Medieval leprosy reconsidered.
Miller, Timothy S. ; Smith-Savage, Rachel
Historians recognize that during the High Middle Ages--from shortly
after 1000 to 1300 A.D.--Western Europe experienced a period of
unparalleled growth. Populations tripled; first schools and then
universities flourished; new cathedrals rose up in many cities; and,
commerce and manufacturing had been revitalized on the Italian peninsula and gradually spread throughout Western Europe. Ironically, this period
also witnessed an unprecedented outbreak of leprosy in the region, a
disease that could be horribly disfiguring, but fortunately did not have
a significant impact on demographic growth.
This leprosy "epidemic" and the attempts of Latin
Christian society (Roman Catholic Europe) to deal with the health
problems it created have attracted the attention of experts in the
history of medicine and cultural historians. (1) Unfortunately, some of
these scholars have failed to read the medieval sources in their proper
contexts, sources that describe both the outbreak of leprosy and the
organization of leprosaria, the medieval hospices designed to care for
victims of the disease. This has caused some of them to misrepresent medieval Christianity's response to leprosy as an attempt to punish
victims of the disease rather than to assist them in their suffering.
Most studies published in English during the past thirty years have
focused on evidence from Latin Europe during the time of the leprosy
epidemic beginning ca. 1100 A.D. To understand the Latin sources of the
High Middle Ages properly, one must study them together with the Greek
sources of the patristic age (300 to 500 A.D.), a period during which
the Early Byzantine Empire experienced an outbreak of leprosy similar to
that which occurred in England, France, Italy, and Germany in the two
centuries following the First Crusade (1099). Accordingly, this study
will first describe what modern medical science has discovered
concerning leprosy. It will then review some of the opinions historians
have expressed regarding how medieval society viewed leprosy and treated
its victims. Lastly, it will examine primary sources and reinterpret the
evidence they present in the wider context of Christian society as a
whole.
In 1873, the Norwegian scientist, Armauer Hansen, correctly
identified Mycobacterium leprae as the bacterium which causes leprosy.
Although Mycobacterium leprae exists in only one strain, leprosy can
appear in several forms depending upon how effectively the human
hosts' biological defenses combat the infection. In its most
extreme form, leprosy causes skin lesions and raised tumors,
disfigurement of the face, and even loss of fingers and toes. These
horrific symptoms doubtless explain why ancient and medieval societies
often forced lepers to live in isolation from communities. In its less
severe manifestations, however, leprosy can be confused with other skin
diseases. In fact, the leprosy of ancient Israel, described so vividly
in the Old Testament, was certainly not the disfiguring disease caused
by Mycobacterium leprae, but a milder form of skin allment. True leprosy
seems to have first appeared in the Mediterranean basin during the
Hellenistic period and to have become especially well-established in
Egypt by the time of the famous Greek physician Galen (129-200 A.D.).
Modern science also has proven that leprosy is contagious as ancient and
medieval societies suspected. Most people, however, possess a natural
immunity to the disease. Thus, leprosy does not sweep through a society
killing millions in a few months. It affects only a small number of
people (five to ten percent of the population) whose bodies cannot
resist Mycobacterium leprae. (2)
Several recent influential books have reexamined medieval leprosy.
Each of these studies emphasize that Christian Europe's response to
lepers reflected a more general program to identify and isolate alien
elements in society. In his popular history of medicine, Roy Porter briefly discusses the leprosy epidemic of the High Middle Ages. He
claims that the medieval Church excluded lepers from society by
imprisoning them in leprosaria and then justified this harsh treatment
by depicting leprosy as punishment for one's sins. Porter also
emphasizes how ecclesiastical leaders portrayed leprosy as a living
death and even developed a special religious service for lepers that
simulated a funeral mass. The victims of leprosy were dead to the world,
and in their seclusion they should remain as separate from the healthy
as the deceased were from the living. (3)
In a fascinating monograph on epidemic diseases, Sheldon Watts,
another historian of medicine, examines the political, cultural, and
economic implications of disease. In his chapter on leprosy, Watts
interprets the medieval sources much as Porter does. (4) Watts begins by
identifying the ancient Greek physician, Aretaios of Cappadocia, a
contemporary of Galen, as the first writer to provide an accurate
description of true leprosy. Subsequently, Christian Western Europe lost
the enlightened tradition of Greek physicians such as Aretaios whose
writings and scientific outlook managed to survive only among Muslim
physicians. According to Watts, the Latin Christian world depended on
the Jewish Old Testament for its understanding of leprosy. The Law of
Moses excluded lepers from the camp of Israel because of their impurity.
As Watts concludes, "On this foundation (the Christian exegesis of
the Mosaic Law) would be built the conviction that leprosy was
God's punishment for sin and that lepers must be driven out of the
camp." (5)
Watts also describes how the leprosy epidemic of the High Middle
Ages resulted in the proliferation of leprosaria, especially in France.
By the 1220s, Paris alone had forty-five leprosaria and Europe as a
whole possessed several thousand. (6) According to Watts, these
leprosaria actually served as detention centers for people whom the
local elite--both church hierarchs and lay rulers--considered potential
trouble-makers. People were accused by informants of having contracted
leprosy, tried by panels representing the local bishop and secular
authority, and then incarcerated in leprosaria. As Watts explains, no
medical experts sat on these examining boards. When during the
fourteenth century physicians secured seats on these juries, the number
of real lepers, identified by these procedures, dwindled, and the
leprosy epidemic suddenly ended, an epidemic which Watts asserts had
been fabricated. In other words, Watts maintains that medieval leprosy
was a construct disease--i.e., a disease invented by those in power to
secure their political, cultural, and economic dominance. (7) Much of
Watts' account of medieval responses to leprosy reinforces
widely-held views that Christian society isolated lepers as symbols of
sin as well as bearers of a contagious disease. His assertion that the
leprosy epidemic was purely a tool of political oppression, however, has
not found wide support primarily because of convincing archeological
evidence (see below) that many lepers were buried in leprosaria
cemeteries.
A third book, Mending Bodies, Saving Souls, by physician and
medical historian Guenter Risse, focuses on the history of hospitals and
devotes a chapter to the medieval leprosy outbreak and the foundation of
leprosaria. In agreement with Watts, Risse identifies France as the
center of leprosaria construction. The will of King Louis VIII (who died
in 1228) suggests that the French realm had 2,000 leper hospitals. Risse
also accepts the view that the church enforced segregation of lepers
because of their supposed sinfulness. Although Risse echoes many of the
arguments presented by Porter and Watts, he offers two new observations.
First, he emphasizes how those who founded leprosaria also drafted
regulations for daily life in their institutions, regulations that were
patterned on monastery rules. These leprosarium regulae required that
lepers wear a habit similar to those worn by monks and spend some time
as novitiates before gaining formal acceptance within the leprosarium.
These rules also outlined fasts and even expulsion from the community as
punishments for disobedience and misconduct, regulations which cast
doubt on the role of leprosaria as institutions for confining
society's undesirables. Second, some of the leprosaria became
wealthy through large endowments and provided those lepers in their care
with a comfortable life. (8)
In The Formation of a Persecuting Society, a book which influenced
the works of Watts and Risse, medieval historian Robert I. Moore
maintains that leprosaria might have begun as charitable institutions,
but they evolved into tools to isolate lepers and persecute them. Moore
views the incarceration of lepers as part of a European-wide movement to
identify and persecute minority groups, not only lepers, but Jews and
various Christian heretics as well. (9) Although much of what Moore
claims about medieval society's response to leprosy represents
mainstream views, his comparison of lepers to religious non-conformists
remains controversial because most scholars have not seen a clear
parallel between isolating supposed victims of a contagious disease with
the repression of heretics.
Porter, Watts, Risse, and Moore all rely on perhaps the best and
most complete discussion of medieval leprosy in English, historian Saul
Brody's The Disease of the Soul. Brody's monograph focuses on
the image of leprosy in medieval literature, but it also provides an
excellent overview of the entire history of the disease from its arrival
in the ancient Middle East until its disappearance in the late Middle
Ages. Brody's careful examination of medieval romance literature
proves that leprosy was often viewed as a symbol for sin.
Brody first summarizes the German romance, Der arme Heinrich (Poor
Henry), written by Hartmann yon Aue just before 1200. Heinrich, the hero
of the story, was the perfect knight--brave in battle, handsome in
appearance, and intelligent in conversation--but his personal gifts had
filled him with pride. As a result of his arrogance, God struck him with
leprosy. Heinrich sought a cure from the best doctors in Christendom and
even visited Salerno, twelfth-century Europe's most famous medical
school. There a learned physician told him that only the blood from a
virgin's heart could cure him, a virgin who would willingly give up
her life for him. Heinrich eventually won the love of a pure peasant
girl who was willing to offer her life to restore his health. God,
however, cured Heinrich only when the knight demonstrated that he loved
the girl more than he valued his own health. (10)
Brody also analyses a later English romance, Robert Henryson's
Testament of Cresseid (1507). In this story, Cresseid's lover
Troilos rejected her in favor of the beautiful Diomedes. In her
bitterness, Cresseid turned to a life of pure pleasure, filled with
sexual excesses. The gods punished her lust by striking her with
leprosy, which in this story clearly symbolizes sin, the leprosy of the
soul. (11)
Unlike Porter, Watts, and Risse, however, Brody stresses that
medieval people not only saw leprosy as a mark of sin, but they also
interpreted it as a sign of God's blessing. In 1239, the bishop of
Tournai called the disease a special gift from God. Continuing an
ancient Christian tradition from Greek patristic times, some medieval
authors called it the holy disease. Other authors related it to the
suffering of Lazarus, the poor man in Luke's gospel who went
immediately to heaven upon his death. Finally, medieval Christians
believed that Jesus frequently appeared in the form of a leper to show
his solidarity with the most humble of people. (12)
Stephen R. Ell, another historian of medicine, repeats many of the
assertions discussed above in his article on leprosy in The Dictionary
of the Middle Ages, a standard reference work for both general readers
and medievalists. He writes:
In the High and later Middle Ages, the leper was legally and
religiously cut off from the rest of society. He was seen as morally
unclean. Special hospitals served to segregate lepers. Fear of the
disease, religious impulses, and social attitudes combined to create
this situation. (13)
As this study will demonstrate, Ell's statements ignore
medieval society's strong impulse to assist lepers, an impulse
clearly inspired by the Christian tradition.
Having reviewed these well-known monographs and Ell's
encyclopedia article, we shall now examine primary-source evidence
regarding medieval leprosy to emphasize some different perspectives on
how Christians viewed the disease and treated those who suffered from
it. This requires a careful reading of medieval Latin texts in the light
of earlier Byzantine texts of the fourth and fifth centuries and of
important archaeological evidence--the skeletons of leper victims.
Modern pathological research has demonstrated that advanced leprosy
not only attacks skin tissue, but it eventually corrodes the bone around
the oral and nasal cavities and scars finger and toe bones. By examining
skeletal remains from leprosarium cemeteries, archaeologists can
determine which skeletons show signs of the disease and thus estimate
how many residents in leper hospitals actually suffered from this
illness. (14)
Using this method of research, Vilhelm Moller-Christensen has found
that in the Danish cemetery at Naestved, a leprosarium which functioned
from 1250 to 1550, seventy percent of the 500 skeletons studied showed
clear signs of leprosy. When one considers that autopsies on modern
leper victims have confirmed scarring on the bones of only fifty-four
percent of the cases and that non-leprous staff members at leper
hospitals also were buried in the leprosarium cemeteries,
Moller-Christiansen's research casts serious doubt on Watts'
claim that few residents in medieval leper hospitals actually suffered
from the disease. (15)
In his book, Watts mentions Moller-Christensen's research, but
he dismisses it because the Naestved leprosarium lay beyond the
heartland of Medieval Europe. (16) Watts, however, ignores the research
of Egon Schmitz-Cliever who excavated the cemetery of the Melaten
leprosarium outside Aachen in the heart of Western Europe.
Schmitz-Cliever examined the skeletons of forty people buried between
1230 and the early 1500s; only three did not show leprous markings on
their bones. (17)
Turning from archeological evidence to written primary sources, one
finds that modern scholars have often failed to understand the earlier
Greek texts in their proper historical context. As a consequence, they
have not related them correctly to later statements on leprosy in the
Latin documents of the High Middle Ages. We shall begin by examining the
observations of leprosy made by Aretaios, the ancient Greek physician
who wrote ca. 150 A.D. what Watts, Risse, and Brody identify as the
first accurate description of the disease. Aretaios mentioned the
blotches and fissures of the skin, the discoloration of the complexion,
and the loss of fingers and toes. He also claimed that the cause of
leprosy was the same physical process as that which causes death.--i.e.,
a cooling of the body through the rising of the cool and dry humor (one
of the four basic fluids of the body according to ancient Greek medical
theory) called black bile. According to Aretaios, the hair of lepers
fell out and then their fingers and toes dropped off as the remoter
parts of the body died. Aretaios explained that leper victims did not
immediately experience full death, but suffered a long debilitating state between life and death. (18)
It is important to notice that Aretaios, a Greek medical scientist,
first described leprosy as a kind of living death. Two fourth-century
Christian writers--Gregory of Nazianzos and an anonymous biographer of
John Chrysostom, bishop of Constantinople from 398 to 405--adopted this
image and used it to arouse sympathy for lepers. (19) Since the writings
of Gregory of Nazianzos were extremely popular, that image would he
embraced by later Byzantine and Latin writers. (20) Thus, the idea that
leprosy was a form of living death did not derive from Christian
interpretations of the Old Testament, but ultimately from Greek
scientific writers, those enlightened scientists whom Watts claims only
the medieval Islamic world studied and preserved. (21)
It is now useful to consider a second category of primary-source
documents--Greek patristic texts from the fourth and fifth
centuries--which modern studies of medieval leprosy have often ignored
or misunderstood, especially as they relate to later Latin views on
leprosy. Perhaps the most influential ancient physician, Galen, had
stated in the second century that leprosy flourished especially in
Egypt, a province in the eastern, Greek-speaking half of the Roman
Empire. From Egypt leprosy spread to Palestine, Syria, and Asia Minor.
(22) As these eastern provinces became predominantly Christian after the
emperor Constantine's conversion to Christianity ca. 312, bishops
in these areas began to address the subject of leprosy because the
disease was now spreading rapidly in these regions. Gregory, bishop of
Nyssa in Asia Minor during the 370s, delivered a fascinating sermon on
leprosy which clearly stated that the disease had recently become much
more common in Cappadocia. Although Gregory of Nyssa's sermon
focused on moral and religious issues, he presented perhaps an even
better clinical description of leprosy than had either Aretaios or
Galen. Gregory of Nyssa mentioned all the symptoms that Aretaios had
identified, but he added a raspy voice, and most importantly, the loss
of sensation in the affected skin. This loss of feeling later became the
key to distinguishing leprosy from other skin ailments. Gregory of Nyssa
also described how people rejected lepers, expelling them from
marketplaces, public baths, cities, and even their family homes. He
stressed, however, that Christ expected his followers to help these most
wretched of human beings. By accepting lepers, by feeding them, by
embracing them, even physically, Christians merited salvation. Gregory
of Nyssa also tried, by using a scientific argument, to convince his
congregation not to reject lepers. According to the bishop, the disease
was not contagious because one could not contract the humoral imbalance--excess black bile in the blood--that caused leprosy by
contact with a person infected with the disease. Preserving one's
health, therefore, did not require that an individual avoid lepers, nor
did society as a whole need to banish from populated areas those who had
contracted this disease. (23)
Another Gregory, bishop of Nazianzos, and a friend of Gregory of
Nyssa, wrote an even more extensive treatise on lepers and their
illness. He composed this essay as a sermon on the Christian obligation
to assist victims of the disease. Gregory of Nazianzos specifically
condemned those people--whether pagans or Christians--who justified
rejecting lepers because God had sent this disease to punish them.
Gregory of Nazianos argued that the Book of Job taught Christians that
it was impossible to comprehend why God acts as He does. Gregory of
Nazianzos believed that Job himself had suffered from leprosy and thus
served as an example of how good people must frequently bear great
evils, but Christians should not dare to claim that they fathom why God
permits some to fall ill and others to remain healthy. (24)
John Chrysostom, another leading figure in Greek patristic
literature, also addressed the issue of leprosy while he served as
bishop of Constantinople (395-404). During his episcopacy, he began
construction of a large leprosarium outside the capital. He planned this
institution not to isolate lepers, but to give them a healthy place to
live near a river, and to offer them all the benefits of a home and of
communal life. The traditional Greco-Roman citystates (poleis), not yet
fully Christianized in the late fourth century, had taken these benefits
away from lepers. John Chrysostom never thought of the leprosarium as
confinement, but as an institution of comfort for those deprived of the
benefits of the polis community. (25)
Almost forty years later, Cyril, the famous bishop of Alexandria
from 412 to 444, further elaborated the Christian view of leprosy when
he wrote a significant commentary on the Mosaic Law's regulations
regarding leprosy. On the one hand, the Old Testament banned lepers from
the camp, but on the other hand, it provided a complicated set of
rituals including the sacrifice of a dove which a leper should perform
if he/she were healed and sought readmission to society (an indication
that Old Testament leprosy was not what Aretaios, Galen, and subsequent
medieval society identified it as a disease which was incurable). Cyril
stressed that Christians should never interpret these Old Testament laws
literally because it would be an evil act to ban lepers from society;
these people deserved mercy, not rejection. Rather, Cyril interpreted
the passage allegorically: leprosy was sin and the sacrificed dove
Christ's saving death on the cross. (26)
Cyril's treatise reinforces the point made by both Gregory of
Nyssa and Gregory of Nazianzos, namely that Christians should not reject
the victims of leprosy, but assist them. It also shows how leprosy came
to represent sin. In the Greek-speaking Christian world which evolved
into the Byzantine Empire, bishops, monks, and lay people were able to
distinguish allegory from reality. Although Byzantine writers continued
to describe sin as spiritual leprosy, such allegorical language had no
effect on the actual treatment of lepers. A twelfth-century jurist of
Constantinople, Theodore Balsamon, observed how Byzantine society
allowed lepers access to the same churches, cities, and assemblies that
healthy people attended. (27) Were Latin-speaking Christians also able
to distinguish symbol from reality?
In the Western Roman Empire--the Latin speaking provinces of Italy,
Gaul, Spain, and North Africa--leprosy also began to claim more victims
by the late fourth century. In a letter written before 400, Saint
Jerome--a monk and priest of the Roman Church--praised a wealthy widow
named Fabiola, a resident of Rome, for her many charitable activities.
Jerome believed that her outstanding act of charity was constructing a
hospital in Rome for those with distorted feet, inflamed complexions,
and truncated noses, people whose blood had become turgid, i.e., muddy
with the black bile of leprosy (the cause of Aretaios' living
death). Fabiola built her leprosarium for these dying people, and even
personally served them by washing their oozing flesh. As in the sermons
of the two Gregories, Jerome portrayed the care of lepers as the
greatest act of Christian charity. (28)
Outside of Rome, few references to leprosy survive from the Western
provinces until 539 when the bishops of Gaul met in a synod at Orleans.
Here the bishops approved a number of canons to regulate Christian life
in the new political world of German dominance. One of these canons
stated that Christian piety required that the bishop of each city
provide lepers with food and clothing from the resources of the local
church. At a later synod held in Lyons in 583, the bishops reaffirmed
that they themselves should assist lepers but added that leprosy victims
should receive aid only in the cities where they had permanent residence
and should not wander from place to place. The synod of Lyons thus
enacted the first restrictive regulation against lepers found in our
research of primary sources. (29)
By the end of the sixth century, some bishops in Gaul had set up
permanent institutions to house and feed lepers. Bishop Gregory of Tours mentioned one such leprosarium at Cabillonum, the modern
Chalon-sur-Sa6ne. Ca. 550 Cabillonum's Bishop Agricola had built
just outside the town an institution that Gregory of Tours described as
a xenodochion (hospice in Greek) for lepers. Gregory of Tours did not
provide any details on how this leprosarium functioned, but he did refer
to a church attached to the hospice which was large enough to hold a
grand assembly of local abbots and clergymen. (30)
One should notice that Gregory of Tours chose a Greek word
xenodochion for Agricola's leprosarium. Jerome had employed another
Greek term nosokomeion (hospital for the sick) in referring to
Fabiola's refuge at Rome. As Galen had noticed, leprosy was
especially common in Egypt and the Eastern provinces of the Roman Empire
and rare in Germany and the North. The Latin sources reviewed here also
suggest that leprosy and methods to assist its victims began in the East
and then moved West.
During the sixth and seventh centuries, sources from Frankish Gaul
and contemporary Italy occasionally refer to leprosy. During the eighth
century, however, references to the illness became even rarer. The
Carolingian rulers, Pepin III and his illustrious son Charlemagne,
mention the disease in their cartularies, but thereafter, references to
leprosy and to leprosaria almost disappear from West European sources
until the epidemic of the twelfth and thirteenth centuries described by
Porter, Watts, Risse, Moore, and Brody. (31)
Most scholars agree that the Crusades caused the return of leprosy
to Italy, France, England, and Germany in the High Middle Ages. The
crusaders apparently contracted the disease in Palestine after 1098 and
then carried it back to Western Europe on their return home. This would
explain the sudden reappearance of leprosy in the twelfth century and
also its concentration in France, the primary recruiting ground for
Christian warriors against Islam. As Porter, Watts, Risse, Moore, and
Brody each emphasize, the chief response of Western Christian society
during the High Middle Ages to the spread of leprosy was to support
leprosaria, but as this study demonstrates, these institutions had a
long history stretching back to the Greek Christian fathers of the
fourth and fifth centuries, institutions which were clearly not meant to
confine lepers or punish them for their alleged sins.
Numerous collections of regulations survive from the French
leprosaria of the twelfth and thirteenth centuries and provide much
information on how the lepers lived their daily lives in these hospices.
As a consequence, far more information is known about Western European
institutions than about leprosaria supported by John Chrysostom in
Constantinople or by Bishop Cyril in Alexandria. It is therefore helpful
to examine a few of these regulations to see how leper hospices of the
High Middle Ages treated those infected with the disease. (32)
The bishop of Montpellier (Southern France) together with the local
count approved one of the oldest surviving regulations in the 1150s for
the town's leprosarium. These rules required that lepers who wished
to enter the leprosarium surrender their property (one would assume
movable property) upon entering the community. After a ten-day period,
lepers had to decide whether to join the community. If some decided to
leave, they received back their belongings and were free to reenter the
secular world. The leprosarium did not force the sick to stay. Once
members of the community, lepers were now required to attend church
services each day and to pray for the benefactors of the community.
These statutes include few details concerning organization; they mention
only that the lepers--always referred to as brothers and sisters (the
hospice accepted both men and women)--should obey the administrators,
but provide no indication of who these administrators were or how they
were chosen. (33)
The statutes of the leprosarium at Lille in Northern France provide
additional evidence that medieval leprosaria were not designed to
imprison lepers or to punish them in any way. Walter, Bishop of Tournai,
approved these rules in 1239. In his introduction, in fact, Walter
declared that leprosy had come from God as a special gift because
through leprosy God was calling the sick to holiness. In his balanced
account, Brody cites this passage to demonstrate how medieval people
interpreted leprosy as both a curse and a blessing. (34) The rules of
Lille did include restrictions on the behavior of lepers: they should
not leave the leprosarium without permission; when they did leave, they
should always travel in pairs; and, there should be no private
conversations between women and men. Such regulations, however, were the
same for contemporary monks and friars who were considered members of
medieval society's First Estate. The rules also mentioned that the
leprosarium had a gate which opened onto a piazza and that houses stood
across the square opposite the hospice entrance. Thus, the founders had
not located this leprosarium in a remote location, isolated from other
dwellings. These statutes mention only two officers in the community: a
magister and a priest chaplain. The rules of Lille say nothing about how
to select these officers. (35)
The statutes of the leprosarium of Brives, issued in 1259, for a
hospice in the Loire Valley offer a more thorough explanation of
organization. They required that the brothers and sisters elect their
magister and stipulated that he should be a leper himself. Moreover,
these rules gave considerable power to the community of lepers, called
the collegium. The magister was to make all major decisions affecting
the institution with the advice and consent of the collegium. Even some
punishments meted out to the brothers and sisters required the consent
of a committee formed from the collegium. The leper community at Brives
apparently functioned democratically. To be sure, the rules for conduct
seem repressive by modern standards--no games, no conversations between
men and women, repetitious prayers throughout the day--but again these
regulations simply reflected monastic community life. (26)
In his book on Anglo-Norman medicine, historian Edward Kealey
studied English leprosaria and included a commentary on the earliest
regulations to survive from any leper hospital in Europe, those from
Saint Mary Magdalene at Dudston (ca. 1130). In agreement with the
interpretation of the French leprosaria regulae offered in this study,
Kealey concludes that these Anglo-Norman rules were designed to assist
lepers, not to punish or imprison them. As in the case of French
asylums, lepers had to leave this institution if they refused to obey
its regulations. (37)
Although Kealey did not find any evidence that the Magdelana
leprosarium incarcerated its residents, Risse and especially Moore
insist that French leper hospitals were designed to confine lepers. Both
of these scholars stress the significance of Canon 23 of the Third
Lateran Council, held in 1179 under Pope Alexander III. This canon
required that leprosaria throughout Europe provide chapels and
cemeteries for leper hospitals and hire leper priests to serve there.
Moore interprets this canon as the decisive step in incarcerating
lepers. If one reexamines the wording of this canon, however, one
notices that the bishops of the council envisaged this regulation as
offering a great benefit to the lepers. It not only guaranteed
leprosaria their own chapels and chaplains as all monasteries had, but
it exempted lepers from paying tithes to the local bishop. In fact,
Canon 23 said nothing to restrict lepers' freedom to leave the
leprosaria. (38)
Even a cursory rereading of the primary sources reveals that
leprosaria were never designed to confine victims of leprosy. From their
inception in the Greek provinces of the Late Roman Empire until they
disappeared from Western Europe during the sixteenth century, leprosaria
were designed to assist lepers, not incarcerate them. Upon reviewing
another set of documents, however, one will see more clearly why some
elements of medieval society did reject victims of leprosy.
In 643, the Lombard king Rothari issued a code of law which,
although written in Latin, derived from the old Germanic customary laws
of the Lombard tribe. When the Lombards had entered Italy in 568, they
were among the least Romanized Germanic tribes. Some Lombard clans still
practiced the ancient Teutonic religion, although most had become
Christians of the Germanic Arian creed. Among Rothari's statutes,
drawn up for a primitive Germanic people--only the Saxons of North
Germany and Britain had less Roman influence--one dealt with leprosy.
The Lombard rule regarding lepers, Chapter 176 of Rothari's
Edict (the customary name of the code) clearly did punish lepers. This
regulation required that those whom the judge or the people confirmed as
having leprosy had to leave the city where they dwelled and give up
their own homes to live in isolation. Moreover, these people lost all
control over their property as though they had died. Lepers retained
only a fight to receive sustenance from the revenues of their former
property which apparently lepers' heirs were to manage. (39)
Rothari's law had no subsequent effect on any ecclesiastical
rulings by popes or on any decrees of church synods, but it did
influence secular legislation. In 789, Charlemagne, who more than a
decade earlier had conquered Lombard northern Italy and annexed it to
his Frankish-Roman state, issued some new laws for his Western European
Empire. Among the laws of 789, one reflected the sentiments of
Rothari's statute; Charlemagne decreed that lepers "should not
mix with other people." (40)
A closer parallel to Chapter 176 of Rothari's Edict appeared
more than 400 years later in the North German code of customary law
called the Sachsenspiegel (Mirror of the Saxons). These regulations were
drawn up in the early thirteenth century, but they preserved aspects of
earlier Saxon customary law. (41) The Sachsenspiegel had the force of
law precisely in those northern regions of Germany which had resisted
Romanization until Charlemagne's brutal conquest of the early ninth
century. Echoing Lombard law, the Sachsenspiegel stipulated that lepers
no longer could inherit any property. Unlike the Lombard law, however,
the Sachsenspiegel allowed lepers to retain the use of the property they
had owned when they first had become ill. (42)
Perhaps the most striking example of leper exclusion and loss of
legal rights is found in English Common Law, supposedly the great
bulwark of personal freedom that offered the English the necessary tools
to resist oppressive government. In his commentary on thirteenth-century
English law, Henry of Bracton stated that English law compared lepers to
those who were excommunicated from the Church. The victim of leprosy had
to leave society to join a leprosarium. From that time forward, a leper
could not inherit property or make contracts. Like the Sachsenspiegel,
Henry of Bracton mentioned that common law tradition allowed lepers to
retain control of property that they had owned when they had fallen ill.
(43)
Rothari's Edict, Carolingian legislation, the Sachsenspiegel,
and Henry of Bracton's commentary on English Common Law either
exclude lepers from society and/or impose severe restrictions on their
legal rights. It should be noted that all of these codes originated in
societies strongly influenced by Germanic customary law, a legal system
less profoundly informed by Christian values than the Roman law of
Justinian.
Christian concepts and institutions, whether in the Greek East or
the Latin West, were not responsible for banishing lepers from healthy
society. Balsamon testified that lepers in twelfth-century
Constantinople continued to live with healthy people. (44) Thus, Greek
Christian writers and preachers had apparently succeeded in convincing
Greco-Roman communities of the Eastern Mediterranean to modify their
initial response to isolate lepers. In Latin society of the twelfth
century, however, lepers did suffer exclusion in some areas, but the
concepts motivating this reaction derived from Germanic customs, not
from Christian doctrine. The Christian leprosaria, branded by Watts,
Risse, Moore, Brody, and Ells as places of exile, never served as
prisons, but as havens of physical and spiritual support in an often
hostile secular world.
To acquire an accurate understanding of leprosy and medieval
society's reaction to it, one must read more carefully the primary
sources, and view them in the context of medieval values, i.e., that
death to the world was the highest vocation one could aspire to and that
physical suffering brought salvation. Instead, too many scholars,
especially those writing in English, have viewed the medieval response
to leprosy as superstitious and cruel, and, as Moore states explicitly,
as reflecting a general trend to persecute those who were different. The
primary sources examined in this essay clearly show that such a view is
incorrect.
ENDNOTES
(1) Leprosy never spread rapidly because a majority in any
population group have a natural immunity to the disease. Thus, only a
small number develop the severe form of leprosy called lepromatous
leprosy, the stage at which the disfigurement of the face and limbs
begins. For a good description of the disease and its symptoms, see
Eugene Braunwald, et al., Harrison's Principles of Internal
Medicine, 15th ed. (New York: McGraw-Hill, 2001), 1035-40.
(2) Keith Manchester, "Tuberculosis and Leposy in Antiquity:
An Interpretation" Medical History 28 (1984):166-67; Saul N. Brody,
The Disease of the Soul: Leprosy in Medieval Literature (Ithaca, NY:
Cornell University Press, 1974), 21-33; Sheldon Watts, Epidemics and
History: Disease, Power, and Imperialism (New Haven, CT: Yale University
Press, 1997), 43-44.
(3) Roy Porter, The Greatest Benefit to Mankind: A Medical History
of Humanity (New York: W.W. Norton & Company, Inc., 1998), 121-22.
(4) Watts, Epidemics and History, 40-83.
(5) Ibid., 47-48.
(6) Ibid., 50.
(7) Ibid., 41 and 64. Watts' account of leprosy has been
influenced by Mary Douglas, "Witchcraft and Leprosy: Two Strategies
of Exclusion," Man, n.s., 26 (December 1991):723-36.
(8) Guenter Risse, Mending Bodies, Saving Souls: A History of
Hospitals (New York: Oxford University Press, 1999), 179-84, esp. 181.
For a summary of leprosaria rules, see the introduction to Leon Le
Grand's edition of leprosaria rules. Leon Le Grand, Statuts
d'hotels-Dieu et de leproseries; recueil de texts du XIIe au XIVe
siecle (Statutes of Hospitals and Leposaria; Collection of Texts from
the Twelfth and Thirteen Centuries) (Paris: Picard, 1901), xxv-xxix.
(9) Robert I. Moore, The Formation of a Persecuting Society: Power
and Deviance in Western Europe, 950-1250 (Oxford: Basil Blackwell,
1987), 48-80.
(10) Brody, The Disease of the Soul, 147-57.
(11) Ibid., 173-75.
(12) Ibid., 101-03.
(13) Dictionary of the Middle Ages, ed. Joseph R. Strayer, et al.
(New York: Charles Scribner, 1982-89), VII:549-52.
(14) Manchester, "Tuberculosis and Leprosy in Antiquity,"
167-68.
(15) Ibid., 170-72.
(16) Watts, Epidemics and History, 56.
(17) Egon Schmitz-Cliever, "Zur Osteoarchaologie der
mittelalterlichen Lepta," (Concerning Osteoarcheology of medieval
leprosy) Medizinhistorisches 8 (1973):182-220, esp. 194-95.
(18) Aretaeus, ed. Karl Hude, Corpus medicorum graecorum
(Collection of Greek Medical Authors), 2 (Berlin: In aedibus Academiae
scientiarum, 1958), Liber 4.13 (pp. 85-90).
(19) Gregory of Nazianzos, De pauperum amando (oratio XIV), in
Patriologiae cursus completus. Series graeca (Concerning the Love of the
Poor (Oration 14), in Complete Collection of Patrology. Greek Series),
ed. Jacques P. Migne, 161 vols (Paris: P.J. Migne, 1857-66), vol. 35,
cols. 857-909, esp. col. 869 (leprosy as living death) [Hereafter the
Patriologiae cursus completus. Series graeca cited as PG]. For the
unedited life of John Chrysostom, see note 25.
(20) The works of Gregory of Nazianzos, especially his sermons, had
a strong impact on Latin Christianity. See Dictionaire de Spiritualite
(Dictionary of Spirituality), vol. 6 (Paris: Beauchesne, 1957), col.
966. See note 28 for Jerome's description of leprosy in Latin, a
description which follows Aretaios' observations very closely.
(21) Watts, Epidemics and History, 46.
(22) Galen, Ad Glauconem de medendi methodo, in Claudii Galen opera
(To Glaucon concerning the method of healing, in Complete Works of
Claudius Galen) 2 (p. 142).
(23) Gregory of Nyssa, In illud quatenus uni ex his fecistis mihi
fecistis (De pauperibus amandis II) (Concerning "whatever you have
done for one of these, you have done for me" (Concerning the love
of the poor, II)), ed. Adrian van Heck, Gregorii Nysseni opera (Complete
Works of Gregory of Nyssa), vol. 9.1 (Leiden: Brill, 1967), 111-27.
(24) Gregory of Nazianzos, De pauperum amando (oratio XIV), PG,
vol. 35, cols. 857-909.
(25) This description of Chrysostom's leprosarium is found in
an unpublished life of John Chrysostom by an unknown author, identified
by modern scholars as Pseudo-Martyrios. For the passage cited here see
Parisinus graecus 1519, pp. 491-96 (folios numbered as pages) in the
Bibliotheque Nationale (see Henri Omont, Inventaire sommaire des
manuscripts grecs de la Bibliotheque Nationale (Summary Inventory of
Greek Manuscripts in the National Library)[Paris: Alphonse Picard,
1888]. vol. 2, p. 76 [ms. 1519]). This biographical oration is of key
importance for understanding the episcopacy of John Chrysostom. For a
discussion of its significance and why it remains unpublished, see
Claudia Tiersch, Johannes Chrysostomos in Konstantinopel (398-404):
Weltsicht und Wirken eines Bischofs in der Hauptstadt des Ostromischen
Reiches (John Chyrsostom in Constantinople: Worldview and Works of a
Bishop in the Capital of the East Roman Empire) (Tubingen: Mohr Siebeck,
2000), 14-18.
(26) Cyril of Alexandria, Glaphyrorum in Leviticam liber (Book of
Refinements regarding Leviticus), PG, 69, cols. 353-57.
(27) Theodore Balsamon, Commentarii: Sancti Athanasii Alexandriae
epistola ad Amunem monachum (Commentaries: The Letter of Saint
Athanasius of Alexandria to Amoun the Monk), PG, vol. 138, col. 552.
(28) Saint Jerome, Ep. 77, Ad Oceanum de morte Fabiolae, in Sancti
Hieronymi epistulae (Letter 77: To Oceanus concerning the Death of
Fabiola), pars 2 (epp. 71-120), ed. Isidorus Hilberg, Corpus Scriptorum
Ecclesiasticorum Latinorum (Corpus of Latin Ecclesiastical Writers), 55
(Vienna and Leipzig: Freytag, 1912), 43-44.
(29) Thomas Sternberg, Orientalium more secutus: Raume und
Institutionen der Caritas des 5 bis 7 Jahrhunderts in Gallien (Following
the Custom of the Easterners: Places and Institutions of Charity in
fifth- and sixth-century Gaul) Jahrbuch fur Antike und Christentum.
(Yearbook for Antiquity and Christianity) Erganzungsband (Supplement) 16
(Munster: Aschendorffsche Verlagsbuchhandlung, 1999), 170-71.
(30) Gregory of Tours, Liber in Gloria confessorum, cap. 85, in
Monumenta Germaniae Historica, Scriptores Rerum Merovingicarum (Glory of
the Confessors, 85 in Historical Monuments of German Writers of
Merovingian Events), ed. Bruno Krusch et al. (Hanover: Impensis
bibliopoli Hahniani, 1884-85), vol. 1, part 2, 802-03.
(31) Sternburg, Orientalium more secutus, 170-71 et passim;
Rothari's Edict in The Lombard Laws. trans. Katherine Fisher Drew
(Philadelphia: University of Pennsylvania Press, 1973), p. 83 (cap.
176).
(32) The community regulations for medieval French leprosaria were
collected and published by Le Grand, in Statuts d'hotels-Dieu et de
leproseries. See Le Grande's introduction to leprosaria, xxv-xxix.
(33) Ibid., 181-83.
(34) Ibid., 199; see also Brody, The Disease of the Soul, 101-03.
(35) Le Grand, Statuts d'hotels-Dieu et de leproseries,
199-203
(36) Ibid., 206-14. The bishop of Puy who confirmed these statutes
later became Pope Clement IV in 1265.
(37) Edward J. Kealey, Medieval Medicus: A Social History of
Anglo-Norman Medicine (Baltimore, MD: Johns Hopkins University Press,
1981), 103-05 (general comments on leprosy), 107-16 (the regulations of
Saint Mary Magdalene).
(38) See also Moore, The Formation of a Persecuting Society, 51:
"In 1179 the Third Lateran Council reiterated that lepers should be
segregated, and were forbidden to go to church or to share churches or
cemeteries with the healthy." Compared with Latin text of Canon 23
of the Third Lateran Council, in Sacrorum conciliorum nova et amplissima
collection (New and most complete collection of the sacred councils),
ed. Giovanni D. Mansi, 53 vols. in 58 parts (Paris-Leipzig: Welter,
1901-29; reprint, Graz: Akademiscke Druk-und Verlagsarstalt, 1960-61),
vol. 22, col. 230.
(39) Rothari's Edict, in The Lombard Laws, trans. Katherine
Fischer Drew (Philadelphia: University of Pennsylvania Press, 1973), p.
83 (cap. 176).
(40) Capitulare generale (anno 789), in Monumenta Germaniae
Historica, Leges (General capitulary (year 789) in Historical Monuments
of Germany, The Laws), vol. 1, ed. Georg H. Pertz (Hannover: Impensis
bibliopolii aulici Hahniani, 1885), p. 69 (cap. 20).
(41) See the new English translation with introduction by Maria
Dobozy, The Saxon Mirror: A Sachsenspiegel of the Fourteenth Century
(Philadelphia: University of Pennsylvania Press, 1999). Dobozy states
that the Sachsenspiegel was based on old Saxon custom but also contained
significant innovations derived from Christian concepts and from new
governmental structures of the twelfth and thirteenth centuries.
(42) Ibid., Book 1.4 (p. 70).
(43) Frederick Pollock and Frederic Maitland, The History of
English Law Before the Time of Edward 1 (Cambridge: Cambridge University
Press, 1952), 1:480.
(44) Balsamon, Commentarii (Commentaries), PG, vol. 138, col. 552.
TIMOTHY S. MILLER is a Professor of History at Salisbury University
in Salisbury, Maryland; RACHEL SMITH-SAVAGE received her B.A. in History
in 2005 from Salisbury University.