “Jesus Christus . . . quatinus innueret medicinam et solacia humana in necessitate non refutanda . . .”

100 Defense, ed. Stoll, 52: “Qua ratione igitur purus homo uituperat, quod deus homo non uituperandum manifestat?” The sense of purus meaning “pure” is used later in the treatise: “in futuro regno . . . purior inuenitur.” See Defense, ed. Stoll, 60.

101 Defense, ed. Stoll, 54: “Valde enim salubris est infirmitas, quae mentem a duritia frangit . . .”

102 Defense, ed. Stoll, 54: “. . . ut dum uitiis pulsentur, de uirtutibus non superbiant, dum uero aut animi aut carnis dolore atteruntur, a mundi amore trahantur.”

103 Augustine, Confessions 2.2.4, ed. James O'Donnell (Oxford, 1992), 1:17; trans. Carolyn J. B. Hammond (Cambridge, MA, 2014), 1:64–65. This notion of merciful discipline can also be traced to the Scriptures, for example, 2 Macc. 6:12–16.

104 Defense, ed. Stoll, 56, quoting Isid. Sent. 3.4.2a, 202: “Dei iudicia numquam iniusta.”

105 For a description of the “universe of disease” in the Middle Ages and the high prevalence of non-lethal chronic afflictions, see Park, Katherine, “Medicine and Society in Medieval Europe,” in Medicine in Society: Historical Essays, ed. Wear, Andrew (Cambridge, 1992), 59–90, at 60Google Scholar.

106 Defense, ed. Stoll, 56: “Non sunt, inquit apostolus, condigne passiones huius temporis ad futuram gloriam, quae reuelabitur in nobis (Rom 8:18).”

107 Defense, ed. Stoll, 56: “non ideo humana refutanda medicina sed cum gratiarum actione in labore utenda (Rom 8:18).”

108 Defense, ed. Stoll, 56: “Cui enim hoc iuxta hystoriam medicinali more actum esse non uidetur, quando hactenus medici hoc solent agere, cum aliquid amarum et fastidiosum esse sentiant, melle aut alio aliquid, quo amaritudinem fastidiumque temperari existimant, commiscent.”

109 Such an interpretation of John 9 has historical precedent, as Lightfoot writes in his commentary on John: “Irenaeus, adv. Haer. 5.15.2, and other early writers see a connexion [sic] between this verse and Gen. 2:7, where man is formed from the dust of the ground . . . the thought here is either of re-creation or of complete creation. Saliva has been often and widely believed to possess curative power.” See Lightfoot, R. H., St. John's Gospel: A Commentary (Oxford, 1957), 202Google Scholar.

110 Luke, to whom the Gospel of Luke and Acts were attributed, was widely respected by the fourth century as a skillful physician, based on Paul's passing reference to “Luke the physician” (Col. 4:14). See Strelan, Rick, Luke the Priest: The Authority of the Author of the Third Gospel (Abingdon, 2016), 90 and 99–100Google Scholar. Cosmas and Damianus (twin brothers) studied medicine in Syria and were renowned for treating patients without fees. After their martyrdom (ca. 300 under Diocletian, though the evidence is problematic), they were believed to have performed many posthumous healings and soon became patron saints of medicine, venerated with shrines, artwork, and building dedications across Europe. See Duffin, Jacalyn, Medical Saints: Cosmas and Damian in a Postmodern World (Oxford, 2013), 3240CrossRefGoogle Scholar; and Maskarinec, Maya, City of Saints: Rebuilding Rome in the Early Middle Ages (Philadelphia, 2018), 3237CrossRefGoogle Scholar. A poetic text immediately following the Defense in the Lorscher Arzneibuch, likely originally composed by Isidore, includes Cosmas and Damianus as among medicine's world-famous masters: “Cosmas, Damianus, Ippocratis, Galienus, quos claros orbis celebrat medicina magistros . . .” Defense, ed. Stoll, 64, with discussion at 25–27.

111 Defense, ed. Stoll, 58: “Honora medicum propter necessitatem, etenim illum creauit altissimus . . . Altissimus, ait idem sapiens, creauit de terra medicinam, et uir prudens non abhorrebit illi.”

112 Defense, ed. Stoll, 58: “Vult enim deus honorari in mirabilibus suis, quae per hominem geruntur.” Compare Ecclus. 38:6: “et dedit homini scientiam Altissimus honorari in mirabilibus suis.”

113 Defense, ed. Stoll, 58: “quidquid boni per hominem geritur, a deo perficitur.” Leja, “The Sacred Art” (n. 2 above), 27 and 30, rightly concludes that in this and related early medieval medical texts, physicians are “recast as mediums of divine intervention,” parallel to saints and their capacity for divine healing.

114 Defense, ed. Stoll, 50–51: “dominus Paulo per Annaniae manus inpositionem lumen redderet.”

115 Defense, ed. Stoll, 58: “Omnia . . . opera nostra operatus est nobis dominus.”

116 Defense, ed. Stoll, 48 and 52: “deus omnipotens . . . rerum cui summa potestas . . . absit, ut deo aliquid impossibile asscribatur.”

117 Defense, ed. Stoll, 60: “Nolite ergo pigri esse languentibus domini gratia subuenire.”

118 Isidore tells us that the difference between aegrotatio and aegritudo is that the former relates to the body and the latter to the soul. See Isidore, De differentiis verborum 142 (70): “Sicut aegrotatio in corpore, sic aegritudo in animo nomen habet non seiunctum a dolore,” ed. and trans. Carmen Codoñer, in Isidoro de Sevilla: Diferencias, Libro I (Paris, 1992), 158.

119 The analogy is taken from Jerome, Commentarius in Abacuc 1.1.35–43, ed. S. Mantelli, CCL 76–76A bis 1 (Turnhout, 2018), 10. However, the author pares down some of Jerome's flourishes and presents the illustration more simply.

120 Defense, ed. Stoll, 60.

121 Defense, ed. Stoll, 50: “donum esse spiritus sancti dicitur, per quam homo ad opus bonum exercendum reparatur.”

122 Defense, ed. Stoll, 60: “. . . cum ignorantes noxia et contraria nobis petimus . . .”

123 Isid. Sent. 3.3.2, 201: “Quosdam etiam praesciens multum peccare posse, [Deus] in salutem flagellat eos corporis infirmitate, ne peccent, ut eis utilius sit frangi languoribus ad salutem, quam manere incolumes ad damnationem.”

124 For example, the sixth-century Rule of Benedict permits special food and baths for the sick, while adding, “The sick should remember that they are being served out of respect for God. Therefore they must not, with their trivial demands, annoy the brothers serving them.” See Regula Benedicti 36.4, ed. A. de Vogüé, in La Régle de S. Benoît, SC 182 (Paris, 1972), 2:570; trans. Kardong, Benedict's Rule (n. 29 above), 302. Similar passages occur in other early monastic rules. See Kardong, “Concordia regularum 65” (n. 30 above), 327–34.

125 The Defense uses the phrase “ne murmurationis malum,” which also appears in the Rule of Benedict 34.6 (cited in the previous note).

126 Defense, ed. Stoll, 60: “ad patientiae medicamenta recurrat, unde illi non fallitur, quin ad aeternam salutem non tantum corporis, sed etiam animae peruenire ualeat.”

127 Defense, ed. Stoll, 60: “Quanto enim hic unusquisque tribulatione tunditur, tanto in futuro regno, si tamen patiens, purior inuenitur.”

128 In quoting Cassiodorus, the Defense addresses not only medici, but also, more broadly, all those caring for the sick. For a description of the blurred bounds between professional and lay healers and the nebulous distinction between various types of healthcare practitioners in premodern Europe, see Park, “Medicine and Society in Medieval Europe” (n. 105 above).

129 See, for example, Smaragdus, Expositio in Regulam S. Benedicti (n. 30 above), 100 and 248–51.

130 It is worth noting that the perception of physicians as avaricious has long existed. See Pseudo-Pliny, writing in the early fourth century, Plinii Secundi quae fertur una cum Gargilii Martialis medicina, ed. Valentine Rose (Leipzig, 1875), 7. See also Sharpe, “Isidore of Seville” (n. 64 above), 13; and Sigerist, “The Latin Medical Literature of the Early Middle Ages” (n. 2 above), 136.

131 Defense, ed. Stoll, 60: “scire debetis . . . quia in pauperioribus magis Christus uisitatur, diuitum quippe habundantia ipsa sibi uisitationem exigit medicorum.”

132 Defense, ed. Stoll, 61: “Hic quippe superbia nostra retunditur, qui in hominibus non naturam, qua ad imaginem dei facti sunt, sed honores et diuitias ueneramur . . .”

133 See n. 28 above.

134 Defense, ed. Stoll, 61: “. . . qui puluis et cinis sumus, ad pauperes ‘grotos intrare dedignamus . . . Visitate ergo quos pauperes aspicitis et quos foris cernitis dispectos saeculi, intus arbitramini amicos dei ad uisitandum. Namque pigri cur estis, quando hoc, quod iacenti in terra porrigitis, sedenti in caelo datis.”

135 Defense, ed. Stoll, 62: “si hoc facientes Christi et non uestram gloriam quaeritis . . . audire meremini: Venite benedicti patris mei . . . Hos ergo legite et quemadmodum dixerint, medicamina conficite . . . ”

136 Defense, ed. Stoll, 61: “A Christo mercedem recepturi, a quo calicem aquae frigidae in nomine eius datum certum est remunerari regno perenni, in quo cum patre et spiritu sancto uiuit et regnat in saecula saeculorum.”

137 Wallis, “A Monastic Defense of Medicine” (n. 3 above), 91.

138 Strelan, Luke the Priest (n. 110 above), 74–90. See nn. 176–77 below.

139 Defense, ed. Stoll, 58: “cuius laus in euangelio per omnes ecclesias esse narrator.”

140 Defense, ed. Stoll; and Musitelli, Sergio and Bossi, Ilaria, “A Medieval Controversy Against the Secularization of Medicine,” Research 1 (2014), doi: 10.13070/rs.en.1.1250CrossRefGoogle Scholar. Though generally unreliable as to its analysis, the paper by Musitelli and Bossi contains many helpful suggestions as to the text's sources. Klaus D. Fischer also provided me with some of his notes on the manuscript's sources (personal correspondence).

141 See n. 1 above. This incipit syntactically and thematically resembles the incipit from Jerome's Prologus in Libro Job: “Cogor per singulos Scripurae divinae libros adversariorum respondere maledictis, qui interpretationem meam reprehensionem Septuaginta interpretum criminantur . . .” See Biblia Sacra iuxta Vulgatam versionem, ed. Bonifatius Fischer et al. (Stuttgart, 1975), 731. Both authors are “compelled to respond” to their detractors and explain their modus operandi in a colorful introduction.

142 Cass. Instit. 1.1.8, 22.

143 Isid. Diff. II 37–38, 96. Compare Anonymus ad Cuimnanum 1.83–85, ed. B. Bischoff and B. Löfstedt, CCL 133D (Turnhout, 1992), 3; and Isid. Etym. 2.24.1 and 13.6.1.

144 Isid. Diff. II 40, 100; and Anonymus ad Cuimnanum 1.7.295–97, ed. Bischoff and Löfstedt, 9–10. Compare Isid. Etym. 2.24.5.

145 For example, Gregory, Homiliae in Hiezechihelem 1, hom. 3.8, ed. M. Adriaen, CCL 142 (Turnhout, 1971), 37.

146 The first quotation is from Isid. Diff. II 39, 99. Compare Anonymus ad Cuimnanum 1.7.283–85, ed. Bischoff and Löfstedt, 9; and Isid. Etym. 2.24.7. Bede acclaims Gregory as an orator in his treatise on rhetoric. See Bede, De arte metrica et de schematibus et tropis 2.1.12.125–28 and 2.2.12.279–83, ed. C. B. Kendall, CCL 123A (Turnhout, 1975), 142–71, at 149 and 169. The Defense is thus an early witness to Bede.

147 Isid. Diff. II 38.25–27, 99.

148 Isid. Diff. II 38.5–9, 97. Compare Anonymus ad Cuimnanum 1.90–93, ed. Bischoff and Löfstedt, 3.

149 For example, Isid. Etym. 2.24.1.

150 Isid. Diff. II 38.24, 99. Compare Anonymus ad Cuimnanum 1.7 (n. 143 above), 9; and Isid. Etym., 4.9.1.

151 Isid. Sent. 3.3.4, 201. For Isidore on health and the balance of the humors, see Isid. Etym 4.5.1.

152 For Raphael as “medicine of God,” see Greg. Hom. Evang. 34.9, 307; and Isid. Etym. 7.5.13. The “medicine” is fish gall (Tob. 6:1–9 and 11:10–14). See n. 88 above.

153 In Latin, a single letter changes the meaning from the indicative manducat (“He eats vegetables”), which is the accepted reading, to the jussive manducet (“Let him eat vegetables”), a common variant in Vulgate manuscripts.

154 The Defense plausibly derives this argument from Jerome's letter to Eustochium. See Jerome, Epistle 22.8, ed. I. Hilberg, CSEL 54 (Vienna, 1910), 143–45. Like the Defense, Jerome's interpretation of Paul's vinous advice to Timothy (1 Tim. 5:23) relates to propriety. Paul specified a “little” dose to exclude overindulgence and was speaking more as a medicus than as an apostolus. Moreover, Jerome invokes the same two verses as the Defense (Eph. 5:18 and Rom. 14:21), in the same order. If this connection is correct, it is further evidence of the Defense's author creatively adapting his sources. Unlike Jerome, the Defense expounds the verse from Ephesians, rephrases the one from Romans (before quoting it verbatim), and explains rather than merely claims that Paul was speaking medicinally, not morally. Gregory the Great also interprets Paul's advice as belonging to the “healing art.” See Greg. Hom. Evang. 4.3, 29.

155 Defense, ed. Stoll, 52: “Numquid non sine medicamentis nos potest sanos permittere consisti, qui solo sermone uniuersa ualet restaurare.” The latter phrase quotes from a liturgical antiphon for St. Agatha's feast day (cantus ID 003733): “Medicinam carnalem corpori meo numquam exhibui sed habeo dominum Jesum Christum qui solo sermone restaurat universa.” See n. 42 above.

156 Gregory, Dialogues 4.42.3 (n. 70 above), 2:152.

157 This detail, absent from our current critical edition, may be an embellishment.

158 Gregory, Dialogues 2.35.4 and 4.8 (n. 70 above), 2:238 and 3:42.

159 Greg. Hom. Evang. 22.1, 181.

160 Greg. Hom. Evang. 34.1, 300.

161 Greg. Hom. Evang. 27.4, 232.

162 Gregory, Dialogues 4.57.8 (n. 70 above), 3:188.

163 Isid. Sent. 3.1.1, 194.

164 Isid. Sent. 3.1.5, 195.

165 Isid. Sent. 3.3.7, 202.

166 Compare Isid. Sent. 3.1.10, 195.

167 Both verses are quoted by Isid. Sent. 3.1.10, 195.

168 Ps. 106:4 is quoted by Isid. Sent. 3.3.3, 201, while Rev. 3:19 is quoted by Isid. Sent. 3.2.6, 198.

169 Isid. Sent. 3.1.11, 196.

170 “Evil of grumbling” echoes the Rule of Benedict 34.6 (n. 125 above). The second quotation is from Isidore, Synonyma 1.29, ed. Jacques Elfassi, CCL 111B (Turnhout, 2009), 224.

171 Isid. Sent., 3.4.2a, 202; and Greg. Hom. Evang. 11.5, 79.

172 Compare Gregory, Homilies on Ezekiel 1, hom. 3.11 (n. 145 above), 39.

173 Compare Isidore, In vetus testamentum. In Regum IV, 2.1, PL 83.419.

174 Compare Isidore, In vetus testamentum. In Exodum, 21.3, PL 83.297.

175 Compare Isidore, In vetus testamentum. In Regum IV, 2.2, PL 83.419.

176 This passage paraphrases Jerome, De viris illustribus 7.5, ed. A. Ceresa-Gastaldo, Biblioteca Patristica 12 (Florence, 1988), 88.

177 2 Cor. 8:18, which is also quoted by Jerome, De viris illustribus 7.1, in reference to Luke.

178 An analogy simplified from Jerome, Commentarius In Abacuc 1.1.35–43 (n. 119 above), 10.

179 Compare Greg. Hom. Evang. 15.4, 107.

180 Compare Cass. Instit. 1.31, 78.

181 This verse is quoted in part by Greg. Hom. Evang. 40.12, 410.

182 This sentence is adapted from Greg. Hom. Evang. 40.12, 410. See n. 28 above.

183 Cass. Instit. 1.31, 78. Fischer warns against assuming that these medical texts were known to our author, since the Defense is directly quoting from Cassiodorus here. See Fischer, “Das Lorscher Arzneibuch” (n. 2 above), 182–83. The identity of the texts is also enigmatic. See the detailed analysis by Courcelle, Pierre, Late Latin Writers and their Greek Sources, trans. Wedeck, Harry (Cambridge, MA, 1969), 403409Google Scholar, with some new suggestions by Nicholas Everett, “The Manuscript Evidence for Pharmacy in the Early Middle Ages,” in Writing the Early Medieval West (n. 8 above), 119–22.