The first principle of the medieval infirmary is that the sick come before everything else. A monastic rule written in the sixth century, which shaped the life of Western monasteries for centuries afterwards, places the care of the sick above every other duty of the house: “Before all things and above all things, care must be taken of the sick, so that they may truly be served as Christ himself.”

The reason is taken from the Gospel. At the Last Judgment Christ says to those on his right hand, “I was sick, and you visited me,” and “as long as you did it to one of these my least brethren, you did it to me.” The rule reads these words as they stand. Whoever serves a sick brother serves Christ; whoever neglects him neglects Christ. The care of the sick is therefore not one good work among many. It is a form of worship, carried on in the sickroom rather than in the choir.

From this one chapter grew six hundred years of building. Because the sick were to be served first, they needed a place of their own: near enough to the church to share in its prayer, and far enough from the working house to be quiet. The infirmary, with its own rooms, its own kitchen, and its own brother in charge, began as the answer to a single sentence of the rule.

The rule did not only command care; it made room for it. For the sick, the ordinary discipline of the house was relaxed. Baths, which the healthy took rarely, were to be offered to the sick as often as it helped them. The meat of four-footed animals, which the rule otherwise withheld, was allowed to those who were very weak, until they had regained their strength. In the customs that later grew up around the rule, the infirmary was also released from the strict silence of the cloister, so that the sick could ask for what they needed and be spoken to with kindness.

The rule also asked something of the sick. They were to remember that they were being served for the honor of God, and they were not to distress the brothers who served them by excessive demands. Yet even here the rule protected them: a sick brother who was hard to serve was still to be borne with patience, because the reward for that patience is all the greater. The duty ran in both directions, but its weight lay on those who were well.

Responsibility for all of this rested on the abbot. He was to appoint a brother to serve the sick—one who feared God and was diligent and careful—and to give the sick a room set apart for them. He was to see that they were never neglected, whether by the cellarer who supplied them or by the brothers who served them. If they were neglected, the fault was his own: the rule reminds the abbot that he must answer for every failing of those in his charge. The infirmarian was not a volunteer but an office, and the office was guarded by the highest authority in the house.

Three things follow from this chapter, and they shaped every infirmary that came after it. The sick are served for the sake of Christ, not for profit or reputation. Their care takes precedence over the ordinary order of the day. And someone is named to be responsible for it, so that no sick person depends on goodwill alone.

At IHS Bethlehem Church, “before all things and above all things” is our first duty, taken exactly as it stands. When a request for prayer for a sick person reaches us, the name is added to our prayers before any other work of the corporation is taken up—before observation, before writing, before any work of art. Nothing on our calendar is allowed to delay it.