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(Un)shaping pastors into physicians – Lund University’s fifth faculty and pastoral medicine

"Pastoral medicine"

When discussing university history in general and Lund University’s history in particular, two facts seem to be the most significant: that the early universities only had four faculties – theology, law, medicine and philosophy – and that most of the other faculties that exist today emerged from the Faculty of Philosophy.

The division into four faculties is still maintained to some extent at the annual Doctoral Degree Conferment Ceremony in Lund Cathedral, where the “faculties of philosophy” collectively confer their doctorates. It is also expressed in other contexts, such as the four “faculty frogs” on the fountain in the University Square, or the four “faculty lines” in the student song “O, gamla klang- och jubeltid” (Oh, old days of music and celebration). It is therefore not particularly strange that many assume that this four-faculty scheme reigned supreme in Lund until the division of the Faculty of Philosophy in 1956.However, the fact is that between 1821 (or perhaps even 1811) and 1841, Lund University could boast of having a fifth faculty. Its name would today seem somewhat contradictory, “The Faculty of Medicine-Theology”, and its aim was to teach the subject alternately referred to as “pastoral medicine” or “pastor’s medicine” – a basic education in medicine for future pastors.

Image: Johan Bernhard Pramberg’s records of lecturers in “pastoral medicine”, spring semester of 1815.

A need of physicians

Image: Johan Bernhard Pramberg, lecturer in pastoral medicine

Sweden around 1800 was a country in need of physicians. Academically trained doctors generally stayed in the cities and were probably too expensive for the everyday citizen to call on. Thus, in rural areas, people were forced to make do with household remedies, quack doctors or, when epidemics struck, the attempts by the powers that were to prevent diseases from spreading though quarantine and harsh measures.

However, one category of public, academically educated, officials who could in fact be found throughout the country were pastors; they were probably the only reasonably educated men living in close proximity of the rest of the population.

A union of the medical and pastoral professions, or at least a place where pastors could receive medical training, was therefore discussed during the second half of the 18th century and the beginning of the 19th century as a possible solution to the lack of physicians. Government official Erik Bergstedt described the intended benefit of medically trained pastors in the following way:

In a country so vast in relation to its population, where not enough real and specifically appointed doctors can be found to make them readily available to peasants and others living far away from major cities, it seems that it would be quite useful if pastors would have sufficient medical knowledge to serve their parishioners, when sickness or unfortunate illnesses render them in need of medical or surgical assistance.

Of course, this was not only discussed in an altruistic spirit, but also from the perspective of the common good. Having more people with medical training in the countryside would result in fewer deaths, which in turn would mean more taxpayers and more soldiers to recruit. One particular event (as we will see) appears to have been the turning point in resolving the issue of pastoral medicine 1809, the same year that Sweden lost Finland and thus a quarter of its population.
Even strictly religious theorists were able to justify a union of the pastoral and medical professions. Future bishop of Karlstad Johan Jacob Hedrén argued that;

The real profession of religious teaching is to awaken and maintain a religious mindset among people of all classes: at the dawn of life among the emerging youth, during the attention to worldly matters and worries in manhood, during times of loneliness and suffering among the elderly, to refer to a higher power, a wiser ruler, and a better life than the experiences of the outer senses are able to detect. Each and every enlightened and zealous teacher has undoubtedly examined, in public speeches, when teaching the young, or in the daily interaction with his audience, even in houses of sorrow and sickness, how the knowledge he acquired about the work of the Creation regarding the natural order and the conditions for health and illness, in the best possible way, helps him to turn people to the faith that is his goal.

There was thus an idea that pastors, through the art of medicine, could more easily disseminate a religious message to the people. Surely, this also included Christian notions of mercy.

In 1809, the Swedish Riksdag of the Estates decided to set up 50 scholarships of 100 crowns each “for the immediate pursuit of pastoral and medical studies”. Of these, 34 scholarships were awarded to Uppsala and 16 to Lund. The scholarships could only be awarded to students who had completed a degree of Bachelor of Arts or a degree in Medicine-Philosophy (a preliminary degree for admission to the Faculty of Medicine), or to pastors under 30. However, only 10 of the 16 scholarships in Lund appear to have been awarded continuously. The scholarship period was initially six semesters with the possibility of an extension; in 1824, it was reduced to six scholarships over three semesters.

According to the statutes, the scholarships were to be awarded jointly by the Faculty of Theology and the Faculty of Medicine, and this is where the fifth faculty of Lund University comes in. In 1811, the two faculties convened for the first time, initially as the “Faculties of Theology and Medicine”, but as of the autumn semester of 1821, it became the “Faculty of Medicine-Theology”.

Whether this entailed the actual establishment of a new faculty, or was simply a manifestation of hubris, is somewhat unclear, but the name change suggests that the Faculty of Medicine-Theology considered itself to be, and operated as, an independent faculty. The fact that the faculty felt it necessary to acquire its own document cabinet as early as 1816 suggests that it already considered itself to be separate from its mother faculties.

The faculty’s remit mainly involved awarding scholarships, administration of the pastoral-medical education, contacts with the university chancellor, and examining scholarship holders in both medicine and theology once per semester. However, as of autumn semester 1834, these examinations ceased “when scholarships were no longer awarded to students but only to Master’s and Bachelor’s students”.

So, what was it really like to study pastoral medicine at Lund University? We know that the course in pastoral medicine ran for three semesters and was originally to be taken twice (hence the scholarship period of six semesters), but we do not really know what the course was about. The preserved documentation consists of lecture records from the spring semester of 1815, in which Johan Bernhard Pramberg describes the contents of his lectures in pastoral medicine.

In his lectures, he focused on practice; for example, issues regarding suffocation, drowning and poisoning occupied the entire month of February, while March was spent on hygiene and dietary issues, and the remainder of the semester was devoted to fevers, chills and inflammations. It is important to remember that the course was intended as an introduction rather than an actual medical education; a letter from the king in 1813 stressed that the purpose of the scholarships was not;

to shape pastors into physicians, but to provide several of them with such sound and broad knowledge in medicine that, in lieu of proper doctors, they could come to the aid of those taken ill.

From the lecture records it is clear that, to Pramberg and to pastoral medicine, diseases were caused by miasma, i.e. by “bad air”, which was a very common medical explanation for the onset of disease. In the same lecture as he accounted for the “more common causes of disease among peasants” to the prospective pastors, he spoke about “the influence of the atmosphere”, and the day after, he spoke about “the poor location and condition of their abodes. Filth inside and out”.

The combined physician/pastor was to prevent “Causes that aggravate incurred diseases among peasants: neglect, filth, bad air, [...] abuse of strong substances, ignorance, superstitions, trust in quack doctors, etc.”. Thus, the pastoral physician was not only to resuscitate drowning and poisoned patients, but also to discipline members of their parishes to ensure that they kept themselves healthy – not only cure but take action with regard to “the occurrence of diseases”, as Pramberg said.

Who studied pastoral medicine, and why did they do it?

Image: Martin Erik Ahlman, professor of theology and member of the Faculty of Medicine-Theology

An astonishing amount of time was devoted to seeming death; as described earlier, all of February was spent on covering various forms of suffocation and poisoning and associated states of unconsciousness – the first lecture of the semester was on “fainting and its treatment”. The focus on the mysterious condition in which a human being is in a state between life and death was timely. Seeming death was a condition that reached almost epidemic proportions during the 18th and 19th centuries, at the same time as it relfected the romantic fixation on the relationship between the living and the dead.

This is perhaps best illustrated in Mary Shelley’s Frankenstein, which was published in 1818, about the same time as Pramberg taught prospective pastors about resuscitation of the seemingly dead.

So, who studied pastoral medicine, and why did they do it? First of all, many of the scholarship holders were older students, who often already had a Master’s degree or were practising pastors. Although there were exceptions, about half of the scholarship holders had completed half, all or nearly all of their entire studies. Remember that the scholarship rules stipulated that the scholarship holders were required to have completed a degree of Bachelor.

If we look at the students who were examined during the autumn semester of 1828, Lars Theodor Sjöbeck had a degree of Master of Arts and a Bachelor’s degree in medicine, Otto Wilhelm Hansson was a pastor, Carl Fredrik Kjellberg had a Bachelor’s degree in medicine-philosophy, and Lars Petter Brunnér had a degree of Bachelor of Arts. Sjöbeck eventually became a regimental physician at the grenadier battalion of Småland and Kjellberg became a provincial doctor in Vänersborg. Hansson continued on his theological path and became a parish pastor in Västra Karaby, while Brunnér deviated from the group and started teaching natural history at Kalmar upper-secondary school before he went insane.

On closer examination of these four students, although three out of four continued to pursue a medical career or pastorhood, in two cases it was hardly as pastors, and we do not know whether Hansson ever indeed helped his parishioners with medical problems.

Concerns were raised

Image:Henrik Reuterdahl. Archbishop, member of parliament, member of the Swedish Academy and medicine-theology scholarship holder.

The doubts as to how much the scholarship holders benefited from their studies in medicine-theology were expressed several times during the faculty’s existence. Concerns were raised even before the scholarships were set up, warning that the pastoral doctor would not be “skilled or even usable” in either profession, but rather an “imposter in both”. Professor of Theology Martin Erik Ahlman argued back in 1818, when the faculty was to report its “successes” to the university chancellor, that;

During the two semesters I have been a member of the faculties, I have not been able to find that the establishment of the scholarships has been of any benefit whatsoever to studies in theology. As far as I can tell from the two examinations I have been involved in, the students have generally not been very eager to gain further insights in theology than those they acquired when preparing for the theology exam. Just the same, I have passed them all, as I do not hold them responsible for this neglect, which would cause them to lose their scholarships.

The fact that many of the faculty’s students did not feel particularly drawn to the actual purpose of the studies was confirmed by parish pastor Paul Gabriel Ahnfelt (scholarship holder 1821–1823) who, in his student memoir Studentminnen (a work described by Nordisk familjebok as “full of unsupported anecdotes as well as hasty and offensive statements about many who have passed away and others still alive”), describes how his true intent when applying for the scholarships was not so much to learn about medicine as it was to get out of a financial predicament.

Furthermore, the studies were presumably relatively easy. According to Ahnfelt, to pass the final exam it was enough to read “Pontins socken-apotek” (the Pontin parish pharmacy), a book about how to set up a rural pharmacy. And the teacher’s demands were hardly greater. Ahnfelt wrote that Professor of Obstetrics Carl Fredrik Liljewalch “gave the medical theologians the gentlest of treatments. After we graduated, he had a good laugh at our evident ignorance”, and that Liljewalch’s colleague Professor of Theoretical Medicine Eberhard Zacharias Munck of Rosenschöld “loathed ‘pastoral medicine’, which you could tell from his questions”. Accordingly, we can conclude that the medicine-theology scholarships were simply considered to be easy money.

The students’ lack of interest is also evident in Pramberg’s aforementioned lecture records; he had to cancel his lectures five times due to missing participants, one of which was on 1 May. Perhaps the scholarship holders had been abusing “strong substances” the day before, and thus found themselves in certain state of “seeming death” on May 1st?

In spite of Ahnfelt’s less than flattering description of the scholarships, several well-known names at the time were medicine-theology scholarship holders. Among them, we have parish pastor Nils Lovén (scholarship holder 1818–1822) who, through his work Folklifvet i Skytts härad i Skåne vid början af detta århundrade: barndomsminnen (Folk life in the Skåne district of Skytt at the beginning of this century: childhood memories) became known as a folklore researcher under the pseudonym Nicolovius.

Even more famous, at least in Lund, was the future academic celebrity and professor of mathematics Carl Johan Hill (scholarship holder 1817–1821). In addition to being an inspector for both Kalmar nation and Södermanland nation, he is also known for being the father of famous painter Carl Fredrik Hill. Finally, we have the former assistant at the University Library Henrik Reuterdahl (scholarship holder 1818–1820) who became a member of parliament, archbishop and member of the Swedish Academy.

All the same, Lund University’s fifth faculty would not survive for long. In 1841, the king announced that that the medical-theological scholarships were to be divided between the faculties of medicine and theology to be allocated separately. Consequently, the Faculty of Medicine-Theology held its last meeting on Lucia Day in December 1841 to decide on the division of scholarships and to dissolve itself. And so, the story of the fifth faculty had come to an end.

Now, almost 180 years later, one cannot help but reflect on what the Faculty of Medicine-Theology would have been like today. It certainly would not have been necessary to form an entire faculty (self-appointed or not) to award a few scholarships. Perhaps the fifth faculty most closely resembles today’s cross-faculty organisational units, established for more or less specific research or education purposes, uniting researchers, students and staff from different areas within the University.

From this perspective, the Faculty of Medicine-Theology is more than just an anecdote of university history – it was Lund University’s first interdisciplinary specialised centre!

Henrik Ullstad
Archivist at the University Archives