This successful hygienic and sanitary work, which brought about practically the complete obliteration of leprosy in the Middle Ages, furnished the first example of the possibility of eradicating a disease that had become a scourge to mankind. That this should have been accomplished by a movement that had its greatest source in the Thirteenth Century, is all the more surprising, since we are usually accustomed to think of the people of those times, as sadly lacking in any interest in sanitary matters. The significance of the success of the segregation movement was lost upon men down almost to our own time. This was, however, because it was considered that most of the epidemic diseases were conveyed by the air. They were thought infectious and due to a climatic condition rather than to contagion, that is conveyed by actual contact with the person having the disease or something that had touched him, which is the view now held. With the beginning of the crusade against tuberculosis in the latter part of the Nineteenth Century, however, the most encouraging factor for those engaged in it, was the history of the success of segregation methods and careful [{344}] prevention of the spread of the disease which had been pursued against leprosy. In a word the lessons in sanitation and prophylaxis of the Thirteenth Century are only now bearing fruit, because the intervening centuries did not have sufficient knowledge to realize their import and take advantage of them.
Pope Innocent III. was not the only occupant of the papal throne whose name deserves to be remembered with benedictions in connection with the hospital movement of the Thirteenth Century. His successors took up the work of encouragement where he had left it at his death and did much to bring about the successful accomplishment of his intentions in even wider spheres. Honorius III. is distinguished by having made into an order the Antonine Congregation of Vienna, which was especially devoted to the care of patients suffering from the holy fire and from various mutilations. The disease known as the holy fire seems to have been what is called in modern times erysipelas. During the Middle Ages it received various titles such as St. Anthony's fire, St. Francis' fire, and the like, the latter part of the designation evidently being due to the intense redness which characterizes the disease, and which can be compared to nothing better than the erythema consequent upon a rather severe burn. This affection was a great deal commoner in the Middle Ages than in later times, though it must not be forgotten that its disappearance has come mainly in the last twenty-five years.
It is now known to be a contagious disease and indeed, as Oliver Wendell Holmes pointed out over half a century ago, may readily be carried from place to place by the physician in attendance. It does not always manifest itself as erysipelas when thus carried, however, and the merit of Dr. Holmes' work was in pointing out the fact that physicians who attended patients suffering from erysipelas and then waited on obstetrical cases, were especially likely to carry the infection which manifested itself as puerperal fever. A number of cases of this kind were reported and discussed by him, and there is no doubt that his warning served to save many precious lives.
Of course nothing was known of this in the Thirteenth Century, yet the encouragement given to this religious order, which devoted itself practically exclusively to the care in special [{345}] hospitals of erysipelas, must have had not a little effect in bringing about a limitation of the spread of the disease. In such hospitals patients were not likely to come in contact with many persons and consequently the contagion-radius of the disease was limited. In our own time immediate segregation of cases when discovered has practically eradicated it, so that many a young physician, even though ten years in practise, has never seen a case of it. It was so common in America during the Civil War and for half a century prior thereto, that there were frequent epidemics of it in hospitals and it was generally recognized that the disease was so contagious that when it once gained a foothold in a hospital, nearly every patient suffering from an open wound was likely to be affected by it.
It is interesting then to learn that these people of the Middle Ages attempted to control the disease by erecting special hospitals for it, though unfortunately we are not in a position to know just how much was accomplished by these means. A congregation devoted to the special care of the disease had been organized, as we have said, early in the Thirteenth Century. At the end of this century this was given the full weight of his amplest approval by Pope Boniface VIII., who conferred on it the privilege of having priests among its members. It will be remembered that Pope Boniface VIII. is said to have issued the Bull which forbade the practise of dissection. The decretal in question, however, which was not a Bull, only regulated, as I have shown, the abuse which had sprung up of dismembering bodies and boiling them in order to be able to carry them to a distance for burial, and was in itself an excellent hygienic measure.
Many orders for the care of special needs of humanity were established during the Thirteenth Century. It is from this period that most of the religious habits worn by women originate. These used to be considered rather cumbersome for such a serious work as the nursing and care of the sick, but in recent years quite a different view has been taken. The covering of the head, for instance, and the shearing of the hair must have been of distinct value in preventing communication of certain diseases. There has been a curious assimilation in the last few years, of the dress required to be worn by nurses in operating [{346}] rooms to that worn by most of the religious communities. The head must be completely covered, and the garments worn are of material that can be washed. It will be recalled that the headdresses of religious, being as a rule of spotless white, must be renewed frequently and therefore must be kept in a condition of what is practically surgical cleanliness. While this was not at all the intention of those who adopted the particular style of headdress worn by religious, yet their choice has proved, in what may well be considered a Providential way, to be an excellent protective for the patients against certain dangers that would inevitably have been present, if their dress had been the ordinary one of the women of their class during these many centuries of hospital nursing by religious women.
The organization of charity is supposed to be a feature of social life that was reserved for these modern times. A subsequent chapter on Democracy, Christian Socialism and National Patriotism, shows how false this notion is from one standpoint; a little additional interpretation will show that the generations which organized the hospitals, took care of the lepers in such a way as to prevent their becoming sources of infection for others, and segregated such severe contagious diseases as erysipelas, not only knew how to organize charitable efforts, but were able to accomplish their purposes in this matter in such a way, that the friction of the charity organization itself absorbed as little as possible of the beneficent energy put into it, and much less than is the case in our own time. Besides the monasteries were really active centers of charity organization of the most practical character. They not only gave to the people when their necessities required it, but they were active employers of labor and in times of scarcity constantly made large sacrifices in order to keep their people employed, and even the community itself went on short rations in order that the suffering in the neighborhood might not be extreme. In times of prosperity there were, no doubt, abuses in monasteries, but no one ever accused them of neglecting the poor during times of famine.
While the Thirteenth Century was so intent upon the relief of the social needs consequent upon illness and injury, it did not neglect other forms of social endeavor. One of the crying [{347}] evils of the Thirteenth Century was the fact that mariners and merchants, as well as pilgrims to the Holy Land, were not infrequently captured by corsairs from the northern coast of Africa, and sold into slavery. At times, if there was hope of a very large ransom, news of the condition of these poor victims might find its way to their homes. As a rule, however, they were as much lost to family and friends as if they had actually been swallowed up by the sea, which was usually concluded to have been their fate. The hardships thus endured and the utter helplessness of their conditions made them fitting subjects for special social effort. The institution which was to provide relief for this sad state of affairs had its rise in a typically Thirteenth Century way—what, doubtless, the modern world would be apt to think of as characteristically medieval—but the result achieved was as good an example of practical benevolence as has ever been effected in the most matter-of-fact of centuries.
