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.
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