Wednesday, May 20, 2020


Public Health

Lewis Mumford (1895-1990), The City in History (New York: Harcourt Brace Jovanovich, Inc., 1961), pp. 295-296:
Contrary to still current prejudice, many medieval towns, in their remedial and preventive measures for health, were far in advance of their Victorian successors. Public hospitals were one of the definite Christian contributions to the city. Jerome relates that in A.D. 360 Fabiola gave up his [sic, should be her] villa for the care of the needy sick, otherwise left to die wretchedly in the streets of Rome. From that time on, very rapidly after the eleventh century, the holy orders founded hospitals in almost every town: there would be at least two in most German towns, one for lepers, and one for other types of disease, according to Heil; while in "big" cities such as Breslau, with its 30,000 inhabitants in the fifteenth century, there would be as many as fifteen, or one for every two thousand people. What modern city can show anything like such adequate accommodations?

And note: these are the rule, rather than exceptions. Toulouse in 1262 had seven leproseries and thirteen hospitals; and one of these hospitals contained fifty-six beds; while Florence in the thirteenth century, Giovanni Villani records, with a population of about 90,000 people, had thirty hospitals with more than a thousand beds. Here, too, both in their number and in their modest domestic scale, the medieval town still has something to teach its elephantine, dehumanized successor.

Official municipal physicians made their appearance in the fourteenth century, even before the Black Death: in Constance as early as 1312. In Venice, a permanent health magistracy was created in 1485, to which in 1556 inspection and enforcement machinery were added that long served as a model to the rest of Europe. Contagious diseases, incidentally, were usually isolated outside city walls. The value of isolation wards, with separate toilets, had long been proved by the better equipped monasteries. Finally, the establishment of quarantine, for people passing in and out of cities from foreign parts, was one of the major innovations of medieval medicine. Much as travellers hated it, the practice was based on sound empiric observations, erring only on the side of caution, by allowing for almost three times the necessary incubation period.

The curtailment of infectious diseases and the gradual eradication of leprosy in Europe, thanks to the same policy of strict isolation, was nothing less than a triumph of preventive medicine. The rationalist physicians of the early nineteenth century, who confidently regarded contagion and infection without direct contact as superstitious figments of the medieval imagination, were not in fact as acute observers of cause and effect as their medieval predecessors.

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