The Church and epidemics in history

by Prof. Roberto de Mattei

The following talk was given at Voice of the Family’s conference “Health of the sick and salvation of souls – Church and society in this dark hour of history”, held in Rome on 23 October 2021.

Epidemics, or pandemics, constitute a chapter in the history of medicine that is of particular importance for its social relevance. An epidemic is in fact a collective evil that has a strong impact on the ideas and customs of a people.

How has the Church behaved in history in the face of epidemics? I will try to offer a few “history flashes”, recalling that in speaking of the Church I am referring not only to the ecclesiastical authorities but to all the Christian people who are part of the Church, starting with the saints, who are the highest expression of the sensus fidei and of the sensus moralis of the Mystical Body of Christ.

The Church, founded by Jesus Christ, has as its primary mission the eternal salvation of souls, but does not neglect the temporal health of bodies, due to the inseparable bond that exists between soul and body.[1] For this reason the Church in its history has shown itself to be the supreme guardian of the spiritual and material good of man, protecting the health of the body and showing the soul the way of eternal salvation.

And since the Church is not a private association but a public institution, it has publicly carried out this mission ever since, under the Emperor Constantine (306-337), it left the catacombs. It is to that era that the first examples of shelters for the sick date back, called xenodochi or nosocomi, according to the term used by St Jerome, who states that St Fabiola (d. 399) was the first to establish a hospital in Rome to house the poor and the sick.[2]

The so-called “Arabian canons” of the Council of Nicaea (325) established that every city should have a place to host pilgrims, the sick, and the poor.[3] These places of hospitality developed near the episcopal sees and monasteries, along the major roadways and pilgrimage routes. Among these hospices we must mention the one founded by St Benedict of Norcia (480-547), near Salerno, which gave rise to the Salernian Medical School, the first and most important medical institution in Europe.[4]

In Rome, among the oldest hospitals we find the Hospital of Santo Spirito in Sassia, whose origins seem to date back to the 8th century, when the “schola sassonum” was founded, an inn and hospital for welcoming the Angles and Saxons who came to visit the tombs of the apostles. Many other places of this kind arose through the initiative of the Church in the following centuries. At first hospitals were places of “welcome” rather than of treatment and were not staffed by physicians. In Paris, for example, at the Hotel-Dieu, the doctor came once a week.[5] The structure of the hospital was that of a church, at the centre or end of which was an altar, to allow all the sick to attend Mass. As soon as the patient arrived he had to go to confession, and if he did not do so he was likely to be discharged. With the bull Supra gregem Dominicum[6] of 8 March 1566 St Pius V (1566-1572) confirmed the decree Cum infirmitas[7] of Pope Innocent III, which required doctors to exhort the sick to receive the sacraments. For the Church, tending to the sick is a corporal work of mercy, yet supernatural life has a much greater value than natural life, because the body will die but is called to rise again in glory.

These are the religious and moral principles professed by the founders of the great hospitaller religious orders, such as St John of God (1495-1550) and St Camillus de Lellis (1550-1614). And it was in the light of these principles that the Church faced the great epidemics of history.

The first great epidemic that is remembered in Christian history broke out in Constantinople in 541 and is called the Justinian plague (482-565), from the name of the Emperor of the East who was reigning at the time. “A plague”, writes the historian Procopius of Caesarea (490-560), “that barely stopped short of destroying the whole human race. (…) It is impossible for words or thoughts to arrive at an explanation for this: it can only be attributed to the will of God.”[8]

The circulation of the disease was not as rapid as it is today. Only a few decades later did it reach the West. When Pope Pelagius II died in Rome in the year 590, due to the spread of the plague, the monk Gregory (590-604) was elected as his successor, not only because of the holiness of his life but also because of the extraordinary organisational skills he had demonstrated as praefectus urbis, the highest civil office in Rome, which he held before entering the cloister.

Gregory effectively organised hospitaller assistance, but also led a grand penitential procession of the clergy and the Roman people to ask God to end the scourge.[9] At the end of this procession there appeared on top of the Mausoleum of Hadrian an Angel who was sheathing his sword as a sign that the plague was over. The statue of St Michael the Archangel sheathing his sword on top of Castel Sant’Angelo transmits the memory of this event down through the centuries.

If the Angel sheathed the sword, this means that it had first been drawn to punish the sins of the Roman people, as St Gregory himself had stated in one of his sermons, inviting the Romans to follow, contrite and penitent, the example of the inhabitants of Nineveh: “Look around you,” he exclaimed, “here is the sword of God’s wrath wielded over the whole people.”[10]

For centuries Christians have prayed to the Lord to be freed from the evils of the body. The shrine of Lourdes, with its miracles, confirms how pleasing these prayers are to Heaven. But if someone admits that God may free humanity from the individual and collective evils that afflict it, how can he deny that the Lord may use these same evils to strike and purify unrepentant humanity? This is why the Church has always considered epidemics as divine punishments, like wars, famines, and other calamities. Hence the prayer in the Rogations: A fame, peste et bello, libera nos Domine: “from famine, war, and plague, deliver us Lord”.

Historians observe that pandemics very often accompany great historical upheavals.[11] The plague epidemic of 541 coincided with the disintegration of the Western Roman Empire. The famous “Black Plague” of 1348 in turn marked the end of the Middle Ages. This plague, according to the most reliable figures, killed between 40 and 60 percent of the entire population of Europe, the Middle East, and North Africa.[12] The figures for the Justinian plague are similar. The American historian Kyle Harper has written that “if the trauma of the pandemic of the fourteenth century in many ways marked the threshold between the Middle Ages and the modern world, the disintegrating force of the first plague deserves to be considered as the moment of transition from Antiquity to the Middle Ages”.[13]

Plague scourged Europe for four centuries. Famous is that of Milan, known as the plague of Saint Charles, from the name of the archbishop of that city, Charles Borromeo (1538-1584).[14] While the plague was spreading, Cardinal Borromeo ordered three general processions, “to appease the wrath of God”. He himself took the place at the head of the people, dressed in the purple cloak, hooded and barefoot, the penitent’s rope around his neck and a large cross in his hand. St Charles also suggested to the magistrates of Milan that they rebuild the sanctuary dedicated to St Sebastian and celebrate a solemn feast in his honour. In July 1577 the plague ceased and the first stone of the temple was laid, where on 20 January of each year a Mass is still celebrated to commemorate the end of the scourge.

Alessandro Manzoni, in The Betrothed (I Promessi Sposi), made famous another plague that scourged Milan, that of 1630, during the Thirty Years War. Another Borromeo archbishop of Milan, Cardinal Federico (1564-1631), shone, like his uncle, for his charity towards plague victims.

In that same year, the bubonic plague broke out in Bavaria. The inhabitants of the town of Oberammergau promised that if God would free the population from the scourge, the city council would stage a performance of the Passion every ten years. The plague spared Oberammergau and the sacred representation has become an international event that is repeated regularly, with the inhabitants of the village as the actors.

In the spring of 1629 the epidemic also reached Venice, mowing down thousands of victims. Doge Niccolò Contarini (1553-1631) and the Senate asked the Virgin Mary to spare the city, vowing to build a large church in her honour and to organise every year, in perpetuity, a procession to this temple. The plague ceased and the architect Baldassarre Longhena (1598-1682) built the monumental church of Santa Maria della Salute, which can still be admired today at the entrance to the Grand Canal. Since then, every 21 November, the day the plague ended, a grand procession has been held from San Marco to the votive temple.

This is how Christian Europe reacted in the face of epidemics.

Another important moment in history was what the historian Paul Hazard has called the “European crisis of conscience”, between 1685 and 1715.[15] Two holy souls were living in the city of Marseille at that time: the bishop, Henri Francois-Xavier de Belsunce (1670-1755) and a Visitandine nun, Anne-Madeleine Remusat (1796-1730), spiritual heir of St Margaret Mary Alacoque. Both propagated devotion to the Sacred Heart, outraged by the Jansenists.

On 25 May 1720, a ship from the Orient docked in Marseille, and the plague spread throughout the city. The death toll was enormous. The pavement was covered with the sick and dying, stretched out on mattresses and abandoned without help. Everyone fled, even the doctors. Bishop De Belsunce remained at his post and, in June of 1721, consecrated the city to the Sacred Heart of Jesus, leading a public procession from the Basilica of Notre Dame de la Garde to the church of Accoules. Immediately after the consecration, the plague began to subside. In September, the city was free of the disease.

The plague withdrew, but in the era of the Enlightenment and the French Revolution a new epidemic appeared in Europe: smallpox. In the 18th century, smallpox was the leading cause of death in Europe, with sixty million victims. The survivors were marked with indelible scars that disfigured their faces and bodies.

In 1774 the disease struck the king of France, Louis XV (1715-1774), who had made his court a den of immorality and unbelief. On 10 May, before the king passed away, his body already decaying, Paris archbishop Christophe de Beaumont (1703-1781) stopped at the threshold of the chamber, pronouncing these words in front of the assembled court: “My lords, the King charges me to tell you that he asks God’s forgiveness for having offended him and given scandal to his court.”[16]

His successor Louis XVI (1774-1793) and the whole royal family asked to be vaccinated against smallpox, which took place on 24 June 1774, in the rudimentary form of inoculation with pus from an infected person. It was a courageous undertaking of serious risks, which leads us to reflect on how, in an era like our own, the demand is for vaccination with zero risk. Furthermore, it must be borne in mind that the discovery of the smallpox vaccine took place only in 1798, through the work of Edward Jenner (1749-1823), who used, with less risk and greater effectiveness, cowpox instead of the application of human pus.[17]

In Italy, one of Jenner’s first followers was Count Monaldo Leopardi (1776-1847), father of the more famous poet Giacomo (1798-1837). Count Monaldo is often accused of retrograde and reactionary ideas, but he carefully followed the scientific progress of the time and when a new epidemic of smallpox hit the Papal States between 1801 and 1802 he saw to the vaccination of his entire family and the population of Recanati, of which he was governor.[18] Thanks in part to the influence of Count Leopardi, in 1822 Pope Pius VII (1800-1823) wanted to implement a massive vaccination campaign in the Papal States, with a decree by Cardinal Consalvi that defined Jenner’s method as a means given to humanity by Divine Providence.[19]

In those same years a new disease appeared in Europe, cholera, called Indian or Asian cholera because the first cluster was in the Ganges valley. The first major pandemic broke out in 1817 and, from India, reached the mouth of the Volga. The second wave between 1828 and 1830 spread to the heart of Europe. From France it passed to Italy, hitting Genoa, Turin, and then Rome. Pope Gregory XVI (1831-1846) organised a strict sanitary cordon, with military-controlled barriers, which rigorously blocked border crossings in the pontifical state. A commission he established imposed a quarantine of at least fourteen days, “health passports” in order to be able to circulate, and the suspension of all religious holidays and all types of gatherings. Punishment for violations of these provisions went as far as the death penalty.[20]These sanitary provisions were accompanied by prayers. On 6 August a solemn procession of the image of Our Lady of San Luca was made from the basilica of Saint Mary Major to the church of the Gesù. The cholera finally withdrew from Rome.

What happened in Rome did not however happen in the great European capitals. Viscount de Chateaubriand (1768-1848), who was in Paris in 1832, wrote in his Memoirs: “If this scourge had come among us in a religious century (…) it would have left a startling picture. Imagine a funeral cloth flying as a flag on top of the towers of Notre Dame (…) the churches full of a groaning crowd, (…) the monks at the crossroads with crucifix in hand, calling the people to penance, preaching the wrath and the judgement of God, which have become visible on the corpses already blackened by the fire of hell”. It was not like that. “Cholera has befallen us in a century of philanthropy, of incredulity, of newspapers, of earthly administration.”[21]

After the French Revolution Europe had become unbelieving, and infectious diseases were enveloped in a romantic halo. This was the case with tuberculosis, embellished by many artists in the 19th century. When it was proved that the disease was contagious, the sick were forced to enter the sanatoriums, which became golden prisons where fifty percent of them died. Tuberculosis was not caused by a virus, but by a bacterium, as the German microbiologist Robert Koch demonstrated in 1882. In 1894, the Franco-Swiss physician Alexandre Yersin (1863-1943) succeeded in isolating the pathogen of plague, demonstrating that it too is not a virus, but a bacterium whose name today, Yersinia pestis, comes from that of its discoverer.

The 20th century opened with the “Spanish flu”, a devastating epidemic that between 1918 and 1920 claimed more victims than the First World War,[22] but was erased from memory by a genuine “conspiracy of silence”.[23] Yet the German Chief of Staff Erich Ludendorff (1865-1937) blamed this epidemic for the failure of his great military offensive of 1918. Among the victims of the “Spanish flu” were two of the three little shepherds of Fatima, St Francisco and St Jacinta Marto. Francisco fell ill in December 1918 and died on 4 April 1919. Jacinta entered the hospital shortly after and ascended to Heaven on 20 February 1920.

In Italy the prefects and mayors imposed the closing of the churches and even the silence of the bells that every day with their funeral toll recalled the reality of death.[24] The Church accepted these restrictive measures, and appeals to penance and public prayer became increasingly rare.

This loss of the supernatural spirit in Western society was clearly felt in the face of the spread of AIDS, or HIV (Human immunodeficiency virus), as it was called starting in 1985. This disease spreads mainly among homosexuals. But if in the 16th century everyone considered syphilis as a just punishment for the sins of men,[25] five centuries later, the mass media cursed those who, like Cardinal Giuseppe Siri (1906-1989), dared to call AIDS a “punishment from God”.[26]

AIDS was followed in the 21st century by Ebola, SARS, and COVID-19, which has so far caused five million deaths worldwide. The social impact of COVID seems even more profound than that of Spanish flu, because it has brought to light the fragility of the world health system and above all the instability and psychological vulnerability of Western man, unable to face suffering and death with courage.

Yet epidemics still loom over humanity. The plague bacterium “is out there, lurking,”[27] writes historian Kyle Harper. Scientists even resuscitate pandemic viruses, as happened between 1996 and 1998 when, on behalf of the National Institutes of Health in the United States, a team of researchers went to the island of Spitzbergen in Norway and dug up some corpses that had been frozen for eighty years, to bring the Spanish flu virus back to life,[28] or they produce new pathogens, through laboratory techniques such as gain-of-function, as almost certainly happened at the Wuhan Institute of Virology with SARS-CoV-2.[29]

No voice is raised to call for a ban on gain-of-function, a branch of research that creates the most aggressive mutations of viruses in the laboratory under the pretext of preventing pandemics, just as no voice is calling for a ban on genetic engineering experiments on foetuses and embryos. For this reason, the contribution of churchmen such as Cardinal Eijk, capable of combining solid moral doctrine with accurate scientific competence, is precious.

The Church has always encouraged man’s effort to dominate the forces of nature and use them for his own benefit. That is why she has embraced all the advances in medical science, starting with vaccination. In the hands of the doctor, Pius XII states, “the properties of the most virulent poisons are used to prepare effective remedies,”[30] and “vast laboratories, equipped with modern equipment, produce in abundance vaccines and serums that provide the body with the means to fight effectively against infection.”[31]

However, scientific progress is not enough, because man is a compound of soul and body, and in the relationship of mutual dependence that unites them, the primacy belongs to the spiritual soul, which determines and governs the psychosomatic unity of the human being.

Because of original sin, the law of mankind is the law of suffering and death. However, as Pius XII again teaches, “Suffering and death have become, for every man who does not reject Christ, means of redemption and sanctification. Thus the journey of mankind, which unfolds in all its length under the sign of the Cross as it matures and purifies the soul here below, leads it to the limitless happiness of a life that has no end.”[32]

We must say it. The Church’s spiritual response to the COVID-19 pandemic appears inadequate. And I am not referring only to the responsibilities of churchmen, but also to those of the ordinary faithful, devoid of that supernatural spirit which helps the Christian to overcome fear. This supernatural spirit must be sought above all in the example of many saints who during pandemics showed their deep love for their neighbour and for God, offering their lives, from St Louis Gonzaga (1568-1591) to St Damien de Veuster (1840-1889), the apostle of the lepers on the island of Molokai.

And it is precisely from the disease of leprosy that I want to draw the last “flash” of my talk.

Leprosy, or Hansen’s disease, present in so many pages of the Gospel, is one of the oldest diseases in human history. The disease covered the body with sores, altered the face and stiffened the limbs, causing them to fall off piece by piece. Lepers were segregated from the rest of society in designated lazarets, like plague sufferers.

During the Crusades, assistance for lepers was established in the form of the Hospitaller Orders, which later became military. The first, in 1099, was the Order of St John of Jerusalem, which later became that of Malta. In the same year the Order of St Lazarus was created to welcome those soldiers who, although sick, still had the strength to fight. No one imagined that sitting on the throne of Jerusalem one hundred years later would be a leper king, Baldwin IV (1161-1185).

His story is told to us by a direct witness, his tutor the future archbishop William of Tyre (1130-1186).[33] It was William who noticed the first symptoms of the disease that had struck the boy, watching him play with the other kids. In the game they injured their arms and hands, but Baldwin seemed insensitive to the injuries. It is still a mystery how this thirteen-year-old boy, struck by the terrible disease, could be elected king of Jerusalem. This happened on 15 July 1174.

The disease progressed, but Baldwin did not give up governing and above all did not give up fighting. He personally led his own troops and was hoisted on horseback as long as his health permitted, then he had himself carried to the battlefield on a litter.

The most extraordinary battle took place near the castle of Montgiscard on 25 November 1177. Baldwin IV had left Jerusalem to rush to the defence of the city of Ashkelon, besieged by the Muslims. When the Crusaders reached the hills that opened the way to the city, a huge army of 30,000 men led by Saladin himself appeared before them. Baldwin had only 500 knights and a few thousand infantry units, but he did not abandon the field. His reaction has been immortalised in a famous painting by the nineteenth-century painter Charles-Philippe Larivière (1798-1876): “The Battle of Ashkelon”. The young sovereign, plagued by leprosy, venerated the relic of the True Cross that had been brought by the bishop of Bethlehem, then ordered the attack against the overwhelming forces of the enemy.

The Crusaders charged with such an onrush that the sultan’s army was disoriented and dispersed across the immense plain. At the front of the Crusader charge, next to the Templars, rode the knights of the Order of Saint Lazarus, who with their faces disfigured by leprosy fought without the protection of the helmet, to strike terror into the enemy. But the witnesses say that also fighting alongside the Crusaders that day were St George and an angel, exterminator of enemies, while the light of the True Cross illuminated the battlefield.[34]

To fight a war that is not at this moment military, but cultural and moral, our wounded souls need supernatural help. This divine help will come only when we face the external and internal evils that afflict us with the militant spirit of Baldwin, the Leper King.

It is also with this spirit that the Church has faced epidemics throughout its history.

[1] Cf. for example Il corpo umano, in Insegnamenti pontifici, Monks of Solesmes (Eds.) Italian translation by Paoline, Rome 1959.
[2] “Prima omnium nosókomion instituit”. Cf. St Jerome. Epistula. 77, 6, in Saint Jérôme. Lettres,J. Labourt (Ed.), Les Belles Lettres, Paris 1954, vol. IV, p. 45. Cf. Also Marilena Amerise, L’attività assistenziale di Fabiola. L’epistola 77 di Girolamo, in “Giornale di storia della medicina”, vol. 24, no. 2 (2012), pp. 307-319.
[3] Cosimo D. Fonseca, Forme assistenziali e strutture caritative della Chiesa nel medioevo, in Storia religiosa della Lombardia, 1, Varese 1986, p.275. Cf. also Tiffany A. Ziegler, Medieval Healthcare and the Rise of Charitable Institutions: The History of the Municipal Hospital, Palgrave, London 2018. 
[4] Adalberto Pazzini, I santi nella storia della medicina, Casa Editrice “Mediterranea”, Rome 1937, pp. 441 ff.
[5] Luigi Mezzadri, Luigi Nuovo, Storia della Carità, Jaca Book, Milan 1999, p. 47.
[6] Bullarium Romanum, vol. VII, pp. 430-431.
[7] Lateran Council IV, Constitution XXII. 
[8] Procopius of Caesarea, The Gothic War, II, 22, 1-2.
[9] Gregory of Tours, Historiae Francorum, liber X, 1, in Opera omnia, J.P. Migne (Ed.), Paris 1849, column 528.
[10] https://www.corrispondenzaromana.it/san-gregorio-magno-e-il-coronavirus-del-suo-tempo/
[11] Cf. Gastone Breccia, Andrea Frediani, Epidemie e guerre che hanno cambiato il corso della storia, Newton Compton, Rome 2020.
[12] Ole J. Benedictow, The Black Death 1346-1353: The Complete History, The Boydell Press, Woodbridge 2004, p. 383.
[13] Kyle Harper, Il destino di Roma. Clima, epidemie e la fine di un impero, Einaudi, Turin 2019, p. 256 {translator: please note that this is a back translation, not the original English}
[14] https://www.robertodemattei.it/2020/03/17/come-san-carlo-borromeo-affronto-lepidemia-del-suo-tempo/
[15] Paul Hazard, La crise de la conscience européenne (1680-1715), Paris 1935, 2 vols.
[16] Pierre Darmont, La variole, les nobles et les princes, Editions Complexe, Paris 1990.
[17] Cf. William L. Langer, L’immunizzazione contro il vaiolo prima di Jenner, in Le Scienze, no. 97, 1976, pp. 62-70; Barouk M. Assael, Il favoloso innesto. Storia sociale della vaccinazione, Laterza, Roma-Bari 1995. 
[18] Valentina Sordoni, “L’immortale britanno”. Monaldo Leopardi e il vaccino contro il vaiolo, Edizioni di Storia e Letteratura, Rome 1921.
[19] Edict of Cardinal Ercole Consalvi of 20 June 1822, in Effemeridi letterarie di Roma, Tomo VIII, Rome, 1822, p. 103. Cf. also Dante Cecchi, L’introduzione della vaccinazione nello Stato Pontificio (1814-1822), “Rivista di storia del diritto contemporaneo”, anno 2 (1977), no. 3, pp. 197-206; Yves M. Bercé and J.C. Otteni, Pratique de la vaccination antivariolique dans les Provinces de l’Etat pontifical au 19e siecle. Remarques sur le supposé interdit vaccinal de Léon XII, “Revue d’histoire ecclésiastique”, 103.2 (April-June 2008), pp. 448-466.
[20] Cf. Marcello Teodonio, Francesco Negro, Colera, omeopatia ed altre storie, Rome 1837, Fratelli Palombi, Rome 1988; Francesco Leoni, Le epidemie di colera nell’ultimo decennio dello Stato pontificio, Apes, Rome 1993.
[21] François-René Chateaubriand, Memorie d’oltretomba, Libro XXXIV, Capitolo XIV, Italian translation, Einaudi-Gallimard, Turin 1995, pp. 450-451.
[22] Laura Spinney, 1918. L’influenza spagnola. La pandemia che cambiò il mondo, Marsilio, Venezia 1918, p. 187.
[23] Eugenia Tognotti, La “spagnola” in Italia. Storia dell’influenza che fece temere la fine del mondo (1918-1919), Franco Angeli, Milan 2015, pp. 25-27. 
[24] Ibid, pp.162-163.
[25] Ludwig von Pastor, Storia dei Papi dalla fine del Medioevo, Desclée & C., Rome 1926-1963, vol. III, p. 8.[26] Agenzia Ansa, 23 March 1987. Sui castighi divini, cf. Roberto de Mattei, Punishment or Mercy? The divine hand in the age of the coronavirus, Calx Mariae Publishing, London 2021.
[27] Harper, Il destino di Roma, p. 263. {translator: again, may not coincide with the original English}
[28] Paul Bernard, with Steve Quay and Angus Dalgleish, L’origine del virus, Chiarelettere, Milan 2021, pp. 21-26.
[29] Roberto de Mattei, Le origini misteriose del coronavirus, Fiducia, Rome 2021.
[30] Pius XII, Address to Catholic physicians of 29 September 1949.
[31] Pius XII, Address to participants in the 4th Conference on Microbiology, 13 September 1953.
[32] Pius XII, Address to the Italian Medical-Biological Union of 12 November 1944.
[33] Guillelmus Tyrensis (1130-1186), Chronique. Edition critique par R.B.C. Huygens, Brepols, Turnholt 1986, pp. 958-1059. Cf. also Bernard Hamilton, The Leper King and his Heirs: Baldwin IV and the Crusader Kingdom of Jerusalem, Cambridge University Press, 2006.
[34] Miriam Rita Tessera, “Una grande luce apparve dall’Oriente”: la visione provvidenziale della battaglia di Montgisard nelle cronache del XII-XIII secolo, in Mediterraneo medievale. Cristiani, musulmani ed eretici tra Europa e Oltremare (secoli IX-XIII), Marco Meschini (Ed.), Vita e Pensiero, Milan 2001, pp. 87-102.