Attitudes of New England Puritan Ministers
towards Disease and Medicine

Late Seventeenth and Eighteenth Century

An Marie Katrien Vandenberghe *

Scriptie voorgelegd aan de Faculteit Letteren en Wijsbegeerte,
Aanvullende Opleiding Geschiedenis

Academiejaar: 2000-2001

Lehigh University in Bethlehem (Pennsylvania)
Katholieke Universiteit Leuven

Promotor:Prof. Dr. Roger Simon

In all times and societies, people have tried to give a meaningful answer to the ‘why’ of suffering, disease and pain. A countless number of stories, explanations and thoughts are locked up in the memory of history. This study calls one of these stories back to life, namely that of late seventeenth and eighteenth century Puritan or Congregationalist ministers, whose ancestors settled in colonial New England (Massachusetts, Connecticut, New Hampshire) in the first half of the seventeenth century. Supported by sermons and medical writings of those preachers, I will explore how they interpreted the phenomenon of disease.[1] This larger question can be broken down into four smaller ones: What were the origins and reasons for the existence of suffering and disease? Were diseases judged as positive or negative entities for human life? How did Puritan preachers believe a sick person should behave during his or her illness? And finally, to what extent was a sick person allowed to search for healing and use medicine?

The last question receives an extra dimension since Christian theology and medicine have constantly been subjected to a potential field of tensions. Throughout the centuries, Christianity possessed two doctrines that were inherently opposite to the purpose of medical practice. The Christian belief, especially since church father Augustine (354-430), proclaimed a strong dualistic view on man, in which the body was considered as inferior towards the divine and immortal soul, which was destined to unite itself with God in heaven after death. Because of this, Christian learning and preaching emphasized the healthy condition of the soul, an emphasis that often went hand in hand with a neglect of the earthly and bodily aspects of human existence. Yet, the primary concern of medicine was exactly the improvement of bodily health, which could create tensions with a religious belief that considered the health of the soul to be more important. A second potential bottleneck was situated in the Christian dogma of a divine Providence that determined all events in the world, even on the level of a person’s individual life. God could realize His will through nature, but the idea of a divine Providence also assumed that He realized His plans in miraculous ways, which could not be traced by the human mind. Especially the latter could clash with a medical science that tried to base its knowledge on a regular and rational course of nature and body functioning.[2]

Those potential tensions between Christianity and medicine did not necessarily have to dominate the relation between the two. In strong contrast with the historiographical warfare-metaphor, which states that the historical relation between religion and science has been one of conflict and misunderstanding, the American historian Darrel W. Amundsen stressed that throughout history three possible relations occurred between Christianity and medicine. First, religion and medicine could simply function next to each other without any positive or negative interaction. A second possibility was that religion and medicine each had their own, but complementary function. In this case, the representatives of the religious side had to grant the human body, maybe not an equal, but at least a positive right to exist next to the soul. They could accomplish that by stressing that not only the soul, but also the body, was a creation of God, and therefore needed to be respected and cared for. Doctors, in turn, had to look on themselves as instruments that God used to realize His will on earth. Finally, religion and medicine could also be involved in a hostile and competitive relation, which meant that the underlying field of tensions came explicitely to the surface.[3] By investigating which of these three schematic relations Puritan ministers most resembled, I concluded that, despite the fact that they interpreted suffering and disease in a strongly religious and moralizing way, Puritan preachers of late seventeenth and eighteenth century New England displayed a practical openness towards scientific explanations for disease and the use of medicine.

And now, Reader, Wether thou art Sick, or Well; I address thee. . . .[4]

The Puritan views on suffering and disease were backed up by one central religious dogma, viz. the idea of an omnipresent divine Providence. God not only had created the world, but He also “orders and disposes all Things throughout the World.”[5] His eyes were in all places at all times, and everything from a sparrow that fell out of a tree to the arrival of the Mayflower in the New World, happened because God wanted it to happen. However, He was not only the creator of prosperity and goodness in the world. Death, war, afflictions and diseases came from God as well. All colonial ministers agreed with their colleague Benjamin Wadsworth (1670-1737), who stressed that every man and wife “should most seriously consider and acknowledge, that ‘t is the Great God who brings Sickness upon them. . . . He prevents them, sends them, removes them just as he will. All our bodily illnesses and ailments whatsoever, are ordered forth by God, as to the kind or sort, the measure and degree, the duration, and all the preceeding, consomitant and consequent circumstances of them.”[6] There was however one large exception on the rule of divine Providence, namely human sinfulness, which the first human beings had brought on their children and which accounted for the fundamental origin of suffering, disease and death. Even though there were more than two thousand different diseases wandering around the world, the primary cause of all of them was the “Sin of our First Parents.”[7]

All the suffering and diseases in the world should nevertheless not only be considered as a single punishment for that one sin of Adam and Eve, since human sinfulness did not stop at that one slip. Every human being was born with a leaning towards evil and every human became, time after time, guilty of new sins. “Remember,” as Cotton Mather (1663-1728) pointed out to his listeners, “That the Sin of every Individual man, does but Repeat and Renew the cause of Sickness unto him.”[8] According to Puritan clergymen the daily suffering and pain of people was thus not so much the direct result of original sin. “More often” humans or entire nations “suffer and are punish’d for their own personal Iniquities.”[9] Puritan preachers believed in a strong and logic connection between disease and personal sin. Proof of that lies in the advice which each minister again and again gave to the sick person and his family, namely to search their soul to try and find out what they had done to displease God.[10]

Puritans also linked certain kinds of diseases to certain kinds of sin. Bodily afflictions were mostly the consequence of sins performed with the body. Cotton Mather especially proved to be a strong believer in a correspondence between the sin and those parts of the body that were in pain. When someone was afflicted by tooth ache, for example, this person probably had sinned with his teeth “by Sinful, Graceless, Excessive Eating” or “by Evil Speeches.”[11] The ministers often sought in the characteristics of the disease some clue to the kind of sin which caused it, such as the place of the pain, the duration, the hardness. They stressed that the “Sin is Legible in the Chastiment,” thus in the disease.[12]

This generally present link between disease and personal sin, however, did not preclude the possibility that God sometimes made people sick for other reasons besides their own sinful misbehavior. Some persons did in fact still get punished for the thousands year old original sin. That explained why newly born, who had never done anything wrong themselves, could get sick and die. God also visited people with afflictions as a punishment for the sins of their parents, or prior generation. Sometimes, God kept sending certain diseases upon the same family for several generations.[13] With this last observation, Congregationalist minister John Mellen (1723-1807) perhaps tried to give an explanation for the existence of certain hereditary diseases. Although these exceptions to the general rule of disease as punishment for a person’s own sin could seem unjust and incomprehensible to man, Puritan ministers underlined heavily that they were no less part of God’s perfect and wise government of the world.

All Puritan preachers, however, indicated that, besides original or individual sin, divine Providence sometimes also had other plans in mind when making people sick. Or, like Cotton Mather explained: “Sickness does not always come, to manage a Controversy of God with us, for some Iniquity.”[14] God made some persons sick to test their faith and patience, as He had tested Job. This kind of suffering was reserved for God’s most beloved children. In that case, diseases must not be seen as punishments, but as “Love Tokens.”[15] According to historian Patricia Watson, this explanation of disease and pain as a trial was typical for Puritan ministers from the middle decades of the eighteenth century onwards. Those ministers still saw individual and epidemic diseases as a product of divine Providence, but, contrary to their seventeenth and early eighteenth century colleagues, they no longer made a connection between suffering and sinful misbehavior. The meaning of disease as some form of punishment faded away and was replaced by the explanation of suffering as a divine trial of someone’s faith, patience and humbleness. But, although attitudes towards disease of Puritan ministers did change during the eighteenth century, I believe the shift was not as radical as Patricia Watson described. Puritan or Congregationalist clergymen such as Joseph Emerson (1700-1767), John Mellen (1723-1807), Nathaniel Hooker (1737-1770) and Samuel Ely (1740-1814), who lived and wrote their sermons well into and even after the middle decades of the eighteenth century, kept on referring to original and personal sin as cause for suffering and sickness.[16] What did change then?

Seventeenth and early eighteenth century Puritan clergymen’s visions on suffering and disease leaned closely to the Old Testament’s link between disease and sinfulness and the image of a God of Wrath. Sick people are in the Old Script often presented as sinful and bad persons. Catholicism is usually said to have replaced this Old Testament view with the idea that sickness should not so much be seen as a punishment, but more as a precious gift from God, who sent suffering not to wicked persons, but to his most beloved children. In that way, He gave them the opportunity to already do repentance for their small sins on earth, so they could go straight to heaven after their death. From this viewpoint, the sick were actually ennobled by illness, because their suffering proved that God had reserved them for heaven. Puritanism and Calvinism in general, however, were characterized by a revived emphasis on the Old Testament teachings and therefore by a return to pre-Christian conceptions such as a God of wrath who made persons sick as revenge for their sins. In the same line, seventeenth and early eighteenth century New England Puritan ministers such as James Allen, Benjamin Wadsworth, Increase Mather and his son Cotton did not see sickness as a sign of grace, but more often as a symptom of immorality.[17]

Puritan attitudes, however, became somewhat milder during the eighteenth century. Cotton Mather and other early eighteenth century ministers admitted that God did not always send diseases to punish people: on some occasions, as mentioned above, God used suffering as a way to put someone on trial. In the eyes of early Puritans, nevertheless, this ‘someone’ only referred to the very small group of extremely holy persons from the Bible, for example Job. Plain New Englanders did not belong to this exceptional category. They were made sick for their sins. Later eighteenth century ministers, however, expanded this category to include normal people, instead of important Bible figures only. They spoke of two kinds of suffering people: the righteous and the wicked. Contrary to the statement of Patricia Watson, the diseases of the so-called wicked or truly sinful persons were still interpreted as punishments. The suffering that God sent to the righteous group, however, became interpreted as a divine test of faith. While the early eighteenth century explanations of disease still leaned very strongly on concepts such as sinfulness and punishment, later explanations of disease became more equally divided between punishment for sin on the one hand and trial of faith and patience on the other. More and more, suffering and disease positively evolved into a sign of grace. This difference between early and later eighteenth century ministers can be illustrated very well in two fragments respectively from Cotton Mather (1663-1728) and Nathaniel Hooker (1737-1770). Mather explained how sickness was “not always” a punishment for sin, “yet often” it was. In Hooker’s sermon, on the other hand, we read that “SICKNESS is sometimes sent with a view to chasten”, but also that “GOD sometimes sends SICKNESS upon men to try their patience, constancy, and other graces.” Later in this article I will return to an explanation for that chronological shift.[18]

Although during the eighteenth century another explanation for suffering became equally valid besides sin, one central belief remained untouched: behind each epidemic or personal disease lay God’s willing and directive hand. But how exactly did this divine Providence cause sickness in a community or in an individual person? Did Puritan ministers pay attention to this question? And if they did, did they believe that God operated in a direct, miraculous way, or did He realize His will through natural means only? I will now turn to this more technical side of the divine origin of disease.

In their sermons, Puritan ministers did not say too much about the topic. Only occasionally, I found a few relevant sentences. Most Puritans of the early eighteenth century onwards believed that miracles no longer occurred in their days and were characteristics of biblical times only. Visions of angels or the Virgin Mary were said to be limited to ignorant Catholic countries.[19] Most Puritan ministers thus seemed to interpret God’s providential working in a regular, natural way. Clergyman Benjamin Wadsworth, for example, explained to his listeners that sometimes it is very easy to link a certain disease with a natural cause. When someone has wet his feet the day before, it is not difficult to explain that this person has caught a cold or when a person has eaten too much, it is logic he or she will have a stomach ache. Sometimes, however, persons are seized with an illness for which no natural explanation can be pointed out. But Wadsworth stressed that also in such a case, there was a natural cause; man just had not yet discovered which one. Whether the natural cause could or could not be discovered, the most important acknowledgement to make was that God had “fix’d the ordinary connexion between natural causes and their effects.”[20]

Nevertheless, the question remains how exactly divine Providence had fixed this connection according to Puritan ministers. Had God constructed nature in such an independent regular way that it made people ill when they had sinned? Or did God Himself interfere each time, again and again, using and directing the forces of nature, if He thought someone deserved to be sick? In the first case, the reasoning was largely based on the idea of a self-regulating, natural system, in which God played an almost deistic part. In the latter scenario, there was less room for regular laws of nature, because God himself intervened a lot more directly. Since Puritan ministers believed that it was God who sent each disease and who determined the type, the duration, the harshness and whether it could be healed or not, it seems logic at first sight that Puritans probably leaned closer to the image of an interventional God. Yet the sermons do not really permit confirmation of this position, because they remain silent on the subject. Cotton Mather, however, did deal with this issue in his 1724 medical treatise The Angel of Bethesda.

That work consists of sixty-six loosely connected chapters on various diseases, in which Mather described a particular disease and listed a long series of possible remedies. The first five chapters were more about diseases in general and talked about their cause and mechanism. Those chapters are important, because here Mather tried to reconcile his religious and scientific-medical explanations for disease. His thoughts show clearly that Mather did not adhere so much to the image of an interventional God. Religious doctrines such as the overall present divine providence and the idea of sickness as punishment for sin took on a quasi-scientific character. Cotton Mather seemed to believe in an independent, natural system which was present in the human body and which could make sin cause a sickness in the body without God’s direct interference. Central in his thinking frame was the Hebrew concept of the Nishmath-Chajim. [21]

According to Cotton Mather, man was made up of three basic components, namely the rational soul (mind, or upper soul), the physical body and the Nishmath-Chajim, which was “a Middle Nature, between the Rational Soul . . . and the Corporeal mass; . . . the medium of Communication, by which they work upon one another.” The Nishmath was composed of small particles “which may be smaller than those of the Light itself” and which were spread throughout the various part of the body. It was a vital principle, which enabled to perform all the unconscious, biological processes in the body: “This, tis, that sees, that hears, that feels; and performs several Digestions in the Body.” That’s why Mather called this principle the Nishmath-Chaijm, Hebrew for “The Breath of Life.” It was a life-directing principle inhering in animals as well as men, on which God had imprinted His teleological faculties and tendencies. Because the Nishmath-Chajim stood in between soul and body, it enabled the soul “to penetrate into the Causes of Things” and in this way to turn a sin into a bodily sickness. For sin, which began in the rational soul, was impressed upon the Nishmath, and the latter then exhibited “a Sickness of the Spirit” which in turn was passed on to the body in the form of physical illness. Because of this process, Mather considered the Nishmath as “the Seat of our Diseases, or the Source of them.” When the sins of the soul were projected on the Nishmath, the latter could no longer perfectly direct the biological functions in the body, and thus caused pain and disease therein. The Nishmath was thus a vitalist force that God had built into each human being and that created a mechanical link between moral sin and the body, by which He could punish sinners without having to interfere directly in miraculous ways[22].

Cotton Mather also relied on the Nishmath to give a scientific explanation of how original sin was passed from one generation to the next. A living being, after all, received his Nishmath from his parents. Before original sin, the Nishmath functioned perfectly and man could not become sick. Afterwards, however, Adam and Eve’s middle soul became troubled and this would have a continual reflection on the Nishmath of all further generations, which would become vulnerable for disease and death. This explained “How the Dispositions of our original Sin are convey’d and infus’d into us.”[23]

For Cotton Mather, the Nishmath formed the secondary, natural cause, which God used to send sickness upon them. But this concept could only explain the connection between personal sin and an individual disease. It did not clarify where collective epidemics came from and how they were linked with the sinfulness of a community. Mather also tried to tackle this problem in his Angel of Bethesda. Referring to the medical writings of the Dutch physician Antony Van Leeuwenhoek (1632-1723), Mather introduced the hypothesis of the existence of minute “animals” or “animalculae”, which inhabited plants, animals and humans. These small creatures entered humans through food, drinking, respiration and even through the skin. Once in the body of a host, these microscopic animals multiplied rapidly, could injure the blood vessels and cause sickness. There were different species of these animals, “from whence may flow a Variety of Diseases,” such as small pox, throat distemper and measles. If an enormous amount of them invaded a community at once, they produced epidemics. They could be transmitted from one person to another by contact. Admittedly, not always when the animalculae invaded a body they caused a disease. If the processes of bodily secretions continued normally, the animals may have been cast out before they did any harm. Whether the little animals would be cast out, depended on the efficiency of the Nishmath. If the Nishmath did not function properly and the usual evacuations were obstructed, then the animals were free to realize their sickening influence.[24] Mather was explaining what we now call resistance or immunity. At the same time, although he did not literally implicate it himself, we could assume that by bringing the Nishmath into his explanation about ‘immunity’, Mather was trying to link a person’s vulnerability for an epidemic disease to his or her sinful state. After all, the animals could cause sickness when the bodily processes of secretion did not work, thus when the Nishmath was not functioning properly, thus when the upper soul was sick, and thus when the person had sinned. Mather did not elaborate on the question where these small animals came from. He just referred very briefly to them as the “Armies” of God, which will attack men “On His order.”[25] So, on this particular point, he seemed rather to rely on a directly interfering God after all. Cotton Mather was not the only Puritan clergyman to believe in the existence of tiny sickening insects. His Boston colleague Benjamin Colman, although only briefly, also referred to pathogenic animals in his defense treatise on the small pox inoculation of 1721.[26]

The Angel of Bethesda from Cotton Mather gave us an insight into how this Puritan minister thought of the concrete working of divine Providence in causing sickness upon people. His vitalist principle of the Nishmath-Chajim was no original concept. As Cotton himself indicated in his chapter on the Nishmath, he found the idea in the medical works of the German physician Paracelcus (1493-1541) and his Flemish disciple and physician Jan-Baptist Van Helmont (1578-1644). Both physicians rejected the Galenic medicine which was still very popular in academic circles in their time. Paracelsus and Van Helmont believed in the existence of a divine vitalist principle in the human body, which formed the link between the soul and the body and directed the biological movements of the body through chemical processes. They called this principle the archeus and Cotton would rename it Nishmath-Chajim. Paracelsus and Van Helmont were the founders of the medical doctrine of vitalism. In their own time, their vitalist theory could not count on great success, at least not in Catholic circles. Van Helmont was even castigated by the theological faculty of the Catholic University of Leuven (Belgium) for his acceptance of the monstrous superstitions of the Paracelsian school. This Catholic aversion to the theories of Paracelsus and Van Helmont probably explains part of the popularity their medical books enjoyed among English Protestants. Historian Patricia Watson, who investigated the widespread phenomenon in New England of the preacher-physician, even concluded that the medical treatise of Jan-Baptist Van Helmont was a very popular item on the bookshelf of many Puritan ministers: one third of the book collections examined included the writings of Van Helmont.[27] This suggests that probably more Puritan ministers besides Cotton Mather believed in the existence of a vitalist principle, which linked soul to body and, sin to sickness. We do not possess proof to back up this suggestion, though, as only Cotton wrote explicitely on how exactly the divine providence caused illness.[28]

Following in the physico-theological footsteps of contemporary scientists, Mather tried to pour his religious explanation for disease and epidemics into a regular, scientific frame.[29] He even urged colonial physicians to start investigating diseases in mechanical terms and no longer in ridiculous astronomic terms. The causes and cures for sickness had to be found in regular laws of nature. After all, “tis time to have done with the metaphysical Jargon, which for a long Time has passed for the Rationale of Medicine. How much would the Art of Medicine be improved, if our Physicians more generally had the mathematical skill of a Dr Mead or a Dr Morgan, and would go his Way to work, mathematically, and by the Laws of Matter and Motion, to find out the Cause and Cure of Diseases.”[30] In general, Puritan ministers seemed not afraid of scientific, mechanical explanations for diseases. They did not consider them as a threat to their religious interpretations of suffering and disease. On the contrary, Cotton Mather even used them to support his religious thoughts. As I will show later, the Puritans evidenced a similar openness towards ‘worldly’ knowledge and use of medicine.[31]

It is not so strange that Puritan ministers did not try to explore the secondary, mechanical-natural causes of sickness in their sermons. After all, the purpose of sermons on suffering and disease was to clarify the religious sides of afflictions. The most important lesson was that sickness and epidemics came from God. How exactly God made it happen was less relevant. Puritan preachers wanted primarily to underline the role and motives of God in suffering and diseases, or as in the words of Cotton Mather: “every Disease, whatever be the Next Cause of it, must be look’d upon as proceeding from God, the First Cause of all.”[32] In sermons, suffering and disease were thus in the first place presented from God’s viewpoint as divine punishments for sin or as trials of faith and patience. Yet, what were God’s ends in this? Puritan ministers believed that everything that God created, even pain and afflictions, was part of His righteousness, wisdom and goodness.

So Sickness, is to Teach us. . . . [33]

Puritan ministers recognized that suffering, disease and pain frightened most people. They saw this fear as a normal and natural reaction. To fight this fear and to remain calm under every affliction, however, they advised to look at the reasons why God punished sin with sickness or why He put persons He loved to a painful trial. Only then, the sick and their family would learn to understand that God was actually afflicting them “for their best Good.”[34] Here above I have pointed out the difference in explaining suffering and disease between seventeenth and early eighteenth century ministers on the one side and middle to late eighteenth century Puritan preachers on the other. While the former stressed the link between disease and sinfulness, the latter made more room for the idea of sickness as divine trial. This different approach will also be reflected in the way both groups of ministers attached certain values to the afflictions which God sent upon men.

Early Puritan ministers, who essentially put forth disease as punishment for sin, underlined the righteousness of God’s afflicting hand. As sinners, “We all deserve to be sick” and sick persons only had themselves to blame for their condition of suffering and pain.[35] But the deeper end for God to afflict sinful persons went further than a righteous punishment. Puritan ministers agreed that God made persons sick because “they need it.”[36] The affliction was meant as a warning against sin, a way to make people realize what they had done wrong and a way to wean them from any further sinning. So, in the eyes of late seventeenth and early eighteenth Puritan ministers, God was a severe, righteous judge, but He also acted as a loving father, because in punishing people He made the sick, their families and friends “both Sorry for Sin, and Afraid of Sin.”[37]

Middle and later eighteenth century Puritan clergymen, however, valued the suffering sent by God more equally for two reasons. On the one hand, they labeled bodily diseases positive because, like their older colleagues, they recognized that suffering could help sinners “to reform their Vices, to cure their Vanity, Wordliness, Extravagance, Folly, and to make ‘em serious humble and wise, to consider their latter End.” On the other hand, these ‘younger’ Puritan ministers also judged sickness as something fruitful for another beneficial end. After all, they sometimes interpreted suffering as a punishment, but sometimes also as a trial, namely for good Christian persons who only had small sins. In the latter case, just as with the punishment, God had more in mind than a pure test of faith. God tested those persons, not because they had sinned, but because He loved them and wanted to “ripen them for Glory.”[38] God hoped that these good Christians would become even better ones by proving their faith, patience and loyalty throughout the painful sufferings He sent to them. In contrast to ministers such as James Allen, Increase Mather, his son Cotton Mather and Benjamin Wadsworth, these later eighteenth century Puritan preachers did seem to interpret afflictions, at least as they were explained as a trial, as a way by which God wanted to lead His good children into heaven. In Nathaniel Hooker’s sermon we read: “God sometimes sends SICKNESS upon men to try their patience . . . as a means to bring his children home to glory [heaven].”[39] The question is how this could be reconciled with the Puritan theology of predestination, which stated that whether someone did or did not to go heaven could not be influenced.

The answer lies in the fact that from the middle of the eighteenth century, original Puritan religious beliefs started deteriorating, among which the idea of predestination. This shift could be seen, for example, in the changing Puritan attitudes towards death. In the seventeenth and the beginning of the eighteenth century, Puritan New Englanders pictured death as a doubtful passage to heaven, because of the uncertainty of the outcome of the divine predestination. From the middle of the eighteenth century onwards, however, focus shifted to the positive vision of death as a peaceful passage to heaven. Grace was no longer limited to the elect, as in austere Calvinism, but was more and more presented as a gift for all good humans.[40] This softening in Puritan thinking about predestination has to be explained against the background of the Great Awakening (1730-1740), which was not only as a major period of religious revival and missionary efforts for Puritanism, but also for other colonial denominations such as Anglicanism, Presbyterianism, Baptism, Quakerism and Methodism. Therefore a more competitive ‘market’ of Christian religions came into existence during and after the Great Awakening and by the end of the eighteenth century, Puritanism was reduced to only one of several denominations amid New England’s growing Protestant pluralism. In order to keep their followers and attract new ones, Puritan churches stood much more chance if their ministers softened some sharp theological edges, such as the idea of predestination before birth and disease as a punishment for sin.[41] From the middle of the eighteenth century, Puritan preachers hardly spoke about predestination any more. And instead of presenting pain and sickness as a punishment for all people, the pain of normal, good men and women became, in a more attractive and comforting way, explained as a divine trial by which God prepared His chosen ones for heaven. Sickness sent over as a trial was thus evaluated as a sign of grace, because it was a positive proof that God wanted “to prove and improve Mens Vertue, their patience, their Faith, their Submission.”[42]

While early Puritan ministers concentrated more on the warning advantage and their later colleagues divided their admiration more equally among afflictions as warning and as possibility to improve someone’s virtue, all of them also recognized a series of other fruitful ends in the diseases that God sent upon persons and communities. Suffering and sickness furnished the sick, their family and friends with opportunities to incorporate some important Christian lessons and duties they “should otherwise never learn or do.”[43] First of all, sickness reminded people of their mortality. When someone’s life was moving on “smoothly,” the person scarcely looked to what was behind or in front of him. He did not worry about death and God’s eternal judgment. Yet this relaxed attitude changed, “if the symptoms of a mortal or heavy disease appear upon him.” For an afflicted, painful body “directs our views to death, and calls for preparation for it” before it was too late.[44] Secondly, closely related to the mortality issue, bodily suffering could teach both the afflicted as the healthy persons not to attach too much value to earthly things, such as health, property and even beloved friends.[45] Life on earth was only temporary. Thirdly, “afflictions enliven our prayers” and thus improved, according to the ministers, “our Entercourse with Heaven.”[46] Finally, suffering and sickness created for healthy persons an opportunity to take care for a sick family member or friend. In this way, Christians could fulfill their duty of visiting and ministering the sick, which Puritan preachers pictured as one of the “essential branches of christian and moral duty.” Additionally, persons who had been sick, would in the future be more sensitive to sympathize and take care for others who were in pain. No one was more capable of comforting the sick, than “those who have themselves been afflicted.”[47] A disease and some pain now and then could make people more human, understandable and compassionate towards “suffering fellow creatures.”[48]

In summary, Puritan ministers admitted that diseases and pain were “evil” when looked at from the viewpoint of human “Flesh and Blood,” thus from the natural, physical side.[49] However, they tried to make clear that God’s afflictive dealings with mankind could not be judged on the basis of the pain and discomfort they brought. Christians had to bear in mind that it was God who sent all those diseases and He sent them with deeper ends than just painful punishments or trials. As a warning against sin, a strengthener of virtues, a reminder of mortality, frailty and humbleness and an occasion for prayer and the Christian duty of charity, “Afflictions help us to understand more about God, Christ and ourselves.”[50] Puritan ministers evaluated God’s afflictive dealings with mankind as righteous and good, “For All is well that is done by GOD”, who was “a Wise, a Just, and a Good GOD.”[51]

‘T is the absolute duty of all christians to have their wills entirely resigned to the all-perfect, all-disposing will of God.[52]

If God sent sickness upon people for their own advantage, how should the sick then have to behave? First of all, Puritan Ministers expected suffering people to recognize God as the first cause of their pain and affliction. The ill had to believe with all their heart and reason that they were sick because God wanted them to be in pain: “Whatever Evil they [the sick] Suffer…It would be well, if the people of God would Judge All to be Well, that may befall them, even in the most Afflictive Dealings of God.”[53] It was part of the Christian obedience to God that every person resigned his will to the will of God. According to Puritan ministers, this meant that the sick had to try and avoid “the least opposition or repugnancy” against God’s providence, whether merciful or afflictive. They had to aspire not to let any complaint cross their lips and “fully consent and agree to the holy and wise providence of God.”[54] Many Puritan preachers referred to the Old Testament figure of Job as the ideal pattern of patience for suffering afflictions: although he was deprived of his health, property and family, he was never mad at God, nor did he complain. The Sick who adopted an attitude of “great impatience” and “great murmurings against God” would only offend God’s wisdom and goodness, would enlarge their sins and throw away all the advantages of God’s afflictions. Sick persons had to display a humble and submissive behavior. They could comfort themselves with the thought that God punished them less than they actually deserved, namely the torments of hell. Puritan ministers called upon their sick parishioners to be thankful for the “so many Months and Years of Health and Ease” which proceeded this time of pain and illness. They should also realize that God’s afflictions were always mixed with acts of divine mercy and compassion, although no human being deserved it. That was why sick persons had to be thankful, if God gave them only one disease “instead of several different diseases”, if He gave them only pain in one or some parts of the body “instead of an acute pain in all parts of thy Body” or if He let them keep some material favors during their afflictions, such as a “comfortable House to shelter thee”, a “comfortable Bed to ly on” or a “Husband or Wife, Parents or Children, ore some kind Friends . . . ready to sympathize with thee.”[55]

In a next step, since the origin of sickness lay in human sinfulness, Puritan ministers put considerable emphasis on the Christian duty of the sick to undertake a painstaking introspection in attempting to find the exact sin for which God stretched His rebuking hand: “If Sickness be come upon you, Examine the Cause of the Sickness, I mean, the Sin that is the Moral Cause of it. . . . Immediately fall to enquiring what Controversy of God with us may be the most probable Cause of our Sickness.”[56] As a guideline for this duty, Cotton Mather advised his parishioners to read “the EXPOSITION of the TEN COMMANDMENTS in the Catechisms.” Those who felt too ill to read it themselves, should ask someone else to read it “over unto thee.”[57] The disease itself could also give sick persons directions in this search, since the sort of sickness and its place in the body could be related with the sin for which it was a punishment. Although middle and late eighteenth century clergymen did not explain all diseases as punishments for sin, but also recognized the possibility of a trial, they also disciplined all sick people to investigate their soul for possible sins. So, according to Nathaniel Hooker, when persons were afflicted, “We should search…and see if there be any evil way within us, that we may suppose GOD intends to rebuke and chastise.”[58] Once the sinful cause of the disease or epidemic was found, the afflicted persons or community should make a penitent confession of them to God and ask for forgiveness.

The way to ask for pardon was to bring a “Sacrifice”, but not a sacrifice of their own disease and pain. Puritans saw afflictions mainly as a warning and not as an opportunity for works of repentance. The only sacrifice which Puritan clergymen believed that could help them in gaining divine pardon, was “the Alsufficient Sacrifice of our Lord Jesus Christ”. In case of sickness or other afflictions it was the pain and suffering of Christ which had to be pleaded with God as a mediating ransom for forgiveness by praying the following words: “O Most Glorious God; Our Lord Jesus Christ hath Suffered that Wrath of thine, which is due to us for our Sins: Let the Sufferings of our Lord Jesus Christ save us from thy Wrath: Oh, Pity us, and Pardon us, and let us be saved from horrible Sicknesses, for the sake of the sufferings from Christ Our Lord.”[59]

Thirdly, the chief concern of sick persons or communities should be their sinfulness and, not their sickness: “A Sick Person should be more Desirous to be Delivered from Sin, than from Sickness… Count it better to have the Iniquity taken away, than to say, I am not Sick.”[60] To stimulate this concern, Puritan ministers underlined the danger of dying unforgiven. Additionally, to plead Christ’s sacrifice, to be delivered from sin and to remain patient, afflicted persons had to “maintain a constant course of Prayer at all times.”[61] If they themselves were too weak, they should ask their family and friends to pray for them.

The Puritan doctrine of the sick to resign their will to that of God without complaint, should also be a guideline for behavior during the further course and outcome of the disease. The sick person had to leave the “Issue of the Sickness” completely in God’s providence. Whether God decided to keep someone ill, to restore his health or to bring him to death, as a good Christian, this person had to accept God’s decision: “Be willing to Dy or to Live, just as the Great GOD shall Please to Appoint.”[62] Sick persons should in the first place not desire for the restoration of their bodily health. Their wish should be to please God and thus follow His wise will. Because diseases were the “forerunners” of death and the possible return of health depended entirely unto God’s will and was thus uncertain, Puritan ministers seriously urged the sick to prepare themselves for death. During these preparations, the sick should “think on all their sins as far as they can, heartily hating, loathing of them, and trusting in the Blood of Christ for the pardon of them.” They should forgive the mistakes of their enemies and start weaning themselves from this world, so they would be prepared to “quit’ and part with their Houses, Gardens, Orchards, Friends, Relatives, all their Outward Comforts and Enjoyments whatsoever” by the time that death knocked on their door.[63]

When the health of a sick person was restored, this did not mean that his or her Christian obligations were over. First, recovered persons were strongly expected to acknowledge that it was God who spared and delivered them from the sickness and the pain. In a next step, they had to be very thankful to God for His goodness in giving them back their health. At the same time, they should also keep in mind the comforts and mercies that God gave them during their disease, because their condition could have been much worse and more painful. And, because they themselves had tasted the pain and bitterness of sickness, in the future, they should become peculiarly attentive and compassionate to the suffering of persons in their family and community. As the most important duty of healed persons, Puritan ministers stressed that they should try to avoid sin, since that was the main reason why God afflicted them in the first place. “More zealously than ever,” healed persons had to return to the Christian path of the Ten Commandments and behave in such a way not to sin against God any more. Finally, Puritan clergymen underlined that healed persons should not think that, because they were saved from disease and death once, the danger of death would not return. Eventually, everyone must die.[64]

The major duty of sick and healthy Puritan New Englanders was thus to resign their will to the will of God and always accept His decisions, even if these were afflictive and painful. Murmuring or trying to escape was labeled as sinful. At this point, the question emerges, whether Puritan ministers allowed room for the use of medicine in their attitudes towards suffering and disease? After all, if a sick person should accept God’s will, could the search for bodily health then not be interpreted as a an attempt to escape God’s afflictions?

We must not be Pagan Stoicks![65]

Despite chronological changes during the eighteenth century, Puritan ministers have always interpreted the origin and purpose of disease and the ideal behavior under sickness in a thoroughly religious way. But, although one would assume that they would consider the use of medicine as disobedience against the will of God, Puritan ministers of both the late seventeenth and the eighteenth century did not see it as a sin if sick people tried to get well again. Moreover, the search for bodily healing was not only allowed, but even an obligation. God was not only the righteous Giver of disease and pain, but also the merciful Inventor of medicine on which mankind could rely in times of pain and suffering. God had bestowed nature with all kinds of healing powers and, through experience and research, man could discover and use them. Therefore, refusing the use of medicine was, first of all, an insult to God’s mercy. Secondly, it was a sinful neglect of that other gift from God, namely life and the body as its carrier. Looking for a cure was thus part of the Christian obligations under illness: “It’s a duty to use the best means . . . for bodily health and life.” The sick who neglected this duty sinned against the commandment “Thou shalt not Kill”, which included the obligation to try to preserve a person’s own life and health.[66] Nevertheless, Puritan ministers did subject the search for physical health to a series of conditions in order to act in accordance with the will of God.

First, the sick should be more concerned about the sinful state of their soul than their bodily health. After all, although both gifts from God, the immortal soul is worth more than the earthly body. Moreover, the sins of the soul were the cause of the sickness of the body. Therefore, the first reflex of a sick person should be to turn to God and ask forgiveness for his or her sins. Puritan ministers even promoted this duty as a way to enlarge the chance of regaining health. If God saw suffering persons regretting their sins, He would be more inclined to remove the disease or, at least, to support and calm the sick in their hour of death.

Next, as God had to be seen as the first cause of a disease, its symptoms, length and heaviness, He also had to be looked at as “the Author and Giver of Health.” Puritan ministers meant thereby that, although sick persons had to turn to physicians and their remedies “as an Ordinance of God,” they should always keep in mind that it was God, and God alone, who could decide if those medical treatments would have a healing effect. The sick should not trust physicians and medicines in themselves. Physicians and medicines had to be seen as instruments of God’s will and even “the best Physicians, the best Medicines, the best Methods” would cure nobody “without Gods Blessing.” They received their healing capacities through God’s providence. Thus, before giving his parishioners a list of practical medical advice concerning the measles, such as provoking a “gentle vomit”, “a moderate sweat”, or drinking “hot honey”, Cotton Mather stressed that they should “by no means forget” that God was the “Lord our Healer” and that the medical remedies could only lead to healing “if Heaven afford a Blessing.”[67]

Finally, sick people, their relatives and friends were not allowed to use whatever healing remedy they wanted. Puritan ministers rejected the use of charms, sorcery and other supernatural techniques, although they conceded that some of those practices could be effective. Cotton Mather, for example, wrote: “How frequently is Bleeding Stancht, by writing something, with Some Ceremonies, on the Forehead! How frequently is a Tootache Eas’d, and an Ulcer Stop’d, and an Ague Check’d, by Papers, with some Terms and Scrawls in them, sealed up and worn around the Neck.” But, no matter how effective, sorcery and charms were associated with the Devil, and people who relied on them were “ungodly” because they did not trust God in their illness, but rather sought help from “The Spirits of the Invisible World.” Puritan ministers promoted the use of natural cures because they were created by God Himself “out of the Earth, and he that is wise will not abhor them.”[68] In addition to using natural remedies, the sick were encouraged to confess their sins and pray to God for relief and support. Yet, these prayers and confessions could not be seen as medicines, but as ways to seek contact and to reconcile with God. It was forbidden to use religious incantations to effect a direct bodily cure, since it would imply a superstitious belief in the magical powers of words instead of in God. The sick should also not rely on the so-called supernatural powers of their ministers. While Christ and the apostles possessed miraculous healing powers, Puritan ministers had to be looked upon “in their ordinary [human] Capacity only.” Although in daily life some Puritan ministers, such as Hugh Adams (1676-1748), did believe in their own magical-religious healing powers, the official Puritan and Protestant teaching in general was that clergymen could only help the sick by spiritual counseling and natural remedies.[69]

Although restricted by these three conditions, the search for physical healing and the use of medicine was no problematic issue for Puritan ministers. The relaxed views of Puritan clergymen towards medicine can best be explained in comparison with the sermons of eighteenth century Catholic priests which I studied for the Southern Netherlands (current Belgian territory) and which demonstrated a more conflicting attitude towards medicine. The studied Catholic priests also described the medical art, its practitioners and remedies as a merciful creation of God. But, at the same time, they seemed to have more difficulties in combining the duty to use medicine with the duty to accept patiently the afflictions that God distributed. The potential field of tensions between religion and medicine, which was described in the introduction, was more present in Catholic views on healing and medicine and gave way to a tensed, often contradictory, rhetoric. Many Catholic clergymen did not bluntly reject the use of medicine. However, simultaneously, they did criticize the people who ran to a physician in times of illness on the charge of trying to escape the disease and thus rejecting God’s will. One of them, Matthias Agola (1628-1701), even argued that medicine was an invention from the Devil. Belgian Catholic priests also subjected the use of medicine to one more limitation than did New England Puritans. The search for healing was permitted, but, if a sick person noticed no medical cure could heal him any more, he had to abandon every further use of medicine and accept the fact that God wanted him to suffer the pain and discomfort of that disease. Persons who at that point kept on trying to get well again behaved against the will of God. Every healing attempt had to be stopped.[70] Puritan sermons did not put such limitations on the use of medicine. In the description of the dying process of Deborah Prince and John Russell, for example, the respective preachers Thomas Prince (1687-1758) and David Tappan (1752-1803) mentioned that, although the victims in both cases were known to be dying for a long time already, a physician was present and was still trying to reverse the result of the disease.[71]

A series of factors, social and theological, can explain why Puritan ministers talked about medical practice in a more realistic and positive sense than did their Belgian Catholic colleagues on the other side of the ocean. First, compared to Catholic preachers, more Puritan ministers were actively engaged in medical practice themselves. On a survey of twenty eighteenth century Belgian priests, only one was known to perform as a physician, namely Prosper Florisoone (†1798); he was not even a trained physician, but more of a quack. In New England, however, the phenomenon of the preacher-physician was generally widespread. Since no physician of eminence joined the immigrants in the seventeenth century and no formal medical education was offered at colonial universities prior to the organization of a medical faculty at the College of Philadelphia in 1765, medical practice was, until well into the eighteenth century, largely performed by three groups of people: governors, ministers and schoolteachers. Of the 3252 New Englanders who graduated from Yale and Harvard between 1704 and 1770, 388 practiced medicine and 100 out of this number were preacher-physicians. The motivation of ministers to pursue the art of healing was multifaceted. Clergymen were often the most educated members of rural communities and therefore possessed at least a rudimentary knowledge of medicine. Many probably felt responsible, not only to provide spiritual guidance to the afflicted, but also to try to heal their painful bodies. Yet, other factors, such as a scarcity of trained physicians in many colonial areas, the inability of the poor to afford a secular doctor and the clergyman’s desire to boost his income, all contributed to the widespread phenomenon of the preacher-physician in New England.[72] Of the twelve Puritan clergymen referred to in this study, at least four were known for sure to be engaged in medicine: Increase and Cotton Mather, Benjamin Colman and Nathaniel Hooker. In 1713 Cotton Mather was even elected as a member of the London Royal Society of Science and Medicine.[73] Apart from the relatively high participation of Puritan ministers in medical activities, there were also three theological features which contributed to a more familiar and practical attitude towards medicine.

First, since Puritans rejected the Catholic contempus mundi tradition, they expressed more respect for worldly things, such as earthly life, the physical body and health. Although both Catholics and Puritans believed in man’s innate depravity and in the inferiority of mortal existence compared to eternal life, the latter demonstrated an aversion to extreme Catholic expressions of monasticism, physical mortification, glorification of suffering and pain and dislike of worldly happiness. While Catholic sermons on suffering and death strongly stressed the potential sinfulness of worldly things and the human body, Puritan preachers showed more appreciation and thankfulness for earthly happiness and physical health. They stressed the fact that worldly things were good in themselves and were created by God to sweeten the human path to heaven. True Christians should not only long for death and heaven, but should also enjoy life on earth.[74] According to Thomas Prince, for example, one of the infirmities in the character of his daughter Deborah was the fact “that she was afraid of Comfort.” She was so obsessed with thoughts of “Salvation and Eternity” that she “seemed to grow dead of the present World”, not enjoying the periods of “Light and Comfort” in her life, which was an “ungrateful Negligence.”[75] Because Puritan theology demonstrated a larger appreciation for earthly comfort, happiness and health, the use of medicine to protect and recover this health was a less problematic issue. Secondly, as historian Charles Webster has argued, Puritan interest in medical science and practice was stimulated by expectations about Christ’s second coming, by which the bond between man on the one hand and God and nature on the other would be restored to perfect condition as before the Fall. This meant that mankind would no longer be threatened by pain and diseases. Puritan divines believed that knowledge in medicine was an important duty to achieve because by gaining control over the body’s ailments, mankind would contribute to the restoration of the bond with God and nature and stimulate Christ’s coming.[76]

A third theological explanation for the different approach of medicine between Puritan and Catholic clergymen can be found in the fact that the former did not interpret disease and pain as an opportunity to do repentance for sin. For both Puritan as Catholic clergymen afflictions were seen as a warning against sin. For Catholic priests, however, the advantage of suffering and pain did not stop there. While Puritans only interpreted disease as a confronting warning against sin, Catholics bestowed suffering and sickness with a second, extra positive meaning. For the latter, the pain and discomfort that accompanied a disease could literally be used to mortify the sins in their bodies and souls. Just as Christ had suffered on the cross for human sinfulness, sick persons themselves could follow this example and offer to God their discomforts and pain in order to do penance and obtain forgiveness. For Catholic priests suffering and pain thus possessed an advantage that puritan ministers did not recognize. The reason for that difference lies in the Puritan theology of predestination. Saving grace was essential to attain salvation and reach heaven. But, contrary to Catholic teachings, Puritans believed that the divine granting of saving grace could not be influenced by good works or rituals of penance: an individual’s fate was determined by God long before his or her actual arrival on earth. Catholics did not adhere to the idea of predestination. For them, it was only at the end of one’s life that God decided whether a person was fit for heaven and this decision depended on the person’s behavior during his life and the amount of sins for which he or she still had to do penance. So, more than Puritans, Catholic preachers looked upon earthly suffering as a precious and graceful gift from God, because by sending sickness to people He gave them the opportunity to do penance for their sins before their death and increase the chance to go to heaven, or at least shorten their time in purgatory.[77] Although Puritan sermons also judged suffering and sickness positively, since it came from God and was a fruitful warning against further sinning, they did not glorify suffering and disease to the extent Catholics did and thus had fewer problems in encouraging the use of medicine to try to remove sickness.

A good illustration of the positive and practical attitude of the Puritan ministry towards medical practice was the inoculation controversy of 1721 in Boston. From April 1721 to the early winter of 1722, Boston was ravaged by smallpox. Approximately 6000 of the town’s 12000 inhabitants were infected and 900 of them died. The epidemic was accompanied by a month-long dispute and pamphlet war between the Boston physicians, who, under the leadership of the European-trained William Douglas, were against inoculation, and the Boston ministry, led by Cotton Mather, who defended this preventive procedure. Although practiced for more than a century in parts of Asia, Africa and eastern Europe, smallpox inoculation, or variolation of people with human smallpox, was hardly a proven method. Cotton Mather had read two positive articles about inoculation in a volume of the Royal Society’s Philosophical Transactions in 1721. When in that same year, smallpox broke out in Boston, Cotton Mather called on the town’s physicians to consider using inoculation to prevent further victims. All the Boston lay physicians rejected the idea, except for doctor Zabdiel Boylston (1679-1766), who performed the first inoculations in Colonial America on Mather’s six year old son and two African American servants. Boylston, however, met with the opposition of the other lay medical practitioners, who believed that inoculation would help to spread instead of limit the disease. Most of all, these practitioners were against the mingling of the Boston clergy in what they saw as an exclusive medical affair.[78] Cotton Mather and other Puritan Boston ministers, such as his father Increase, Benjamin Colman, Thomas Prince, John Webb (1687-1750) and William Cooper (1694-1743) supported Boylston in his inoculation attempts and even wrote a collective pro-inoculation letter to the Boston Gazette on 31 July 1721.[79]

Much has already been written about the smallpox inoculation controversy and the fact that the Boston clergy defended and supported the practice of inoculation against the majority of the city’s lay physicians has resulted in various historical explanations. Some historians interpreted it as an attempt of the Boston clergymen to safeguard their double role as preacher-physicians against the growing authority and professionalism of the city’s lay practitioners.[80] Others, such as historian Maxine Van de Wetering, have argued that the ministers’ support of inoculation was an expression of their concern for saving lives and alleviating human suffering. I agree with Van de Wetering and believe that the Boston clergymen were in the first place driven by human reasons to do good: in their eyes inoculation gave an opportunity to apply medicine to the welfare of the townspeople who were suffering from smallpox.[81] That the Boston ministers were not trying to undermine the authority of lay practitioners can be proven in a series of factors. First, Cotton Mather did not start inoculating by himself, but recommended the procedure to the town’s lay physicians, because he believed the experiments should only be performed by skilful physicians, under which he did not count himself. Additionally, not only in the inoculation controversy, but also in earlier medical writings, Cotton Mather recognized the more authoritative role of trained lay physicians in medical issues. In 1713, when the measles were raging in Boston, for example, Mather wrote a pamphlet with medical advice on treatment of this disease. In the introduction, he explained how this Letter About a Good Management was meant as a “pure act of Charity to the Poor” because “Good Physicians are not every where at Hand.” His intentions were thus humanitarian. Throughout this pamphlet, he also carefully acknowledged his respect for more educated physicians. He stressed that his text contained medical guidelines for people who had no access to a doctor, but, that if it was possible, “A Skilful Physician must be consulted withal.”[82]

Maxine Van de Wetering is correct in her conviction that the opinions of the ministers in the inoculation debate show how Puritan clergymen like Increase Mather, his son Cotton, Benjamin Colman, John Webb and Thomas Prince had open minds towards the scientific pursuits of medicine and its application to the welfare of the sick. She was on the wrong track, however, when she tried to prove that “the real significance” of the role of Cotton Mather in the Letter on the measles of 1713 and in the inoculation controversy of 1721 “was that it marked a shift in the minister’s approach to illness.” Van de Wetering argued that since the Letter on the measles, Mather’s attitude towards disease no longer referred to sinfulness and religious moralization, but offered practical, naturalistic remedies for treating a disease. Evidence of this chronological shift could, according to her, be found in a comparison between the Letter about a good management of the Measles of 1713 and an earlier written essay called Wholesome Words (1702). While Mather in Wholesome Words still displayed a strong moralizing and religious approach to sickness, in the Letter of 1713 and later, his emphasis was wholly on symptomatic descriptions and practical advice on medical remedies.[83] The mistake Van de Wetering made, however, was that she compared two completely different types of sources.

Wholesome Words was no part of Mather’s medical writings, but was a sermon and thus meant to interpret phenomena, in this case suffering and disease, in a religious way. The Letter on the measles, on the contrary, was a medical piece, meant to give people practical advice on treatment of a disease. The real significance of Mather’s writings after 1713 did not lie in a shift from religious to humanitarian-medical interpretation of disease, but in the fact that these two approaches, religious and medical, were and remained both present, which was what this article has hopefully demonstrated about Puritan attitudes towards disease and medicine. Mather’s conception of disease as a deserved and humiliating punishment of God for sin did not abate as he became more adept in modern medicine. After all, if he had removed himself from an orthodox religious interpretation of suffering and disease, why then did he republish the sermon Wholesome Words in 1713, the same year he wrote the Letter on the measles? Why then did he, after the inoculation controversy of 1721, wrote a whole chapter in his medical book The Angel of Bethesda (1724) on sin as the “Grand CAUSE of Sickness” and, in a chapter on smallpox in the same book, encourage the sick to look upon “the nasty Pustuls” as “Emblems of the Errors which thy Life has been filled withal?”[84] Mather’s medical writings and the Boston ministery’s interference in the inoculation controversy should not be interpreted as a move away from religious moralization of sickness, but as an expression of Puritan openness towards the search for healing and the use of medicine ‘despite of’ a prominent religious approach of disease.

This article illustrated in the first place the religious way by which Puritan ministers explained the origin and reasons for disease and pain. While late seventeenth and early eighteenth century preachers pointed out sickness mainly as a punishment from God for sin, later eighteenth century sermons divided their attention more equally between two reasons: a punishment for sinners and a divine trial for the more godly Christians. Both groups judged suffering and disease as righteous and positive acts of God, since afflictions were spiritually beneficial in various ways; they made humans humble, aware of death and their fragile body, and, above all, aware of their past sins. The best way for the sick, their relatives and friends to profit from these advantages was to subject their will to the will of God and not to try to escape His afflictive hand. This duty of submission strangely did not cause a conflicting relation with the search for healing and the use of medicine. The potential tensions between Christianity and medicine did not come to the surface in late seventeenth and eighteenth Puritan sermons and writings. On the contrary, Puritan ministers tried not only to reconcile religious and scientific-medical explanations for disease, for example through the concept of the Nishmath-Chajim, but also to combine the duty of submission to God’s will in suffering with a practical, more relaxed attitude towards the pursuit of medicine to help people in pain and sickness.